Acts Online
GT Shield

Long Term Insurance Act, 1998 (Act No. 52 of 1998)

Regulations

Regulations under the Long-term Insurance Act, 1998

Part 7 : Contracts Identified as Health Policies under Section 72(2A)(a) of the Act

7.2 Categories and types of contracts identified as health policies

 

(1) The categories and types of contracts set out in the table below are identified as health policies. A contract will only be a health policy for purposes of this Part if it meets the contract description and requirements relating to policy benefits of a specific category and type of contract set out in the table below.

 

TABLE

Category

Contract Type

Contract description

Requirements relating to policy benefits

1

Non-medical expense cover as a result of hospitalisation

A contract in terms of which a person, in return for a premium, undertakes to provide policy benefits on the happening of a health event that results in hospitalisation.

Policy benefits—

(a) Are a fixed sum of money which does do not exceed R3 000.00 (three thousand Rand) per insured per day or a maximum lump sum amount of R20 000.00 (twenty thousand Rand) per annum irrespective of the number of days in hospital;
(b) does not require hospitalisation for a period of longer than 3 days before they become payable;
(c) once it becomes payable, are calculated from day 1 of hospitalisation; and
(d) may not be paid or ceded to the provider of a relevant health service.

2

Frail Care

A contract—

(a) in terms of which a person, in return for a premium, undertakes to provide policy benefits upon a health event; and
(b) the purpose of which is to cover the costs or expenses of assistance for activities of daily living.

3

HlV, Aids, tuberculosis or malaria testing and treatment

A contract—

(a) in terms of which a person, in return for a premium, undertakes to provide policy benefits if a health event relating to HIV, Aids, tuberculosis or malaria occurs; and
(b) the purpose of which is to cover the costs or expenses of testing and treatment of HIV, Aids, tuberculosis or malaria.

Policy benefits are provided as a rider benefit.

4

Medical emergency evacuation or transport

A contract—

(a) in terms of which a person, in return for a premium, undertakes to provide policy benefits upon a health event; and
(b) the purpose of which is to–
(i) cover the costs of or provide emergency evacuation or transport to a medical treatment facility; or
(ii) cover the cost of emergency medical treatment.

Policy benefits are provided as a rider benefit.

 

(2) All amounts referred to in sub-regulation (1) escalate annually, from the effective date of this Part, by the Consumer Price Index (CPI) annual inflation rate published by Statistics South Africa (as defined in section 1 of the Statistics Act, 1999 (Act No. 6 of 1999)).