| (1) |
The categories and types of contracts set out in the table below are identified as accident and health policies. A contract will only be an accident and 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. |
|
Category
|
Contract Type
|
Contract description
|
Requirements relating to policy benefits
|
|
1
|
Medical expense shortfall
|
A contract—
| (a) |
in terms of which a person, in return for a premium, undertakes to provide policy benefits if a health event contemplated in the contract as a risk event occurs; and |
| (b) |
the purpose of which is to cover the difference or a part of the difference between the total costs or expenses of a relevant health service and the amount a person's medical scheme paid. |
|
Policy benefits—
| (a) |
are one or more sums of money; and |
| (b) |
in aggregate, do not exceed R150 000,00 (one hundred and fifty thousand Rand) per insured person per annum. |
|
|
2
|
Non-medical expense cover as a result of hospitalisation
|
A contract—
| (a) |
in terms of which a person, in return for a premium, undertakes to provide policy benefits if a health event contemplated in the contract as a risk event resulting in hospitalisation occurs; and |
| (b) |
the purpose of which is to cover non-medical expenses associated with hospitalisation. |
|
Policy benefits—
| (a) |
are a fixed some sum of money per insured per day not exceeding R3 000,00 (three thousand Rand) 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 health service. |
|
|
3
|
HIV, Aids, tuberculosis and 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 (contemplated in the contract as a risk event) occurs; and |
| (b) |
the purpose of which is to cover expenses for testing and treatment of HIV, Aids, tuberculosis or malaria |
|
|
|
4
|
International travel insurance
|
A contract—
| (a) |
in terms of which a person, in return for a premium, undertakes to provide policy benefits if a health event contemplated in the contract as a risk occurs; and |
| (b) |
the purpose of which is to cover costs associated with a relevant health service while travelling in a country in which the insured persons are not ordinarily resident. |
|
|
|
5
|
Medical emergency evacuation or transport
|
A contract—
| (a) |
in terms of which a person, in return for a premium, undertakes to provide policy benefits if a health event contemplated in the contract as a risk occurs; 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. |
|
|
| (2) |
All amounts referred to in subregulation (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)). |
[Regulation 7.2 inserted by regulation 2 of Notice No. 1582 of 2016]
Housing Development Agency Act, 2008
