MAXWEALTH CLIENT TERMS AND CONDITIONS

Please read these terms and conditions carefully so that you understand what you are paying for. Always ensure that your personal information like your contact details and that of your family members are updated so that we know who to contact regarding our Maxwealth product purchased by you.

To make corrections or general enquiries, you could log onto our website at www.maxwealth.co.za or call 012 142 0002. Maxwealth is not a financial services provider and the Maxwealth product does not represent financial or investment advice.

The Maxwealth product consist of all the following as one package, accidental death life cover, medical expense cover and a bereavement cover and a will and last testament (which is optional to you) and these are not separate products each with its own premium but they form one product which the premium covers and nonpayment of premiums makes your entitlement to cover under any of the above void.

The phrases defined below are standard terms used for the Maxwealth product.

Accidental death: A sudden and unforeseen event occurring at an identifiable place and time, which has a visible, violent or external cause, and results in the death of the life assured.

Accidental death benefit (ADB) cover: An accidental death benefit covers the life assured for accidental death and not for death due to natural causes.

Beneficiary: On the death of the assured life, this is the person or institution stated in the life insurance policy to whom the insurer pays the cover amount to.

Certificate of Insurance: Once you have purchased the Maxwealth product and subject to your payment having been received you will receive a certificate to confirm your cover.

Effective date of this policy: The date on which you have purchased the Maxwealth product, but subject to you having made your first payment. You will be covered once the first premium has been received.

Event: Refers to a claim because of the death of the insured, or a claim for medical expenses under the medical cover.

Last Will and Testament: A last will and testament is a legal document that communicates a person’s final wishes pertaining to dealing with possessions and dependents.

Life assured: The person who purchased the Maxwealth product and on whose life the policy becomes payable.

Material information: The life assured must provide information to enable the product supplier to accurately assess the risk they are taking on. They must supply the information before the policy commences because the product supplier will use it to determine acceptance or declinature of the risk, and liability to pay out the benefits under the product.

Medical cover: Relates only to medical expenses of the assured because of treatment by a registered medical health practitioner who is registered with the health professions Council of South Africa and does not include treatment by herbal practitioners, witch doctors or traditional or spiritual healers. Claims are only for treatment and medical procedures and not for any consumables and medicine required after the medical treatment. Cover includes consumables used in executing the treatment on and at that specific instance.

Natural death: Death that occurs from natural causes such as disease or old age, rather than from an act of violence or injury sustained in an accident.

Premium payment terms: The premiums are payable monthly and in advance for cover to be effective.

Product supplier: The authorized financial services provider that underwrites the life, medical and bereavement insurance policy.

Stand-alone benefit: If a claim pays out under the medical cover, this will not reduce the cover amount under any other benefit on the policy.

Sum assured: The amount of R50 000.00 for accidental death, R18 000.00 for bereavement and R10 000.00 for medical cover.

Term of policy: This policy is on a month to month basis and subject to you making payment for the premium.

General Terms and Conditions

Contract of insurance

In return for your payment and the receipt and acceptance of your premium, Maxwealth will provide insurance cover through its underwriter according to the terms of your product purchased.

It is a condition of this insurance cover that your premiums must have been paid in the month preceding the event and any claim under this policy.

Your policy certificate highlights the specifics of your insurance cover and the terms and details therein are very important. Please check this document carefully and let Maxwealth know should you have any queries.

If your payment is not received within 30 (thirty) days of the normal deduction date, the policy will be cancelled, and all benefits and/or cover will be suspended from the date that the collection attempt failed.

Annual premium escalation and premium guarantee period

An annual premium escalation and premium guarantee period may be applicable depending on the conditions prescribed by the underwriter.

Reinstatement

Should your contract no longer be in force, you may request Maxwealth to reinstate your contract against payment without penalty and subject to you making the advance payment of the premium for the product. As you are not covered when payment is not made you will not be liable for premiums not paid.

Governing law and currency

All benefit amounts specified in your product contract are in the currency of the Republic of South Africa and all amounts payable to or by the underwriters will be in South African Rand. South African law will govern this contract. Maxwealth may change the contractual terms of your policy if any laws or legislation affecting this product change.

Underwriting

This Maxwealth product is underwritten by Santam who pays the benefits and who has accepted you as a life assured without the requirement of HIV or medical tests.

Cancellation

If you decide to cancel your policy, you do so in writing. You will not be entitled to repayment of any premiums in the case of your cancellation as the underwriter has accepted your risk from date of payment of your premium and you enjoyed cover.

Claims

Call the Maxwealth Claims Department www.maxwealth.co.za or at 012 142 0002 to inform Maxwealth of any events that may or may not give rise to a claim, such as a death, or a claim for medical expenses.

When a claim is made Maxwealth will ask you or your beneficiary a series of questions, including details of the full circumstances surrounding the incident. Most details can be gathered telephonically.

Certain documents will be required from to confirm the details of the claim. Claims will be assessed once Maxwealth receives all the necessary information. The assessment and validation of claims is also done by the underwriter and subject to the underwriter’s approval claims will be paid out. Maxwealth only accepts original or

certified copies of documents. These documents should be delivered or posted to them.

Maxwealth will only accept a claim if:

  • the definitions and requirements of the insured event have been met;
  • they rule that the claim is valid;
  • they have received and accepted all the information required;
  • the premiums for the policy have been paid in full; and
  • the cover has not been cancelled.

All claims are assessed in South Africa only.

Should a nominated beneficiary be a minor at the time of your death, benefits payable to such beneficiary will only be made into a registered trust or the Guardian’s Fund.

Where you have a Will, and nominated Maxwealth as the executor of your estate the benefit of your policy will be paid to Maxwealth who will use it to assist and support your family during the winding up process and use it to pay for executor’s fees.

Medical cover

The medical cover under the policy is only for claims by the policy holder for medical treatment received by him.

Winding up of your Estate

Where Maxwealth has been appointed as the executor of your estate they will require the original Will and certain material information of the beneficiaries to your estate. Maxwealth reserves the right to not accept the appointment as executor of your estate.

Where you have cancelled your policy or it has been cancelled because of you not paying then Maxwealth will not accept the appointment as executor.

The costs of winding up your estate is 3.5% of its total value excluding expenses like advertisements of registration of transfer of property.

The accidental death cover is part of your estate assets and the balance is paid to the beneficiaries in your Will.

Important claims time limits

Maxwealth must be notified of an event that may result in a claim for a death benefit within 6 (six) months of its occurrence.

Initial claim documentation must be sent to Maxwealth within 3 (three) months of you notifying Maxwealth of the claim event.

Claims may be rejected if Maxwealth do not receive notification within the prescribed period.

Disputed claims

Maxwealth will provide you or your beneficiaries to your estate with notice within a reasonable period after receipt of the claim, advising you or them whether the claim is accepted or rejected. The notice will contain the reasons for the dispute or rejection.

Should your claim be rejected or disputed, you can either refer your complaint to the Ombudsman for Long-term Insurance or institute legal proceedings against your product supplier within 6 (six) months from receipt of their confirmation.

Contract duration

Cover under this Maxwealth product will begin on the effective date, provided the policy/product holder has paid the first premium. The contract will remain in force subject to premiums being paid.

Payments

Premiums are payable monthly in advance by debit order and are payable for the whole Maxwealth product and premiums are not allocated proportionate to a certain portion of the product.

True and complete information, material misrepresentation, or non-disclosure

Maxwealth and the underwriter can only assess and accept a risk if you supply them with complete and truthful answers before the policy commencement date or effective date of change. If they find that information provided to them was incorrect or certain details were withheld, either at application stage or at a time when changes were made to the policy, and this information is, in their opinion, material to the assessment of the risk, they may repudiate your claim, repudiate future claims or cancel the policy. In such a case, your product supplier will not refund the premiums already paid to them and they may recover monies already paid to you for claims that relate to the misrepresentation or non-disclosure.

Material information

Information is material if a reasonable person would consider that the information should have been correctly disclosed to Maxwealth by the life assured so that they could form their own view as to the impact of that information in assessing the relevant risk.

Fraudulent or deliberate acts

Maxwealth will terminate the contract and admit no claim if:

  • any claim under this policy is in any respect fraudulent; or
  • it is found that fraudulent means or false information was used to benefit from the cover granted; or
  • you knowingly allow anyone acting on your behalf to provide false information to obtain a benefit.

Your product supplier will make no refunds for premiums already paid and may initiate legal proceedings against the defrauding party.

CONTACTING US:

Visit us on our website: www.maxwealth.co.za

Dial 012 142 0002