Critical Condition Benefit:
$ 600 000 or 2 x annual salary, whichever is lower.
Conditions covered:
Stroke
Coma
Blindness
Heart attack
Cancer
Paraplegia / paralysis
Accelerated Benefit
An accelerated benefit is reliant on the member having at least the same sum assured Group Life Benefit. If the member claims under the accelerated benefit the amount paid for the benefit reduces the Group Life Benefit, i.e. if the member receives a USD 10 000 benefit under the Critical Condition Benefit, the Group Life Benefit will be reduced by USD 10 000.
Re-instatement options
Re-instatement options available for schemes with Group Life Benefits as well as Critical Condition Benefits.
Benefits are:
The member survives 31 days after a Critical Condition incident
If the member meets the reinstatement option requirements, the Group Life and Critical Condition Benefit will be reinstated. The Critical Condition Benefit claimed for and any associated incident, which is pre-defined in the policy are not reinstated, but all other conditions are.
Payment of benefits
All benefits are paid to the member.
Waiting period:
Benefits are not payable during a 6-month waiting period.
Eligibility
The maximum entry age is 64.
The maximum cover age is 65 or normal retirement age, whichever is earlier
Exclusions
Exclusions applicable to the Critical Condition Benefit:
Active participation in war, riot and civil commotion or terrorism,
all claims related to atomic, biological and chemical warfare or terrorism,
the commission of a crime, attempted suicide or self inflicted injury and deliberate exposure to exceptional danger,
non-compliance with recommended medical treatment,
pre-existing conditions the member suffered in the 12 month period before joining the Scheme and for which the member claims in the first 2 years of membership,
any conditions for which the member has previously claimed.
Conversion Option
If selected, this option is compulsory for all scheme members at the commencement of the scheme.
When can the Conversion Option be exercised?
If the member leaves service for any reason, other than for reasons of ill health, any time up to 5 years prior to the Scheme’s maximum cover age.
Life will pay for the evidence.
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Conversion Option restrictions
If the Conversion Option was not initially selected at the Scheme commencement date, the Conversion Option will need to have been active on the Scheme for a full 12 months, before any member will be able to exercise this option.
Conversion Option requirements
HIV test
Cotinine test.
Additional Benefit - Conversion Option Interim benefit
If a member suffers a Critical Condition incident during the 30 day period, and has not yet applied for the benefit, he will automatically qualify for the full benefit they would have been eligible to convert, subject to meeting the policy’s terms and conditions.
Period of application to exercise the Conversion Option:
Within 30 days of leaving his employer’s service.
Claims Process
Notification period
Within 3 months of the incident giving rise to the claim.
The notification period for a coronary artery disease requiring surgery, commences from the date the claimant is first advised by a specialist to undergo surgery.
Submission of claim documents
3 months from the date of disability and any additional
documentation must be submitted within 30 days of the request
Claim documents to be submitted
A completed notification of a potential disability claim form,
Section A:
Part 1 - Claimant's personal statement,
Part 2 - Employer’s statement,
Section B:
Confidential medical report,
all available clinical evidence relevant to the claim,
an original certified copy of member’s identity document,
an original certified copy of the member’s payslip for the last completed month of employment,
any other documentation as requested by Global Alliance Life.
Who pays for disability claim evidence?
Initial - Member or employer.
Further - Global Alliance Life.
Independent - Global Alliance Life.
assessment evidence
Appeal evidence - Member or proposer. If the claim is found to be valid, Global Alliance
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