Benefits
Option 1
A monthly benefit of 75% of the Member’s salary, but subject to a maximum benefit of US$10 000 per month.
A maximum waiver of premium benefits of US$2 100 per month.
Option 2
A monthly benefit of 100% of salary, but subject to a maximum benefit of US$10 000 per month.
A maximum waiver of premium benefits of US$2 100 per month.
Definition of disability
The member must no longer be capable due to illness, injury or accident of fulfilling a significant part of the duties of:
The member’s own occupation for the initial period, including the waiting period, and
Thereafter an alternate occupation in the open labour market.
Variable initial period
24 months (including the waiting period) as a standard, but we also offer 12 months where requested.
Freestanding Benefit
A freestanding benefit can be taken on its own, i.e. it does not have to be taken in conjunction with another benefit.
Waiting period options
1,3,6,12 or 24 months.
Escalators
Income Replacement Disability Benefit schemes can select an escalator benefit. The purpose of the escalator benefit is to ensure that the benefit remains abreast of inflation. When an escalator is selected, the monthly benefit payment can increase at a specific rate after every year of payment. The escalation rates offered range from 3% to 10%, but will be restricted to the year on year CPI for any one year.
It is important to note that when the 100% scale of benefit is selected only the 75% portion escalates.
What happens with a claim where the member returns to work and then becomes disabled again?
If a member fully recovers so that they are no longer considered disabled and becomes disabled again within 90 days by the same illness, accident or injury that caused the initial claim, the disability benefit will begin again immediately, provided that the member did not return to work against doctors orders. The benefit will start again from the day that the member is no longer able to work. The waiting period will be waived and the member will not receive any benefit payment for the period the member was at work.
Loss of earnings benefit
If the member is considered disabled and then at any stage performs their own or an alternate occupation for any form of
payment, or if Global Alliance Life consider the member capable of engaging in their own occupation or an alternate occupation (even if the member is not actually doing so), the member's disability benefit will be reduced according to our loss of earnings formula.
Our loss of earnings formula
A x (S - R)
S
Loss of earnings key
A= Gross actual monthly disability benefit.
S = Gross monthly salary immediately before disablement adjusted by Global Alliance Life to take the CPI into account.
R = Gross remuneration actually being paid, or if the member is not actually engaged in an own or an alternate occupation, as applicable the member's potential remuneration as Global Alliance Life determines.
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Payment of benefits
All benefits are paid to the employer. There are certain instances where arrangements can be made for payment to be made directly to the claimant, if the policy conditions allow for it.
When do benefits cease?
Benefits cease on the earlier of the following events:
The member is no longer considered disabled.
The member resides outside of Global Alliance Life territories.
The member reaches retirement age.
The member dies.
The member does not submit the requested medical evidence.
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 Income Replacement Disability 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 for conditions the member suffered in the 6 month period before joining the scheme and for which the member claims in the first year of membership.
Conversion Option
The option allows a Member to convert his Group benefits to an Individual life Policy, underwritten by Global Alliance Life, at individual life rates subject to medical underwriting.If the Member resigns from the Employer’s service, before age 60, he is eligible for this option, but needs to apply to Global Alliance Life within 30 days of resignation. The Employer can only select group scheme Conversion Option benefits at the commencement date.
Requirements:
HIV/Aids test.
Cotinine test
If a member dies during the 30 day period, after becoming eligible to exercise the Conversion Option, he will automatically qualify for the full benefit that he would have been eligible to convert, subject to meeting the group scheme Policy terms and conditions.
Claims Process
Notification period
Within 1 month from the date of the incident giving rise to a disability claim.
Submission of claim documents
3 months from the date of disability. Any additional documentation must be submitted within 60 days of the request by Global Alliance Life.
Claim documents to be submitted
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.
Certified copies of member’s identity document.
Copy of the member’s payslip for the last completed month of employment.
Detailed member display report as confirmation of pensionable salary.
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 Life will pay for the evidence.
Review of Income Replacement Disability Benefit claims
All Income Replacement Disability Benefit claims are reviewed at least once a year.
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