ER24 FamSAFE Policy Terms & Conditions
   
ResQ includes
  1. Medical Services Program by ER24
AxiMed includes
  1. Medical Services Program by ER24
  2. FASA Hospital Expenses Plan by Hollard
   

MEDICAL EMERGENCY SERVICE PROGRAM BY ER24

Applicable to all FamSAFE options

ER24 will provide you with the following services as a result of your involvement in a Medical Emergency, subject to the limits of the Benefit Table:

Identification:

Each member is entitled to a free ER24 plastic wallet card, which contains the call centre telephone number – 084124; your PIN and personal details. This card forms part of the ER24 identification range which will help connect you to the ER24 call centre in an emergency and – thru your PIN – help them verify your FamSAFE benefits which will facilitate immediate access to private ambulance and hospital care.

This card will be sent to the member when we have received your completed form which is included with your FamSAFE Policy Pack. Simply complete this form and return to us and ER24 will create and maintain a datafile of your personal details which is only used for your benefit in a medical emergency.

The member may also purchase additional ER24 Identification or MedicAlert® Bracelet from the range for self and / or dependants for your added protection in a medical emergency. This is optional.

Medical Advice and Information Hotline:

The ER24 medical personnel, including paramedics, nurses and doctors, are available 24 hours a day to provide general medical information and advice. This is an advisory service, as a telephonic conversation does not permit an accurate diagnosis.

Emergency Medical Advice and Assistance Hotline:

In addition to the general medical advice service, one call to the same number will trigger the ER24 medical operators who will guide you through a medical crisis situation, provide emergency advice and organise for you to receive the support you need utilising the 24 hour Alarm Centre Doctor.

This service includes referrals to Crisis lines in case of:

Family and Domestic Abuse
Rape Counselling
Trauma Counselling
Child Abuse
Bereavement Counselling
HIV Counselling
Suicide Hotline - Life Line
Poison Hotline – In House

Medical Doctor present in Alarm Centre 24 Hours per day:

International SOS is the only 24 hours Alarm Centre in Southern Africa that can guarantee a Medical Doctor on duty 24 hours a day, seven days a week.

Emergency Medical Response to the scene of a Medical Emergency:

An appropriate road and/or air response will be undertaken utilising an ambulance, a rapid response vehicle, a helicopter or a faxed wing aircraft (all of which are manned by appropriately qualified and experienced emergency care practitioners, paramedics or Doctors) immediately to the scene of a medical emergency where appropriate life saving support will be provided to the member/s and where relevant, the member/s will be stabilised before transfer is provided to the closest appropriate medical facility.

Medical Transportation:

In the event of your involvement in Medical Emergency, ER24 will arrange and pay up to the amount specified in the Benefit Table for Emergency Medical Transportation by road and/or by air ambulance, under appropriate medical supervision, if necessary, to the nearest medical facility capable of providing adequate care. Medical considerations, the degree of urgency, your state and fitness to travel and other considerations, including, but not limited to, airport availability, weather conditions and distance to be covered as assessed by the ER24 Doctor and support staff will determine whether transport will be provided by medically equipped aircraft, helicopter, regular scheduled flight, rail or road.

Inter-hospital Transfer:

If the ER24 Doctor, in consultation with the attending doctor, determines that you should be transferred to an alternate medical facility (because the necessary treatment cannot be continued at the present facility) ER24 will arrange and pay up to the amount specified in the Benefit Table for your transportation to the closest facility where the treatment can be continued after you have been stabilised.

Upgrade Transfer:

If the hospital does not have certain equipment for a procedure and the member needs to be taken to another facility with the relevant equipment, ER24 will arrange and pay up to a maximum of one hospital transfer per event leading to the original hospital admission.

Downgrade Transfer:

Only medically justified cases requiring stretcher transport under medical supervision going to Frail Care or a Step-down Facility such as Hospice or a Rehabilitation Centre will be allowed a maximum of one hospital transfer per hospital event.

Medical Repatriation:

In the event of your hospitalisation outside of your home town, ER24 will arrange and pay up to the amount specified in the Benefit Table for repatriation to your home town: Provided that such repatriation is recommended by the ER24 doctor as being medically justified and requiring medical supervision. ER24 will also, in its sole discretion, determine the means of transportation.

Escorted Return of Minors:

In the event of your minor children being stranded as a result of your Hospitalisation, we will arrange and pay for their transportation, under supervision where necessary, into the care of a person nominated by you, within the Territory.

In-hospital Medical Monitoring:

We will monitor your medical condition for the duration of your hospitalisation outside of your hometown. If required, we will keep a nominated family member or business colleague informed of your medical progress.

Compassionate Visits:

Should You be hospitalised outside your home town for a period exceeding five (5) consecutive days, we will arrange and pay up to the limit specified in the Benefit Table for the economy class transportation of a close relative to visit you.

Repatriation of Mortal Remains:

In the event of your death outside of your home town, we will assist with the necessary formalities and will pay up to the amount specified in the Benefit Table towards the cost of transporting your mortal remains to a location in your home town.

Transfer of life saving medications and emergency blood:

If life saving emergency medication or emergency blood products (excluding standard routine delivery and/or charges for blood) are required which can not be obtained at the medical facility responsible for the member’s treatment, then we will arrange for the emergency medication to be transported to the member.

EXCLUSIONS:

Self-Inflicted Injuries Transportation
BENEFIT SUMMARY
ER24 will provide the Member with the following services as a result of a Medical Emergency within the Territory:
ER24 MEDICAL ASSISTANCE BENEFIT / LIMIT
Medical Advice And Information Hotline Advice Only
Emergency Medical Advice And Assistance Line Advice Only
Referrals to Crisis Lines Advice Only
Referrals To Medical Practitioners & Facilities Advice Only
Emergency Response Full cost, subject to BHF rates
Medical Transportation Full cost, subject to BHF rates
Inter-Hospital Transfer Full cost, subject to BHF rates
Medical Repatriation Full cost, subject to BHF rates
Escorted Return Of Minors Full cost
Repatriation of Mortal Remains R20 000
In-Hospital Medical Monitoring Service only
Compassionate Visits Advice Only R 2 000-00

TERRITORY: SOUTH AFRICA; LESOTHO; SWAZILAND

PLEASE NOTE:

NO ROUTINE AMBULANCE TRANSFERS
NO AMBULANCE TRANSPORT DUE TO LACK OF TRANSPORT
ONLY MEDICALLY JUSTIFIED TRANSFERS

 

Legal, Roadside and Home Access

ER24 will assist you in a legal, roadside or home emergency on 084124. All costs incurred (other than those incurred internally by ER24) will be for the member’s account.

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FASA MEDICAL EXPENSES PLAN BY HOLLARD INSURANCE (Policy Wording)

Applicable to AxiMED only

Whereas the Insured named in the Schedule has applied to Hollard Insurance, the Insurer, for the instance described herein, the Insurer agrees to provide such insurance subject to:

a) Any proposal or other information supplied by or on behalf of the Insured Person disclosing all facts that are material to the insurance and known to the Insured Person and forming the basis of this insurance;

b) The payment of the premium as stated herein;

c) The terms and conditions, provisions and exceptions set out herein or contained in any endorsements attached hereto or subsequently included in this policy.

 

OPERATIVE CLAUSE

If during the period of insurance an Insured Person sustains bodily injury as the result of an accident which directly results, within 12 (twelve) calendar months, in Hospitalisation as defined, the Insurer will pay to the Insured Person or his/her legal personal representative the Compensation stated in the Schedule to this Policy.

DEFINITIONS

The following words or phrases shall bear the meaning stated below:

“Insured Person” - shall mean the person who takes out this Policy and is identified as such in the Policy Schedule and is a paid up subscriber to this Policy and, where applicable, shall include such person’s nominated spouse and dependent children.

“Spouse” - shall mean the nominated spouse of the Insured Person named in the Schedule to this Policy.

“Dependent Children” - shall mean unmarried children under 19 (nineteen) years or under 25 (twenty five) years if undergoing full time education and primarily dependent on the Insured Person named in the Schedule to this Policy for support and maintenance.

“Area” - shall mean only the Republic of South Africa, including Namibia, Lesotho and Swaziland.

“Accident” - shall mean a fortuitous unexpected event occurring at an identifiable place and time, and shall include insect, spider or animal bites other than those causing Malaria,

“Bodily Injury” - means traumatic bodily injury caused by an accident and shall be deemed to include bodily injury caused by starvation, thirst and exposure to the elements as a result of an accidental occurrence.

“Hospital” - shall mean an establishment which meets all the following requirements:

i holds a license as a hospital;
ii operates primarily for the reception, care and treatment of sick, ailing or injured persons as outpatients;
iii provides organised facilities for diagnosis and medical and surgical treatment;
iv is not primarily a day clinic, clinic, rest or convalescent home or similar establishment and is not, other than incidentally a place for the treatment of alcoholics or drug addicts.

“In-Hospital Expenses” - shall mean reasonable expenses necessarily incurred for surgical anaesthetic, ward fees, and other medical treatment incurred within 12 calendar months of the date of the accident.

“Medical Treatment” - shall mean a physician’s medical advice, treatment, consultations, and prescribed or repeat medication in a hospital.


PROVISOS

Provided always that:

1. No amount payable under this Policy shall carry interest;

2. The Insurer reserves the right to change or increase premiums from time to time or to amend the terms, conditions and exclusions of cover in respect of all Policies issued under this Plan, subject to 30 days notice in writing

EXCLUSIONS

The Insurer shall not be liable to pay compensation for any claim directly or indirectly consequent upon;

  1. war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, military or usurped power or whilst the Insured Person is on active service with the military,naval, air or police services of any nation.
  2. participation in labour disturbances, riot strikes, lock out or the Insured person’s commission of a criminal offence.
  3. wilful exposure to danger (except in an attempt to save human life) intentional self-inflicted injury, suicide or attempt thereat, or the Insured person being in a state of insanity.
  4. the insured Person engaging in aviation, gliding, parachuting or any form of aerial flight other than as a passenger in a fully licenced aircraft provided that the term “passenger” shall not include any person who is a member of the crew of the aircraft or who is in such aircraft for the purpose of undertaking any trade or technical operation therein.
  5. the bodily injury being caused by or contributed to or arising from nuclear weapons, material, ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from combustion of nuclear fuel sustained during the course of such Insured person’s employment. For the purpose of this exclusion only, combustion shall include any self-sustaining process of nuclear fission.
  6. or caused by or contributed to, arising or resulting from or traceable to any physical defect or infirmity which existed prior to the accident, provided that if the disability of the Insured Person is merely aggravated by such pre-existing condition, the Insurer may in its discretion pay an amount which it considers would have been payable but for such aggravation.
  7. the Insured Person being under the influence of alcohol, drugs or narcotics unless such drugs or narcotics were administered lawfully by a qualified medical practitioner (other than the Insured person) or unless prescribed by and taken in accordance with the directions of a qualified medical practitioner (other than the Insured person).
  8. the Insured person engaging in mining, underground work or work with explosives.
  9. infection from venereal disease or Acquired Immune Deficiency Syndrome (AIDS) or Aids Related Complex (ARC) howsoever this syndrome has been acquired or may be named.
  10. the Insured person being over 75 years of age.
  11. participation in sport as a professional player.


CONDITIONS

  1. The Policy and the Schedule shall be read together as one contract and any word or expression to which a specific meaning has been attached in any part of this Policy or the Schedule shall bear such specific meaning wherever it may appear.
  2. This Policy will be governed by the laws of the Republic of South Africa, whose courts shall have jurisdiction in any dispute arising hereunder.
  3. The Insured Persons shall take all reasonable precautions to prevent accidents.
  4. Notice must be given to the Insurer in writing within 60 (sixty) days of any occurrence which may give rise to a claim under this Policy.
  5. After incurring bodily injury for which compensation may be payable under this Policy the Insured Person shall, when reasonably required by the Insurer so to do, submit to medical examination and undergo any treatment specified. The Insurer shall not be liable to make any payment unless this Condition is complied with to their satisfaction. All certificates, information and evidence required by the Insurer shall be furnished in the form prescribed and without expense to the Insurer. The Insured Person shall submit to medical examination on behalf of and at the expense of the Insurer as often as shall be required in connection with any claim.
    Qualified medical advice shall be sought and followed promptly on the occurrence of any bodily injury and the Insurer shall not be liable for any part of any claim which in the opinion of this medical adviser arises from the unreasonable or wilful neglect or failure of an Insured Person to seek and remain under the care of a qualified member of the medical profession.
    In the event of the Insurer disclaiming liability in respect of any claim and an action or suit not being commenced within 12 (twelve) months such claim shall be forfeited.
  6. The Insurer may cancel this Policy by giving 30 (thirty) days written notice to the Insured at his or her last known address in which event cover shall cease at 24h00 on the last day for which a premium has been paid.
  7. Cover in respect of the Insured Person shall terminate immediately on the first of the following dates
    a) on the day before the Insured Person named in the Schedule to this Policy attains the age of 75 (seventy five) years, or
    b) on the death of the Insured Person named in the Schedule to this Policy, or
    c) upon the non-payment of premium. If a monthly premium debit is dishonoured, and if such premium is dishonoured a second time, all cover under this Policy shall cease at 24h00 on the last day for which the premium has been paid.
  8. If any claim under this Policy shall be in any respect fraudulent or if any fraudulent means or devices shall be used by an Insured person or anyone acting on the Insured Person’s behalf to obtain benefit under this Policy the Insurer shall be under liability in respect of such claim.
  9. Failure to comply with any part of theses Conditions shall render the claim null and void.


NOTICE OF RIGHT TO EXAMINE YOUR POLICY

You have the right to examine this Policy at your leisure for 21 (twenty one) days from the time you receive it. You may return it for cancellation, without obligation, if during this period you find that it is not what you want, merely return the Schedule to us marked “please cancel” with your signature and we will cancel it and refund you any premium which may have been paid.

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