Coverdetail

COVER DETAILS: UP TO R100 000

The policy provides cover for accidental death and accidental injuries only. This excludes all natural causes. If we admit a claim, we will pay the cover amount linked to the particular claim event as set out below.

Claim Event	Cover Amount
TOTAL COVER AMOUNT	R100 000

Accidental death	R100 000
A benefit may be claimed when the death of the life insured resulted directly and solely from a bodily injury.

Total loss of vision:
Both eyes	R100 000
Permanent, irreversible and total loss of vision in both eyes, with sharpness of vision of 6/60 or worse in the better eye when measured with the use of visual aids.
One eye	R25 000
Permanent, irreversible and total loss of vision in one eye with sharpness of vision of 3/60 or worse when measured with the use of visual aids.
Total loss of hearing	R50 000
Permanent, irreversible and total loss of hearing in both ears. This means that the average hearing levels, tested with hearing aids when applicable, at audible frequencies is less than 90 decibels.

Serious burns	R30 000
Third-degree burn wounds that are full thickness of the skin and cover at least 10% of the body surface area, as determined by the Lund and Browder chart or equivalent.

Coma	R100 000
A condition of unconsciousness where the life insured • presents with a Glasgow Coma Scale of 8 or less, and • is dependent on life-sustaining aids, such as a ventilator and intravenous infusion, for an uninterrupted period of at least 72 hours. Medical sedation for purposes of ventilation or to reduce brain oedema is not regarded as being in a coma for this purpose.

Amputation:
Thumb	R25 000
Complete physical severance of a thumb at the level of the metacarpo-phalangeal (MP) joint.
Any other finger (per finger, capped at R50 000 in total)	R10 000 per finger, capped at R50 000
Complete physical severance of any finger other than the thumb at the level of the metacarpo-phalangeal (MP) joint.
Hand or foot	R50 000
Complete physical severance of one hand at the level of the wrist, or one foot at the level of the ankle joint. Surgical reconstruction after amputation will not affect this benefit.
Arm or leg	R75 000
Complete physical severance of one arm above the level of the elbow, or one leg above the level of the knee. Surgical reconstruction after amputation will not affect this benefit.

Paraplegia	R100 000
Total, permanent and irrecoverable loss of function of both lower extremities, with or without loss of bowel or bladder function. (Paraplegia)
Quadriplegia	R100 000
Total, permanent and irrecoverable loss of function of all four limbs. (Quadriplegia)

Penetrating gunshot wounds or stab wounds:
Head	R100 000
Penetrating gunshot wound of the skull or penetration by a sharp object through the skull resulting in surgical exploration of the skull under general anaesthetic.
Neck, chest or abdomen	R50 000
Penetrating gunshot wound of the chest or abdomen or penetration by a sharp object into the chest or abdominal cavities, resulting in surgical exploration under general anaesthetic.

Fractures:
Multiple rib fractures	R50 000
Multiple rib fractures, resulting in artificial ventilation in an intensive care unit in order to sustain a stable blood-gas profile.
Rib fracture not requiring hospitalisation (per such fracture , capped at R20 000 in total)	R5 000 per fracture, capped at R20 000
Fracture of any rib(s) which needs conservative treatment on an outpatient basis.
Unstable pelvis fracture	R50 000
More than one fracture of the pelvic framework, resulting in instability, and requiring surgical intervention.
Fracture-dislocation of the spine requiring fusion.	R50 000
Objective radiological evidence of a fracture-dislocation of the spine, involving dislocation of the facet joints, with or without neurological deficit.
Any fracture with open reduction and internal fixation, excluding fingers and toes (per such fracture, capped at R30 000 in total)	R10 000 per fracture, capped at R30 000
Any fracture that needs open surgical reduction and internal fixation under general anaesthetic. This benefit excludes fractures of fingers or toes.
Any fracture of the toes or fingers requiring fixation with a K-wire (per such fracture, capped at R30 000 in total)	R5 000 per fracture, capped at R30 000
Any fracture of a finger or toe that needs open surgical reduction and internal fixation under general anaesthetic.
Any fracture requiring immobilisation for at least two weeks, excluding minor toes and fingers (per such fracture, capped at R15 000 in total)	R5 000 per fracture, capped at R15 000
Any fracture requiring immobilization with a plaster cast, splint or brace for at least two weeks. Fractures of the third and fourth toes, and third and fourth fingers are not covered by this benefit.
Fracture of the skull requiring reconstructive surgery	R25 000
Depressed or displaced skull fracture of the frontal, parietal, temporal, sphenoid or occipital bones requiring surgical correction.
Fracture of the facial bones requiring reconstructive surgery	R25 000
Fractures of the frontal bones, orbital bones, zygoma, and/or maxilla resulting in maxillofacial reconstructive surgery.

Loss of bowel or bladder function	R50 000
Total, permanent and irrecoverable loss of function of the bowel or bladder, resulting in a permanent stoma or indwelling catheter.

Loss of function of a limb	R50 000
Total, permanent and irrecoverable loss of function of an upper or lower limb. Maximum medical improvement must have been reached with little or no chance of significant further improvement. The loss of function will be estimated after all medical, surgical and rehabilitation measures have been applied. All percentages of loss of function are calculated per limb according to principles and ratings of the latest edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment.

Fat embolism of the lungs after injury	R25 000
Fat embolism in the lung following a fracture, confirmed by a ventilation-perfusion (VQ) scan.

Rupture of the liver, spleen or kidney	R25 000
Blunt injury to the abdomen resulting in rupture of the liver or spleen, or injury to the kidney, necessitating emergency laparotomy and surgical repair, splenectomy or nephrectomy.

Head injury	R75 000
A head injury requiring surgery in the form of a craniotomy, decompression holes to drain a brain bleeding, or open reduction of a depressed skull fracture.

Near drowning	R50 000
Near drowning necessitating emergency resuscitation as witnessed by paramedical personnel, and requiring care in an intensive care unit for at least 48 hours.

Animal bite to the face requiring plastic surgery	R25 000
Animal bite to the face requiring primary suturing followed by multi-phase repair by a plastic and reconstructive surgeon under general anaesthetic.
Animal bite to any part of the body, requiring intervention in theatre on more than one occasion.	R10 000
Animal bite to any part of the body, requiring debridement under anaesthetic, and followed by secondary suturing and/or closing of defect with the use of skin flaps.
Snake bite	R10 000
A poisonous snake bite confirmed medically, necessitating anti-venom treatment and hospitalization for at least 48 hours.

Severe blood loss requiring blood transfusion	R5 000
Severe blood loss due to an injury, necessitating at least 2 units of blood transfusion.

Admission into ICU for 48 hours or more	R50 000
Admission into a registered intensive care unit with mechanical ventilation continuously for at least 48 hours.

COVER DETAILS: UP TO R500 000

Claim Event	Cover Amount
TOTAL COVER AMOUNT	R500 000

Accidental death	R500 000
A benefit may be claimed when the death of the life insured resulted directly and solely from a bodily injury.

Total loss of vision:
Both eyes	R500 000
Permanent, irreversible and total loss of vision in both eyes, with sharpness of vision of 6/60 or worse in the better eye when measured with the use of visual aids.
One eye	R125 000
Permanent, irreversible and total loss of vision in one eye with sharpness of vision of 3/60 or worse when measured with the use of visual aids.
Total loss of hearing	R250 000
Permanent, irreversible and total loss of hearing in both ears. This means that the average hearing levels, tested with hearing aids when applicable, at audible frequencies is less than 90 decibels.

Serious burns	R150 000
Third-degree burn wounds that are full thickness of the skin and cover at least 10% of the body surface area, as determined by the Lund and Browder chart or equivalent.

Coma	R500 000
A condition of unconsciousness where the life insured • presents with a Glasgow Coma Scale of 8 or less, and • is dependent on life-sustaining aids, such as a ventilator and intravenous infusion, for an uninterrupted period of at least 72 hours. Medical sedation for purposes of ventilation or to reduce brain oedema is not regarded as being in a coma for this purpose.

Amputation:
Thumb	R125 000
Complete physical severance of a thumb at the level of the metacarpo-phalangeal (MP) joint.
Any other finger (per finger, capped at R50 000 in total)	R50 000 per finger, capped at R250 000
Complete physical severance of any finger other than the thumb at the level of the metacarpo-phalangeal (MP) joint.
Hand or foot	R250 000
Complete physical severance of one hand at the level of the wrist, or one foot at the level of the ankle joint. Surgical reconstruction after amputation will not affect this benefit.
Arm or leg	R375 000
Complete physical severance of one arm above the level of the elbow, or one leg above the level of the knee. Surgical reconstruction after amputation will not affect this benefit.

Paraplegia	R500 000
Total, permanent and irrecoverable loss of function of both lower extremities, with or without loss of bowel or bladder function. (Paraplegia)
Quadriplegia	R500 000
Total, permanent and irrecoverable loss of function of all four limbs. (Quadriplegia)

Penetrating gunshot wounds or stab wounds:
Head	R500 000
Penetrating gunshot wound of the skull or penetration by a sharp object through the skull resulting in surgical exploration of the skull under general anaesthetic.
Neck, chest or abdomen	R250 000
Penetrating gunshot wound of the chest or abdomen or penetration by a sharp object into the chest or abdominal cavities, resulting in surgical exploration under general anaesthetic.

Fractures:
Multiple rib fractures	R250 000
Multiple rib fractures, resulting in artificial ventilation in an intensive care unit in order to sustain a stable blood-gas profile.
Rib fracture not requiring hospitalisation (per such fracture , capped at R20 000 in total)	R20 000 per fracture, capped at R20 000
Fracture of any rib(s) which needs conservative treatment on an outpatient basis.
Unstable pelvis fracture	R250 000
More than one fracture of the pelvic framework, resulting in instability, and requiring surgical intervention.
Fracture-dislocation of the spine requiring fusion.	R250 000
Objective radiological evidence of a fracture-dislocation of the spine, involving dislocation of the facet joints, with or without neurological deficit.
Any fracture with open reduction and internal fixation, excluding fingers and toes (per such fracture, capped at R30 000 in total)	R30 000 per fracture, capped at R30 000
Any fracture that needs open surgical reduction and internal fixation under general anaesthetic. This benefit excludes fractures of fingers or toes.
Any fracture of the toes or fingers requiring fixation with a K-wire (per such fracture, capped at R30 000 in total)	R30 000 per fracture, capped at R30 000
Any fracture of a finger or toe that needs open surgical reduction and internal fixation under general anaesthetic.
Any fracture requiring immobilisation for at least two weeks, excluding minor toes and fingers (per such fracture, capped at R15 000 in total)	R15 000 per fracture, capped at R15 000
Any fracture requiring immobilization with a plaster cast, splint or brace for at least two weeks. Fractures of the third and fourth toes, and third and fourth fingers are not covered by this benefit.
Fracture of the skull requiring reconstructive surgery	R125 000
Depressed or displaced skull fracture of the frontal, parietal, temporal, sphenoid or occipital bones requiring surgical correction.
Fracture of the facial bones requiring reconstructive surgery	R125 000
Fractures of the frontal bones, orbital bones, zygoma, and/or maxilla resulting in maxillofacial reconstructive surgery.

Loss of bowel or bladder function	R250 000
Total, permanent and irrecoverable loss of function of the bowel or bladder, resulting in a permanent stoma or indwelling catheter.

Loss of function of a limb	R250 000
Total, permanent and irrecoverable loss of function of an upper or lower limb. Maximum medical improvement must have been reached with little or no chance of significant further improvement. The loss of function will be estimated after all medical, surgical and rehabilitation measures have been applied. All percentages of loss of function are calculated per limb according to principles and ratings of the latest edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment.

Fat embolism of the lungs after injury	R125 000
Fat embolism in the lung following a fracture, confirmed by a ventilation-perfusion (VQ) scan.

Rupture of the liver, spleen or kidney	R125 000
Blunt injury to the abdomen resulting in rupture of the liver or spleen, or injury to the kidney, necessitating emergency laparotomy and surgical repair, splenectomy or nephrectomy.

Head injury	R375 000
A head injury requiring surgery in the form of a craniotomy, decompression holes to drain a brain bleeding, or open reduction of a depressed skull fracture.

Near drowning	R250 000
Near drowning necessitating emergency resuscitation as witnessed by paramedical personnel, and requiring care in an intensive care unit for at least 48 hours.

Animal bite to the face requiring plastic surgery	R125 000
Animal bite to the face requiring primary suturing followed by multi-phase repair by a plastic and reconstructive surgeon under general anaesthetic.
Animal bite to any part of the body, requiring intervention in theatre on more than one occasion.	R50 000
Animal bite to any part of the body, requiring debridement under anaesthetic, and followed by secondary suturing and/or closing of defect with the use of skin flaps.
Snake bite	R50 000
A poisonous snake bite confirmed medically, necessitating anti-venom treatment and hospitalization for at least 48 hours.

Severe blood loss requiring blood transfusion	R25 000
Severe blood loss due to an injury, necessitating at least 2 units of blood transfusion.

Admission into ICU for 48 hours or more	R250 000
Admission into a registered intensive care unit with mechanical ventilation continuously for at least 48 hours.

COVER DETAILS: UP TO R1 000 000

Claim Event	Cover Amount
TOTAL COVER AMOUNT	R1 000 000

Accidental death	R1 000 000
A benefit may be claimed when the death of the life insured resulted directly and solely from a bodily injury.

Total loss of vision:
Both eyes	R1 000 000
Permanent, irreversible and total loss of vision in both eyes, with sharpness of vision of 6/60 or worse in the better eye when measured with the use of visual aids.
One eye	R250 000
Permanent, irreversible and total loss of vision in one eye with sharpness of vision of 3/60 or worse when measured with the use of visual aids.
Total loss of hearing	R500 000
Permanent, irreversible and total loss of hearing in both ears. This means that the average hearing levels, tested with hearing aids when applicable, at audible frequencies is less than 90 decibels.

Serious burns	R300 000
Third-degree burn wounds that are full thickness of the skin and cover at least 10% of the body surface area, as determined by the Lund and Browder chart or equivalent.

Coma	R1 000 000
A condition of unconsciousness where the life insured • presents with a Glasgow Coma Scale of 8 or less, and • is dependent on life-sustaining aids, such as a ventilator and intravenous infusion, for an uninterrupted period of at least 72 hours. Medical sedation for purposes of ventilation or to reduce brain oedema is not regarded as being in a coma for this purpose.

Amputation:
Thumb	R250 000
Complete physical severance of a thumb at the level of the metacarpo-phalangeal (MP) joint.
Any other finger (per finger, capped at R50 000 in total)	R100 000 per finger, capped at R500 000
Complete physical severance of any finger other than the thumb at the level of the metacarpo-phalangeal (MP) joint.
Hand or foot	R500 000
Complete physical severance of one hand at the level of the wrist, or one foot at the level of the ankle joint. Surgical reconstruction after amputation will not affect this benefit.
Arm or leg	R750 000
Complete physical severance of one arm above the level of the elbow, or one leg above the level of the knee. Surgical reconstruction after amputation will not affect this benefit.

Paraplegia	R1 000 000
Total, permanent and irrecoverable loss of function of both lower extremities, with or without loss of bowel or bladder function. (Paraplegia)
Quadriplegia	R1 000 000
Total, permanent and irrecoverable loss of function of all four limbs. (Quadriplegia)

Penetrating gunshot wounds or stab wounds:
Head	R1 000 000
Penetrating gunshot wound of the skull or penetration by a sharp object through the skull resulting in surgical exploration of the skull under general anaesthetic.
Neck, chest or abdomen	R500 000
Penetrating gunshot wound of the chest or abdomen or penetration by a sharp object into the chest or abdominal cavities, resulting in surgical exploration under general anaesthetic.

Fractures:
Multiple rib fractures	R500 000
Multiple rib fractures, resulting in artificial ventilation in an intensive care unit in order to sustain a stable blood-gas profile.
Rib fracture not requiring hospitalisation (per such fracture , capped at R20 000 in total)	R20 000 per fracture, capped at R20 000
Fracture of any rib(s) which needs conservative treatment on an outpatient basis.
Unstable pelvis fracture	R500 000
More than one fracture of the pelvic framework, resulting in instability, and requiring surgical intervention.
Fracture-dislocation of the spine requiring fusion.	R500 000
Objective radiological evidence of a fracture-dislocation of the spine, involving dislocation of the facet joints, with or without neurological deficit.
Any fracture with open reduction and internal fixation, excluding fingers and toes (per such fracture, capped at R30 000 in total)	R30 000 per fracture, capped at R30 000
Any fracture that needs open surgical reduction and internal fixation under general anaesthetic. This benefit excludes fractures of fingers or toes.
Any fracture of the toes or fingers requiring fixation with a K-wire (per such fracture, capped at R30 000 in total)	R30 000 per fracture, capped at R30 000
Any fracture of a finger or toe that needs open surgical reduction and internal fixation under general anaesthetic.
Any fracture requiring immobilisation for at least two weeks, excluding minor toes and fingers (per such fracture, capped at R15 000 in total)	R15 000 per fracture, capped at R15 000
Any fracture requiring immobilization with a plaster cast, splint or brace for at least two weeks. Fractures of the third and fourth toes, and third and fourth fingers are not covered by this benefit.
Fracture of the skull requiring reconstructive surgery	R250 000
Depressed or displaced skull fracture of the frontal, parietal, temporal, sphenoid or occipital bones requiring surgical correction.
Fracture of the facial bones requiring reconstructive surgery	R250 000
Fractures of the frontal bones, orbital bones, zygoma, and/or maxilla resulting in maxillofacial reconstructive surgery.

Loss of bowel or bladder function	R500 000
Total, permanent and irrecoverable loss of function of the bowel or bladder, resulting in a permanent stoma or indwelling catheter.

Loss of function of a limb	R500 000
Total, permanent and irrecoverable loss of function of an upper or lower limb. Maximum medical improvement must have been reached with little or no chance of significant further improvement. The loss of function will be estimated after all medical, surgical and rehabilitation measures have been applied. All percentages of loss of function are calculated per limb according to principles and ratings of the latest edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment.

Fat embolism of the lungs after injury	R250 000
Fat embolism in the lung following a fracture, confirmed by a ventilation-perfusion (VQ) scan.

Rupture of the liver, spleen or kidney	R250 000
Blunt injury to the abdomen resulting in rupture of the liver or spleen, or injury to the kidney, necessitating emergency laparotomy and surgical repair, splenectomy or nephrectomy.

Head injury	R750 000
A head injury requiring surgery in the form of a craniotomy, decompression holes to drain a brain bleeding, or open reduction of a depressed skull fracture.

Near drowning	R500 000
Near drowning necessitating emergency resuscitation as witnessed by paramedical personnel, and requiring care in an intensive care unit for at least 48 hours.

Animal bite to the face requiring plastic surgery	R250 000
Animal bite to the face requiring primary suturing followed by multi-phase repair by a plastic and reconstructive surgeon under general anaesthetic.
Animal bite to any part of the body, requiring intervention in theatre on more than one occasion.	R100 000
Animal bite to any part of the body, requiring debridement under anaesthetic, and followed by secondary suturing and/or closing of defect with the use of skin flaps.
Snake bite	R100 000
A poisonous snake bite confirmed medically, necessitating anti-venom treatment and hospitalization for at least 48 hours.

Severe blood loss requiring blood transfusion	R50 000
Severe blood loss due to an injury, necessitating at least 2 units of blood transfusion.

Admission into ICU for 48 hours or more	R500 000
Admission into a registered intensive care unit with mechanical ventilation continuously for at least 48 hours.