You can cancel your policy at any time by giving Sovereign notice in writing. Sovereign does not have to refund any part of the premium you have paid. As there are annual MajorCare benefit entitlements within your policy, you may remain liable to pay any premium due on this policy through to the next anniversary date , this will be at Sovereign ’s discretion. From (and including) the date that Sovereign receives notice of cancellation of your policy, you will not be entitled to any MajorCare benefits under this policy unless otherwise agreed and confirmed in writing by Sovereign .
For any claim enquiries or before incurring any costs in respect of a claim a life assured should first call our MajorCare Claims Hotline on 0800 500 1080
There are two ways to claim a MajorCare benefit:
> you can seek prior approval from Sovereign in
accordance with section 4a below and we will arrange to pay the respective eligible provider s or health providers directly, less any excess ; or > you can pay for the medical costs incurred yourself and then submit your claim to Sovereign for reimbursement in accordance with section 4b below. Sovereign strongly recommends that you utilise our prior approval service at all times. This will ensure that Sovereign approves all medical treatments or procedures before you incur any costs.
b) When can Sovereign cancel this policy?
If you or a life assured has:
> failed to disclose all material information to us prior to inception, variation or reinstatement of this policy; or > made a statement on the faith of which this policy was issued, renewed, varied or reinstated, that was, in terms of the Insurance Law Reform Act 1977:
a) Prior approval and direct payment process for claims:
Sovereign has preferred provider relationships with a number of health providers and private hospitals . Prior approval and direct payment processes to these eligible providers or health providers and Sovereign approved facilities are streamlined. We therefore encourage you to use these eligible provider s or health providers and Sovereign approved facilities . The policy owner must comply with the following requirements when seeking Sovereign ’s prior approval and direct payment of any claims: > Prior approval requests should be made as soon as you are aware of a pending private hospital admission, MRI or CT scan. We need a minimum of seven working days to process a claim prior to the actual private hospital admission or procedure. Failure to notify Sovereign within the required time frame may result in a prior approval authorisation being declined, or, held up until Sovereign has had the opportunity to fully assess the claim.
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materia l, and
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substantially incorrect , and
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for a life policy made either fraudulently ; or
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within the period of three years immediately preceding the date on which the policy is sought to be avoided or the date of death of the life assured , whichever is earlier.
Sovereign may, at its complete discretion, either:
> Avoid from inception your entire policy (this means this policy is deemed never to have existed), or > Avoid from inception any individual benefit(s) provided by your policy (this means the individual benefit(s) are deemed never to have existed), or > Alter the terms upon which cover is provided under your policy. If we choose to alter the terms of your policy we may do so effective from the risk commencement date . If this policy or any MajorCare benefit provided by this policy is avoided from inception you will forfeit and we will be entitled to retain all premiums paid in relation to the benefit or policy. Sovereign can cancel this policy and decline liability in respect of any claim made under this policy if you , a life assured or anyone acting on your behalf makes a claim under this policy that is false or fraudulent in any respect. In the event that fraud is established after payment of the claim all amounts paid in relation to the false or fraudulent claim must be repaid to Sovereign . Sovereign can cancel this policy if a premium has not been paid within 31 days of the premium due date .
> The policy owner should provide Sovereign with:
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details of the planned medical treatment or procedure; and
– a copy of your health provider’s referral certificate and any other relevant clinical notes that may be requested by us in order to satisfy us that the medical treatment or procedure being contemplated is medically necessary and that it falls within the terms and benefits of this MajorCare policy. > Where possible you should provide Sovereign with an estimate of the costs for the medical treatment or procedure, if the hospital and surgeon are not Sovereign approved providers.
> Allow Sovereign in its sole discretion to:
4. How to claim a benefit
– contact the healthcare provider and obtain an estimate of the costs associated with the medical treatment or procedure under the claim;
134 MAJUMB-SA version 7 Effective 5 December 2016
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