Terms & Condition
1. DEFINITIONS
The terms defined below shall bear the meanings herein assigned to them and unless inconsistent with the context, as words, and expressions importing the one gender shall include any other genders, words signifying the singular number shall include the plural and vice versa.
1.1. ENTERPRISE LIFE means ENTERPRISE Life Assurance Company Limited.
1.2. COMMENCEMENT DATE means the date on which the POLICY commences as set out in the SCHEDULE.
1.3. DEATH BENEFIT means the benefit payable on the death of a LIFE ASSURED as set out in the SCHEDULE and subject to the terms and conditions of the POLICY.
1.4. ELIGIBLE MEMBER means a MEMBER who has not attained the TERMINATION AGE and who on first becoming eligible has not attained the MAXIMUM ENTRY AGE as set out in the SCHEDULE
1.5. GUARDIAN means an adult custodian to whom the MEMBER has been effectively entrusted.
1.6. MEMBER means a person who is an active member of the Association and is fully paid up.
1.7. ENTRY DATE means the first day on which an ELIGIBLE MEMBER becomes a LIFE ASSURED. Such date may coincide with or precede the COMMENCEMENT DATE.
1.8. LIFE ASSURED means an ELIGIBLE MEMBER in respect of whom benefits are payable in terms of the POLICY.
1.9. MAXIMUM ENTRY AGE means the maximum permissible age of any ELIGIBLE MEMBER at the date of first becoming eligible as specified in the SCHEDULE.
1.10. PARENT means biological or any adult guardian to whom the MEMBER has been effectively entrusted
1.11. PARENT- IN-LAW means the biological parents of a legally recognized wife.
1.12. POLICY means this POLICY contracted between ENTERPRISE LIFE and the POLICYHOLDER, together with the SCHEDULE thereto, as amended from time to time.
1.13. POLICYHOLDER means the juristic person specified as the POLICYHOLDER in the schedule.
1.14. POLICY REVIEW DATE means the date on which the POLICY is reviewed as set out in the SCHEDULE.
1.15. POLICY YEAR means the period from the COMMENCEMENT DATE to the POLICY REVIEW DATE and thereafter to the subsequent annual anniversaries of the POLICY REVIEW DATE.
1.16. SCHEDULE means the schedule attaching to and forming part of the POLICY as amended from time to time.
1.17. SPOUSE means the person to whom the scheme MEMBER is legally married or with whom s/he has an agreement recognized as a marriage in accordance with some law or custom and who cohabits with the member as if married.
- CONDITIONS FOR PROVISION OF COVER
- Eligibility for cover
- Every LIFE ASSURED is entitled to a DEATH BENEFIT under the POLICY.
- Notwithstanding anything to the contrary contained elsewhere in the POLICY, the DEATH BENEFIT is compulsory for all ELIGIBLE MEMBERS subject to the provisions of paragraph 2.5
- Actively a Member
- An active member is a MEMBER who has paid the full premium on the ENTRY DATE, failing which his ENTRY DATE shall be delayed the payment is made in full.
- Territorial Limits
There are no territorial limits applicable to this policy.
- Cessation of the death benefit
- Notwithstanding any other provisions of the POLICY a LIFE ASSURED’s entitlement to a DEATH BENEFIT shall cease on the earliest of:
- The termination of the POLICY
- The cessation of payment of premiums.
- The LIFE ASSURED ceasing to be an ELIGIBLE MEMBER; and
- The payment of the DEATH BENEFIT upon the death of the LIFE ASSURED
3.1 PAYMENT OF DEATH BENEFITS
3.1 The POLICYHOLDER shall provide proof of death of a LIFE ASSURED satisfactory to ENTERPRISE LIFE together with such other information as ENTERPRISE LIFE may reasonably require in order to establish the validity of a claim whereupon ENTERPRISE LIFE shall pay the DEATH BENEFIT to the POLICYHOLDER.
3.2 A claim application shall be notified with documents to the Association’s scheme administrator who would in turn lodge it with ENTERPRISE LIFE within three months of the date of death of a LIFE ASSURED and ENTERPRISE LIFE shall thereafter process the claim without undue delay.
3.3 Documents required for the various benefits are:
Death: Mortuary receipts, Obituary, Coroners Report, Medical Certificate, Medical Certificate of cause of Death or other documents to confirm the authenticity of the claim
Critical Illness: Medical Records
Total Permanent Disability: Medical Records
4. PAYMENTS OF PREMIUMS
4.1 Premiums are to be paid regularly for the duration of the policy.
4.2 A period of grace of one calendar month shall be allowed for payment of the premiums.
4.3 If the full amount of all outstanding premiums is not received by ENTERPRISE LIFE by the expiry of the period of grace, all cover shall cease as at the last day of the month for which a premium was received, unless agreed otherwise in writing by ENTERPRISE LIFE.
4.4 Members who join the scheme after the commencement of the cover will have their premiums pro-rated for the period of cover.
5. RATE GUARANTEE
5.1 The premium rate shall be guaranteed for a period of twelve months from the COMMENCEMENT DATE.
5.2 Upon ENTERPRISE LIFE giving two months’ written notice to the POLICYHOLDER, the premium rate may be altered in consultation with the Policyholder to take effect from the start of a POLICY YEAR. In the event that the POLICYHOLDER does not accept the altered premium rate then the POLICY shall terminate at the end of the two month notice period.
5.3 Not withstanding the provisions of paragraphs 5.1and 5.2 above, ENTERPRISE LIFE reserves the right to change the premium rate in consultation with the Policyholder and giving one month’s written notice of it’s intention to do so, if:
5.3.1 There is a change in membership or categories of members which, in the opinion of ENTERPRISE LIFE materially affects the risk it has assumed under the POLICY.
5.3.2 The activities of the MEMBER change to such an extent that in the opinion of ENTERPRISE LIFE it materially affects the risk it has assumed under the POLICY; or
5.3.3 The benefit structure of risk benefits provided under the POLICY changes.
6. PROOF OF AGE AND PARTICULARS
6.1 The POLICYHOLDER shall, from time to time and by mutual agreement with ENTERPRISE LIFE, provide to ENTERPRISE LIFE all information relevant to the determination of benefits and premiums in terms of the POLICY.
6.2 In the event that any information required in terms of paragraph 6.1 is not provided within six weeks of it being requested, and if it is material to ENTERPRISE LIFE’s ability to meet its obligations in terms of the POLICY, ENTERPRISE LIFE may give the POLICYHOLDER two week’s written notice of its intention to terminate the cover provided under the POLICY notwithstanding any other provisions of the POLICY. On the expiry of the two-week notice period, the POLICY shall cease unless ENTERPRISE LIFE has agreed otherwise in writing.
6.3 ENTERPRISE LIFE shall not be liable to any person in respect of any misrepresentations, errors or omissions contained in the information provided to it in terms of paragraphs 6.1 and 6.4
6.4 Evidence of the age or any other information that may influence the extent of the risk of any LIFE ASSURED under the POLICY shall be required to the satisfaction of ENTERPRISE LIFE before any DEATH BENEFIT is paid. If a date of birth, or any other information that influences the extent of the risk previously notified to ENTERPRISE LIFE in respect of a LIFE ASSURED proves to be incorrect, ENTERPRISE LIFE shall, after consulting with the POLICYHOLDER, calculate the premiums that should have been paid and adjust the premiums retrospectively to the date on which the LIFE ASSURED became entitled to the cover in terms of the POLICY or make such adjustment to the cover as it considers appropriate.
6.5 Should any amount owed to ENTERPRISE LIFE as a result of such premium adjustment not be paid within the period of grace envisaged in paragraph 4.2, ENTERPRISE LIFE shall reduce the cover, as it considers appropriate by reference to the premiums actually received in respect of the LIFE ASSURED.
6.6 ENTERPRISE LIFE shall keep a register of all the LIVES ASSURED under the POLICY and shall record therein the information supplied by the POLICYHOLDER.
6.7 ENTERPRISE LIFE shall be entitled, at all reasonable times, to inspect and make copies of any records of the MEMBER relevant to the operation of the POLICY.
6.8 Members who join the scheme after the commencement of the policy will go through six months waiting period
