Recover-Care

Introduction

Recover-Care pays the insured person a lump sum benefit per day in the event of hospitalisation. The insured person may opt for a daily benefit of R400, R600 or R1,000. The benefit is paid from the fourth day of hospitalisation. This cover is ideal for people who are not receiving a monthly income and receive remineration through commission. The maximum age at entry is 65 years next birthday.

Benefit

If a person is hospitalised for 13 days and has selected R1,000 cover per day, then the benefit is calculated as follows:

Benefit payable - 10 days x R1,000 = R10,000

Limits

Maximum benefit payable is 45 days of hospital confinement.

Exclusions

The exclusions applied to this particular product are listed below. It is also important to note that all pre-existing conditions will be excluded unless accepted in writing by Turnberry.

1. Nuclear weapons or nuclear material or by ionising radiation or contimination by radioactivity from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission;
2. Investigations, treatment or surgery for obesity its sequel or cosmetic surgery directly or indirectly caused by or related to or in conseqauence of cosmetic surgery other than as a result of an insured event otherwise insured. For the purpose of this exception cosmetic suregery shall include surgery for breast reduction or reconstruction unless necessitated as a result of treatment for cancer;
3. Routine physical examination or any laboratory test or procedure of a purely diagnostic nature e.g. x-rays and scans or any other examination where there are no objective indications of impairment in normal health except in the course of a disability established by prior call or attendance of a Medical Practioner;
4. Investigations, treatment or surgery for artificial insemination or hormone treatment for infertility;
5. Suicide, attempted suicide or intentional self-injury;
6. The taking of any drug or narcotic unless prescribed by and taken in accordance with the instructions of a Medical Practioner (other than the insured person) or drug addiction;
7. Psychiatric conditions including but not limited to insanity, depression and mental stress related conditions;
8. Hysterectomies within the first 12 months of a contract, except where malignancy can be proved;
9. An event directly attributable to the insured person having an alcohol content exceeding the legal limit or the insured person suffering from alcoholism or any illness caused by the use of alcohol;
10. Participation in
    1. Active military duty, police duty, police reservist duty, civil commotion, labour disturbances, riot, strike or the activities of locked out workers;
    2. Aviation other than as a fare paying passenger;
    3. Any form of race or speed contest (other than on foot or involving any non-mechanically propelled vehicle, vessel, craft or aircraft);
11. The table of benefits applies in the territory of RSA and no benefits are payable for expenses incurred for transport charges or for services rendered whilst being transported in any emergency vehicle, vessel or aircraft;

Waiting periods

There is a three month waiting period on all policies, except in the event of an accident.

Premium rates

Claims procedure

1. Follow your medical aid's hospital pre-authorisation for hospital admission.
2. Turnberry musty be furnished with the following:
   1. Written notice of the claim within 6 months from the date of treatment for such incident;
   2. Supply in writing any such proof or other information as Turnberry may reasonably request, which would include your Medical Aid remittance advice and hospital and doctor's accounts providing the following information:
      1. The pre-authorisation number
      2. The ICD 10 code for the condition
      3. The procedure / tariff codes
3. Any claims in terms of this policy will prescribe after 12 calendar months from the date of occurence of the insured incident if the claim is outstanding and not a subject of a then pending court case.

Disclaimer

The purpose of this product description is to provide a brief overview of Tunrberry's products. In the event of any dispute the terms and conditions as stated in the client's policy document issued by Turnberry shall prevail.