As its name suggests, our Total Cover policy provides both life and death insurance benefits when you and your family need them the most. The plan insures against major conditions, such as: terminal illness, heart attack, stroke and serious accident; and while your employer may provide some support, if you cannot work due to illness our product provides you with a lump sum payment.
Recovery & Death Benefits: If you suffer an accident or serious illness you need peace, quiet and time to recover. Alliance recovery benefit is an additional sum that helps you focus on your rehabilitation. The product does not cease if you claim living benefits and your balance will still be paid in the event of death, until the policy expires.
The Total Cover policy provides you with the following benefits:
Total sum insured
|Min 60% / max 100%
of total sum insured (TSI)
|30% of total sum insured at diagnosis date of serious illness (SI)||10% of total sum insured.
Recovery Benefits (RB) directly related to serious illness
- TSI is payable on death, providing no previous claim has been made for SI or RB (which, if claimed, reduces the death benefit component by up to 40%).
- Only one claim is covered by the benefits under SI. Benefits are payable once only and are subject to the terms and conditions of the policy.
The benefits are available for three components: Death, Serious Illness and Recovery Benefit. Each is payable as a lump sum, with benefits distributed as follows:
- The benefit is payable on the death of the insured.
- The balance of any living benefits unclaimed prior to death will be paid.
Serious Illness or a Serious Accident (as defined)
- Once the benefit qualification period has ended, a lump sum is paid in the event that the insured is diagnosed as having suffered any 1 of the 3 Serious Illness components. A 60-day qualification period applies (from the policy start date) before cover begins (the benefit commencement date) for all conditions except Serious Accident, which is covered from day one.
- Serious Illness Benefit can only be claimed once.
Recovery or Relocation Benefit (incapacity for work directly related to Serious Illness)
- Recovery Benefit is paid as a lump sum to assist an individual’s recuperation and rehabilitation in the event they are unable to work as a direct result of a serious illness.
- The benefit is payable only if a Serious Illness claim is accepted following certification by a qualified medical specialist.
- Incapacity must be total, meaning the individual cannot work in any capacity for at least six consecutive months from the diagnosis date. This must be confirmed by the attending doctor/s regularly, via a monthly certificate, during the period of incapacity. If accepted, the benefit is paid after the 6-month period has elapsed.
- If the insured has his/her work visa cancelled due to an inability to work directly caused by the serious illness condition, and they are requested to leave the country, the benefit will still be paid.
- Recovery or Relocation Benefit (incapacity to work) is directly related to serious illness as certified by a qualified medical specialist.
- Serious Illness Benefit covers heart attack, stroke, terminal diagnosis and serious accident.
Serious Illness Include
- Severe heart attack
- Terminal diagnosis – where death is expected within 12 months (conditions apply)
The following are not covered by the benefits:
- Transient Ischemic Attacks
- Brain damage due to an Injury, infection, vasculitis and inflammatory disease
- Vascular disease affecting the eye or optic nerve
- Ischemic disorders of the vestibular system
- Neurological symptoms caused by migraine
- Other acute coronary syndromes without the stipulated cardiac enzyme elevation and impairment of LV function.
- Causes of troponin elevation other than myocardial infarction.
A definite diagnosis by the attending Specialist Consultant of an illness that satisfies both of the following:
- The illness either has no known cure or has progressed to the point where it cannot be cured.
- In the opinion of the attending Consultant, the illness is expected to lead to death within 12 months.
The claim is paid if the insured suffers a severe bodily injury sustained solely through direct, external and violent means and independently of all other causes where they are immediately admitted as an inpatient to hospital for at least 12 consecutive days to receive medical treatment.
- Stays in hospital for less than 12 consecutive days
- Serious accident occurred due to alcohol
- Serious accident due to illegal drug abuse
- Serious accident as a result of a criminal act
You will be considered incapacitated if, after a review of all medical and associated supporting material, we agree that you are not capable of working in your normal job in any meaningful capacity (totally disabled), as a direct result of the condition; subject to the following:
- You were employed full time and earning a salary at the time of incapacitation.
- You are not working in any other employment or self-employment.
- The incapacity has been continuous for six months since the diagnosis of sudden illness (conditions apply).
- A Recovery Benefit claim will not be considered after 12 months from the date of acceptance of a Serious Illness claim
Benefit structure & Qualification period
Qualification Period Exclusions -no benefits are payable in this period
|Accidental death and serious Illness||No qualification period||Usual per market
|Death through Illness||60 days from date of acceptance||Only covers listed conditions|
|Serious illness||60 days from date of acceptance||Only covers listed conditions|
|Recovery benefit||6 months after payment of SI Claim||Incapacity has to be directly related to the sudden illness condition claimed.|
Qualification Period Definition: Qualification Period means the period where no benefits are payable or can be claimed. Any illness that is diagnosed or where clear symptoms have arisen within this period and led to a diagnosis, will not be eligible and excluded from a claim in the future.