Rules > Policyholder Protection Rules (Long-term Insurance), 2017 > Chapter 1 : Interpretation

2.1	In these rules "the Act" means the Long-term Insurance Act, 1998 (Act No. 52 of 1998), including the Regulations promulgated under section 72 of the Act, and any word or expression to which a meaning has been assigned in the Act bears, subject to context, that meaning unless otherwise defined, and—

"advertisement"

means any communication published through any medium and in any form, by itself or together with any other communication, which is intended to create interest by the public in the business, policies or related services of an insurer, or to persuade the public (or a part thereof) to transact in relation to a policy or related service of the insurer in any manner, but which does not purport to provide detailed information to or for a specific policyholder regarding a specific policy or related service;

[Definition inserted by rule 4(a) of Notice No. 997, GG 41928, dated 28 September 2018]

"advice"

has the meaning assigned to it in the FAIS Act;

[Definition substituted by rule 4(b) of Notice No. 997, GG 41928, dated 28 September 2018]

"beneficiary"

in respect of a—

(a)	registered insurer, means—

(i)	a person nominated by the policyholder as the person in respect of whom the insurer should meet policy benefits; or

(ii)

in the case of a fund member policy, a fund policy or a group scheme, a person nominated by the fund, member of the fund or member of the group scheme, or person otherwise determined in accordance with the rules of that fund or group scheme as the person in respect of whom the insurer should meet policy benefits;

(b)

licensed insurer, has the meaning assigned to it in Schedule 2 of the Insurance Act; and for purposes of these rules includes in the case of a fund policy, a person nominated by the fund, or person otherwise determined in accordance with the rules of that fund as the person in respect of whom the insurer should meet policy benefits;

[Definition substituted by rule 4(c) of Notice No. 997, GG 41928, dated 28 September 2018]

"business day"

means any day excluding a Saturday, Sunday or public holiday;

[Definition inserted by rule 4(d) of Notice No. 997, GG 41928, dated 28 September 2018]

"claim"

means, unless the context indicates otherwise, a demand for policy benefits by a person in relation to a policy, irrespective of whether or not the person's demand is valid;

"claimant"

means a person who makes a claim;

"credit life insurance"

has the meaning assigned to in the National Credit Act;

"exclusion"

means a loss or risk event not covered under a policy;

"existing policy"

means a policy entered into before the date on which the relevant rule takes effect;

"FAIS Act"

means the Financial Advisory and Intermediary Services Act, 2002 (Act No. 37 of 2002);

"FAIS General Code of Conduct"

means the General Code of Conduct for Authorised Financial Services Providers and Representatives published in Board Notice No. 89 of 2003, and amended from time to time, under section 15 of the FAIS Act;

"fund"

has the meaning assigned to it in Part 1 of the Regulations;

[Definition inserted by rule 4(e) of Notice No. 997, GG 41928, dated 28 September 2018]

"fund member policy"

has the meaning assigned to it in Part 3A of the Regulations;

"fund policy"

has the meaning assigned to it in Part 1 of the Regulations;

[Definition inserted by rule 4(f) of Notice No. 997, GG 41928, dated 28 September 2018]

"independent intermediary"

has the meaning assigned to it in Part 3A of the Regulations;

"insurer"

means a long-term insurer;

"intermediary"

means a an independent intermediary or representative, respectively;

[Definition inserted by rule 4(g) of Notice No. 997, GG 41928, dated 28 September 2018]

"investment value"

in respect of a—

(a)	registered insurer, means the value of a policy calculated as the accumulated basic premium and investment return stated in or ascertainable from the policy, less deductions specifically provided for in the policy;

(b)	licensed insurer, has the meaning assigned to it in Schedule 2 of the Insurance Act;

[Definition substituted by rule 4(h) of Notice No. 997, GG 41928, dated 28 September 2018]

"loyalty benefit"

means any benefit (including a so-called cash- or premium-back bonus) that is directly or indirectly provided or made available to a policyholder by an insurer or an associate of the insurer, which benefit is wholly or partially contingent upon—

(a)	the policy or policies of that policyholder with that insurer remaining in place;

(b)	the policyholder increasing any policy benefit to be provided under a policy; or

(c)	the policyholder entering into any other policy or policy benefit or utilising any related services offered by that insurer or its associate.

"mandatory credit life insurance"

means credit life insurance contemplated in section 106(1)(a) of the National Credit Act;

"member"

means a member of a fund or a member of a group scheme;

"member of a fund"

means any person in respect of whom a fund, under a fund policy, insures its liability to provide benefits to such person in terms of its rules;

"member of a group scheme"

means—

(a)	a person who participates in a group scheme to insure him or herself; or

(b)	a person who participates in a group scheme to insure the lives of one or more other persons in which the first-mentioned person has an insurable interest;

"National Credit Act"

means the National Credit Act, 2005 (Act No. 34 of 2005);

"new policy"

means a policy entered into on or after the date on which the relevant rule takes effect;

"no-claim bonus"

means any benefit that is directly or indirectly provided or made available to a policyholder by an insurer in the event that the policyholder does not claim or does not make a certain claim under the policy within a specified period of time;

"ombud"

has the meaning assigned to it in the—

(a)	Financial Services Ombud Schemes Act, 2004 (Act No. 37 of 2004) up until such time as such Act is repealed through Schedule 4 of the Financial Sector Regulation Act; and

(b)	Financial Sector Regulation Act from the date on which such Act repeals the Financial Services Ombud Schemes Act, 2004 (Act No. 37 of 2004) through Schedule 4 of such Act;

[Definition inserted by rule 4(i) of Notice No. 997, GG 41928, dated 28 September 2018]

"optional credit life insurance"

means credit life insurance contemplated in section 106(3) of the National Credit Act;

"outsourcing"

means an outsourcing arrangement as defined in section 1 of the Financial Sector Regulation Act, and includes rendering services under a binder agreement, but excludes rendering services as intermediary, and “outsourced” has a corresponding meaning;

[Definition substituted by rule 4(j) of Notice No. 997, GG 41928, dated 28 September 2018]

"plain language"

means communication that—

(a) is clear and easy to understand;

(b) avoids uncertainty or confusion; and

(c) is adequate and appropriate in the circumstances,

taking into account the factually established or reasonably assumed level of knowledge of the person or average persons at whom the communication is targeted;

"policy"

means a long-term policy;

"policyholder"

has the meaning assigned to it in the Act and includes any person in respect of whom a fund, under a fund member policy, insures its liability to provide benefits to such person in terms of its rules;

"potential member"

means a person who—

(a)	has applied to or otherwise approached an insurer, an intermediary, a fund or a group scheme to become a member;

(b)	has been solicited by an insurer, an intermediary, a fund or a group scheme to become a member; or

(c)	has received advertising, as defined in rule 10, in relation to any fund or group scheme;

"potential policyholder''

means a person who—

(a)	has applied to or otherwise approached an insurer or an intermediary to become a policyholder;

(b)	has been solicited by an insurer or an intermediary to become a policyholder; or

(c)	has received advertising, as defined in rule 10, in relation to any policy or related service of an insurer;

"Regulations"

means the Regulations made under the Long-term Insurance Act, 1998, promulgated by GN R. 1492 of 27 November 1998 and amended from time to time;

"related service"

means any service or benefit provided or made available by an insurer or any associate of that insurer, together with or in connection with any policy or policy benefit, and includes a loyalty benefit and a no-claim bonus;

"representative"

has the meaning assigned to it in Part 3A of the Regulations;

"repudiate"

in relation to a claim means any action by which an insurer rejects or refuses to pay a claim or any part of a claim, for any reason, and includes instances where a claimant lodges a claim –

(a) in respect of a loss event or risk not covered by a policy; and

(b) in respect of a loss event or risk covered by a policy, but the premium or premiums payable in respect of that policy are not paid;

[Definition inserted by rule 4(k) of Notice No. 997, GG 41928, dated 28 September 2018]

"risk policy"

means a policy that provides risk benefits only or that provides primarily risk benefits;

"senior manager"

has the meaning assigned to it in the Insurance Act;

[Definition inserted by rule 4(l) of Notice No. 997, GG 41928, dated 28 September 2018]

"service provider''

means any person (whether or not that person is the agent of the insurer) with whom an insurer has an arrangement relating to the marketing, distribution, administration or provision of policies or related services;

"variation of a policy"

means any act that results in a change to—

(a) the premium;

(b) any term;

(c) any condition;

(d) any policy benefit;

(e) any exclusion; or

(f) the duration of a policy,

excluding any explicit pre-determined or determinable variation stated or provided for in the policy, and "variation of an existing policy" and "varying" has a corresponding meaning;

"waiting period"

means a period during which a policyholder is not entitled to policy benefits;

"white labelling"

refers to the marketing of or offering of a specific policy of an insurer under the brand of another person who is not the insurer in terms of an arrangement between the insurer and that other person; and

"writing"

includes any communication by any appropriate electronic medium that is accurately and readily reducible to written or printed form; and "written" has a corresponding meaning.

2.2	Despite section 2.1, the meanings assigned to the following terms in the Regulations shall not have such meanings for purposes of these rules, and the grammatical meaning of these terms will apply—

Long Term Insurance Act, 1998 (Act No. 52 of 1998)

Rules

Policyholder Protection Rules (Long-term Insurance), 2017

Chapter 1 : Interpretation

2. Definitions

"advertisement"

"advice"

"beneficiary"

"business day"

"claim"

"claimant"

means a person who makes a claim;

"credit life insurance"

has the meaning assigned to in the National Credit Act;

"exclusion"

means a loss or risk event not covered under a policy;

"existing policy"

means a policy entered into before the date on which the relevant rule takes effect;

means the Financial Advisory and Intermediary Services Act, 2002 (Act No. 37 of 2002);

means the General Code of Conduct for Authorised Financial Services Providers and Representatives published in Board Notice No. 89 of 2003, and amended from time to time, under section 15 of the FAIS Act;

"fund"

has the meaning assigned to it in Part 1 of the Regulations;

"fund member policy"

has the meaning assigned to it in Part 3A of the Regulations;

"fund policy"

has the meaning assigned to it in Part 1 of the Regulations;

"independent intermediary"

has the meaning assigned to it in Part 3A of the Regulations;

"insurer"

means a long-term insurer;

"intermediary"

means a an independent intermediary or representative, respectively;

"investment value"

in respect of a—

"loyalty benefit"

means any benefit (including a so-called cash- or premium-back bonus) that is directly or indirectly provided or made available to a policyholder by an insurer or an associate of the insurer, which benefit is wholly or partially contingent upon—

"mandatory credit life insurance"

means credit life insurance contemplated in section 106(1)(a) of the National Credit Act;

"member"

means a member of a fund or a member of a group scheme;

"member of a fund"

means any person in respect of whom a fund, under a fund policy, insures its liability to provide benefits to such person in terms of its rules;

"member of a group scheme"

means—

"National Credit Act"

means the National Credit Act, 2005 (Act No. 34 of 2005);

"new policy"

means a policy entered into on or after the date on which the relevant rule takes effect;

"no-claim bonus"

means any benefit that is directly or indirectly provided or made available to a policyholder by an insurer in the event that the policyholder does not claim or does not make a certain claim under the policy within a specified period of time;

"ombud"

has the meaning assigned to it in the—

"optional credit life insurance"

means credit life insurance contemplated in section 106(3) of the National Credit Act;

"outsourcing"

"plain language"

means communication that—

(a) is clear and easy to understand;

(b) avoids uncertainty or confusion; and

(c) is adequate and appropriate in the circumstances,

taking into account the factually established or reasonably assumed level of knowledge of the person or average persons at whom the communication is targeted;

"policy"

means a long-term policy;

"policyholder"

has the meaning assigned to it in the Act and includes any person in respect of whom a fund, under a fund member policy, insures its liability to provide benefits to such person in terms of its rules;

"potential member"

means a person who—

"potential policyholder''

means a person who—

"Regulations"

means the Regulations made under the Long-term Insurance Act, 1998, promulgated by GN R. 1492 of 27 November 1998 and amended from time to time;

"related service"

means any service or benefit provided or made available by an insurer or any associate of that insurer, together with or in connection with any policy or policy benefit, and includes a loyalty benefit and a no-claim bonus;

"representative"

has the meaning assigned to it in Part 3A of the Regulations;

"repudiate"

"risk policy"

means a policy that provides risk benefits only or that provides primarily risk benefits;

"senior manager"

has the meaning assigned to it in the Insurance Act;