Long Term Insurance Act, 1998 (Act No. 52 of 1998)RegulationsRegulations under the Long-term Insurance Act, 1998Part 7 : Contracts Identified as Health Policies under Section 72(2A)(a) of the Act7.1 Definitions and interpretation |
In this Part 7, unless the context indicates otherwise—
means a period in which a policyholder is not entitled to claim policy benefits in respect of a specific condition for which medical advice, diagnosis, care or treatment was recommended or received within a period of 12 months preceding the day on which the policy was entered into;
"general waiting period"
means a period in which a policyholder is not entitled to claim any, or may only claim certain, policy benefits;
"hospitalisation"
means any admission for a procedure or administration of a therapeutic or diagnostic medical intervention wherein a person is expected to stay overnight in a facility;
"insurer''
means a long-term insurer;
"medical scheme"
has the meaning assigned under section 1 of the Medical Schemes Act;
"member"
has the meaning assigned under section 1 of the Medical Schemes Act;
"policy"
means a long-term policy;
"product line"
in relation to a category and type of contract referred to in Regulation 7.2(1), means health policies that have the same or closely related contractual terms offered or entered into by an insurer;
"relevant health service"
has the meaning assigned under section 1 of the Medical Schemes Act;
"rider benefit"
means an additional insurance obligation under a long-term policy which obligation is ancillary to the primary insurance obligations assumed under that policy;
"this Part"
means this Part 7;
"underwritten on a group basis"
means where the risks relating to a policy forming part of a product line are rated based on the characteristics of a group of people (other than characteristics that relate to or may result in specific health conditions) together as opposed to that of the individual to whom the policy relates.