Definitions

Accident/s means a sudden unexpected and specific event which occurs at an identifiable time (moment or point in time) and place and which results in Injury.

Accumulation Limit means the maximum liability We will be responsible for under this Policy in respect of any one Illness and/or Injury or series of Illnesses and/or Injury/ies arising from any one source or cause.

Aids means an opportunistic infection, or a malignant neoplasm. For the purpose of this definition the term “Acquired Immune Deficiency Syndrome” shall have the meaning assigned to it by the World Health Organization. Opportunistic infection shall include but not be limited to Pneumonia caused by Pneumocystis Carini, the organism of chronic enteritis virus and or disseminated fungal infections. Malignant Neoplasm shall include but not be limited to Kaposi’s Sarcoma, lymphoma of the central nervous system and or other malignancies now known or which become known as immediate causes of death or Illness in the presence of Acquired Immune Deficiency Syndrome. Acquired Immune Deficiency Syndrome shall include HIV (Human Immune Deficiency Virus), Encephalathy (dementia) or HIV wasting syndrome.

AIG means AIG South Africa Limited –Registration No 1962/003192/06

AIG Assist means International SOS, the claims Co-ordination Company authorised by Us and AIG the Underwriter to assist in the management and control of claims incurred or likely to be incurred under this Policy. It also provides emergency travel and pre-departure health information and the AIG Assist services.

Any One Life Limit means the maximum liability We shall be responsible for under this Policy in respect of any one Accident, Illness and/or Injury or series of Accidents, Illnesses and Injuries arising from one source or cause during an Insured Journey, to any one person.

Area means the territorial limits of South Africa.

Beneficiary/ies means the person or persons nominated by the Insured Person.

Contact Sport means any sport in which physical contact between players is an accepted part of play.

Conveyance Limit means the maximum liability We will be responsible for under this Policy in respect of any one Accident or series of Accidents from any one source or cause involving an aircraft, motor vehicle or other conveyance whilst traveling as a fare paying passenger.

Date of Loss means:

1. for Illness, the first date of diagnosis or the date You first became aware of the Illness;
2. for Injury, the date of the Accident.

Effective Date means:

1. for Cancellation - the date the Policy is issued;
2. for Medical Expenses, Assistance Services and Curtailment - the commencement of the Insured Journey.

Excess/Deductible means the first amount, or period, of each and every loss payable by You as shown in the Schedule of Benefits.

Hazardous Pursuits means any activity which introduces or increases the possibility of a loss arising from a peril or which may influence the extent of a loss.

Holder means the Holder named in the Master Policy who is SA TOURMED (Pty) Ltd.

Hospital means a legally constituted establishment that operates pursuant to the laws of the country in which it is based and which meets the following requirements:

1. it operates primarily for the reception, medical care and treatment of sick, ailing or injured persons on a resident in-patient basis;
2. it admits resident in-patients only under the supervision of a Medical Practitioner;
3. it maintains organized facilities for the medical diagnosis and treatment of such persons and provides (where appropriate) facilities for major surgery within the confines of the establishment or facilities controlled by the establishment;
4. it provides a full-time nursing service by or under the supervision of a staff of nurses;
5. it is not a health hydro or nature clinic, a mental institution, an institution confined primarily to the treatment of psychiatric disease, the psychiatric department of a hospital, a place for the treatment of chemical dependence, an establishment or a special unit of a hospital used primarily as a place for treatment of drug addicts or alcoholics, a hospice, frail centre, a rest home or nursing, convalescent, rehabilitation, assisted living or extended care centre.

Illness means any fortuitous sickness, illness or disease originating, contracted, commencing or manifesting itself during the Insured Journey.

Injury means a bodily injury or physical trauma to You resulting from an Accident (occurring solely, and directly and independently of any other cause or any other physical defect or infirmity existing prior to the Accident) in an Insured Event prior to Your return to Your Point of Departure. Exposure to the elements of nature as a direct result of an Accident shall be deemed to be Injury.

Insured Event means a Benefit provided under this Policy.

Insured Journey means when an Insured Person passes through passport control at the Point of Departure to the Area.

Insured Person means You the person named on the Policy Receipt and with respect to whom premium has been paid and who does not permanently reside in the Area.

International Journey means an Insured Journey commencing at the time of departure from the Point of Departure, for the purpose of traveling in a direct and timeous direction to the Point of Destination, inside the Area, including the return journey to the Point of Departure.

International SOS (SOS) means the claims Co-ordination Company authorised by TOURMED and AIG the Underwriter to assist in the management and control of claims incurred or likely to be incurred under this Policy. It also provides emergency travel and pre-departure health information and the AIG Assist services.

Legal Representative/s means the person or persons who manages the legal affairs of another because of incapacity or Death.

Manual Worker means unskilled, semi-skilled, and/or skilled physical labour involving working with the hands and/or the use and/or operation of mechanical and/or non-mechanical machinery and/or equipment.

Medical Practitioner means a person currently licensed and registered to practice medicine, or a person whose fees are readily acceptable to the local Social Security Services or Medical Aid, and who is someone other than You under this Policy or a member of Your immediate family.

Medical Treatment means a Medical Practitioner’s medical advice, treatment, consultations and prescribed or repeat maintenance medication.

Point of Departure means the point from which You commence an Insured Journey (usual place of residence or business), outside of the Area.

Point of Destination means the temporary place of residence (or business) to where You continue an Insured Journey, within the Area.

Policy means this document embodying the contract of insurance subject to the terms and conditions as defined in the Master Policy and shall include any subsequent endorsements, amendments and declarations thereto.

Policy Period means the period shown in the Policy Schedule.

Pre-Existing Medical Condition/s means any condition for which within the 6 consecutive months period prior to the Effective Date of Coverage:

1. You have consulted a Medical Practitioner or Specialist; or
2. You have received treatment or advice; or
3. the manifestation of symptoms would have caused a reasonable person to seek advice;
   It also includes any condition known to You prior to the Effective Date of Coverage under this Policy where You:
4. are on the waiting list for Medical Treatment; or
5. are traveling for the purpose of obtaining Medical Treatment (even if this is not the sole reason for the Insured Journey); or
6. have received a terminal prognosis; or
7. have been recommended to continue or to commence any Medical Treatment or medication after the Effective Date of Coverage.

Professional Player means if You earn in excess of 50% of Your income from playing sport.

Professional Sport means any sport for which You receive or earn in excess of 50% of Your income as a result of your participation.

Public Conveyance means any scheduled or chartered conveyance legally licensed to carry passengers for hire operating commercially in accordance with all locally applicable laws and regulations and in which You are traveling only as a fare-paying passenger but excluding all non-pressurised single engine piston aircraft, taxis or hired motor vehicles.

Reasonable and Customary Charges means the charges which:

1. are required for the treatment, supplies or medical service medically required to treat Your condition; and
2. do not exceed the usual level of charges for similar treatment, supplies or medical services in the locality where the expenses are incurred; and
3. do not exceed the charges for treatment that would have been made if no insurance existed.

Sound Natural Teeth means natural teeth excluding teeth with precious metals or any artificial fillings, including caps and crowns.

TOURMED means SA TOURMED (Proprietry) Limited, a company providing medical travel insurance and administration underwritten by AIG South Africa, a subsidiary of AIG of America. 

Terrorist Act means any actual or threatened use of force or violence directed at or causing damage, Injury, harm or disruption, or commission of an act dangerous to human life or property, against any individual, property, or government, with the stated or unstated objective of pursuing economic, ethnic, nationalistic, political, racial or religious interests, whether such interests are declared or not. Robberies or other criminal acts, primarily committed for personal gain and acts arising primarily from prior personal relationships between perpetrator/s and victim/s shall not be considered Terrorist Acts.

Terrorism shall also include any act, which is verified or recognized by the (relevant) government as an act of terrorism.

War means war, whether declared or not, or any warlike activities, including use of military force by any sovereign national to achieve economic, geographic, nationalistic, political, racial, religious or other ends.

We/Our/Us/Insurer means SA TOURMED (Pty) Limited Registration Number 2002/019719/07 or AIG, AIG Assist and SOS, being the parties who will perform and undertake certain of the functions under this Policy.

You/Your means the Insured Person named in the Policy Schedule
 

Words in the singular include the plural and vice versa

TOURMED provides the required travel medical insurance for the traveler to Southern Africa