EMERGENCY SERVICES ASSISTANCE AGREEMENT by qSfCWp1

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									                                                                                                         Annexure B: Page 1




ANNEXURE B

POLICY WORDINGS & TERMS AND CONDITIONS




Contents

     Description of Product / Service                                                     Page no.

          1.   Introduction
                 1.1. Definitions                                                              1
                 1.2. Limitation of Assistance Benefits                                        2
                 1.3. Abuse / Misuse of Funds                                                  2
                 1.4. Member Listing                                                           2
                 1.5. Safety of Service Provider                                               2
          2.   Assistance Products
                2.1. Teacher Assist                                                            2
                2.2. HIV Prevention                                                            3
                2.3. Medical Emergency Assistance                                              4
                2.4. Legal Access Line                                                         6
          3.   General Terms & Conditions                                                      6




1.     INTRODUCTION

the Client wishes to provide their members with a package of benefits to assist in times of emergency.

       1.1. DEFINITIONS
             1.1.1. “Area” shall only mean the Republic of South Africa.
             1.1.2. “the Client” shall mean Channel Life Limited as stated in the Agreement;
             1.1.3. “the Company” shall mean Customer Loyalty Consultants as stated in the Agreement;
             1.1.4. “Eligible Person” shall mean any person included on the Declaration who will be entitled to receive
                    the Services as reflected in Annexure “B” and as stated in the Agreement;
             1.1.5. “Emergency medical treatment” shall mean medical treatment administered in response to an
                    episode of illness or injury that of necessity requires immediate medical attention.
             1.1.6. “Illness” shall mean bodily illness, sickness or disease;
             1.1.7. “Injured/injury” shall mean bodily injury caused by accidental, violent, external and visible means.
             1.1.8. ‘Life threatening medical emergency” shall mean any injury or illness that is threatening human
                    life, and requires immediate medical intervention to preserve life.
             1.1.9. “Service Provider” shall mean any entity appointed by The Company to provide a service to an
                    Eligible Person. The Company will ensure that the Service Provider is qualified to render such
                    service in an efficient and professional manner.
             1.1.10.“You, your” shall mean the Eligible Person;
             1.1.11. Words appearing in the singular, where applicable, also imply plural and vice versa.
             1.1.12. The male gender refers to the feminine and vice versa.




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                                                                                                         Annexure B: Page 2




     1.2. LIMITATION OF ASSISTANCE BENEFITS (APPLICABLE TO ALL PARTS)
           The Company reserves the right to suspend, curtail or limit services in the Area or part thereof in the
           event of rebellion, riot, military uprising, war, labour disturbance and strikes, nuclear accidents, acts of
           God, refusal by Government Authorities to permit the provision of services or any other event
           prohibiting service. The Company, however, endeavor to provide service wherever possible.
     1.3. ABUSE / MISUSE OF BENEFITS
           The objective of these benefits is to assist members of the Client in times of emergency and abuse of
           the benefits will result in depletion of the fund which will be detrimental to the entire group. If any
           member is found to abuse or misuse any benefit, they will be blacklisted and will no longer be entitled
           to any assistance and any premiums paid will be forfeited.
     1.4. MEMBER LISTINGS
           In order for call centre consultants to confirm membership, the Client is to provide a complete and
           accurate list of their members electronically by the 5th working day of each month. Although the
           Company will not refuse assistance to any person whose membership cannot be verified, said person
           will be responsible to settle any costs incurred directly with the service provider who may require this
           to be done prior to any service being rendered.
     1.5. SAFETY OF SERVICE PROVIDER
           The Company relies on a team of preferred service providers to render assistance to members. The
           Company shall at all times endeavour to send a service provider to render assistance however if the
           service provider deems it unsafe to person and equipment to render such assistance at a particular
           location, the Company retains the right to render such assistance when it is safe to do so.




2.   ASSISTANCE PRODUCTS
     2.1. TEACHER ASSIST
          2.1.1. The service
                    Telephonic advice and information relating to the following school subjects within the
                       General Education Certificate (grades 4 to 9):
                        English
                        Afrikaans
                        Mathematics
                        Science
                        Natural Science
                        Human & Social Sciences
                        Life Skills
                        Technology
                        Entrepreneurship
                        African Languages
                    Telephonic advice and information relating to the following school subjects within the
                       Further Education and Training (grades 10 to 12):
                        Group A – English, Afrikaans
                        Group B - Mathematics
                        Group C – Physical Science, Biology
                        Group D – African Languages
                        Group E – Geography, History, Economics, Art
                        Group F – Accountancy, Business Economics, Computer Studies, Hotel Keeping &
                          Catering, Technical drawing, Agricultural Sciences
                        Human & Social Sciences
                        Life Skills
                        Technology
                        Entrepreneurship
                        African Languages




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                                                                                                   Annexure B: Page 3




   2.1.2.     Hours – This service shall be available to paid up members through the Customer Loyalty
                       Consultants Call Centre between the hours of 15:00 and 21:00, 7 days a week. It should
                       be noted that during school holidays the service could be limited due to the unavailability
                       of school teachers.


2.2. HIV PREVENTION PROGRAMME
     The possibility of coming into contact with HIV / AIDS is not limited to sexual intercourse. It may be
     contracted through various means like trauma, blood transfusion, rape, motor vehicle accidents, use of
     needles for injections, sports injuries, injuries on duty etc.
     The HIV Prevention Program is a product that ensures that each member within a group has a first port of
     call
      2.2.1. The Service
              2.2.1.1. Two incidents per family per annum.
              2.2.1.2. A maximum of two consultations by a doctor per incident.
              2.2.1.3. A maximum of two blood tests per incident. The initial blood test (HIV Elisa) will
                        determine the patient’s HIV status at the time of the exposure. Should the patient test
                        HIV positive no Anti-retroviral treatment will be given (see * below). If, however, the
                        patient is HIV negative the 3-day starter pack will be supplied and the procedures
                        explained to the patient for the usage of the medicine.
              2.2.1.4. Medicine, being:
              2.2.1.5. 3-day starter pack of AZT or 3TC or a combination of both;
              2.2.1.6. in the event of sexual exposure, standard medication for the prevention of sexually
                        transmitted infections, if required;
              2.2.1.7. in the event of sexual exposure, morning after pill (to prevent pregnancy), if required.
              2.2.1.8. 28 day treatment protocols
              2.2.1.9. A follow-up blood test after 3 months
              2.2.1.10. Ongoing phone-in counselling service to all employees and their families. Life long
                        advice will be offered to the patients and their doctors who phone in.

        Note
        A member is defined as, principal member, one spouse and blood children of the principle member and
        married spouse under 21 years.

        Should the patient be HIV positive on the initial test, then it will be suggested that the patient see his/her
        doctor as soon as possible and that the doctor contacts the call centre to establish the type of
        assistance that they will be able to offer in the future.

   2.2.2.     Additional Patient Costs – Not covered by the programme
            If the patient requires emergency evacuation it will be arranged. However, the patient will be liable for
            this cost.
            Should there be any trauma that requires surgical or other procedures, this will not be covered by the
            programme and will be explained to the patient in advance as well as to the attending medical officer.
            The patient can pay for this him/herself, or can claim it from his/her medical scheme or can be
            referred to a government trauma centre.




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                                                                                                 Annexure B: Page 4




2.3. MEDICAL ASSISTANCE
     2.3.1. The service
               Emergency telephonic medical advice and information
               Emergency medical response by road or air to scene of medical emergency
               Transfer of patient to most appropriate medical facility
               Emotional support and tele-counselling
               Transfer of life saving medication and emergency blood
               Companionship and/or care of stranded minors
               Repatriation of patient or return of mortal remains
               Confidential non-emergency medical information and advice
     2.3.2. Advanced Life Support
              2.3.2.1. Emergency Medical Advice & Information:
                       The service provider will provide the Eligible Person (or caller on his/her behalf) with
                       advice and information regarding any emergency medical condition by telephone so that
                       emergency assistance can immediately be provided to a person suffering illness or injury
                       until a medical team arrives at the scene. The advice and information shall be regarded
                       as such and not as an accurate or definitive diagnosis of any condition any person might
                       suffer.
              2.3.2.2. Definitions & Life Support
                       Utilising a fleet of air or road mobile intensive care ambulances and rapid medical
                       intervention vehicles (manned by doctors, nurses and paramedics) immediate response
                       is undertaken to the scene of a medical emergency where appropriate advanced life
                       saving resuscitation will be provided to the Eligible Person and where relevant, the
                       Eligible Person will be stabilised before transfer is provided to the closest appropriate
                       medical facility.
              2.3.2.3. Transfer of the Eligible Person to the most appropriate medical facility:
                       In all life threatening medical emergencies, the Eligible Person will be transported by
                       road or air to the most appropriate and closest hospital that can effectively manage that
                       particular condition and provide continuity of care, as determined and at the sole
                       discretion of the Medical Director of the service provider.
                       If the condition is not life threatening, but necessitates the use of an ambulance, the
                       Eligible Person will be transported to a preferred provider hospital if necessary, as
                       determined and at the sole discretion of the Medical Director of the service provider.
                       All elective aeromedical transfers serve to upgrade the continuity of care of the Eligible
                       Person to a tertiary medical facility and must be deemed to be medically justified prior to
                       air ambulance transportation. Any elective aeromedical transfer destined for a lower
                       level of care, step-down facility or for chronic management, will be evaluated case by
                       case at the sole discretion of the Medical Director of the service provider.
              2.3.2.4. Transfer of the Eligible Person to a specialist diagnostic and therapeutic medical
                       care centre:
                       Any Eligible Person who requires specialist diagnostic or therapeutic procedures which
                       cannot be performed by the admitting hospital, will be transferred by road or air to the
                       receiving facility where such procedures or specialist care can be performed, as
                       determined and at the sole discretion of the Medical Director of the service provider. The
                       transfer of the Eligible Person shall be limited to one one-way transfer to the facility able
                       to provide the specialist diagnostic interventions. Any return trip that is undertaken will
                       not be covered under this Agreement. The CALL CENTRE must arrange all
                       arrangements for transfer of a patient.
              2.3.2.5. Transfer of Life Saving medications and emergency blood if required:
                       If life saving emergency medications or emergency blood products (thus excluding
                       standard routine delivery and/or charges for blood) are required which cannot be
                       obtained at the medical facility responsible for the Eligible Person’s treatment, then the
                       emergency medication will be transported to the Eligible Person.




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                                                                                   Annexure B: Page 5




2.3.2.6. Admission deposit guarantees:
         If necessary, a financial guarantee of up to R5,000-00 will be provided to ensure
         immediate and appropriate emergency medical care of the Eligible Person by the
         emergency department of the receiving medical facility, thus preventing any delays in
         treatment due to financial policies enforced by specifically private medical institutions.
         All such deposits will be refundable to Customer Loyalty Consultants by the Eligible
         Person or his/her medical aid society within 30 (thirty) days.
         Should the Eligible Person not have appropriate medical cover, or sufficient personal
         funds available for treatment of the condition when admitted to the specific hospital, it is
         possible that such facility will not admit the Eligible Person. This is a practicality of the
         South African medical environment, which the service provider cannot affect or override.
2.3.2.7. Comprehensive Pre-hospital Services
          2.3.2.7.1. Non-emergency / general medical (telephonic) consultation and advice:
                       2.3.2.7.1.1. Medical and nursing practitioners will provide an Eligible
                                    Person with advice and information regarding medical
                                    conditions by telephone.
                       2.3.2.7.1.2. This will inter alia include:
                                    2.3.2.7.1.2.1. general medical advice;
                                    2.3.2.7.1.2.2. chemical substance misuse or abuse;
                                    2.3.2.7.1.2.3. data concerning referrals to hospitals, doctors,
                                                     dentists and pharmacies;
                                    2.3.2.7.1.2.4. medical travel information and advice;
                                    2.3.2.7.1.2.5. generic medicine advice;
                                    2.3.2.7.1.2.6. preferred provider advice and or referral where
                                                     applicable;
                       2.3.2.7.1.3. The advice and information shall be regarded as such and not
                                    as an accurate or definitive diagnosis of any condition any
                                    person might suffer.
          2.3.2.7.2. Repatriation of Eligible Person / return of mortal remains:
                       2.3.2.7.2.1. Any Eligible Person who is hospitalised away from his normal
                                    place of residence and requires medical assistance in order
                                    to return, will be repatriated, by road or air, whichever is the
                                    most appropriate, to his hometown hospital or residence
                                    within the Area. This will only apply to the Eligible Person’s
                                    place of permanent residence and will be defined as the
                                    Eligible Person requiring definitive medical intervention whilst
                                    in transit, as determined by the Medical Director of the service
                                    provider.
                       2.3.2.7.2.2. In the unfortunate event that death occurs whilst the Eligible
                                    Person is away from home, repatriation of the mortal remains
                                    will be undertaken to the Eligible Person’s town of permanent
                                    residence within the Area.
          2.3.2.7.3. Companionship and/or care of stranded minors:
                     In the event any minors are left stranded due to any Medical Emergency
                     occurring whilst away from home, arrangements will be made to accompany
                     the minors back to their residence or to other place of safety, both within the
                     Area.
          2.3.2.7.4. Routine Medically justifiable ambulance transfers
                     Whenever non-emergency medically justifiable ambulance transport is
                     required to transfer the Eligible Person either from home to hospital or from
                     hospital to hospital, arrangements if made through the service provider call
                     Contact Centre will ensure that such transport is undertaken whenever
                     required by road. The medical necessity of such transportation will be
                     determined by the allocated service providers Medical Director. However,



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                                                      any arrangements made with independent ambulance transportation
                                                      services and not authorised and approved by the Company with a
                                                      reference number, are not the responsibility of the Company in any
                                                      way. Medically justifiable transfers will be determined by the Eligible Person
                                                      requiring definitive medical intervention in transit. Should the inter-hospital
                                                      transfer be requested due to the unavailability of other modes of transport
                                                      and not due to medical necessity, the Eligible person will be liable in full for
                                                      the costs of transportation.


Summary of Benefits:

                                                              Table of benefits (VAT included)

                                        Type of assistance                                                              Benefit
     Advanced life support
     Emergency medical advice and information                                                  Telephonic service
     Emergency medical response to scene of medical emergency                                  Doctors, nurses & paramedics / full cost
     Transfer of the Eligible Person to most appropriate medical facility                      Road-or air ambulance / full cost
     Transfer of Eligible Person to specialist diagnostic or therapeutic medical care centre   Road- or air transport
     Transfer of life saving medications & emergency blood if required (excluding normal       Transportation service
     delivery charges)
     Admission deposit guarantees                                                              Up to R5,000-00, but fully refundable
     Comprehensive pre-hospital service
     Non-emergency / general medical (telephonic) consultation and advice                      Telephonic service
     Repatriation of Eligible Person / return of mortal remains                                Road- or air transport
     Companionship and/or care of stranded minors                                              Road transport – full cost
     Routine medically justifiable ambulance transfers                                         Road transport
     One way transfer for special investigations                                               Road transfer




      2.4. LEGAL ASSISTANCE
            An assistance service available to Eligible Persons 24 hours a day, 7 days a week, providing legal
            assistance and referral for legal representation. Eligible Persons are assisted telephonically by qualified
            attorneys and are guided through the legal process.
            2.4.1. The service
                       24 hour telephonic legal advice
                       24 hour legal referral
                       One free 30 minute face-to-face consultation with an attorney
                       Tax advice (telephonic)
                       Advice on courtroom preparation
                       Assistance with legal documentation, such as power of attorney,
                       sale or lease agreements
                       Assistance in drawing up a will
                       Telephonic guidance on contractual law
                       Estate planning guidance



3.    GENERAL TERMS & CONDITIONS (WHERE APPLICABLE THE FOLLOWING CONDITIONS WILL APPLY TO
      ALL SERVICES PROVIDED BY CUSTOMER LOYALTY CONSULTANTS.)
      3.1. This Agreement and any attachments shall be read together as one contract and any word or expression to
             which a specific meaning has attached in any part of this Agreement shall bear such specific meaning
             wherever it may occur. The laws of the Republic of South Africa will govern this Agreement.
      3.2. The Company may, at it’s expense, take proceedings in the Client’s name to recover compensation or secure
             an indemnity from any third party in respect of any injury, loss, damage or expense covered by this
             Agreement. Any amount so recovered shall belong to the Company.
      3.3. If any misrepresentation or concealment is made by the Client or on your behalf in obtaining this Agreement
             or in support of any claim there under, this Agreement shall become void and the premium in respect thereof
             shall be forfeited.



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                                                                                                    Annexure B: Page 7




3.4. The due observance and fulfillment of the terms, provisions and endorsements of this Agreement insofar as
       they relate to anything being done or complied with by the Client, shall be a condition precedent to the
       Company’s liability to make any payment under this Agreement
3.5. No claim or refund under this Agreement shall carry interest.
3.6. Payment of any claim under this Agreement shall only be made in the Republic of South Africa.
3.7. If at any time any claim arises under this Agreement, and there may be any insurance or scheme covering
       the same expenses, loss, damage or liability, the Company shall not pay more than their ratable proportion
       of such claim.
3.8. Where amounts recoverable from the Company are delayed pending finalisation of any claim, payments on
       account will be made to you at the Company’s’ option.
3.9. This Agreement is not assignable. Compensation shall be payable only to the Client or Your legal
       representative whose receipt shall eventually discharge the Company.
3.10. This Agreement constitutes the whole Agreement between the parties hereto and no alteration or addition to
       or variation and no waiver by the Company of any of their rights against the Client hereunder shall be of any
       force or unless reduced to writing and signed by us.
3.11. If the Company (verbally or in writing) repudiates and/or rejects any claim under this Agreement, this done
       by repudiation process, after which the Company will be released from any liability unless summons is
       served on the Company within three months of such repudiation/rejection.
3.12. All headings must be taken into consideration for purposes of interpretation of this Agreement.
3.13. Cover in respect of an Eligible Person will terminate on the first day of the month coinciding with or following:
     3.13.1. non-payment of fee; and/or
     3.13.2. termination of Agreement with the Company.
3.14. Written notice of a claim must be given to the Company at PO Box 66322, Highveld X7, 0169 within 60 days
       after the occurrence or commencement of any event, which may give, rise to a claim.
3.15. The Company reserves the right in consultation with the Client to bring about changes to this policy wording
       and its definitions.




                                                                                              Date of Issue: March 2006

								
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