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INCOME PROTECTOR BENEFIT

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					INCOME PROTECTOR BENEFIT
GENERAL TERMS
These general terms apply to and form part of the Temporary, Extended and Business
Overhead Protector Policies (“Income Protector Policies”), unless otherwise specified or
in conflict with any terms of the Income Protector Policies.


DISABILITY EVENTS
Occupational Disability Definition

For the purposes of the Income Protector Policies only, the definition of “Own
Occupation” below shall be applicable:

“Own Occupation” means the Life Insured will be regarded as disabled if, in the
opinion of Metropolitan Odyssey, injury or illness has rendered him/her unable to
perform the material duties of his/her own occupation, either temporarily or permanently
on a total or partial basis.

Severe Impairment Definition

In addition to the Occupational Disability definition above, the Life Insured will be eligible
to claim under the Severe Impairment definition. Where the Life Insured is severely and
permanently impaired and would qualify to receive a 100% benefit payment under the
Functional Impairment Benefit (Schedule 2) the claim will be admitted, subject to the
terms and conditions applicable to the Functional Impairment Benefit being met.

In order to claim under the Severe Impairment definition the Life Insured must, in the
opinion of the relevant medical specialist, have reached Maximum Medical Improvement
in line with AMA guidelines. Once permanence has been established benefit payments
will be back-dated to the end of the waiting period. Where the Life Insured also qualifies
to claim under the Own Occupation definition, the waiting period and back-dating rules
as set out in the general terms for the Income Protector Policies shall apply.




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Future Insurability Benefit

The Life Insured has the option to increase the Benefit Amount annually up to a
maximum percentage specified by Metropolitan Odyssey without additional underwriting,
in the Anniversary Month of the Policy. If the Benefit Amount is not increased in any 3-
year period the Life Insured will be required to complete a Declaration of Health. The Life
Insured may not increase benefits where they have been loaded for medical reasons or
a benefit has been claimed in the preceding 12 months. The Future Insurability Benefit
will expire following a valid claim under any Temporary, Extended and Business
Overhead Protector Policies held in the name of the Life Insured.

Date of notification

The date of notification shall be the date on which Metropolitan Odyssey receives a
written claim from the Contract Owner for benefits under the Income Protector Policies.

Disability Date

The Disability Date shall be the date of diagnosis of the injury or condition, provided
such diagnosis has been accepted and confirmed by Metropolitan Odyssey. The waiting
period will commence on the Disability Date.

The Disability Date will be determined by Metropolitan Odyssey. Metropolitan Odyssey
reserves the right to change the Disability Date in response to new information regarding
the claim. The Disability Date may not coincide with the date of notification. The
Disability Date, as determined, must be a date after the Commencement Date of the
relevant Policy and before the expiry date of the Policy, allowing for the terms of the
Free Cover Benefit prior to commencement.

Benefit payment term

The benefit payment term shall be selected by the Contract Owner at application date.
The benefit payment term commences on the Disability Date. Following submission of a
valid claim, benefits shall be payable from the end of the waiting period for the balance
of the selected benefit payment term. The selection of a benefit payment term is required
where the Temporary and/or Business Overhead Protector option is selected.




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Payment of Benefit

Benefits will always be payable monthly in arrears.

Benefits being paid shall escalate annually on the anniversary of the Disability Date for
the duration of the claim at a rate selected by the Contract Owner, capped at a
percentage specified by Metropolitan Odyssey. Where a claimant returns to work in a
reduced capacity following a claim and receives a reduced income the Benefit Amount
payable will be reduced pro rata in the ratio of the pre-claim and post-claim income
where income is as defined. Where the Life Insured is off work for less than a month, the
benefit paid will be adjusted on a pro rata basis.

The Life Insured must be employed in his or her nominated occupation at the Disability
Date.

The Life Insured may only submit a claim where the lost income following a disability
event exceeds 25% of the selected Benefit Amount or Pre-Disability Earnings, whichever
is the lesser.

Allowable Income Offsets

The Benefit Amount will not be reduced by amounts received from compensation
schemes, sick leave payments or social security payments. The Benefit Amount will be
reduced by amounts received from other overhead expense or income protection
insurance policies (including but not limited to any annuity or pension products). The
Benefit Amount will be aggregated with any lump-sum disability benefits received by the
claimant.

Proof of loss of income

The Life Insured shall be required to provide proof of loss of income within 3 months of
the Disability Date. Where the Life Insured cannot prove loss of income to Metropolitan
Odyssey’s satisfaction following a claim, Metropolitan Odyssey will recoup any benefit
payments made and the claim shall cease. The Life Insured shall not be required to
provide proof of loss of income in respect of claims accepted under the Severe
Impairment definition.



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Waiting periods and exclusions

Waiting period
A waiting period will be imposed before a benefit is paid, subject to certain exclusions as
specified below. The waiting period, as specified in the Policy Schedule, is the period of
time from the Disability Date during which no benefit is payable.

Premiums must be paid during the waiting period.

Where the 7-day waiting period is selected benefit payments will be backdated to the
Disability Date. For other waiting periods benefits will be payable from the end of the
waiting period for a period ceasing at the end of the selected benefit payment term
(Temporary and Business Overhead Protector only) where benefit payment commences
on the Disability Date.

A 30-day waiting period shall apply to the following conditions even where the 7-day
waiting period has been selected:

       All mental or psychiatric conditions (unless hospitalised for at least 7 days);

       Stress-related disorders;

       Chronic fatigue syndrome;

       Fibromyalgia;

       Headaches / migraines (unless hospitalised for at least 24 hours).




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Back-dated payments

No back-dated payments shall apply for claims under the following conditions:

       Back disorders (unless hospitalised for at least 7 days);

       Pregnancy and related complications (unless hospitalised for at least 7 days).
       Maternity leave is specifically excluded;

       Childbirth (unless hospitalised for at least 7 days);

       Cosmetic surgery;

       Influenza (unless hospitalised for at least 24 hours);

       Upper respiratory tract infections (unless hospitalised for at least 24 hours);

       Laryngitis (unless hospitalised for at least 24 hours);

       Pharyngitis (unless hospitalised for at least 24 hours);

       Bronchitis (unless hospitalised for at least 24 hours);

       Pneumonia (unless hospitalised for at least 24 hours);

       Gastroenteritis (unless hospitalised for at least 24 hours);

       Diarrhoea (unless hospitalised for at least 24 hours).

Assessment of continuance

The Life Insured shall be required during claim assessment and for the duration of the
claim in payment to submit to regular medical or other examinations to assess the
continuance of incapacity at the instance and cost of Metropolitan Odyssey.




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Off period

If a related disability event occurs within 3 months of recovery from a prior related
disability event, no waiting period shall apply to the subsequent disability claim arising
from a related cause, provided that the duration of the first disability event exceeded 28
days.

Change in status of the Life Insured

Metropolitan Odyssey reserves the right to cancel this Policy should the Life Insured
change to an occupation not eligible under the Own Occupation Disability definition as
per the eligibility rules applicable at the time. Metropolitan Odyssey reserves the right to
vary the policy terms in response to changes in occupation and employment status but
may not cancel the Policy except in the circumstances described above. The Contract
Owner is required to notify Metropolitan Odyssey of any changes in occupation of the
Life Insured under the Policy.

Income Protector Waiver of Premium Benefit

Following a successful claim under an Income Protector Policy the premium payable on
the Policy will be waived from the end of the waiting period to the earliest of the end of
the term of the Policy or the recovery of the Life Insured. A minimum of one monthly
premium will be waived on any valid claim, irrespective of the duration of the claim.




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EXCLUSIONS
No payments shall be made in the event of loss of income arising from:

       War (whether declared or not), radioactivity or nuclear explosion, chemical or
       biological warfare, participation in a civil commotion, riot, terrorist activity or
       rebellion;

       Violation of criminal law by the Life Insured, including the consumption of alcohol
       above the legal driving limit;

       Intentional self-inflicted injury or attempted suicide (whether sane or insane) or
       neglect or refusal in seeking and following reasonable medical advice;

       Any undisclosed risky or dangerous activities which, in the opinion of
       Metropolitan Odyssey, may expose the Life Insured to a higher than average risk
       of claim. Hazardous activities includes but is not limited to claims arising from
       participation in extreme altitude climbing (above 3000 m); motorised racing /
       speed contests; speed trials, aviation other than as a fare-paying passenger and
       fighting of any kind except in self-defence;

       Abuse of alcohol; consumption of drugs or narcotics except as prescribed by a
       qualified medical practitioner currently registered with the Health Professions
       Council of South Africa.




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TEMPORARY INCOME PROTECTOR BENEFIT
Benefit

Metropolitan Odyssey will pay the Benefit Amount on a monthly basis, following the
expiry of the waiting period, to the persons entitled to it, should the Life Insured become
disabled as specified in the general terms to the Income Protector Policies. The Benefit
Amount shall be the lesser of the Benefit Amount including increases, if applicable, or
100% of pre-disability earnings, for the selected benefit payment term, less offsets. The
Benefit Amount payable will be determined by Metropolitan Odyssey.

Definition of income

Pre-Disability Earnings shall be defined as the average monthly cost to company income
of the Life Insured from his/her nominated occupation for the twelve months preceding
the disability date. If the Life Insured earns a fluctuating income, average monthly
earnings will be determined over the 36-month period preceding the disability date

For self-employed individuals (director of a private company, sole proprietor, partner,
member of a close corporation) and business owners, pre-disability earnings shall be
defined as the Life Insured’s share of fees from services rendered and gross profit from
trading, less the Life Insured’s share of business overhead expenses. Where the share
of income or expenses is difficult to determine, income shall be determined as any
income, loan account repayments, dividends or other benefits that the Life Insured
receives from the business in his or her personal capacity.

The maximum Benefit Amount determined in accordance with the above will be reduced
by any income benefits received by the Life Insured under other similar income
replacement products.

Passive income (income earned on investments or assets where the Life Insured is not
actively involved in the management of the underlying business) is excluded.




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Payment of benefits

The Contract Owner shall be required to nominate a benefit payment term at inception.
Following a valid claim, the Temporary Income Protector Benefit will be paid from the
end of the waiting period to the end of the selected benefit payment term, where the
benefit payment term commences on the Disability Date. The benefit payment term shall
not exceed 24 months.

Terms and conditions

The payment of benefits shall terminate in any the following circumstances:

       The end of the benefit payment term;

       Death of the Life Insured;

       Failure of the Life Insured to provide satisfactory evidence of continuance of
       incapacity;

       Full recovery of the Life Insured.

       Failure of the Life Insured to provide satisfactory proof of loss of income.

       Policy expiry date;

       Refusal of the Life Insured to follow recommended medical treatment or undergo
       reasonable medical treatment as recommended by the Life Insured doctor and/or
       the Chief Medical Officer of Metropolitan Odyssey.




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Termination of Benefit

The Benefit shall cease upon the earliest of the following:

       On death of the Life Insured;

       At the Policy expiry date;

       Cessation or lapse of the Policy;

       Change in status of the Life Insured resulting in ineligibility for the Temporary
       Income Protector Benefit.




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EXTENDED INCOME PROTECTOR BENEFIT
Benefit

Metropolitan Odyssey will pay the Benefit Amount on a monthly basis, following the
expiry of the waiting period, to the persons entitled to it, should the Life Insured become
disabled as specified in the General Terms to the Income Protector Benefit. The Benefit
Amount shall be the lesser of the current Benefit Amount or 75% of pre-disability
earnings less offsets. The Benefit Amount payable will be determined by Metropolitan
Odyssey.

The Extended Protector Benefit shall cease at the end of the benefit payment term
selected in the Schedule.

A claim will only be admitted upon proof of loss of income being submitted within 3
months of the Disability Date. Where payments are made prior to the claim being
admitted and it can be shown that the Life Insured suffered no loss of income
Metropolitan Odyssey will recoup any income payments made.

A claim may only be submitted where the income lost following a disability event
exceeds 25% of the selected Benefit Amount or pre-disability income, whichever is the
lesser.

Definition of income

Pre-Disability Earnings shall be defined as the average monthly cost to company income
of the Life Insured from his/her nominated occupation for the twelve months preceding
the disability event. If the Life Insured earns a fluctuating income, average monthly
earnings will be determined over the 36-month period preceding the disability event

For self-employed individuals (director of a private company, sole proprietor, partner,
member of a close corporation) and business owners, pre-disability earnings shall be
defined as the Life Insured’s share of fees from services rendered and gross profit from
trading, less the Life Insured’s share of business overhead expenses. Where the share
of income or expenses is difficult to determine, income shall be determined as any
income, loan account repayments, dividends or other benefits that the Life Insured
receives from the business in his or her personal capacity.



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The maximum Benefit Amount determined in accordance with the above will be reduced
by any income benefits received by the Life Insured under other similar income
replacement products.

Passive income (income earned on investments or assets where the Life Insured is not
actively involved in the management of the underlying business) is excluded.

Terms and conditions

Benefits in payment shall terminate in any the following circumstances:

       At the end of the benefit payment term;

       At the Policy expiry date;

       Death of the Life Insured;

       Failure of the Life Insured to provide satisfactory evidence of continuance of
       incapacity.

       Full recovery of the Life Insured.

       Failure of the Life Insured to provide satisfactory proof of loss of income;

       Refusal of the Life Insured to follow recommended medical treatment or undergo
       reasonable medical treatment as recommended by the Life Insured’s doctor
       and/or the Chief Medical Officer of Metropolitan Odyssey.




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Termination of Benefit

The Benefit shall cease upon the earliest of the following:

       Death of the Life Insured;

       The Policy expiry date;

       Cessation or lapse of the Policy;

       Change in status of the Life Insured resulting in ineligibility for the Extended
       Income Protector Benefit;

       The Life Insured returns to work on a partial basis but is able to earn income
       exceeding 75% of pre-disability income.




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