medipet policy wording

7/31/2019 Medipet Policy Wording

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Your Pet Insurance Policy Policy Wording

To be read in conjunction with your policy schedule, this may contain additional terms and conditions.

Helpful Definitions

Behavioural Illness Any changes to your pets normal behaviour, resulting from a mental or emotional disorder which is diagnosed by a vet.

Clinical signs Changes in your pets normal healthy state, its bodily functions or behaviour.

Co Payment period this starts on day 31 of a new Policy up to and including day 60. Within thisperiod compensation will be paid up to 50% of the normal benefit granted perclaim.

ComplementaryTreatment Includes, but is not limited to treatment for behavioural conditions,

physiotherapy, hydrotherapy, homeopathy and acupuncture, rehabilitationtherapy, etc.

Chronic Any condition which requires treatment and or medication for a period of longer than three months.

Disclosure You agree to fully disclose and declare any and all information of material

fact related to your pets state of health or condition at the tim e of signing upfor cover and thereafter. Failure to do so could result in cancellation of youpolicy due to non-disclosure.

Excess You are responsible for the first amount payable in respect of each and everyloss in terms of section 1A and B. This first amount payable (policy excess) is10% of the claim, minimum R200.00 per event. Any variance to this excess ismore specifically stated on the policy schedule.

Family Your husband, wife, civil partner, life partner, parents, grandparents,brothers, sisters, sons, daughters, grandsons and granddaughters.

Home The place in the Republic of South Africa where you normally reside.

Illness Any changes to a normal healthy state, sickness, disease, defects andabnormalities, including defects and abnormalities your pet was born with or was passed on by its parents.

Injury A physical injury or trauma caused by an accident. Not an injury or traumathat occurs over time.

No claims period This is the first 30 days from the date of inception of this Policy.

Pre-existing Condition Any illness or injury that:Happened or first showed clinical signs prior to or within the first 30 days of inception of this Policy of Insurance, including any condition related to or forming part thereof.

This is in addition to any exclusion(s) stated on your policy schedule.

Policy Fee Monthly or annual fee charged per policy by Medipet.


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Policy year From the inception of the Policy up until 28 th February of each year, thereafter from the 1 st March to 28 th February each year.

P.Uma Pet Underwriting Management Acceptances (Pty) Ltd

Stale claims period There is no claim unless full details of the claim are received in writingwithin 60 days after an event, and such event gives rise to a claim in termsof this policy.

Vet Registered Veterinary Surgeon.

Veterinary Costs The amount vets in general or referral practice usually charge. These pricesare more specifically detailed within the guidelines of the Veterinary Councilof South Africa.

Veterinary treatment Any examination, consultation, advice, tests, X-rays, legally prescribedmedication, surgery and nursing required to treat an illness, injury or accident, provided by a vet, a veterinary nurse or another member of theveterinary practice under the supervision of the vet. This includesphysiotherapy and treatment of a behavioural illness provided it is carriedout by the qualified and professionally registered persons. Thesequalif ications are subject to P.umas approval.

We, us, our Renasa Insurance Company (Pty) Ltd.

You, your The person named on the policy document.

Your pet Any dog or cat named on the policy schedule.

GENERAL CONDITIONS1. Throughout the policy year you must take all reasonable steps to maintain your pets health and to

prevent injury, illness and loss.You must arrange and pay for your pet to have a yearly check up, annual vaccinations and anytreatment normally recommended by a vet to prevent illness or injury.

2. You must arrange for your pet to be kept vaccinated against the following;Dogs: Distemper, adenovirus infections, parvovirus and rabies. This will be under direction of your

veterinary practices protocol dependent on the area you reside in RSA.

Cats: Feline infectious enteritis (panleukopaenia), Feline herpesvirus, Feline calicivirus and rabies.This will be under direction of your Veterinary Practices protocol and dependant on the areayou reside in RSA.

3. If, when you claim, there is any other insurance under which you are entitled to an indemnity; we will onlypay a proportionate share of the claim. You must tell us the name and address of the other insurancecompany and your policy number with them. If you have any legal rights against another person inrelation to a claim, we may take legal action against them in your name at our expense. You must assistus all you can and provide any documents requested.

4. Your pet is only covered under this policy if you pay the premium.If you pay the yearly premium, in instalments and miss an instalment you must pay the full outstandingamount within 15 days of the date the instalment was due to be paid. If we do not receive your paymentwithin 15 days of the date the premium was due, your insurance will automatically lapse . You shouldcontact Medipet within that period to ascertain banking details necessary on [email protected] or by telephone on 021 701 2023. If you have paid the premium and you have been indemnified followingthe loss or death of the insured pet you will not be entitled to a refund of premium for the unexpiredperiod. Annual policy holders will receive a pro-rata payment relevant to their claim ratio.

5. You agree that any vet has your permission to release any information we ask for about your pet. If thevet makes a charge for this, you are responsible for such charge.

6. If the veterinary fees you are charged are higher than the fees usually charged by a general or referralpractice, we reserve the right to request a second opinion from a vet of our choice. If the vet we choosedoes not agree with the veterinary fees charged we may at our discretion pay only the veterinary feesusually charged by a general or referral practice in a similar area.

7. If we consider the veterinary treatment or complementary treatment (including treatment for behaviouralissues) you are charged as being excessive compared with the costs of treatment that is normallyrecommended to treat the same illness, injury, accident or condition, we may at our discretion limit
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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payment of benefits to such amount necessary to treat the injury, illness, accident or condition, asadvised by the vet from whom we have requested the second opinion.

8. We will not guarantee verbally on the phone whether a claim for an incident is covered. You must sendus a fully completed claim form. We will then let you have our decision in writing.

9. You must arrange for a vet to examine and treat your pet as soon as possible after it shows clinical signsof an injury or an illness.

10. We strongly advise that you have your pet microchipped and it is the owners responsibility tokeep their information up to date with the microchip company.

11. A letter will be sent to the attending veterinarian requesting more information if any pre-existingconditions are present. This may limit your cover and extend the co-payment period if this is delayed or withheld

MEDIPET OPTION 1 Plan

SECTION 1A- VETERINARY TREATMENT

What you are covered for:

In return for paying your premium we, Renasa Insurance Co (Pty) Ltd, will cover your pet detailed in the attachedpolicy schedule, within South Africa for the cost of veterinary fees necessarily incurred for veterinary treatmentyour pet receives during the policy year to treat illness, and or an injury as the result of an accident with an upper limit of R25000 per annum.You are NOT covered for:

1. The cost of treatment for:a) Any injury, illness or accident that happened or first showed clinical signs either before the inception

of this policy or within the first 30 days from the inception of this Policy: or b) Any consequential costs incurred as a direct result of the identified pre-existing condition referred to

in 1 above.c) 50% of all claims within the co-payment period . (See Page 1)

2. Routine care, preventative treatment without the express prior approval of Renasa or their approvedUMA via Medipet.

3. General health improvements and the treatment for control of fleas. 4. Elective procedures and any subsequent medical costs related thereto.5. Elective euthanasia is specifically excluded.6. Cost of vaccinations, spaying and castration except the cost of treating any complications arising from

these procedures. Medipet strongly supports the neutering of cats and dogs 7. Any treatment in connection with pregnancy or giving birth including breeding, artificial insemination

and mating, or conditions arising therefrom.8. The cost of treating any injury or illness deliberately caused by you or a member of your immediate

family or staff members.9. The cost of house calls except in such circumstances a qualified vet confirms that moving your pet

would be detrimental to your pets health.10. Additional costs for treating your pet outside usual surgery hours - Cover can apply in such

circumstances a qualified vet confirms an emergency consultation is a necessity.11. The cost of hospitalisation unless a qualified vet confirms it is essential.12. The cost of surgical items that can be used more than once.13. The cost of treatment for a behavioural illness subject to the ceiling of R2000 for the duration of the

cover..

Option 1 Rates effective from 01 March 2012Please note a R5.00 policy fee will be added tomonthly policies, and a R50.00 policy fee toannual policies.

monthly annual

first dog 165.00 1650.00

additional dog 148.50 1485.00family dog 145.00 1740.00

first cat 148.00 1480.00

additional cat 133.20 1332.00

family cat 130.00 1560.00


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14. The cost of any form of housing, including cages.15. The cost of bathing, grooming or de-matting your pet unless prior written approval has been given by

P.UMA, via Medipet.16. The cost of dental treatment.17. The cost of post mortem examination.18. The cost of transplant surgery, including any pre and post operative care.19. The cost of any treatment if a claim has not been submitted within the pre-scribed

60 days of your pet having received treatment. The date of first treatment.20. Consequential loss of any kind.21. The cost of cremation or burial.22. The cost of treatment, including medication, for any chronic condition not specifically PRE-

AUTHORISED by P.UMA in writing, via Medipet.23. The cost of replacing your pet in the event of death due to any circumstances.24. The cost of any specialised prescription food irrespective if indicated to treat or support any medical

condition.25. The cost of any complementary treatment not specifically authorised in writing by P.UMA, via Medipet.

HOW TO CLAIM:In the event of a claim in terms of this Policy, you must do the following;

a) Report an incident to Medipet in writing by fax on 021 701 2027 or email [email protected] as soon asis practical after the discovery of a potential loss.

b) Within 60 days send us the fully completed claim form together with the detailed invoices and any other relevant information setting out the specific costs involved for each procedure.

SECTION 1B COMPLEMENTARY TREATMENT


Cover for any complementary treatment can be included with the prior written consent of P.UMA only viaMedipet.Costs of treatment for behavioural conditions shall be limited to R2000 for the lifetime of your pet, and is subjectto prior written approval by P.UMA, via Medipet.

Complementary treatment is deemed as: Any treatment not forming part of normal main stream veterinary treatment, including but not limited toacupuncture, behavioural treatment, physiotherapy, homeopathy, food supplements, hydrotherapy, rehabilitationcare, etc.

SECTION 2 ADVERTISING AND REWARDS

If your pet is stolen or goes missing during the policy year, we will pay the cost of advertising up to R250 per year.

HOW TO CLAIMPlease phone us on 021 701 2023 or email [email protected] for approval on any reward before youadvertise it and we will talk you through the process.

SECTION 3 BOARDING FEES

WHAT WE WILL PAY

If something unexpectedly happens to you that is out of your control and renders you unable to care for your pet,we will pay the cost of boarding your pet at a licensed kennel or cattery or towards the cost of someone, whodoes not live with you looking after your pet. Cover is limited to R500 per cat per annum and R1000 per dog per annum.

SECTION 4 THEFT

WHAT WE WILL PAYWe will pay R1000 towards your dog if it is stolen or goes missing and is not recovered or does not return . .

WHAT WE WILL NOT PAY1. Any amount if you or the person looking after your pet has freely parted with it, even if tricked into doing

so, unless anyone was looking after or transporting your pet in return for money, goods or services.2. The value of your pet.


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SPECIAL CONDITIONS THAT APPLY TO THIS SECTION

If your pet is found or returns, you must repay the full amount (excluding the advertising and reward amount paid)we have paid you.

As soon as it is reasonable to assume that your pet is missing you must: Tell all vets and local rescuecentres within a reasonable distance of the area where your pet was last seen within 5 days of your pet goingmissing. At least one veterinary practice must be notified;

1. If your pet is a dog you must tell the police and ask for the crime reference number or writtenconfirmation of your report.

2. If your pet has not been found within 45 days, please fully complete a claim form and return it to us assoon as possible.

HOW TO CLAIMTo claim for theft or straying you must have advertised the loss of your pet, please send proof of this. We will not pay for this information.

SECTION 5 THIRD PARTY LIABILITY

WHAT WE WILL PAY All amounts which you become legally liable to pay for compensation as a result of physical loss of or damage toproperty, animals or third party persons where someone is physically inured as a result of an incident involvingyour pet during the policy year. We will pay up to a maximum of R1million Rand, (Including all legal expensesrelated thereto) per incident, per policy year and compensation in terms of this section is for;

1. Third party costs awarded against you by a court as a result of loss or damage to third party propertyand or persons, inclusive of all legal costs and expenses for defending an action.

WHAT WE WILL NOT PAY1. Any costs or expenses defending you which we have not agreed to beforehand.2. Any action brought outside South African jurisdiction or that is not decided upon by a South African

Court.3. Any compensation, if you are legally responsible only because of a contract you have entered into.4. Any compensation costs and expenses if you are deemed responsible under the laws of any country,

other than RSA.5. Compensation as a result of reckless disregard of the possible consequences of your acts or omissions.6. The first R1000 of every Third Party claim entertained in terms of this section.7. Other insurance: if, at the time of an event giving rise to a claim under this policy, an insurance exists

with any other insurer covering the insured against the defined event, we (the company) shall be liableto make good only a rateable portion of the amount payable by or to the insured in respect of suchevent.

SPECIAL CONDITIONS THAT APPLY TO THIS SECTION;(All third party potential losses must be immediately reported to Medipet).

1. You agree to provide us with any information connected with the claim we reasonably ask for includingdetails of your pets history.

2. You must not admit responsibility, agree to pay any claim or negotiate with any other person followingan incident.

3. You agree to tell us or help us find out all the circumstances of an incident that results in a claim,

provide written statements and go to court if needed.4. You must allow us to take charge of your claim and allow us to prosecute in your name for our benefit.5. You must immediately send us any writ, summons or legal documents you receive and you must never

send any replies to any of these documents.

HOW TO CLAIMSend to us the claim form together with all correspondence, writs, summons or any other legal documents. Youmust not have answered any of these documents.


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MEDIPET OPTION 2 plan

Option 2 Rates effective from 01 March 2012Please note a R5.00 policy fee will be added tomonthly policies, and a R50.00 policy fee to annualpolicies.

monthly annualfirst dog 200.00 2000.00additional dog 180.00 1800.00

family dog 180.00 2160.00

first cat 179.00 1790.00

additional cat 160.00 1600.00family cat 160.00 1920.00

SECTION 1A - VETERINARY TREATMENT


In return for paying your premium we, Renasa Insurance Co. (Pty) Ltd, will cover your pet detailed in the attachedpolicy schedule, within South Africa for the cost of veterinary fees necessarily incurred for veterinary treatmentyour pet receives during the policy year to treat illness, and injury or as the result of an accident up to a maximumof R25000 in any one Policy year. In addition your Option 2 premium covers you for death benefit of R1000 for adog and R500 for a cat. A prescription food contribution of R100 per month for 6 months with the possibility toapply to underwriters for a continuation based on reasonable grounds. Full dental cover subject to the usualexcess.

You are NOT covered for:The cost of treatment for:

1. a. Any injury, illness or accident that happened or first showed clinical signs either before the inceptionof this policy or within the first 30 days from the inception of this Policy: or

b. Any consequential costs incurred as a direct result of the identified pre-existing condition referred toIn 1 above.

c. 50% of all claims within the co-payment period .

2. Routine care, preventative treatment without the express prior approval of Renasa or their approvedUMA via Medipet.

3. General health improvements and the treatment for control of fleas. 4. Elective procedures and any subsequent medical costs related thereto.5. Elective euthanasia is specifically excluded.6. Cost of vaccinations, spaying and castration except the cost of treating any complications arising from

these procedures. Medipet strongly supports the neutering of both cats and dogs. 7. Any treatment in connection with pregnancy or giving birth including breeding, artificial insemination and

mating or conditions arising there from.8. The cost of treating any injury or illness deliberately caused by you or a member of your immediate

family or staff members.9. The cost of house calls except in such circumstances a qualified vet confirms that moving your pet

would be detrimental to your pets health.10. Additional costs for treating your pet outside usual surgery hours - Cover can apply in such

circumstances a qualified vet confirms an emergency consultation is a necessity.11. The cost of hospitalisation unless a qualified vet confirms it is essential.12. The cost of surgical items that can be used more than once.


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13. The cost of treatment for a behavioural illness in excess of the R2000 life-time limit.14. The cost of any form of housing, including cages.15. The cost of bathing, grooming or de-matting your pet unless prior written approval has been given by

P.UMA via Medipet16. The cost of post mortem examination.17. The cost of transplant surgery, including any pre and post operative care.18. The cost of any treatment if a claim has not been submitted within 60 days of your pet receiving

treatment.19. Consequential loss of any kind.20. The cost of treatment, including medication, for any chronic condition not specifically PRE-AUTHORISED

by P.UMA in writing via Medipet.

21. The cost of cremation or burial.22. The cost of replacing your pet in the event of death due to any circumstances.23. The cost of any complementary treatment not specifically authorised in writing by P.UMA via Medipet.

HOW TO CLAIM:In the event of a claim in terms of this Policy, you must do the following;

a) Report an incident to Medipet in writing by fax on 021 701 2027 or email [email protected] assoon as is practical after the discovery of a potential loss.

b) Within 60 days send us the fully completed claim form together with the detailed invoices and any other relevant information setting out the specific costs.

SECTION 1B COMPLEMENTARY TREATMENT


Cover for any complementary treatment can be included with the prior written consent of P.UMA only.Costs of treatment for behavioural conditions shall be limited to R2000 for the lifetime of your pet, and is subjectto prior written approval by P.UMA, via Medipet.

Complementary treatment is deemed as: Any treatment not forming part of normal main-stream veterinary treatment, including but not limited toacupuncture, behavioural treatment, physiotherapy, homeopathy, food supplements, hydrotherapy, rehabilitationcare, etc.

SECTION 2 ADVERTISING AND REWARDS

If your pet is stolen or goes missing during the policy year, we will pay the cost of advertising up to R250 per year.

HOW TO CLAIMPlease phone us on 021 701 2023 or email [email protected] for approval on any reward before youadvertise it and we will talk you through the process.

SECTION 3 BOARDING FEES

WHAT WE WILL PAYIf something unexpectedly happens to you that is out of your control and renders you unable to care for your pet,

we will pay the cost of boarding your pet at a licensed kennel or cattery or towards the cost of someone, whodoes not live with you looking after your pet. Cover is limited to R500 per cat per annum and R1000 per dog per annum.

SECTION 4 THEFT

WHAT WE WILL PAYWe will pay R1000 towards your dog if it is stolen or goes missing and is not recovered or does not return . .

WHAT WE WILL NOT PAY1. Any amount if you or the person looking after your pet has freely parted with it, even if tricked into doing

so, unless anyone was looking after or transporting your pet in return for money, goods or services.2. The value of your pet.

SPECIAL CONDITIONS THAT APPLY TO THIS SECTION


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If your pet is found or returns, you must repay the full amount (excluding the advertising and reward amount paid)we have paid you.

As soon as it is reasonable to assume that your pet is missing you must: Tell all vets and local rescuecentres within a reasonable distance of the area where your pet was last seen within 5 days of your pet goingmissing. At least one veterinary practice must be notified;

1. If your pet is a dog you must tell the police and ask for the crime reference number or written confirmationof your report; and2. If your pet has not been found within 45 days, please fully complete a claim form and return it to us assoon as possible.

HOW TO CLAIMTo claim for theft or straying you must have advertised the loss of your pet, please send proof of this.We will not pay for this information.

SECTION 5 DEATH

WHAT WE WILL PAYR1000.00 for dogs and R500 for cats provided the pet has been on cover for longer than three months and thedeath is not related to a pre-existing condition.

HOW TO CLAIMSubmit a claim form to Medipet with al l relevant invoices and documentation.

SECTION 6 THIRD PARTY LIABILITY

WHAT WE WILL PAY All amounts which you become legally liable to pay for compensation as a result of physical loss of or damage toproperty, animals or third party persons where someone is physically inured as a result of an incident involvingyour pet during the policy year. We will pay up to a maximum of R1million Rand, (Including all legal expensesrelated thereto) per incident, per policy year and compensation in terms of this section is for;

1. Third Party costs awarded against you by a court as a result of loss or damage to third party propertyand or persons, inclusive of all legal costs and expenses for defending an action.

WHAT WE WILL NOT PAY1. Any costs or expenses defending you which we have not agreed to beforehand.2. Any action brought outside South African jurisdiction or that is not decided upon by a South African

Court.3. Any compensation, if you are legally responsible only because of a contract you have entered into.4. Any compensation costs and expenses if you are deemed responsible under the laws of any country,

other than RSA.5. Compensation as a result of reckless disregard of the possible consequences of your acts or omissions.6. The first R1000 of every Third Party claim entertained in terms of this section.7. Other insurance: if, at the time of an event giving rise to a claim under this policy, an insurance exists

with any other insurer covering the insured against the defined event, we (the company) shall be liableto make good only a rateable portion of the amount payable by or to the insured in respect of suchevent.

SPECIAL CONDITIONS THAT APPLY TO THIS SECTION;(All third party potential losses must be immediately reported to Medipet).

1. You agree to provide us with any information connected with the claim we reasonably ask for includingdetails of your pets history.

2. You must not admit responsibility, agree to pay any claim or negotiate with any other person followingan incident.

3. You agree to tell us or help us find out all the circumstances of an incident that results in a claim,provide written statements and go to court if needed.

4. You must allow us to take charge of your claim and allow us to prosecute in your name for our benefit.5. You must immediately send us any writ, summons or legal documents you receive and you must never

send any replies to any of these documents.

HOW TO CLAIMSend to us the claim form together with all correspondence, writs, summons or any other legal documents. Youmust not have answered any of these documents.


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GENERAL POLICY EXCLUSIONSThe following exclusions apply to ALL sections of the policy;

1. The Policy will not apply to any pet less than 8 weeks old.2. Dogs used commercially for guarding, track racing or coursing.3. Any amount if you break the RSA laws/ regulations relating to animal health or importation.

4. Any amount if your pet is confiscated or destroyed by government or public authorities, or under the Animals Act.

5. Legal expenses, fines and penalties connected with or resulting from a Criminal Court Case or an Act of Parliament.

6. Any amount resulting from a disease transmitted from animals to humans.7. Any amount if your pet lives outside RSA.8. Any dog not vaccinated against rabies, distemper, parainfluenza and parvovirus. And any cat not

vaccinated against rabies, feline infectious enteritis (panleukopaenia), calicivirus and cat flu.9. Any journey y ou take your pet on against a vets advice.

FRAUDFraud increases your premium and the premiums of all policy holders. If you

- provide us with false information, or - make a false or exaggerated claim with us, or

- make any claim with us which involves your dishonesty,

We will not pay your claim, we will not pay any future claim, and we will declare the Policy void and be entitled torecover from you any amount of any claim already paid by us.

CANCELLATION OF COVERThis contract gives you a cooling off period.If after receiving your policy document and full policy Terms and Conditions you are not happy you have 14 daysduring which you can cancel the policy and such cancellation will be from inception of the Policy.Thereafter this Policy may be cancelled at any time by either party giving 30 days notice in writing. In the eventthat you have been indemnified for the loss or death of the insured pet there will be no refund of premium.

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