When an employee’s group cover exceeds the medical proof free limit of the fund/scheme, the employee is required to first provide satisfactory medical evidence of good health before he/she can enjoy the full potential group cover that exceeds the medical proof free limit amount.

An employee is however not obliged to obtain and provide medical information. Experience indicates that less than half of employees with group cover in excess of the medical proof free limit go through the process of obtaining and providing this information. In such cases an employee’s group cover is limited to the medical proof free limit of the scheme.

Although underwriting makes things fairer for all employees on the scheme, Sanlam’s Accident Booster will be beneficial in that it gives an employee access to his/her full potential group cover for a wider range of risks not relating to a person’s health.

Sanlam believes this benefit enhancement will provide better outcomes to employees and from 1 August 2018, the benefit will automatically be included to ensure an employee’s full potential group cover is applied if the employee has been declined or simply has not gone for underwriting, and the claim is as a result of an accident.

This feature will be a standard addition to our Group Life, Lump Sum Disability and Income Disability insurance policies in order to make provision for the gap between an employee’s full potential cover and what the employee actually qualifies for, considering the scheme’s medical proof free limit, and will automatically be applied provided that:

  • the individual employee paid premiums on his/her full potential cover; and
  • the employee’s death or disability occurred within 6 months of an accident (i.e. an unexpected event, not contributed to by an illness or disease).