Optivest is a specialist in medical schemes and medical scheme related products and has been serving its national client base for over 20 years in South Africa.

 

Optivest is an authorised financial services provider (FSP number: 13475) and an accredited broker with the Council for Medical Schemes.

1 Personal Details
2 Contact Details
3 Dependent Details
4 Medical Details
5 Payment Details
6 Confirm Details
Step 1 of 6

Your Personal Details

The final step before you get covered it to provide the following details:
Protection of Personal Information Act (POPIA) Declaration* By providing the information in this application form and applying for cover you agree that Insuremed (Pty) Ltd and its underwriter, Western National Insurance Company Ltd., may use this information to provide you with administrative and insurance services. You also agree that we may disclose this information to persons and/or entities that it is necessary to disclose this information to, in order to provide you with the aforementioned services. Your personal information will be stored in a secure encrypted manner and will not be sold or disseminated to any third party without your explicit consent. Additional detail regarding the use of personal information is set out in the Disclosure Notice that will accompany your policy document.
Step 2 of 6

Your Contact Details

Tell us how to get in touch with you.


Step 3 of 6

Your Dependents Details

Add the details of the people you would like to cover on your policy.
Spouse / Life Partner and all children registered as dependents (including full-time students and permanently disabled children) on your medical scheme may be covered on your GapCover policy.
NB: Any changes must be communicated to the Administrator within 30 days of the occurrence and only dependents that are registered on the policy will be covered.(Dependent children are only covered up to their 26th birthday, unless such a child is permanently dependent on the policy holder due to physical or mental disability.)
Step 4 of 6

Your Medical Details


Please submit proof of your current / previous cover in the form of a policy schedule to membership@insuremed.co.za that confirms your inception date and cancellation date within 30 days after activation to enable us to amend your underwriting accordingly?
If yes, please refer to Clause C7 of the Declaration.
Please note: The administrator must be notified if an insured person’s state of health changes from the date of signing the application to the date of inception. These conditions will also be excluded as pre-existing conditions.
Step 5 of 6

Your Payment Details

Complete your bank account details in order to set up a debit order.
Step 6 of 6

Confirm Your Cover Details

Policy Terms

DECLARATION BY APPLICANT

Standard Declaration

I warrant that the information provided to the insurer in connection with the policy, whether in my own handwriting or not, is true and correct.

I, the undersigned, hereby declare that:

  1. All the information that I give, whether telephonic, electronic or written, will form part of the policy.
  2. To the best of my knowledge and belief the information provided in connection with this application, is true and I have not withheld any material facts known to me.
  3. I understand that this is an accident and health policy with stated benefits in terms of the Short-term Insurance Act 53 of 1998. This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
  4. I acknowledge that the sharing of claims information and underwriting (including credit information) by insurers is essential to enable the insurance industry to underwrite policies and assess risk fairly and reduce the incidence of fraudulent claims, in the public interest and with a view to limiting premiums. I hereby waive any rights to privacy of any claim information supplied by me or on my behalf in respect of any insurance claim made or lodged by me and I consent to such information being disclosed to any other insurance company or its agent. I also waive any rights to privacy and consent to the disclosure of any information relevant to claims concerning me or any person I represent. I also acknowledge that information provided by me may be verified against other legitimate sources or databases.
  5. I specifically give consent to Insuremed Administrators contacting my current medical scheme and healthcare providers, as well as the current medical scheme and healthcare providers of my dependents on this policy, to confirm any health information relating to underwriting and claims for Insuremed Administrators, upon request. I understand that Insuremed Administrators will regard any health information supplied by my, or my dependents’ medical scheme or healthcare providers as confidential and will only disclose it to another party upon my express consent.
  6. If the insurer accepts this application, it will be on condition that there is no important change to the facts that I disclosed and upon which this application is based and accepted. If there has been such a change, I must inform the insurer within 30 days of the occurrence in order for him to reassess the risk for the insurance cover.
  7. Upon receipt of my policy document, I will familiarise myself with all the terms and conditions of the policy and contact my Intermediary or the Administrator for clarification should anything be unclear.
  8. This consent is to remain in force after my death OR until I specifically request to end the consent, which will be required in writing.

FEES AND COMMISSION

I acknowledge and appoint Optivest Health Services (FSP no. 13475) as intermediary to provide ongoing intermediary services to me regarding this policy. I agree that the insurer may pay commission to the intermediary in terms of the Short-term Insurance Act 53 of 1998.

IMPORTANT TERMS AND CONDITIONS OF THIS POLICY

I understand and agree that:

  1. To qualify for benefits under this policy, I must be a member, and my insured family must be dependants of a medical scheme approved in terms of the Medical Schemes Act and my dependents must be registered as dependents on the policy.
  2. Cover will commence on the 1st day of the calendar month for which the insurer accepts my application for insurance and receives my first premium.
  3. The Policy Premium may be changed annually, after the insurer has given me 30 days’ notice. If I do not pay my premiums in full, I will not be covered.
  4. In terms of the policy, the insurer will pay the difference between the surgical and consultation fees charged by health professionals for insured events and the benefits payable by my medical scheme. Terms and conditions will apply as stipulated in the policy contract.
  5. A maximum benefit of R177 835.05 will be payable per beneficiary per policy per annum. A sub limit of R15 200 per event is applicable to all CoPay Cover claims and Non-DSP hospital co-payments are limited to one event per policy per annum.
  6. Termination of cover will take place if I have given a calendar month’s written notice of cancellation, if 3 consecutive premiums are unpaid, or if a dependant does not qualify for cover on my policy.
  7. Benefits will not be paid:
    • If the medical scheme pays the entire claim or pays short due to scheme limits or exclusions.
    • If I do not submit my claim within 4 months of the date of payment by my medical scheme.
    • For the first 3 months of cover. (Please refer to full definition and details supplied on the Policy Contract)
    • For the first 12 months of cover in respect of any pre-existing condition. (Please refer to full definition and details supplied on the Policy Wording)
  8. This policy does not cover Prescribed Minimum Benefits (PMB) as defined in the Medical Schemes Act 131 of 1998 with Regulations, which are payable by my medical scheme.
  9. The full terms and conditions are provided in the Policy Contract.

Our Vision

At Optivest, medical schemes and medical scheme related products are our speciality.
It is our vision to enable all South Africans to get medical cover, that suits their individual and family needs while saving them money.

REQUEST A CALL BACK

Protection of Personal Information Act (POPIA) Declaration By providing the information in this form you agree that our fulfillment partner may contact you to provide you with the necessary advice. Your personal information will be stored in a secure encrypted manner and will not be sold or disseminated to any third party without your explicit consent.