Master policy: The collective policy, as accepted by an employer, is referred to as a master policy agreement and the employer will hence be referred to as the master policy holder.
Period of cover: A master policy’s lifetime is 12 months, whereafter it may be renewed, and therefore infers that employees who are covered by a master policy will qualify for cover during this time.
Prorated benefits: Prorated benefits will be applicable to employees joining after the initial employer group activation or take-on date and thereafter proportionally prorated. Proration will be applied to GP consultations, radiology, pathology and dentistry.
Premium increases: Premium increases are effected annually, on the 1st of January and the increase value is based on, inter alia, the claims experience and medical inflation.
The role of the broker: Intermediaries accredited in terms of the Short Term Insurance Act (Commercial lines) may market the Universal Health & Accident Plan, and will receive monthly commission.
Universal Healthcare Provider Network: The Universal Healthcare Provider Network is a group of healthcare providers, which includes doctors, pharmacies, dentists and optometrists who have been contracted by Universal to provide the Universal Health & Accident Plan insured employees with services at negotiated rates. Insured employees are encouraged to make use of the Universal Healthcare Provider Network to avoid co-payments, or to avoid paying for services from their own pockets. In instances where the insured employees make use of an out-of-network provider, the insured person will be required to pay at point of service and submit a claim request to Universal for reimbursement.
