Family Crisis Health Plan

Option form cancelling membership.

Benefits of membership: Employee's whole family includes husband + wife + financially dependent children (e.g. biological, legally adopted, legal guardian) Children covered from birth up to the age of 21. If full time student to the age of 25 and disabled children remain covered.

Daily hospital benefit

TB Cover R5 000 per member / R 25 000 per family per annum.

Medical Emergency Transportation covers emergency transportation by ER24: Ambulance, helicopter and aeroplane evacuation.

HIV Cover provides a helpline 24-hours a day 7 days a week, providing telephonic counselling and advice on HIV/AIDS. Access to an Eliza test within 48 hours followed by ARV, STD and morning after pill where required. HIV testing immediately following exposure. Contact centre must be notified within 24 hours of exposure.

Funeral Benefits

Accidental death benefits covers death due to any form of accident, this includes motor vehicle accidents, gunshot, and fire for example. R70 000 benefit payable in the event of the principal member and/or R35000 for adult dependent and R25000 for a child dependent.

The Cost:        R54.00 per month.

I .......................................................................... Company number ........................

hereby confirm that I do not wish to join the Family Crisis Health Plan and/or wish to cancel my membership with the Family Crisis Health Plan and my employer must not deduct the cost from my wages. I further understand that I can join the Family Crisis Health Plan at any time by advising my employer.