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FAQ | Policy Terms and Conditions

What does “pre-existing condition” mean?

A pre-existing condition is a mental or physical injury and/or illness that existed before the start date of your policy with The Unlimited (prior to the original inception of your cover, or the reinstatement or reissue date of your policy).

This is a condition that would need a doctor: you would either have seen a doctor for treatment or should have seen a doctor.

A pre-existing condition would not have a short-term cure (for example, an acute condition like a cold or flu) and needs ongoing treatment or medicine (for example, a chronic condition like hypertension, diabetes, cancer, heart condition, congenital or HIV/AIDS and related illnesses).

Why is it important to declare a “pre-existing condition” under my policy?

With Death Cover, you will not be covered for a pre-existing condition.

  • This means your claim will not be approved if you die directly or indirectly because of a pre-existing condition.

With Illness Cover, if you have a pre-existing condition then a condition-specific waiting period of 12 months will apply before you can claim.

  • This means you will need to pay for the product for a specific period of time before you can claim for the illness.
What are chronic conditions?

A chronic condition needs ongoing treatment and could include hypertension, high blood pressure, diabetes, cancer, a heart condition, a congenital condition, or an HIV/AIDS-related illness, and/or others.

There are other examples of pre-existing conditions which might affect your claim.

If you are unsure as to whether a specific condition is a chronic condition, and/or whether it is a pre-existing condition, please call our customer care line so that we can help you to ensure that you have the right coverage.

How can pre-existing conditions affect my claim?

The following are real-life examples where a claim is not covered because the correct details were not provided before the start date of the policy.

Death Claims

  • If, for example, you are being treated or should have been treated by a doctor for high blood pressure (hypertension) before the start date of your policy, this is a pre-existing condition. If you pass away from a stroke, your high blood pressure could have been the cause of the stroke. If this happened after the start date of your policy, the insurer can reject your claim.
  • If, for example, you were being treated or should have been treated by a doctor for diabetes before the start date of your policy, this is a pre-existing condition. If you die of heart disease, the diabetes could have been the cause of the heart disease. If this happened after the start date of your policy, the insurer can reject your claim.

Illness Claims

  • If, for example, you contracted HIV/AIDS before taking out your policy and you get an illness like pneumonia and need to be hospitalised, you will only be able to claim if you have first met the waiting period of 12 months.
What is a waiting period?

A waiting period refers to a period specified in your policy. During this time, we need to collect a specified number of successful consecutive monthly payments from you, before you are entitled to claim under the policy. This is calculated from the start date of your policy.

If there is a waiting period in your policy, and you have not completed the waiting period, then you will not be able to claim for that benefit.

If you miss a monthly payment, the relevant waiting period starts again.

Death Claims

  • There is a six-month waiting period for death caused by natural causes on some policies.
  • You will need to make six successful consecutive monthly payments before you can claim. This means if a person covered on this benefit dies of natural causes in the first six months of this policy, the claim will not be approved.
  • There is a 12-month waiting period for death caused by HIV/ AIDS-related illnesses on some policies.You will need to make 12  successful consecutive monthly payments before you can claim. This means if a person covered on this benefit dies of an HIV/AIDS-related illness in the first 12 months of this policy, the claim will not be approved.

Illness Claims

  • There is a three-month general waiting period for illness cover.
  • There is a 12-month condition-specific waiting period for a pre-existing condition.

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The Unlimited is an Authorised Financial Services Provider (FSP No. 21473). Address : 1 Lucas Drive, Hillcrest, Durban, South Africa.

The Unlimited abides strictly by the Financial Advisory and Intermediary Services (FAIS) Act of 2002

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