When you are sick and unable to perform any of your usual occupational duties due to that sickness or a condition;
The SPPI product has two waiting periods, namely, seven (7) days or thirty (30) days. Thus depending on the waiting period you have chosen, the benefit will pay as follows:
Please refer to your policy certificate to confirm if you have a 7 day or 30 day waiting period.
No, to claim the Admission Rider Benefit you only have to be in hospital for four consecutive days (3 consecutive nights) or more. The benefit is payable from day one.
If you have existing exclusions on the sickness benefit these will also apply to the Admission Rider Benefit (hospital claim).
The assessor may request additional information to determine when your illness started and to get a history of your illness. We may also require a general medical history questionnaire. There may be other reasons why the assessor may call for additional information, for example, to determine the effect the condition has on your ability to attend to your activities of daily living and how the sickness affects your ability to do your work. This could include an Independent Medical Evaluation by a Specialist chosen by PPS or an Occupational Therapy Evaluation.
Special protocol for certain medical conditions:
Mental and Behavioural disorders, fibromyalgia, chronic fatigue syndrome, on-going chronic auto-immune and connective tissue disorders, back conditions, conditions that may have started prior to the business being granted, that could become chronic conditions or are already classified as chronic conditions.
Assessor may ask for:
Which hospitals are not covered?
You may qualify for a Partial Sick Pay Benefit if you are unable to carry out all your normal duties or normal work hours compared to a normal working day, due to the sickness, but you are able to attend to some of your usual professional duties.
'Some of your usual professional duties' means that you have spent time during the working day attending to some of your duties and applying your knowledge and skill related to your nominated occupation. Should you be able to attend to duties related to a different occupation, you must advise PPS Insurance (Namibia) of such change of occupation.
You may submit a claim for being able to work on a partial basis which will be considered and paid a partial benefit rate. Calculations will depend on the cover that you have.
Usual Professional Duties are those occupational tasks which you carry out as part of your occupation prior to claim. This includes any administrative duties related to your business or occupation.
Gross Professional Income is personal income and actual expenses derived before tax. As per the terms of the Policy Document, a member cannot receive sick pay benefits in excess of two-thirds of his gross professional income or total cost to company salary at time of claim. Thus, PPS Insurance (Namibia) can perform a financial review when a sick-pay benefit claim has been submitted to determine whether a member has the appropriate amount of cover.
PPS Insurance (Namibia) will require:
A claim for this benefit can be submitted when you suffer from a permanent condition (illness/injury) that may prevent you from using your professional training and knowledge to carry out your own occupation or any other occupation that could be carried out by someone with similar qualifications.
You may be required to submit a report from an Independent specialist (e.g. Occupational Therapist, Neurologist, etc.).Once the initial documentation has been reviewed, PPS will inform you of any additional requirements.
Independent Specialist reports will be paid for by PPS.
This will assist us in ensuring that we make a fair and informed decision regarding your claim.
Yes, once the full sum assured has been paid the benefit ends.
The benefit amount is reflected on your PPS Policy Certificate. You can also ask your Financial Advisor for this information.