1.1 This Membership is not an Insurance Policy as determined by the long-term insurance policy act regulated by the Financial Sector Conduct Authority. This is not a Medical Scheme and the cover is not the same as that of a Medical Scheme. This Membership is not a substitute for a Medical Scheme Membership.
1.2 Subject to Demarcation Regulations, the Company, Big Red Holdings (Pty) Ltd registration number 2019/611231/07 does not refuse membership on the basis of any means of discrimination.
1.3This document should be read in conjunction with your Membership Schedule, as not all cover referred to in wording may be applicable to you.
In this Membership, unless the circumstances indicates a different intention, the following words and expressions bear the meanings given to them and similar expressions bear corresponding meanings –
2.1”Company” referred to herein means Big Red Holdings (Pty) Ltd registration number 2019/611231/07
2.2 “Adult Dependent” means a person over the age of 18 (eighteen) other than a Spouse or Child Dependent of the Principal Member who is wholly or partly dependent on the Principal Member for financial support, including a child of the Principal Member over the age of 18 (eighteen) years who is permanently mentally or physically disabled:
2.3 “Application Date” means the date on which the application for this membership is completed in its entirety and submitted online via the Big Red Tooth website;
2.4 “Benefit” means the Benefit amount as set out in the Membership Schedule, provided by the Company in terms of this Membership;
2.5 “Benefit Start Date” means the date on which a Member becomes entitled to Benefits
2.6 “Child Dependent” means:
2.6.1 The named child of a member under the age of 18 (eighteen) years, including a stepchild, a natural child or legally adopted child, including a child adopted in terms of a customary adoption under a tradition practiced by the people of South Africa provided that the child’s natural parents are both deceased, or an adoption under the tenets of any religion practiced by the people of South Africa provided that the child’s natural parents are both deceased;
2.6.2 A child of a member under the age of 26 (twenty-six) years who is a student at any registered university, technician or tertiary Education institution, registered in terms of any legislation in the Republic of South Africa or such other institution as may be approved by National Risk Managers, and who is unmarried;
2.6.3 Any other person approved by the Company;
2.7 “Commencement Date” means the date on which the application for this Membership becomes effective, as specified in the Membership Schedule;
2.8 “Defined Event” means the event which gives rise to the Member having to seek Dental treatment and which will be payable by the member as set out in this document;
2.9 “Family” means the Member (being a natural person) in whose name this Membership is affected and all Members on the Membership.
2.10 “Grace Period” means the 15 (fifteen) day period of grace allowed for non-payment of Annual Premium.
2.11 “Members” means the member as named on the Membership Schedule and their named Dependents who have applied and been accepted by the Company and whose Premium is paid and up to date;
2.12 “Member” means each individual covered under this membership;
2.13 “Network Dentist” means a Dentist that is part of Big Red Holdings appointed dentist network herein referred to as a Service Provider;
2.14 “Pre-Existing Condition” means a condition for which medical and/or dental advice, diagnosis, care or treatment was recommended or received within the 12 (twelve) month period ending on the Commencement Date;
2.15 “Premium” means the premium payable to the Company on an annual basis in terms of this Membership in order to secure the Benefits;
2.16 “Service Provider” means a Dentist that is part of Big Red Holdings appointed Dentist Network.
2.17 “Spouse” means the named Spouse of a Principal Member, including any life partner. Not more than 1 (one) Spouse shall be covered in respect of each Membership;
2.18 “The/This Membership” means this membership agreement concluded between the Company and the Principal Member in respect of the Benefits under this Membership;
2.19 “Waiting Period” means the number of months from Commencement Date before you can access your Benefits.
2.20 “Year” means a calendar year;
2.21 Any reference to the singular includes the plural and vice versa;
2.22 Any reference to a gender includes other genders;
2.23 The clause headings in this Membership Document have been inserted for convenience only.
3.1 This Membership Document together with the Membership Schedule and application form constitute the entire agreement and any word or expression to which a specific meaning has been assigned shall bear specific meaning wherever it may appear. Please read clauses in their entirety to understand their full meaning.
3.2 The minimum entry age of the Principal Member is 18 (eighteen) years old.
3.3 Once any member has been covered under this membership for a period of 12 (twelve) consecutive months, any Pre-Existing Condition shall no longer apply.
3.4 Membership cover shall commence on the Commencement Date subject to receipt of the Annual Premium by the company, unless otherwise stated.
3.5 The Company may alter the terms and conditions, Premiums, or Benefits of the Membership by providing the Principal Member with at least 31 (thirty-one) days’ notice in writing.
3.6 It shall be the duty of the Principal Member to inform the Company of any material changes which may affect the terms and conditions of the Membership, such as a change in medical health or personal details.
3.7 This Membership shall be cancelled in the event of misrepresentation, mis-description or non-disclosure of any material fact by or on behalf of any Member Person.
3.8 This Membership does not accumulate a cash or surrender value.
3.9 Only 1 (one) Membership may be issued to any one Principal member and dependents.
3.10 This Membership shall be governed by, construed and interpreted in accordance with the law of the Republic of South Africa.
4.1 All Premiums are payable Annually in advance.
4.2 If the Premium is not paid on the Commencement Date, a 15 (fifteen) day Grace Period will be applicable. The Membership will be suspended during the Grace Period and no benefits will be payable.
4.3 Non-payment of the Annual Premium after the 15 (fifteen) day Grace Period will result in automatic termination of this Membership.
Full Mouth Examination
5.1.1 Defined Event
Unlimited per year. Full Mouth Examination includes inspection of the teeth and surrounding tissues of the oral cavity.
5.1.2 Waiting Period
This Benefit is subject to a 0 (zero) month Waiting Period from the Commencement Date.
5.2.1 Defined Event
Unlimited Bitewing X-rays.
5.2.2 Waiting Period
This Benefit is subject to a 0 (zero) month Waiting Period from the Commencement Date.
5.3.1 Defined Event
1 (one) per 6 (six) month interval. Cleaning includes full dental cleaning of the teeth.
5.3.2 Waiting Period
This Benefit is subject to a 0 (Zero) month Waiting Period from the Commencement Date.
Oral Health Discount
5.4.1 Defined Benefit
An initial discount of 40 (Forty) Percent on All Oral health in the 1st (First) year. This benefit will increase on a yearly basis by 5 (Five) percent up to a maximum of 60 (Sixty) percent for maintaining the Membership for 5 (Five) consecutive years.
6.1 Members must make a booking on the Big Red Tooth Dental website to utilize Benefits as contained in this document. The Member may also contact us via telephone on 087 351 8333 or email email@example.com.
6.2 All benefits under this Membership are covered when your Premium is paid.
6.3 It is the sole responsibility of the Member to seek medical assistance immediately when the member becomes aware of a Dental condition that requires treatment. The Company will not be liable to provide cover due to negligence in the treatment of Dental requirements.
7.1 Should the member wish to change personal details, amend any Option or add Dependents onto their existing membership they may contact our practice directly on 087 351 8333, email firstname.lastname@example.org or log on to the website along with their membership number.
7.2 The Member may cancel his/her membership by giving written notification. The Principal Member will, however, still be covered for the remainder of the year for which the last Premium was collected. No Premiums will be refunded in instances where Benefits were not utilized by the Members.
7.3 If the Member cancels the Policy, no benefits will be available after the effective date of termination.
7.4 The Company reserves the right to cancel or vary your membership or that of any of your Dependents by giving written notification, where possible, if you or any of your Dependents:
7.4.1 Provide false information or fail to disclose information upon application;
7.4.2 Provide false information upon registration to the membership;
7.4.3 Allow any other person to use your membership;
7.4.4 Commit any other fraudulent act;
7.4.5 Fails to pay the Premium;
7.4.6 Generally act in a manner indicative of a premeditated selection against the Company
The Company shall not be liable to provide benefits in respect of any member:
8.1.1 If caused by a Pre-Existing Condition within the first 12 (twelve) months of cover;(If applicable)
8.1.2 If caused by, or as a result of, the influence of alcohol, drugs or narcotics upon such Member, unless administered by or prescribed by and taken in accordance with the instructions of a Member of the medical profession (other than himself);
8.1.3 If caused by, or arising from, exposure to, or contamination by, atomic energy and/or nuclear fission or reaction;
8.1.4 Whilst travelling by air other than as a passenger and not as a member of the aero plane crew, technical staff or for the purpose of any technical operation thereon or therein;
8.1.5 Whilst participating in any riot, civil commotion or public disorder, including authorised and sanctioned union activity or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;
8.1.6 Whilst participating in a Professional Sport;
8.1.7 For any claim arising whilst the member is perpetrating an intentional unlawful act in terms of South African Law;
8.1.8 If caused by any gradually operating cause of which the member is aware;
8.1.9 For elective cosmetic surgery, and laser surgery or treatment and costs resulting therefrom;
8.1.10 If injuries are sustained whilst any member driving the vehicle is under the age prescribed by law, or who is not authorised or qualified to drive the vehicle;
8.1.11 For any treatment provided by a Dentist, other than a Service Provider as per 2.21 above.
8.1.12 For services rendered by a person not registered with the Dental Council and/or the South African Professions Council.
8.1.13 For third party claims such as Compensation Fund claims, Workmen’s Compensation claims and Road Accident Fund claims;
8.1.14 For costs incurred as a result of failure to carry out the instructions or advice of a Dentist, including deferring treatment in order to have costs covered once Waiting Periods and endorsements are no longer applicable;