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Policy Terms and Conditions


IMPORTANT INFO & Definitions


These general terms apply to your entire policy. Please read them carefully and do not hesitate to contact us should you have any queries.
In the left column you will find the IMPORTANT INFORMATION and in the right column you will find the Contractual Definitions.

THE CONTRACT

The policy wording and your policy schedule is a legal contract between you and us.
The contract is based on the information you gave us when you applied for the insurance.
Our duty in terms of the contract is to provide the cover explained in this policy wording subject to the terms of the contract:
For those sections which are shown on your policy schedule;
For the insurance period set out on the same schedule.
Your duty in terms of the contract is:
You must act in agreement with all the terms explained in this policy wording.
If you do not carry out your duty in terms of the contract, we may not pay your claim or you may even find that you do not have any cover.

WHO ARE WE TALKING ABOUT

Where we say ‘we’ or ‘us’, we are referring to Oakhurst Insurance Company Limited.
Where we say ‘you’ or ‘your’, the term is used interchangeably and we mean the person who has taken out this insurance policy and the pets who are nominated in the policy schedule.

TRANSFERRING YOUR INTEREST IN THE POLICY

This policy gives rights to you and anyone legally representing you alone. Only you, and anyone legally representing you may claim against this policy. You may not give your rights to anyone else.

DISHONESTY

We may refuse to pay a claim under this policy or cancel the policy from the date on which you have deliberately or dishonestly tried to take advantage of us.
For example, if you dishonestly exaggerate (overstate) the amount of your claim to get an inflated claims payment under your policy or if you give incorrect information to either get cover at a reduced premium or hide the fact that you did not comply with policy terms and conditions, all benefits under this policy will be lost, the policy may be invalid and you may not be entitled to a refund of premium. We may also take legal action against you. If this happens, you will have to repay all amounts which we previously paid towards your claims under this policy.

RELEVANT LAW

You can only be covered by this policy if you are living in South Africa.
This policy is subject to the laws of South Africa only. We (you and us) agree that any legal proceedings between us in connection with this policy will only take place in the courts of South Africa. Because of this, we will only accept findings delivered by a court in South Africa.

THE PREMIUM

It is your responsibility to ensure that there are available funds in your account and that your premium is paid when we submit the debit order. We will deduct premiums by way of a debit order on the last working day before your debit date should it fall on a weekend or public holiday. If we do not receive your premium by the due date as detailed in your schedule or within 15 days after the due date, you will have no cover for that month.
If we do not receive your 1st premium (in the 1st month), the policy will not start and you will not have any cover. Furthermore, when 2 consecutive premiums are not paid, the policy will automatically lapse and you will have no cover going forward.
If you cancel the direct debit that pays your premium for this policy, the policy will automatically be cancelled from the date that the premium was due to be paid.
Unless you tell us otherwise, we may in our discretion continue to try to collect your premium on the due date. All bank charges are for your account. If we have to debit more than once the extra costs are for your account. You will have no cover for any month we did not receive a premium from you. We will only try and collect the premium for 1 month and not for any months for which you did not have cover. In other words, we will never try to collect 2 premiums with 1 direct debit.
We are entitled to amend your premium to allow for changes in future expenses and the expected level of claims. We will give you 90 days advance notice of any change.

CANCELLATION

We may make changes to or cancel your policy at any time for whatever reason by giving you 30 days written notice.
You may cancel this policy at any time by giving us a call.
When this policy is cancelled (by you or by us), all benefits under it will end from the date it is cancelled.
This policy has no savings or investments and it therefor acquires no surrender, paid up, loan or cash value, even if cancelled.

TAKING CARE

You and your family members residing at your residential property must take all reasonable steps to maintain the health of your insured pet and prevent any injury, illness and loss. This includes annual vaccinations and/or any normal treatment recommended by a veterinarian. If you do not, a claim may be rejected or payment of the claim could be reduced.

CHANGES IN YOUR CIRCUMSTANCES

Whenever your or your pets’ circumstances change, you must let us know as soon as you are aware of the change and at least within 30 days of the date the change happened. All changes are part of the contract between you and us and are subject to all the terms of the policy. We will confirm any relevant changes to your details by sending you an updated schedule. If you are not sure whether a change may affect your cover, please contact us to clarify.

Accident

An unforeseen event, which could not reasonably have been expected to occur. The event must result in injury or poisoning caused directly and independently of all other causes by some external and visible means arising from this event.

Behavioural Conditions

Any changes in the insured pet’s normal behaviour resulting from a mental or emotional disorder as diagnosed by a vet.

Clinical Signs

Any changes in the insured pet’s normal behaviour resulting from a mental or emotional disorder as diagnosed by a vet.

Commencement Date

The date that the insurance cover and waiting period starts. This date is stated in your policy schedule.

Congenital

A condition existing at birth and often before birth or that develops during the first month of life.

Excess

The first amount of every claim that you will be responsible for.

Family

Any person related to the insured pet’s owner including, but not limited to spouse, partners, parents, children, grandparents, aunts and uncles.

Hereditary Condition

A condition that has been passed down from your insured pet’s parents or condition common to a specific breed which may present with symptoms during any stage of the insured pet’s life. These include, but are not limited to, hip dysplasia, elbow dysplasia, mange, displacement of the patella, entropion, ectropion and cherry eye.

Injury

Physical harm or damage to part of the pet’s body caused by an unforeseen physical action or force outside the pet’s body. This does not include any injury or trauma that occurs over a period of time.

Insured Pet

The pet insured under this policy and whose name and description is reflected in your policy schedule.

Medical Facility

An institution for health care providing veterinary treatment by specialised staff and equipment, for sick or injured pets where they are given surgical or medical treatment and providing for longer-term patient stays.

Medical Expenses

The costs resulting from treatment for a disease or an accident by a registered veterinarian or other medical practitioner, in the form of medication or therapy, in a medical facility, medical practice or at home.

Period of Insurance

This is a monthly contract that is renewed automatically every time you pay your premium.

Sum Insured

The cover for all benefits under the policy will be the amounts stated in your policy wording and schedule.

Veterinary Treatment

Treatment by a registered veterinarian in a registered animal care facility where the treatment is medically justifiable and necessary as a result of an unforeseen accident, illness or stipulated event in the policy document. To be claimable, treatment must have been conducted within the terms of reference of the South African Veterinarian Association.

Waiting Period

The period of time stated in your policy that must pass before your cover will begin.

Wellness Benefits

Expenses relating to the specific preventative and/or precautionary procedures the pet owner chooses to have the veterinarian perform, as listed in the table in the schedule (and subject to the specified maximum amounts covered).

You/Your

The natural person who has applied to insure a pet under this policy.

WHAT YOU ARE COVERED FOR


You are covered for the elements (subject to the limits stated in your schedule) included in the plan you have chosen. Your cover option will reflect on your policy schedule i.e. either the Accidental Plan, the Basic Plan, the Standard Plan, the Superior Plan or the Exotic Plan, etc.

Third Party Liability Cover

You are covered (subject to the limits stated in your schedule) for amounts you may become legally liable to pay for:
Loss of or damage to property;
Death or bodily injury to any person or third party pet (pet not owned by you);
caused by your insured pet named in the policy schedule during the period of insurance provided that:
The property or third party pet is not owned by you, your family or anyone residing with you;
The property or third party pet is not held in trust by you, or in your custody or control;
The injury was not to a member of your family or anyone residing with you, or their pets residing with you;
The incident happened within South Africa.

Cover Options


Oakhurst Insurance offers five different Pet Insurance plans to suit your individual needs.
The option selected by you will reflect on your policy schedule.

1

ACCIDENTAL PLAN

Cover for veterinary expenses incurred as a result of accidental injury to the pet(s) noted on the policy schedule.
Cover Provided:

  • Veterinary services expenses incurred for the diagnosis and/or treatment of the pet’s accidental injury subject to the maximum cover per category, as listed in the benefit table in the schedule.
  • Third Party liability

2

ACCIDENTAL SENIOR PLAN

Cover for veterinary expenses incurred as a result of accidental injury to the pet(s) noted on the policy schedule.
Cover Provided:

  • Veterinary services expenses incurred for the diagnosis and/or treatment of the pet’s accidental injury subject to the maximum cover per category, as listed in the benefit table in the schedule.
  • Third Party liability

3

BASIC PLAN

Cover for veterinary expenses incurred as a result of accidental injury to and illness of the pet(s) noted on the policy schedule.
Cover Provided:

  • Veterinary services expenses incurred for the diagnosis and/or treatment of the pet’s accidental injury or illness subject to the maximum cover per category, as listed in the benefit table in the schedule.
  • Third Party liability

4

STANDARD PLAN

Cover for veterinary expenses incurred as a result of accidental injury to and illness of the pet(s) noted on the policy schedule.
Cover Provided:

  • Veterinary services expenses incurred for the diagnosis and/or treatment of the pet’s accidental injury or illness subject to the maximum cover per category, as listed in the benefit table in the schedule.
  • Third Party liability

5

SUPERIOR PLAN

Cover for veterinary expenses incurred as a result of accidental injury to and illness of the pet(s) noted on the policy schedule, including illnesses arising from hereditary conditions (subject to a 12 month waiting period) and Wellness benefits.
Cover Provided:

  • Veterinary services expenses incurred for the diagnosis and/or treatment of the pet’s accidental injury or illness subject to the maximum cover per category, as listed in the benefit table in the schedule.
  • Third Party liability

6

EXOTIC PLAN

Cover for veterinary expenses incurred as a result of accidental injury to and illness of the pet(s) noted on the policy schedule.
Cover Provided:

  • Veterinary services expenses incurred for the diagnosis and/or treatment of the pet’s accidental injury or illness subject to the maximum cover per category, as listed in the benefit table in the schedule.
  • Third Party liability

WHAT YOU ARE NOT COVERED FOR


There is no cover if your monthly premium has not been paid by you in advance.

1

There is NO cover for:

  1. Diagnosis or treatment of pre-existing conditions.
  2. Diagnosis or treatment of hereditary conditions for the first 12 months after the start date of your pet’s cover.
  3. Diagnosis or treatment of the insured pet’s injury that was caused intentionally by you or any other resident of your household.
  4. Special diets, pet foods, or dietary or nutritional supplements used to treat or manage a condition or to preserve or improve general nutrition or health, even if prescribed by a veterinarian.
  5. Diagnosis, treatment, training, or therapy for behavioural problems.
  6. Diagnosis or treatments that are experimental, investigational or otherwise not generally accepted in the veterinary medical community.
  7. Elective or preventative procedures or cosmetic surgeries, apart from the specified Wellness benefits under the Superior and Ultimate Plan.
  8. Any cost relating to statutory quarantine.

2

There is no cover for any event which has in any way resulted from an illegal activity and/or non-compliance with any common law, statute or municipal by-law.

3

There is no cover for any claim caused by any illness that you are aware of before the commencement date of this policy or injury to your insured pet suffered before the commencement date of this policy.

4

There is no cover for anything which is caused in any way by participation in:

  1. Civil commotion, labour disturbances, riot, strike, lockout or public disorder or anything causing any of these.
  2. War, invasion, act of a foreign enemy, hostilities, civil war, revolution, rebellion or any other warlike operations whether war was declared or not. This includes any attempt to perform any of these as well as any attempt by a lawfully established authority to control or stop any of the occurrences.

5

You are not covered for anything caused by or contributed to by risks in the nuclear industry in general. These risks include ionising, radiation, radioactive contamination from any nuclear fuel or nuclear waste, burning of nuclear fuel, radioactive, toxic, and explosive or other dangerous properties of any part of nuclear machinery, nuclear weapons, nuclear reaction, nuclear fission, and nuclear radiation.

6

There is no cover for pets used for law enforcement or security purposes.

The following additional exclusions apply if you have chosen the Basic or Standard Plan

  1. Diagnosis or treatment of pre-existing and hereditary conditions.
  2. Medication prescribed more than one year after the pet’s injury.
  3. Boarding, transportation, grooming, or bathing. Boarding includes medical boarding, and bathing includes medicated baths or dips.
  4. Routine examinations, preventive treatment (including vaccines) or diagnostics associated with preventive treatment.

The following additional exclusions apply if you have chosen the Accidental or Accidental Senior Plan

  1. Diagnosis or treatment of any illness/disease or any condition caused by or resulting from an illness/disease.
  2. Diagnosis or treatment of pre-existing and hereditary conditions.
  3. Diagnosis, treatment, or preventive diagnosis or treatment of the insured pet for internal or external parasites including fleas, heartworms, and roundworms.
  4. Diagnosis or treatment of the pet for any condition resulting from or associated with breeding or pregnancy including caesarean section, dystocia, or termination of pregnancy.
  5. Medication prescribed more than one year after the pet’s injury.
  6. Diagnosis, treatment, or preventative diagnosis or treatment of the insured pet for any bacterial or rickettsial fever transmitted by the bite of a tick.
  7. Boarding, transportation, grooming, or bathing. Boarding includes medical boarding, and bathing includes medicated baths or dips.
  8. Routine examinations, preventive treatment (including vaccines) or diagnostics associated with preventive treatment.

The following additional exclusions apply if you have chosen the Exotic Plan

  1. Diagnosis or treatment of pre-existing and hereditary conditions.
  2. Diagnosis or treatment of the pet for any condition resulting from or associated with breeding or pregnancy including caesarean section, dystocia, or termination of pregnancy.
  3. Medication prescribed more than one year after the pet’s injury.
  4. Boarding, transportation, grooming, or bathing. Boarding includes medical boarding, and bathing includes medicated baths or dips.
  5. Liability to third parties arising from any venomous or poisonous pets.
  6. The cost of any vaccinations, internal or external parasites, flea treatment, routine spaying or castration (this does not exclude spaying or castration that is recommended by the attending veterinarian as part of an overall medical condition) or any drugs or medication for routine preventative training or therapy, or any veterinary treatment arising as a result of any of the above.
  7. The cost of wing clipping, teeth, beak nail or claw trimming, or any veterinary treatment arising therefrom.
  8. The cost of treating any injury or illness caused by your other pets, the pets of anyone living with you, or any other animal in your care, or any animal visiting your premises.

CONDITIONS


1

You will be responsible for excess stated in your policy schedule for every event giving rise to a claim.

2

The illness benefit will be subject to a 30 day waiting period from the start of this policy.

3

Your cover is limited to the limits specified in your policy schedule.

4

For a hospitalisation claim to be considered under “accidental cover” the invoice must reflect a charge for accommodation or overnight stay and a procedure must have been completed or treatment for a diagnosed condition must have been completed.

5

A diagnosis must be done within 48 hours from the time of the event giving rise to a claim.

6

You must as often as we may require, at our expense, submit your insured pet to a medical examination before or after a claim has been accepted.

7

It is your responsibility to seek medical assistance immediately once you become aware of any condition that requires medical treatment or your insured pet shows signs of an injury, illness or accident. We will not be liable for any costs incurred consequential to you not having sought medical assistance timeously.

8

We reserve the right to claim from you any amount that you receive from a third party as payment or compensation for an event covered and for which a payment has been made by us under this policy.

9

It is your duty to declare all medical and health information regarding your insured pet when applying for this policy. It is your responsibility to obtain and supply any medical history reports from any veterinarian or facility if requested by us.

10

This policy only covers insured events occurring within the borders of South Africa.

11

Your cover is limited to one Oakhurst Pet Insurance product per pet.

12

There is no cover for any additional medical costs incurred as a result of pre-existing injuries.

13

There is a 30 day waiting period on Wellness benefits.

HOW TO CLAIM


Call us as soon as you can. We will register your claim, and give you a claim number. We will talk you through the process step by step, and deal with your claim as expeditiously as possible.

When an insured event giving rise to a potential claim occurs, you MUST do the following, failing which we may not pay your claim. You must:
1

Report the claim as soon as possible, but at least within 30 days of the event giving rise the claim. Our telephone number for claims is 0861 001 041.
Ideally, as part of the initial notification, you should give us:

  • Your policy number.
  • The insured pet's details.
  • Your name,address, and your home and cell phone number(s).
  • The date and details of the event to be claimed for.
  • Name and address of the relevant veterinary surgeon treating your pet.

2

Thereafter provide us with full details of your claim as soon as possible, but again no later than 30 days thereafter, including a duly completed claim form supported by copies of itemised invoices and other relevant documents such as medical records and lab results.

3

All documentation and information which you provide as evidence or support of any claim must always be true and correct.

Please take note of these further important terms:
1

We settle your claims in the following ways:

  1. We pay you directly into a bank account in your name and always in South African Rand. What you do with the claim payment after we have paid you is your decision and it is your responsibility to settle any accounts for which you may be liable. We do not contract with any third party service providers on your behalf nor will we ever indemnify you against claims from any third party service providers.
  2. The most we will pay for any 1 claim is the amount stated as the sum insured or any limits shown in your policy wording or schedule. We will not pay any interest on the amounts insured under this policy.

2

You must provide us with any medical documents to assist in proving your claim.

3

You must provide us, at your own expense, with any information and assistance that we may reasonably require in order to facilitate application of the policy.

4

Even if you have already claimed and there is information outstanding from you (or the veterinary surgeon) which is needed to finalise the claim, your claim is no longer valid after 12 months from the date of the event which caused your claim.

5

If we don’t pay your claim and you disagree with our decision or if you are not happy with the amount we agree to pay for your claim under this policy you can write to us about your complaint within 90 days of the date of the letter in which we notified you of our decision regarding your claim. After the 90 days, you have a further 180 days in which you can serve a summons on our registered office, failing which any action against us shall be deemed to have prescribed.

HOW WE USE YOUR PERSONAL INFORMATION


You are giving your information to Oakhurst Insurance Company Limited. We are a member of the Badger Group of Companies. In this information statement, ‘we’ ‘us’ and ‘our’ refers to the Group unless otherwise stated.

Your information comprises of all the details you have provided us with and includes information obtained from third parties. If you contact us electronically, we may collect your electronic information identifier e.g. Internet Protocol (IP) address or telephone number supplied by your service provider. To keep your insurance portfolio up to date and to assess risk fairly, we also need to compare and share some of your policy and personal information with other insurers, organisations and within our Group. You allow us to process your personal information.
We may use and share your information with other members of the Group to help us and them:

  • Assess financial and insurance risks.
  • Recover debt.
  • Prevent and detect crime.
  • Develop our services, systems and relationships with you.
  • Understand our customers’ requirements.
  • Develop and test products and services.
We do not disclose your information to anyone outside the Group except:
  • Where we have your permission.
  • Where we are required or permitted to do so by law.
  • To credit reference and fraud prevention agencies and other companies that provides a service to our partners, you or us.
  • Where we may transfer rights and obligations under this agreement.

We would like to keep you informed (by phone, post, e-mail or sms) of selected products and services available from us and our chosen suppliers. If you would prefer not to receive this information from us and have not previously advised us of this, please let us know when you contact us.
From time to time we may change the way we use your information. Where we believe you may not reasonably expect such a change, we will ask your permission.
We will not keep your information for longer than is necessary.

CREDIT REFERENCE AGENCIES

To determine premium payment rates at quote, renewal and/or any future invitations, we will perform checks on your public data through a credit reference agency. These enquiries will be recorded and it will affect your credit rating.

FRAUD PREVENTION AGENCIES

If false or inaccurate information is provided and fraud is identified or suspected, details may be passed to fraud prevention agencies. Law enforcement agencies may access and use this information.
We and other organisations may also access and use this information to prevent fraud and money laundering, for example when:
  • Recovering Debt
  • Checking details on proposals and claims for all types of insurance.


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