1. I agree that I, and my dependants, will be bound by the Total Health Trust Cover Policy Conditions and will abide by them.
2. The Insurer shall not be bound in any way by any representations or undertakings made or given by any person save as contained in the Total Health Trust Cover Policy Conditions.

1. I understand that the Insurer may impose exclusions in respect of myself and / or any of my nominated dependants. This may include one or more of the following:
   • A Waiting Period of up to 24 months applicable for a specified condition, benefit limit (including maternity), avocation, occupation or general health status.
   • Lifetime exclusion of cover in respect of a specified condition, a vocation or occupation.
   • Declining of cover.
   • Three-month condition-specific waiting period for COVID-19 treatment (in and out-patient treatment).
2. I accept any such exclusion that may be imposed in terms of the Total Health Trust Cover Policy Conditions.

1. I acknowledge that it remains my responsibility to ensure that any amounts due by me to the Insurer are paid to the Insurer.
2. I agree that any amounts owing by me because of claims debt must be paid to the Insurer.
3. I also accept that I will be responsible for any costs associated with the recovery of any debts.
4. Acknowledge and accept that the premium paid as subscription to the scheme is non-refundable and non-transferable.

1. I confirm that I have the necessary authorizations to disclose the information that the Insurer may require and provide the necessary authorizations in respect of my nominated dependant(s).
2. I confirm that the information provided in this application, and in any other document submitted in support of this application, is true, correct and complete and that I have not withheld, concealed or misstated any information.
3. I furthermore confirm that I understand that my membership will become null, and void should the above statement be found to be incorrect and that in such an event, all monies paid in respect of my membership shall be forfeited and that the Insurer shall furthermore be entitled to recover any amounts paid for services rendered from the provider and/or myself.
4. I undertake to promptly advise the Insurer of any change in the status of health of myself and any of my nominated dependants that occur prior to the date of registration with the Insurer and acknowledge that additional information may be subject to underwriting. I acknowledge that not doing so may lead to the Insurer reconsidering the basis of my membership application.
5. By signing the above agreement, I hereby and expressly consent to indemnifying Total Health Trust Cover, its agents and/or administrator against any claim, of whatsoever nature, which may be made against any of them, arising from, because of or in connection with the disclosure(s) of any medical information in fulfilling this agreement.
6. I irrevocably authorise any medical practitioner, hospital, medical institution or other person to disclose information about my own, or my nominated dependants’ health status to the Insurer or any entity contracted by the Insurer to fulfil its functions, duties and obligations in terms of this agreement and I agree that this authorisation shall remain in force after my/their death(s).
7. I authorise the Insurer to collect, process and share my personal information and that of any nominated dependants(s) with any entity, including any foreign entity, contracted by the Insurer in order to fulfil its functions, duties and obligations in terms of this agreement, agree that this authorisation shall remain in force after my/their death(s) and understand that this may partially limit my/their right to privacy.

1. I acknowledge that upon cancellation of my policy, any amounts owing to the Insurer will be deducted from any amounts due to me.
2. I confirm that I, and all my dependants, will cancel any existing health insurance cover prior to commencement on Total Health Trust Cover.

1. I consent to the use of any of the contact details given in this application to send me information pertaining to my policy (confidential or other).
2. I agree to inform the Insurer of any change of address and contact details. The Insurer shall not be held liable because of my neglect to inform the Insurer of any changes to the aforementioned.
3. I consent to my telephone conversations with the Insurer being recorded and forming part of the Insurer’s records. I also agree that such records shall remain the sole property of the Insurer.

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