You can claim benefits under this plan no matter what the reason for your hospitalisation is, as long as the claim meets the requirements and conditions of your healthcare plan and is not an excluded condition or during a waiting period.Claims must be submitted within 6 months after the insured life is discharged from the hospital. If you miss this deadline, your claim will not be paid.

Metropolitan will request the necessary documents to process the claim. 
If there is an inquest to get further details, you must submit the required documents within three months of the inquest's conclusion.

When submitting a claim, these are the documents we will require to process your claim: 

Daily Cash benefit claim documents: 

• Claim form. 
• Certificate by medical attendant. 
• Certificate by employer. 
• A copy of the hospital account indicating the date of admission and date of discharge. 
• A copy of the ID of the policy owner. 
• A copy of the ID of the claimant. If the policy owner and claimant is the same person, then only one copy of the ID is required. 
• Bank statement of policy owner. 
• Declaration by police if Daily Cash benefit is due to accident. To be completed by the investigating officer at the police station where the incident was reported. 

Metropolitan may ask for additional documents if needed. These documents include, but are not limited to, ward reports for the hospital stay, payslips and sick leave record.  
 

You may receive the pre-defined daily benefit amount when an insured life has been in hospital for at least 2 full days (48 hours). A full day is defined as a continuous 24-hour period from the time of admission.

If an insured life is admitted to the Intensive Care Unit (ICU), double the daily benefit amount will be paid for each full day spent there, up to a maximum of R3 000 per day.

The maximum number of full days that you may claim is limited to 60 days a year per insured life. 
The first year begins on your plan start date and the limit resets on the plan anniversary. Claims under this policy will be limited to a maximum of R200 000 per year.

This benefit is payable to you, the policy owner. Metropolitan will not pay your health service provider.

There are two kinds of CashBack benefits that you may receive:

• a Loyalty CashBack benefit

Your Loyalty Benefit will pay out even if there have been Daily Cash benefit claims. Metropolitan will pay a percentage of your premiums back to you after 24 months, provided that your plan did not lapse during this 24-month period. Thereafter, Metropolitan will pay a percentage of your premiums back to you every 36 months, provided that your plan did not lapse during this 36-month period.

• a No-Claim Bonus

The No-Claim Bonus rewards you when you have not made any Daily Cash claims within a fixed three-year period. The payment is guaranteed, provided:

• • You have not cancelled the policy.
  • All premiums are paid up to date.
  • No claims have been made for the Daily Cash Benefit for any of the lives covered during the 3-year period.

A waiting period is a period of time when an insured life is not insured for some or all events. Waiting periods apply to each insured life even though premiums are paid. The waiting period starts from the policy entry date. Condition-specific waiting periods of up to twelve months may be applied to the policy. The lives and conditions applied are noted in your plan summary.

A 3-month waiting period applies to each insured life from the entry date when that life was added. The benefit will not pay out if an insured life is hospitalised due to natural causes during the waiting period. If an insured life is hospitalised due to an accident, the benefit may be paid out.