T&C’s:

The HIV protection-treatment service enables you to make use of, at your own discretion, the following services, which typically form part of membership benefits (T&C’s apply):

1. 24-hour access to trauma counselors, providing telephonic trauma counselling as well as counselling for post-traumatic stress disorder;
2. Three consultations (per incident) with a specialist, either a general practitioner, trauma-trained registered nurse or trauma counsellor;
3. Three HIV blood tests (per incident): one immediately after the incident, the second and third at six weeks and then three months respectively (should the beneficiary be HIV positive at the time of the initial blood test, further testing is not covered);
4. Provided that exposure has been established, and strictly on the treating doctor’s orders, if your test is HIV negative (following a rapid test) you will also be provided access to:
   1. A 30-day starter pack of anti-retroviral medication;
   2. A seven-day course of STI (Sexually Transmitted Infections) medication;
   3. A ‘morning-after pill’ to prevent pregnancy in the case of rape;
   4. Registration for an HIV-management program where applicable; and
   5. 24-hours-a-day, 365-days-a-year telephonic access to an HIV counselling centre for information, advice and support.
5. Should your test be HIV positive at the time of the event, you will be provided access to:
   1. 24-hours-a-day, 365-days-a-year telephonic trauma counselling;
   2. 24-hours-a-day, 365-days-a-year telephonic HIV counselling;
   3. Three consultations (per incident) with a specialist, either a general practitioner, trauma-trained registered nurse or trauma counselor;
   4. A seven-day course of STI medication; and
   5. A ‘morning-after pill’ to prevent pregnancy.

Trauma & Assault

Assault is defined as a bodily injury sustained by violent external and visible means. Beneficiaries will receive medical treatment for bodily injury. In the case of trauma, the beneficiary will be able to receive psychological counselling from a public trauma centre or a private institution.

A beneficiary may call the trauma line in the event of:

1. Rape
2. Hijacking
3. Child abuse
4. The death of close family member
5. Armed robbery and assault
6. Domestic violence and/or abuse
7. Kidnapping or abduction
8. Suicide of family members

The helpline arranges the nearest local emergency assistance service for the beneficiary as well as providing emergency medical transport to the nearest, most appropriate medical facility as a result of a bodily injury. If necessary the beneficiary will be stabilised before transportation is provided (inter-hospital transfers are not included).

1. Professional resource nurses maintain a high level of service when manning the helpline.
2. The resource nurses also assist with referrals to psychiatric consultations.
3. Cover for assault includes R5,000 per insured person with a maximum of R10,000 per family per occurrence in respect of medical treatment for bodily injury.
4. Cover for trauma includes R5,000 per insured person with a maximum of R10,000 per family per occurrence in respect of psychiatric consultations.

How do you access the benefits?

Phone our call centre, a 24/7 facilitation centre, which has the infrastructure for beneficiaries suffering from trauma to have access to immediate assistance. The call-centre nurses take control of situations and can refer you to an appropriate service provider.

In the event of trauma, assault or HIV infection you must:

1. Call the helpline and give details of the circumstances, any immediate dangers and your condition.
2. The nurses will arrange for the necessary assistance, whether it be the police or nearest local emergency assistance services etc.
3. The nurses will monitor your medical condition.
4. Should the situation develop into a medical emergency, the nurses will:
   • Arrange for emergency medical evacuation, either by road or air ambulance;
   • Arrange for you to be transported to a hospital with emergency facilities closest to the scene of the incident;
   • Monitor your transportation and condition.

Claims Procedure & Requirements

1. You will be referred to a public trauma centre or medical facility, but can also be referred to a private counselor.
2. You should contact the call centre (083 9000 534) to report the incident telephonically, following the initial telephone counselling by the resource nurse and her referral, if necessary.
3. Forms will be faxed or mailed for you to complete to ensure that the claims process will be undertaken;
4. You will have to pay for treatment and claim back expenses. To claim expenses back, you have to submit the following documentation:
   • Claim form and police case number (for assault);
   • Medical reports in the event of injury;
   • A certified copy of the beneficiary’s identity document; and
   • Your bank details.
5. We will review the above documents to make a decision as to the validity of the claim; if the claim is valid, we will reimburse the beneficiary. Claims must be submitted within 30 days.
6. Requirements
   • The beneficiary must notify the call centre immediately following the incident.
   • If the insurer that underwrites this group scheme repudiates any claim, both ValueBüddy and the insurer will be relieved of liability unless summons is served within 90 days of voidance of liability.
7. Exclusions to the benefits provided:
   Compensation will not be payable as a result of the beneficiary’s:
   • Participation in any riot, civil commotion, labour disturbance, strike or lockout or public disorder or any act of activity which is calculated or directed to bring these about;
   • Willful misconduct;
   • Performance or attempt to perform:
     1. Any act on behalf of any organisation, body or group of persons calculated or directed to overthrow or influence any state or government, or any provincial, local or tribal authority with force, or by means of fear, terrorism or violence.
     2. Any act which is calculated or directed to bring about destruction, damage or bodily injury in order to further any political aim, objective or cause, or to bring about any social or economic change, or in protest against any state or government or any provincial, local or tribal authority for the purpose of inspiring fear in the public or any section thereof.
     3. Should an HIV accidental-exposure claim not be reported within 48 hours (up to a maximum of 72 hours), Overflow cannot accept the claim for the HIV-protection medication, although beneficiaries can still make use of the telephonic advice and trauma counselling; this exclusion pertains to the fact that the anti-retroviral medication or starter pack will no longer be effective after expiry of 72 hours after exposure.
8. Neither ValueBüddy nor the insurer that underwrites this group benefit will be liable for:
   • Any claim which is fraudulent in any respect.
   • Loss, damage or bodily injury deliberately caused by the beneficiary or any person acting in collusion with the beneficiary, consequential loss or damage except as specifically provided.