I warrant that I have been provided with all the information, service provider and plan details, or any additional information as I may have requested.I warrant that all details and facts provided herein are accurate and properly disclosed even if completed by a representative on my behalf. I hereby accept the terms and conditions and I understand that the benefits offered under LionHealth are service and insurance based and is not a medical aid. Iacknowledge that all contributions will run as a payroll reduction and should I cease working at my current employer I will have 10 days to complete a debit order form or my policy will be cancelled. I understand that additional debit order fees may be charged. In the event of any query or anyclaim in terms of this offering. I consent to the disclosure of any relevant information to the service provider, or appointed representative for the purpose of resolving the query. In the event of a service provider not being contracted to the network, I hereby expressly authorise both LionHealth and its nominee to move my medical insurance plan as contained in this application form to any other service provider, provided that the benefits and contributions remain materially similar. I acknowledge that the LionHealth product is INSURANCE AND IS NOT A MEDCIAL AID. I hereby authorise the deduction of the subscription amount for current and due plan contributions, per plan choice, per my details below, on or after the date stipulated hereunder, to ensure contributions are paid and benefits maintained.
LionLife is a licensed insurer and registered FSP (FSP# 15283). LionHealth is a product of LionLife and is insurance based. This is NOT a Medical Aid.