Frequently Asked Questions:

Personal Accident Insurance Policy

for Local National Consultants

CTG’s Personal Accident Insurance Policy ensures the safety of our staff by providing best-in-class duty of care.
This includes support from Assist360, our in-house medical and security assistance company.

We aim to make life easier for our consultants on the ground in complex environments. Make sure you have read
and understand your insurance policy summary. Here are some frequently asked questions, from medical claims to
exclusions and emergencies:

Q: What is CTG’s Personal Accident Insurance? Q: Is there an age limit?

A: A policy aimed at covering CTG staff and
consultants for accidents, emergencies and
occupational risk occurring while under contract
with CTG. It is NOT a substitute for comprehensive
health insurance.
Q: What am I covered for?
A: Illness and accidents that occur while working on
a CTG contract, work-related disability, *childbirth
and reproductive health, and declared *pre-
existing medical conditions (*after 12 months of
uninterrupted contract).
Q: Does the insurance extend to my family?
A: No. Only a consultant with an active CTG
consultancy contract is covered. The policy does not
extend to next of kin, children or relatives.
A: Yes. Consultants over 65 only receive benefits
for work-related death and permanent disability.
They will need to have their own medical insurance.
Q: What do I contribute towards my medical claim?
A: A deductible is applied based on your monthly
income. There is also a co-pay for any claims
related to pre-existing or chronic conditions, if you
are eligible.
Q: Where am I covered?
A: The insurance covers you in your country of
operation only, or overseas on official work
missions.

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DOCUMENTS FOR CLAIMS PROCESS
Q: What are the mandatory documents for claims
approval?
A: - A medical report
- Invoices/receipts with numerical values and dates
- The CTG Medical Claim Form
- Any other supporting documents, such as test
..results or scan images
Q: Where can we find the CTG claims form?
A: Please contact your Account Manager to share the
official CTG medical claim form with you.
CLAIMS PROCESS
Q: Where do I submit my medical claim?
A: All medical claims must be submitted on Tayo under
the Duty of Care section (shield icon), specifically
under the Medical Claims tab.
Q: Can I submit a medical claim as an expense claim
on Tayo?
A: No. All medical claims should be submitted as
a Medical Claim on Tayo. Once reviewed and
approved by the Medical Claims Team, they will be
processed as an expense claim.
Q: What happens to my claim if some documents are
missing?
A: The Medical Claims Team will send you a Tayo
query email asking you for more information or to
submit the requested documents.
Q: What happens if I cannot submit the requested
documents?
A: If there is no response or the requested documents
are not submitted after four weeks, the claim will be
automatically rejected.
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Q: Is a detailed translation required in cases where
the medical report is not in English/in a local
language?
A: No. A brief English summary of the medical report
is enough. It should highlight your diagnosis, the
treatment you received and whether you need any
follow-up treatment.
Q: Who fills out the CTG Medical Claim Form?
A: Consultants or a medical professional can fill out
the form. However, Account Managers are available
to help if needed.
Q: How am I reimbursed for my medical claim?
A: Approved amounts are paid to consultants with the
next month’s payroll.
Q: Why was my medical claim rejected?
A: Your medical claim might be rejected for the
following reasons:
1. The condition is not covered by your plan.
2. You haven't submitted all the required documents.
3. You don't meet the eligibility requirements
outlined in the policy summary.
Q: Can I appeal a rejected claim?
A: Yes. However, the appeal will only be reviewed if
new medical information is provided to ctg.claims@
assist360.org. The Medical Claims Team will then
carefully reassess your claim, considering all the
information provided and the newly submitted
evidence.
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TIMELINES
Q: How long does it take for my claim to be
processed?
A: If all the correct documentation is submitted, claims
should be approved within two working days.
Reimbursements usually occur within one month.
Q: How long is a claim valid for?
A: New claims must be submitted within six months of
receiving treatment.
PRE-EXISTING CONDITIONS
Q: What is a pre-existing condition?
A: Any medical condition, illness, injury or disease
that:
1. You received advice or treatment for, or had
investigated before your CTG Consultancy
Agreement start date and/or,
2. Is recurring or ongoing or results in any
complications directly related to the condition
and/or,
3. You were aware of or had symptoms of or could
reasonably have been expected to be aware of,
at the start of your CTG Consultancy Agreement.
Q: Does the Personal Accident policy cover my
preexisting condition?
A: Pre-existing conditions are only covered if declared
after 12 months of continuous service with CTG and
on a 50% co-pay basis.
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Q: What happens if my contract expires/is inactive?
A: You must have an active CTG contract to submit a
claim.
Q: What does 50% co-pay basis mean?
A: A 50% co-pay means that half of the submitted
invoice for chronic/pre-existing conditions will be
covered/reimbursed.
Q: How can I declare my condition?
A: Here are three ways you can declare your
condition:
1. Obtain a certificate from a medical professional,
which should be submitted before starting your
contract with CTG or at any contract extension.
2. On your Tayo profile Medical Questionnaire
3. Email declaration, including medical reports, to
ctg.claims@assist360.org
Q: How often should consultants update
their Medical Questionnaire form on Tayo?
A: You should update this whenever a new health
condition arises.    
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MATERNITY

Q: Am I covered for childbirth? Q: I am struggling to get pregnant. Does my

A: After 12 months of continuous service, all CTG coverage include assistance with fertility?
consultants are entitled to routine pre-natal, A: Fertility treatment and assisted reproduction
childbirth and post-natal care cover for themselves. technology are not covered under this policy.
However, the policy does cover childbirth-related
costs.
Q: Does maternity coverage refer to maternity leave
as well as medical expenses?
A: No. Maternity leave is determined by local
labour laws and not by CTG. Maternity coverage
specifically refers to medical expenses incurred
during a consultant’s pregnancy. Any notifications
regarding pregnancy and childbirth should be sent
directly to CTG.

EXCLUSIONS

Q: What is an exclusion?
A: An exclusion is a condition/treatment/procedure
that is not covered by the policy.
Q: Are my accommodation and travel costs covered?
A: No. Only direct medical treatment costs are eligible
for cover under this policy.
Q: Is my surgery covered by the insurance policy?
A: Only emergency or life-saving surgeries are eligible
for cover.
Q: Where can I find the list of exclusions?
A: You can find the list of exclusions in your policy
summary, or you can contact the Medical Claims
Team for clarification.
Q: How can I contact the medical claims team for a
query?
A: You can send an email to ctg.claims@assist360.org

EMERGENCIES

Q: Who do I contact in an emergency? Q: When is a Medevac applicable?

A: Assist360’s Global Response Centre is available
at response@assist360.org or +27 (0) 66 572 1848.
Additionally, please notify your Account Manager or
Field Security Officer as soon as possible.
A: A Medevac is applicable when treatment is deemed
an emergency or lifesaving and is not available
at the consultant’s duty station. The approval
for a Medevac is made by the medical team and
insurance company, not the client.

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