CRF
Health4Me – Financial Needs Analysis (FNA) & Record of Advice (ROA)
Please read all sections carefully before completing the application below.
This Record of Advice is provided to CRF members who wish to consider adding Health4Me medical insurance as an additional benefit to their existing retirement fund membership.
Important notes to acknowledge and understand:
- Health4Me is a medical insurance policy, not a medical aid. Cancelling your medical aid and choosing health insurance means losing comprehensive coverage, legal guarantees for prescribed minimum benefits, and protection from large, unexpected medical costs.
- Health4Me is specifically designed to cover those earning less than R40,000.00 and who have no medical aid scheme in place.
- If you are part of a registered medical aid scheme you have the option to include the Momentum Gold day-to-day benefits to enrich your out-of-hospital benefits, subject to you providing a membership certificate.
It is not compulsory for a CRF member to join the Health4Me product.
Premiums will be deducted by the CRF and paid over to the insurer. Members must explicitly choose between:
- Decrease your existing retirement fund contribution to cover the Health4Me insurance premium, OR
- Increase your total monthly contribution to ensure your retirement fund savings remain unchanged while adding Health4Me.
If you choose to redirect part of your current retirement savings to pay the Health4Me premium, your monthly savings towards retirement will decrease by the amount of the premium.
You may elect to voluntarily increase your contributions to the CRF if you wish to offset the premium deduction and maintain your original savings rate. This in turn will increase your monthly contribution to the CRF fund.
For advice or questions about the Health4Me benefit, contact CRF reception:
Day-to-day and major medical event benefits are taxed as a fringe benefit based on the full premium value. Insofar as Momentum Health4Me can be considered as cost in the production of income, the cost of the product is deductible by the employer in terms of the Seventh Schedule of the Income Tax Act:
- Under Section 11(w) for the employees; and
- Under Section 11(a) for their spouses and children (if applicable).
Momentum Health4Me is an insurance product and the benefits are fully insured benefits. Momentum Health4Me does not issue tax certificates to members, and members will not be able to claim tax credits on this product as they would in the case of retirement annuities or medical aid products.
The fringe benefit value taxed in the hands of the employee must be reported under tax source code 3801 (general fringe benefits) on the employee's annual tax certificate.
Please note that this information should not be seen as tax advice; kindly consult a tax specialist for relevant tax advice.
I, the undersigned member ("the Member"), confirm that I have applied for, or am in the process of applying for, a Health4Me insurance policy ("the Policy") made available through GreenBlack Proprietary Limited ("GreenBlack"), the duly authorised licensed intermediary and distributor of the Policy, with FSP Number 48549.
This statutory disclosure is provided by GreenBlack Private Wealth (Pty) Ltd ("GreenBlack") in terms of the Financial Advisory and Intermediary Services Act (FAIS) and the General Code of Conduct.
Business details. GreenBlack Private Wealth (Pty) Ltd · Registration No. 2017/201380/07 · FSP Licence No. 48549.
Physical: CRF Building, 1st Floor, 4 Bridal Close, Tyger Falls, Bellville, 7530.
Postal: Suite 399, Private Bag X22, Tyger Valley, 7536. Website: www.greenblack.co.za.
Your advisor's name and contact details are provided to you by your consultant.
Legal and contractual status. GreenBlack is a private company and a duly authorised intermediary; no conditions or restrictions have been imposed by any of its product suppliers. Your financial advisor is an authorised representative of GreenBlack, appointed in terms of a written agreement, and GreenBlack accepts responsibility for its own actions and for those of the advisor acting within the course and scope of that agreement.
Financial services for which authorised. Under its licence, GreenBlack is authorised to provide advice and intermediary services for Category I and Category II financial products, including Long-term Insurance (Subcategories A, B1, B2, B2-A, B1-A and C), Retail Pension Benefits, Pension Funds Benefits, Securities and Instruments (Shares), Participatory Interests in Collective Investment Schemes and Hedge Funds, Structured Deposits, and Long- and Short-term Deposits. No conditions or restrictions have been imposed by the Registrar.
Professional indemnity. GreenBlack holds Professional Indemnity insurance through Aon Risk Solutions.
Interest and remuneration. GreenBlack maintains a Conflict of Interest Management Policy requiring your advisor to disclose any actual or potential conflict of interest; a copy is available at the office during office hours. Neither GreenBlack nor your advisor holds, directly or indirectly, more than 10% of any product supplier's shares or an equivalent financial interest. The provider may from time to time receive non-cash incentives from product suppliers; specific details will be made available should this occur.
Compliance. GreenBlack has appointed 40Two Consulting as its external compliance practice. Compliance Officer: Mrs Talita Olivier · Tel 021 879 3064 · info@40two.co.za · Unit 3, Palata Building, Bella Rosa Street, Rosenpark, 7530.
Complaints. If you are dissatisfied with any aspect of the service, address your complaint in writing to the Key Individual at the above address. GreenBlack has a written internal complaint resolution system; the written procedures are available at the office during office hours.
Signing of incomplete documents. You are advised and cautioned that no person acting on behalf of GreenBlack may request you to sign any form or document unless all details required to be inserted by you or on your behalf have already been inserted.
Accuracy of information. You are entirely responsible for the accuracy and completeness of all answers, statements and information provided by you or on your behalf. Any misrepresentation or non-disclosure of a material fact, or the inclusion of incorrect information, could result in the cancellation of the transaction by the product supplier.
Waiver of rights. No financial advisor or other person may ask you, or offer any inducement, to waive any right or benefit conferred on you by the General Code of Conduct. A copy of the Code is available on request.
Protection of personal information (POPIA). GreenBlack is committed to the Protection of Personal Information Act. We collect personal information about you and your spouse or dependants only as relevant to rendering financial advice and intermediary services — directly from you, via your appointed advisor, or (where you are insured as a member of a Retirement Fund) from the Fund, to which you consent. Supplying certain information is voluntary, but limited information may affect the quality and completeness of services. We are required under FAIS and the Financial Intelligence Centre Act (FICA) to gather certain information; refusal may prevent us from rendering services and, in certain cases, require reports to the relevant authorities. Data is stored in a cloud environment not hosted in South Africa (details and our POPIA compliance available on request). Your information is shared only with third parties directly engaged by GreenBlack to render services, or with the regulatory authorities, under confidentiality undertakings. You have the right to request, access and correct your information (via the Information Officer), to object to its use, and to complain to the Information Regulator (complaints.IR@justice.gov.za · inforeg@justice.gov.za).
General. All information obtained from you remains confidential unless you provide written consent or disclosure is required by law.
This is provided for your convenience. The full statutory disclosure forms part of your application (pages 5–8) and is the authoritative version you initial and sign.
Please read and agree to both acknowledgements below to continue. 0 of 2 agreed
By agreeing, I confirm each of the following:
7.1 I confirm that it is my responsibility to be in contact with my employer / payroll administrator to ensure that the right amount of tax is deducted from my payslip and paid to SARS with regards to the premiums to Health4Me.
8.1 I confirm that the tax position relating to the Policy and its premiums has been fully explained to me in clear and understandable terms, and that I have been afforded the opportunity to ask questions and seek clarification.
8.2 I confirm that I understand and accept the tax consequences arising from the payment of the premiums in the manner described above.
9.1 Any actual, potential or contingent tax liability, assessment, penalty, interest or claim that may arise now or in the future in relation to the tax treatment of the premiums is a matter solely between myself, my employer (including its payroll or pay office), and SARS, and does not give rise to any claim, recourse or liability against GreenBlack or Health4Me.
9.2 I accordingly indemnify and hold harmless GreenBlack, its directors, officers, employees and agents against any and all claims, losses, liabilities, costs or damages (including legal costs on an attorney-and-client scale) arising from or connected to the tax treatment of the premiums.
10 I acknowledge that the execution of this memorandum and undertaking is a non-negotiable compliance requirement of GreenBlack, and that no Policy will be issued or maintained unless this document is duly signed and retained as part of the compliance record.
11.1 This memorandum and undertaking is intended to be relied upon for regulatory, compliance and audit purposes, including by insurers, intermediaries and regulators.
11.2 I confirm that the contents of this document are true and correct and that I sign it freely, voluntarily and with full knowledge of its implications.
I confirm that GreenBlack's statutory disclosure (set out above) has been provided to me, and that I have read and understood it.
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