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GROUP YEARLY RENEWABLE TERM LIFE INSURANCE
LIFE INSURANCE BENEFIT 1. DESCRIPTION Group Life Insurance is an insurance covering all or certain classes of persons rather than specific individuals. The Life Insurance benefit shall be paid to the beneficiary / ies of the insured person through the Employer in the event of death while in the employ of the employer. 2. ELIGIBILITY All present regular full-time employees/members who are actively at work and who are not more than 65 years of age shall be eligible of coverage. An Employee not actively at work on the date he would normally become eligible only upon his return to active full-time work. Future employees are eligible for coverage immediately after completing a period of continuous employment mutually agreed upon by the Employer and the Insurance Company. 3. SPECIAL FEATURES - No medical examination is required, (up to non-medical free cover limit) - Maximum age of acceptance 20-64 years - Provision may be made to include eligible dependents of the employees - Low cost for premium payment 4. LIFE INSURANCE BENEFIT Death Benefit : The Life Insurance benefit covers the employee/member in case of death regardless of time, place or cause except death due to committing suicide. Free Extended Insurance in Case of Disability Benefit : If the insured employee is terminated because of total disability resulting from accident or illness, the death benefit under this term life insurance is extended, without payment of premium, for the number of months the employee has been continually insured, but not in excess of 12 months or beyond the 60th birthday of the employee. 5. PARTICIPATION REQUIREMENTS The level of participation required to establish and maintain in respect to any plan of insurance shall be : a. 100% of all eligible employees / members if the plan is non-contributory, or b. at least 75% of all eligible employees / members if the plan is contributory. Definition : a. Non-Contributory insurance is insurance for which an employee/member does not share towards the cost. b. Contributory insurance is insurance for which an employee/member shares with the cost. 6. AMOUNT OF INSURANCE Amount of Insurance may be designed in anyone of the following ways : 6.1. Uniform Amount - all persons/employees regardless of salary, position, sex or age will be insured for the same amount. 6.2. Salary Classification - amount of insurance may be determined according to salary bracket. 6.3. Occupational Classification - amount of insurance may be determined according to position title. 6.4. Straight Salary - amount of insurance may be determined by multiples of annual salary e.g. 1 or 2 times annual basic salary. 6.5. Length of Service - amount of insurance may be determined according to length of stay. 6.6. Combination - of two or more of the above schedules. 7. MASTER POLICY AND PREMIUM A Group Master Contract shall be issued to the Company for the term of yearly renewable by determining premium rate each year based on the weighted average of sum insured and the age of the entire group. 8. PROOF OF INSURABILITY No medical examination or other evidence of good health shall be required of any person who is eligible for insurance up to the Free Cover Limit as set out in the Schedule except that in respect of any contributory coverage a medical examination or other evidence of good health may be required if application for insurance is made more than 30 days after date of eligibility for insurance. GROUP ACCIDENTAL DEATH AND DISMEMBERMENT (A.D. & D.) This is a supplementary benefit providing twenty-four hour coverage covering all losses due to accidents. 1. Loss of Life If injury sustained by the Assured Person causes loss of life within 180 days as from the date of accident or the injury sustained by the Assured Person necessitates continuous treatment in a lawfully operated hospital as an in-patient and loss of life occurs because of such injury, the Company will pay compensation in accordance with the sum insured stated in the Schedule. 2. Dismemberment & Loss of Sight If injury sustained by the Assured Person causes loss as stated below within 180 days from date of accident, the company will pay compensation as follows : Percentage Amount of Insurance (%) 2.1 Both hands from the wrist joint or both feet from the ankle joint or sight of both eyes 100% 2.2 One hand from the wrist joint and one foot from the ankle joint 100% 2.3 One hand from the wrist joint and sight of one eye 100% 2.4 One foot from the ankle joint and sight of one eye 100% 2.5 One hand from the wrist joint 60% 2.6 One foot from the ankle joint 60% 2.7 Sight of one eye 60% 2.8 One thumb and one index finger of same hand 25% The Company shall pay in respect of this part that item of loss with the greatest amount one item only. 3. Double Benefit for Public Accident The amount payable in respect of Loss of Life shall be doubled if the accidental death of the Assured Person occurs while the Assured Person in riding as a passenger in a train, Bus or Passenger Elevator car; or in consequence of the burning of any Theatre, Hotel or other Public Building in which the Assured Person shall be at the Commencement of the fire. The insurance in respect of an Assured Person shall Terminate immediately upon receipt of compensation under 1, 2.1 2.7 or 3. GROUP TOTAL AND PERMANENT DISABILITY BENEFIT (TPD) This is a supplementary benefit providing total and permanent disability benefits. DEFINITION Total and permanent disability mean the complete inability of an assured employee to engage in any gainful occupation or employment for compensation, profit or gain for the remainder of his/her lifetime as a result of accidental bodily injury, sickness or disease. The total and irrecoverable loss of sight of both eyes, or the loss by severance of two hands or feet at or feet at or above wrists or ankles, or the total and irrecoverable loss of sight of one eye and loss by severance of either one hand or one foot at or above wrist or ankle will be considered as total and permanent disability. TPD BENEFITS If an Insured Person has been totally and permanently disabled as defined above for a period of six consecutive months while assured and prior to his sixtieth (60) birthday, the sum insured under this benefit shall be payable in 10 equal annual instalments, the first instalment commencing after 6 consecutive months of disability and subsequent payments being made annually thereafter the event of the insured member reaching the age 60 or recovering and being able to follow his own occupation or any other occupation as defined above, no further payments will be made under the provisions, of this policy and the life insurance cover will be reinstated to the members normal entitlement less the total of disability benefit payable under this provision. In the event of the insured member dies prior to the completion of the payment of the instalments, then all outstanding instalments will become payable immediately as a lump sum to the beneficiary. EXCLUSIONS (1) Self-destruction or any attempt thereat while sane or insane. (2) Military or naval service in time of declared or undeclared war or while under orders for warlike operations, or restoration of public order. (3) Entering, operation or servicing, ascending or descending from or with any aerial device or conveyance except as a fare paying passenger on a regularly schedule passenger flight of a commercial aircraft. (4) Nuclear weapons, radiation or radio activity from any nuclear fuel arising from the combustion of nuclear fuel and self sustaining process of nuclear fission. (5) War, declared or undeclared, civil war, revolution, or any warlike operation. GROUP HOSPITALIZATION & SURGICAL EXPENSE BENEFITS (IPD) This is a supplementary benefit providing Group Hospitalization & Surgical. DESCRIPTION OF THE PLAN Group hospitalization and surgical insurance is a supplementary benefits providing for reimbursement of hospitalization and surgical expenses incurred by an insured Group-Member in the course of his or her confinement as a patient in a legally constituted hospital and/or his or her being subject to a surgical operation. The insured person who are actively at-work and not more than age 60 shall be eligible for this insurance. DESCRIPTION OF BENEFITS A. Room and Board Reimbursement of hospital room daily charges up to the daily limit stated in the Schedule of Benefits and subject to a maximum of 31 days. This includes room accommodation, food services and routing nursing care. The benefit will be restricted to a maximum number of days for any one confinement as stated in the Schedule of Benefits, with a confinement for the same cause within 90 days of the previous discharge being regarded as a continuation of the same confinement. B. General Hospital Benefits This benefit pays for the actual cost charged by the hospital during in insured persons confinement but not to exceed the maximum benefit stated in the Schedule of Benefits for the following : 1. drugs and medicines prescribed by the attending Physician ; 2. diagnosis ; 3. administration of blood, but excluding blood and blood plasma ; 4. physical therapy, but excluding tools and equipments ; 5. X-rays and laboratory tests ; 6. use of operating room, anesthetics and oxygen ; 7. ambulance service but not in excess of daily room and board benefit ; 8. dressing, ordinary splints and plaster cases ; 9. electrocardiograms ; 10. oxygen and their administration. C. Surgical Benefits Maximum benefit for professional charges made by the physical or surgeon for performing an operation up to the maximum amount stated in the Schedule of Surgical Benefits. The exact amount of reimbursement for a particular surgical procedure depends on the nature of operation performed. For a small operation which is not required to register as an admitted patient in a hospital shall be covered under the same Schedule of Surgical Benefits. If more than one operation is performed through the same incision, payment will be made for the operation providing the largest benefit. D. Specialists Consultation Benefit The amount actually charged for in-hospital consultation shall be paid up to the maximum amount stated in the Schedule of Benefits. E. Doctors Visit Maximum benefit for the doctors daily professional visits for treatment is payable up to the per visit limit stated in the Schedule of Benefit and a maximum of 31 days per confinement. F. Emergency Out-patient Treatment (Accident) If, as a result of an accident and within twenty-four hours following such and accident an insured person shall require emergency out-patient treatment in the out-patient department of a hospital or a registered medical practitioners office, the company will pay the amount actually charged by the hospital, but not to exceed the maximum limit stated in the Schedule of Benefits. GROUP HOSPITALIZATION & SURGICAL OUT-PATIENT OR CLINICAL BENEFIT (OPD) This is a supplementary benefit providing Group Hospitalization & Surgical. The insured will be reimbursed for a visit at a doctors clinic or at a hospitals out-patient department. The amount payable for each visit will not exceed the amount stated in the Schedule of Benefits up to a maximum of 1 visit per day and 30 visits per year. These benefits include the cost of consultation, medicines supplied or prescribed, laboratory tests or X-ray examinations during any one visit. |