|
Insuring Conditions
- Age limit is from 18 to 60 years old, renewable until 65
- Named basis only
- Applicant should be in good health and free from any impairment or deformity
- Applicant is not confirmed, suspected or a probable case of Covid-19 at time of application
- Asymptomatic cases for COVID-19 and Medical Frontliners are excluded
- Application form must be fully filled out by the applicant.
- Standard COCOGEN Microinsurance Policy Wordings
- Sabotage and Terrorism Exclusion
Coverage
- 24-hour coverage
- Coverage is effective for:
- Insured can get up to two (2) Insurance Packages (same or combination of packages)
- COVID-19 related insurance coverage will be valid after the waiting period of 14 days after the effectivity of the initial policy.
The waiting period will no longer apply if coverage is renewed continuously without interruption.
Terms & Conditions
- Accidental Death pays the Insured’s beneficiary the Sum Insured for death occurring within one year from the date of accident.
- Permanent Total Disablement pays the Insured the Sum Insured covered:
- For the loss of two or more limbs or both eyes.
- For permanent total disablement from gainful employment of any kind other than dismemberment, provided such disability has continued for a period of 52
weeks and it is total, continuous or permanent at the end of this period.
- Permanent Partial Disablement pays the insured a percentage of the principal sum insured covered for permanent loss of use of body parts, according to the
following schedule:
- Permanent and incurable paralysis of all limbs (100%)
- Loss of two or more limbs or both eyes (100%)
- Loss of one limb or one eye (75%)
- Loss of hearing – both ears Loss of hearing – one ear (50%)
- Loss of Speech (50%)
- Others (25%)
- Burial Benefit equivalent to 10% of the sum insured is released if the Insured dies due to accident.
- Daily Hospital Benefit pays the Insured, subject to the limit stated in the Schedule per day up to a maximum of 15 days should Insured be hospitalized due to
accidental causes or COVID-19. This includes confinement in government-designated facilities.
- Cash Assistance for Death due to other Causes pays the Insured’s beneficiary 10% of the Sum Insured if Insured dies due to other causes except when the
cause of death is a pre-existing condition. A pre-existing condition is an injury, illness or disease that affects the Insured Person before the effectivity of the initial
year or reinstatement date whichever is later, of the insurance of the Insured Person.
An injury, illness or disease is considered to be a Pre-Existing Condition if:
- A professional medical advice or treatment was obtained by the Insured Person for such injury, illness or disease before the effectivity of the initial year or
reinstatement date whichever is later, of insurance of the Insured Person under the Policy.
- Such injury, illness or disease has been by its nature, manifestations and conditions evident to the Insured Person before the effectivity of the initial year of
insurance or reinstatement date whichever is later, of the Insured Person under the Policy.
- The onset and pathogenesis can be clinically determined to have started prior to the effectivity of the initial year or reinstatement date whichever is later, of
insurance of the Insured Person under the Policy.
- Cash Assistance due to death caused by COVID-19 pays the Insured’s legal beneficiary, subject to the limit stated in the schedule. Provided always that the
Company shall only be liable of the Insured was tested positive of Covid-19 thru swab testing using the COVID-19 RT-PCR test and diagnosed by a qualified
physician that the cause of death is COVID-19 and after the waiting period.
Waiting Period
This benefit shall be subject to a 14-day waiting period form inception of the initial policy. There should be no symptoms of the COVID-19, and that the first
consultation with a qualified and licensed physician should not have occurred during the waiting period. Waiting Period will no longer apply if this coverage has
been renewed continuously without interruption.
Exceptions
Accidental Death/ Disablement benefit will not be payable for Bodily Injury or Death:
- Arising directly or indirectly as a result of a Pre-Existing Condition (physical or mental defect or infirmity) which had not been declared to and accepted in
writing.
- Arising from:
- HIV Infection and/or any AIDS related illness; or
- Suicide, attempted suicide or intentionally self-inflicted injury, whether the Insured is sane or insane; or
- Consumption of drugs (except under the proper direction of a Medical Practitioner), narcotic substances, poison or alcohol.
- Any bodily or mental infirmity, disease or sickness, or infection other than infection occurring because of an accidental cut or wound.
- Death or injury arising from major disease outbreak (SARS, EBOLA, FLU and other dreaded diseases).
- Death or injury resulting from the Insured Person’s performance of his/her field duties as a member of the Armed Forces or Police, including escort and
security services rendered in whatever capacity or form.
- Death or injury arising from war, invasion, act of foreign enemy, hostilities, or warlike operations (whether declared or not), civil war, mutiny, riot, martial law,
conspiracy, rebellion, revolutions, insurrection, or military or usurped power, civil commotion assuming the proportion of or amounting to a popular uprising.
- Death or injury arising from any nuclear reaction, nuclear radiation or radioactive contamination and chemical or biological contamination.
- Claims arising from accident occurring while the Insured individual is operating or learning to operate or serving as a crew member of an aircraft or seacraft.
- Claims arising from any violation or attempted violation of the law or resistance to a lawful arrest.
- Claims arising from cosmetic or plastic surgery, any dental work, treatment or surgery, eye or ear examination, except to the extent that any of them is
necessary for the treatment or alleviation of injury caused by an accident not herein excluded.
- Death or Bodily Injury due to accident occurring while the Insured is performing his or her duties as an acrobat, asylum attendant, aviator, or boilerman.
- Death or Bodily Injury to diver while performing underwater activities, or to fireman while performing firefighting activities.
- Death or Bodily Injury sustained while engaging in (or practicing for or taking part in training peculiar to) any of the Excluded Activities;
- Aqualung Diving
- Motor Competitions
- Parachuting
- Hurling
- Soccer
- Use of woodworking machinery
- Snow Jumping
- Climbing and/or Mountaineering
-
Baseball
- Professional Football
- Ice Hockey
- Motorcycling in any form
- Polo
- Skydiving
- Water ski-jumping and tricks
- Boxing
- Flying except air travel
-
Professional Basketball
- Wrestling
- Underwater activities involving the use of compressed air or gas
- Hang-gliding
- Hunting
- Power-Boating
- Racing
- Winter
Sports
- Yachting
- If the Insured is below the age of 18 at the time of the accident, or exceeds the age of 65 on inception date of the policy;
- Consequent upon committing or attempting to commit suicide or criminal act or wilfully exposing to needless peril except in an attempt to save human life;
- During travel in aircraft other than one licensed for public passenger service and operated by regular airline on a published scheduled flight over a regular air
route between 2 definitely established airports and in which Insured is travelling as a fare-paying passenger.
- Bodily Injury or Death Disablement or Accidental Medical Expenses consequent upon or contributed to by:
- having taken a drug unless it can be proven that the drug was taken in accordance with proper medical prescription and directions and not for treatment of
drug addiction; or
- while under the influence of alcohol unless it is established that alcohol was not a factor contributing to the happening of the injury; or
- having ingested/inhaled any poison, chemical compound, gas or fumes voluntarily taken, administered, absorbed or inhaled.
- Death, Disablement or Accidental Medical Expenses consequent upon or contributed to by being pregnant or suffering from sickness or disease not resulting
from Bodily Injury or suffering from Bodily Injury due to a gradually operating cause.
- Murder and/or Assault, unless specifically included in the Schedule.
- Riding or driving in any kind of race.
- The actual or threatened malicious use of pathogenic or poisonous biological or chemical materials.
- Neurosis, psychoneurosis, psychopathies or psychosis, anxiety, stress, fatigue or mental or emotional diseases or disorders of any type.
- Arising directly or indirectly as a result of Radiocative contamination, chemical, biological, bichemical and electromagnetic weapons.
- Infectious disease
Notice of Claim
A claim should be reported within thirty (30) days from the time of occurrence.
The original of the claims documentary requirements must be submitted for the immediate evaluation of claim.
Disclaimer
Please be informed that there shall be no recovery hereunder if the murder or assault occurs in any of the following provinces or places: Lanao del Norte, Lanao del Sur, Maguindanao, North Cotabato, South Cotabato, Sultan Kudarat, Sulu Archipelago, Basilan, Tawi Tawi, Zamboanga del Norte, Zamboanga del Sur.
|
