| GENERAL INFORMATION |
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DENTAL BENEFITS |
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A completed Oral Examination Report must be submitted with the first dental claim. All conditions requiring treatment as of the first dental visit are deemed to be pre-existing conditions.
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EXCLUSIONS (Extract from the
policy) |
Medical plans do not cover care,
treatment, services or supplies for:
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Pre-existing
conditions not declared to and accepted by the
Company;
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Which the Insured
Person is entitled to indemnity from a third party or
other benefit plan;
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Birth control;
treatment of impotence or infertility (including
artificial insemination, in-vitro fertilization,
embryo transfer); sterilization reversal or elective
abortion;
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Congenital
conditions;
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Custodial Care,
routine medical check-ups, or any treatments
considered unnecessary by the Company, vaccinations,
counselling, hearing tests, refractive defects of the
eye, corrective eye surgery for refractive error,
corrective devices, or dental treatment unless covered
under the optional benefits cover of this policy for
vision, dental, or medical check-up;
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Disability
resulting from war or any act thereof, service in the
military, naval or air force, riot, civil commotion;
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Hazardous or
professional sports unless declared to and accepted by
the Company;
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Intentionally
self-inflicted injury, suicide, abuse of alcohol, drug
addiction or venereal diseases;
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Cosmetic or
reconstructive surgery;
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Prosthesis,
orthotic devices, corrective devices and medical
appliances not required for a surgical operation;
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AIDS, AIDS Related
Complex, or Human Immunodeficiency Virus (HIV) and
related illness which manifests at any time within
five years from the policy effective date; and
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Expenses incurred
for provision of medical documentation required by the
Company.
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14-DAY FREE LOOK |
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You may return your policy within
fourteen days after receipt for a full refund of the
premiums paid. |
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FREE NEW BORN CHILD COVERAGE
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A child of an Insured Person is
eligible for the same medical plan as the Insured Person
15 days after the later of the date of birth or the date
of discharge on submission of application to the Company
until the Insured Person's next renewal for free.
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GEOGRAPHICAL LOADING |
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Applies to the Medical Plan (&
Private Room Option) premium for residents to cover the high cost of
medical care in that particular area. |
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MATERNITY BENEFIT |
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Expenses are covered where applicable after a 12-month waiting period.
Miscarriage, therapeutic abortions, hydatiform mole and etopic pregnancy are covered after 90 days. Benefit shall include all pre-natal and post-natal care, hospital room and board, professional fees, miscellaneous charges, and up to 7 days of nursery care.
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NO CLAIM DISCOUNT |
A No Claim Discount will be offered to Insured Persons who are not
entitled to Group Discount and whose policy remains claims-free at each renewal. The
No Claim Discount will be applied as follows:
Year 0 No discount
Year 1 10% discount
Year 2 15% discount
Year 3 20% discount(the maximum)
If a claim is made by an Insured Person under the policy during a policy year, any No
Claim Discount achieved will be lost and the status of the discount will be as at Year
0 shown above.
If a claim relating to the previous year is subsequently submitted and accepted, and a
No Claim Discount has already been given, the Company reserves the right to deduct the
equivalent monetary amount of the No Claim Discount from the value of the claim.
The No Claim Discount applies only to the premium in respect of the basic benefits.
Claims against any Additional Benefit Plans will not affect the No Claim Discount.
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OCCUPATIONAL CLASS
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Personal Accident cover is based on
the hazard class associated with an occupation and its
duties. Class 1: very light hazards; Class 2: light
hazards; Class 3: non-hazardous manual labor; and, Class
4: hazardous occupations. Class 3's are quoted on
request and Class 4's have no cover. |
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PRE-EXISTING CONDITION
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Any Disability which existed before
the policy effective date in respect of an Insured
Person, which presented signs and symptoms of which the
Insured Person was aware or should reasonably have been
aware. |
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PREMIUMS |
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Are based on the Insured Person's age
on the first day of the policy year; the rate table in
effect on the premium due date; and, residence, family
status, payment mode and other factors which affect the
cost of insurance. Premiums may be revised based on
claims experience or other criteria which the Company,
at its sole discretion, may determine. Policies renew
automatically upon payment of renewal premium.
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TREATMENT AREA LIMIT
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Does not apply to inpatient expenses
incurred for emergency treatment of injury or acute
illness which occurs wholly after the start of travel
for up to 30 days of travel to the affected areas in any
one policy year. |
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WAITING PERIOD |
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Benefits are not paid for sickness
during the first 30 days of coverage. Benefits for
injuries due to covered accidents occurring wholly after
the effective date are covered immediately. |
