Certificate of Insurance

Transcription

1 Credit Plus Certificate of Insurance and Terms & Conditions Certificate of Insurance This is to certify that you are covered under Group Credit Life. Policy # signed between MetLife Alico and Citibank Period of Coverage: Full tenure of the loan. Premium is paid by deduction from Face Amount. Scope of Coverage: 24 Hours, Worldwide benefit. Coverage Sum Insured Loss of Life (Accident & Sickness) and Permanent Total Disability (Accident & Sickness) 100% of the outstanding balance remaining on the date of loss including up to 3 months of arrears and related interests and subject to a maximum of AED 250,000 for Personal Loans and AED 375,000 for SME loans per life insured, irrespective of the number of loans granted and the outstanding balances. - Insurance coverage is only valid if the premiums are paid. - In case of a claim, the proceeds will be paid to the Policyholder. This certificate and the attached Terms & Conditions are subject to the Policy issued by MetLife Alico & Citibank (the Policyholder). If there exists any conflict between the terms of the Certificate & the Policy, the terms of the Policy shall govern in all cases. For assistance in making a claim under this policy, please contact your Citibank Representative.

2 1.0 DEFINITIONS American Life Insurance Company (MetLife Alico) Credit Plus Terms and Conditions Policy shall mean this agreement, any supplementary contracts or endorsements herein; any amendments hereto signed by the Insurance Company and the Policyholder, Enrollment Forms of the Insured Borrowers and Summary of Cover, which shall together constitute the entire contract between the parties. Policy Year shall mean a period of twelve (12) consecutive months beginning with the Policy Date and subsequent Policy Anniversary. Enrollment Form shall mean, unless otherwise arranged by mutual agreement between the Policyholder and the Insurance Company, the loan application form with the necessary and legal insurance requirements & information included, as to make it valid as a single form for both loan & insurance application. Moreover this document, together with the Summary of Cover, shall be considered as the certificate of insurance of the Insured Borrower. Summary of Cover shall mean the accurate information about the Policy that must be provided by the Policyholder to every Insured Borrower. This information shall describe thoroughly the provisions, terms and conditions of the Policy as to be well understood by the Insured Borrowers. The wording of the Summary of Cover is prepared by the Insurance Company. Borrowers shall mean the persons who have been granted a loan and fulfill the Policyholder s loan requirements. Eligible Borrowers shall mean borrowers who have met the eligibility requirements set forth in this Policy. Insured Borrowers shall mean Eligible Borrowers who, in accordance with the provisions of this Policy, are participating in the insurance plan under this Policy and who have completed the Enrollment Form. Face Amount shall mean the amount of the loan borrowed, net of any interests and prior to any amortization. Outstanding Balance shall mean the outstanding principal debt owed by an Insured Borrower, net of any interest, but including up to 3 delinquent loan installments, on the Date of Loss. The Death Benefit and the Permanent Total Disability Benefit, including up to 3 payment arrears, is based on the original amortization schedule of the loan and will not be effected by any rescheduling of the loan. Entry Date shall mean the effective date of coverage of an Insured Borrower hereunder, which shall be the Policy Date or the date of his becoming an Eligible Borrower, whichever is later. Pronouns: Masculine pronouns used in this Policy shall include both masculine and feminine gender unless the context indicates otherwise. Accident shall mean a sudden, involuntary, violent and external event that directly and independently of disease, aging and degenerative conditions, results in the Insured Borrower s Death or Permanent Total Disability. The loss must occur within 30 days of the accident that was the sole cause of the loss. Sickness shall mean any pathological state or state of abnormal function of bodily organs of the Insured, not caused by an accident, and objectively diagnosable. Date of Loss shall mean: 1. For claims under death benefit, the date of death of the Insured Borrower, 2. For claims under Permanent Total Disability, the date of diagnosis of the total disability of the Insured Borrower. It has to be certified by a physician and approved by the Insurance Company as fulfilling the conditions herein for a Permanent Total Disability claim.

3 Permanent Total Disability shall mean disability from bodily injury, sickness or disease so as to prevent the insured Borrower to perform any kind of work, occupation or profession for compensation, profit or gain for the remainder of his lifetime. 2.0 BENEFITS DEFINITIONS The coverage stated hereunder are valid only in respect of the benefits specially indicated in the Certificate of Insurance by the insertion of the amount of indemnity, its limitation and payment of the appropriate premium. Death Benefit If an insured person dies on account of accident or sickness, which is not excluded according to Clause 3: Exclusions and upon receipt of due proof in writing of the death of the insured member the insurance company will pay to the Policyholder the sum insured as defined in the Certificate of Insurance. Permanent Total Disability Benefit If an Insured Borrower becomes Permanently and Totally Disabled as defined in this policy, which is not excluded according to Clause 3: Exclusions, the Insurance Company will terminate the insurance on the life of such Insured Borrower and in lieu of all other benefits, will pay to the Policyholder the sum insured as defined in the Certificate of Insurance. Such state of PTD shall be exclusively recognized by a physician specially authorised by the Insurance Company according to the definitions and provisions of this Policy. There must be at least 12 continuous months elapsed from the commencement of Total Disability before it can be recognized as being Permanent. However, in case of the total and irrevocable loss of sight of both eyes, or of the loss by severance of two or more limbs (at or above wrist or ankle), the waiting period of 12 months can be waived and the state of PTD be recognized immediately. 3.0 EXCLUSIONS Any Death or Permanent Total Disability caused by or resulting, directly or indirectly, wholly or partly, from any of the following factors will not be covered by this insurance: Any claim due to Sickness occurring within sixty (60) days from the loan disbursement date, Pre-existing physical or mental defect or illness for which the insured person has consulted or received treatment within the 2 years prior to the date of her application for the insurance coverage during the first: a. 6 months from the loan disbursement date in case of death claim, b. 12 months form the loan disbursement date in case of PTD claim. Self-inflicted bodily injury regardless of its date and of its cause, A Sickness directly or indirectly attributed to HIV and/or any related illness including AIDS, Abuse of alcohol or drugs, War, or riot, or civil commotion, Radioactive contamination, Active participation to any illegal act or criminal activity, including attempts to sabotage and terrorism, Flight in a non-scheduled aircraft, Suicide while sane or insane during first 12 months from the loan disbursement date, Participation in any professional sport, Any Psychiatric, mental or nervous disorder, Normal pregnancy, childbirth, abortion or miscarriage, or any complications thereof,

4 Disability attributed by the Insured to subjective complaints not detectable with laboratory measurement, microbiological, biochemical means and/or imaging, The commission of or attempted commission of an assault or any unlawful act, or being engaged in any illegal activity or felony, Any mental condition, including but not limited to nervous breakdown, depression, anxiety or other stress related condition, Backache and related conditions, unless there are definite clinical findings, such as radiological medical evidence of abnormality. ACQUIRED IMMUNE DEFICIENCY SYNDROME - AIDS - DEFINITION No benefits shall be paid under this Policy, in the event of an Insured s Death or Permanent Total Disability caused by an opportunistic infection, a malignant neoplasm or suicide, if at the time of such death or disability there is present in the subject Insured an acquired immune deficiency syndrome. For the purpose of this Clause, the terms Acquired Immune Deficiency Syndrome shall have the meanings assigned to it by the World Health Organization. A copy of the definition is maintained in the Insurance Company s Head Office in the country of issue of the Policy. Opportunistic infection includes but is not limited to pneumocystis carinii pneumonia, organism of chronic enteritis, virus and/or disseminated fungi infection. Malignant neoplasm shall include but not be limited to Kaposi s sarcoma, central nervous system lymphoma, hairy cell leukemia and/or other malignancies now known or which become known as immediate cause of death disability and the incurring of medical expenses in the presence of acquired immune deficiency. Acquired Immune Deficiency Syndrome shall include HIV (Human Immune Deficiency Virus), encephalopathy (dementia), and HIV (Human Immune Deficiency Virus) Wasting Syndrome. 4.0 CLAIMS FORMS AND PROOF OF LOSS The Insurance Company will send claim forms to the claimants upon notice of claim and advice the Policyholder if necessary. The claimants must not delay submitting proof of loss and other claim documents longer or more than ninety (90) days according to the provisions of the Policy. Contact should be made with the Insurance Company s Claims Office to proceed with claim processing. The Company reserves the right to request more detailed information on the circumstances surrounding the Death or Permanent Total Disability of the Insured Borrower should that said circumstances warrants it. The Insurance Company shall keep the right to ask for any other documents which would be necessary to establish the cause and circumstances of the claim, namely in order to check: if the considered Borrower was actually insured and if his premium were paid, if the amortization schedule provided corresponds to the characteristics of the loan mentioned in the Enrollment form sent to the Insurance Company when the Borrower was enrolled in the policy, if the age limits defined under the policy are met, if the benefit to be paid is not in excess of the maximum benefit defined under the policy, if no exclusions are applicable, if all the other conditions defined under the policy are met. The Insured Borrower should be ready to provide the following documents in case of a claim: In case of death: a legal death certificate and an official personal identity data of the Insured Borrower and any other additional document that may be asked by the claims department of the Insurance Company.

5 In case of Permanent Total Disability: evidence that the insured borrower was carrying a registered occupation on the 1st day of the continuous period of disability, medical certificate delivered by a registered physician establishing the state of permanent and total disability, according to the definition given by the insurance policy, an official personal identity data of the Insured Borrower and any other additional document that may be asked by the claims department of the Insurance Company. The Insurance Company shall keep the right to ask for any other documents which would be necessary to establish the cause and circumstances of the claim. 5.0 TERMINATION OF INDIVIDUAL INSURANCE The insurance of an individual shall automatically terminate at the earliest time below: 1. The Insured Borrower reaches age 65; 2. Upon payment of the Death or Permanent Total Disability benefit; 3. Upon settlement by the Insured Borrower of the amount of the loan, including in the event of early termination; 4. Upon cancellation by the Policyholder of the loan agreement of the Insured Borrower, whatever the reason, 5. On the scheduled termination date of the loan, as initially defined in its amortization schedule. 6.0 PREMIUM REFUNDS In case of any early termination of the Insured Borrower s loan, a portion of the single premium paid for the insurance will be refunded in accordance with the following formula R = SP * (1-C) * {Dt * (Dt + 1)}/ {Dn * (Dn + 1)} R = amount of premium refundable to the Insured Borrower SP = single premium paid to the Insurance Company, net of insurance premium tax, if any C = commission or fees rate, Dt = remaining term of the loan (in whole months) as of the early termination date, according to the original amortisation schedule of the loan, Dn = total tenor of the loan in months, as per the original amortisation schedule of the loan