DiGi TELECOMMUNICATIONS PERSONAL ACCIDENT PLAN MASTER POLICY

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Transcription:

DiGi TELECOMMUNICATIONS PERSONAL ACCIDENT PLAN MASTER POLICY 1

SCHEDULE OF BENEFITS DiGi TELECOMMUNICATIONS PERSONAL ACCIDENT PLAN BENEFITS/ MANFAAT-MANFAAT PLAN / PELAN 1 PLAN / PELAN 2 1 Accidental death and disablement / Kematian dan Kehilangan Upaya Akibat Kemalangan RM 160,000 RM 50,000 2 Income Protection to subsidize income / expenses due to accidental permanent total disablement / Perlindungan Pendapatan melalui pembayaran tambahan untuk menampungi pendapatan / perbelanjaan bulanan akibat Kehilangan Upaya Kekal Akibat Kemalangan RM 30,000 RM 15,000 3 Snatch Theft compensation for up to 1 incident per 12 months period / Bayaran pampasan akibat kecurian ragut tertakluk kepada 1 insiden setiap 12 bulan RM 500 RM 250 4 Settlement of outstanding phone bill amount pursuant to any DiGi Postpaid bills (due to accidental death or permanent total disablement) / Penjelasan Jumlah Tertunggak sebenar berkenan manamana bil DiGi Postpaid (disebabkan oleh Kematian atau Kehilangan Upaya Menyeluruh Menyeluruh dan Kekal Akibat Kemalangan) Up to RM 1,000 up to RM 500 2

PART 1 THE CONTRACT This Master Policy O285800639, together with the schedule, the application and any endorsements, is evidence of the contract between the policyholder and us. We agree to provide the insured person the insurance cover described in this policy provided that the insured person pay the premiums when due and we agree to accept it subject to the terms and conditions of this policy. PART 2 DEFINITION We use words in this policy which have a specific meaning to this policy. These words are shown below and each time it is used in the policy, it is shown in bold font. Accident/Accidental shall mean a sudden, unintentional, unexpected, unusual and specific event that occurs at an identifiable time and place which shall, independently of any other cause, be the sole cause of injury. Certificate of Insurance shall mean the document issued to the insured after the applicable premium has been paid. This acts as written proof of insurance coverage. Child/children shall mean a financially dependant child (including stepchildren and those legally adopted) aged 1 year and above and up to 18 years or up to 25 years if they are financially dependent and are in full time education. Date of loss shall mean the date of the accident or date when an injury first occurs, whichever is earlier. Disability shall mean all bodily injury/injuries and related complications sustained, related or are due to the same accident. Doctor shall mean a medical practitioner who is currently registered, licensed and qualified to practice western medicine within the scope of his/her expertise in the geographical area and jurisdiction in where his/her medical services are provided. Effective date shall mean the date this insurance coverage starts as shown in the schedule and certificate of insurance. The insured can purchase this cover via SMS activation and coverage shall commence upon monthly declaration made by the policyholder to us for the insured s person successful enrolment. Family shall mean the insured s spouse and child/children. Immediate family member shall refer to the insured person s spouse, child, parent and their siblings, parent-in-law, grandparent, grandparent-in-law, grandchild, sibling, sibling-in-law, niece or nephew. Injury/Injuries shall mean bodily injury caused solely and directly by an accident. Insured shall mean the person to whom a certificate of insurance is issued by the policyholder. Insured person shall mean the person named in the certificate of insurance who is the: a) insured; or b) insured, the insured s spouse and child/children (if any). Loss of Hearing shall mean permanent irrecoverable loss of hearing where: If a db = Hearing loss at 500 Hertz If b db = Hearing loss at 1000 Hertz If c db = Hearing loss at 2000 Hertz If d db = Hearing loss at 4000 Hertz 1/6 of (a+2b+2c+d) is 80dB Loss of Limb shall mean loss by physical severance of a hand at or above the wrist or of a foot at or above ankle. 3

Loss of Sight shall mean the total, absolute and irrecoverable loss of sight. Loss of Speech shall mean the permanent disability in articulating any 3 of the 4 sounds which contribute to speech (i.e. the Labial sounds, the Alveololabial sounds, the Palatal sounds and the Velar sounds or total loss of the vocal cord or damage of the speech center in the brain resulting in aphasia. Loss of Use shall mean permanent limitation in function in relation to limb, finger or toe following an injury. Permanent shall mean an event that is expected to last for a full period of 6 months commencing from the date of loss, which at the end of such period is concluded by us to be beyond any hope of recovery or improvement. Policyholder refers to DiGi Telecommunications Sdn Bhd (201283-M). Schedule shall mean a document which is issued to the policyholder. This schedule acts as a written proof of insurance coverage. This schedule should be read together with this policy. Schedule of benefits shall mean the benefits made available under this insurance coverage. Spouse shall mean the insured s legal spouse who is named in the certificate of insurance. We, us or our shall mean AIG Malaysia Insurance Berhad (795492-W). PART 3 PERIOD OF COVERAGE This cover will begin on the effective date as stated in the certificate of insurance and shall terminate automatically on the earliest of the following: (a) immediately after an admission of 100% liability by the insured for a claim under the accidental death and disablement benefit which is described in Part 4 - Benefits, item 1; (b) upon the premium due date after the insured s death; (c) on the date this policy is cancelled based on the insured s or our request; or (d) on the 366 th day that the insured has lived continuously outside Malaysia. PART 4 BENEFITS We will pay for the benefits described below for death, disability or loss incurred due to an accident occurring during the period of coverage. We will pay the limits in the schedule of benefit that correspond to the plan stated in the schedule. 1. Accidental death and disablement If the insured person is involved in an accident and as a result suffer from death or a disability that occurs within 1 year from the date of loss, we will pay the insured person based on the percentage that corresponds to the loss, stated in the table below multiplied by the sum insured in item 1 of the schedule of benefits. 4

COMPENSATION TABLE PERCENTAGE OF PRINCIPAL CONDITIONS INSURED SUM 1. Accidental death 100% 2. Permanent total disablement where the insured person is permanently unable to perform 3 of the following daily activities of living: 100% (a) dressing means the ability to put on, take off, secure and unfasten all garments and as appropriate, any braces, artificial limbs or other surgical or medical appliances; (b) feeding means the ability to feed oneself food after its preparation and being made available; (c) mobility means the ability to move indoors from room to room on level surfaces; (d) toileting means the ability to use the lavatory or manage bowel and bladder function through the use of protective undergarments or surgical appliances if appropriate; (e) transferring means the ability to move from a bed to an upright chair or wheelchair and vice versa; or (f) washing means the ability to wash in the bath, or shower or wash by other means. 3. Permanent paralysis of all limbs. 100% 4. Loss of 2 limbs or loss of use of 2 limbs. 100% 5. Loss of 1 limb or loss of use of 1 limb. 100% 6. Loss of speech and hearing. 100% 7. Loss of sight of both eyes. 100% 8. Loss of sight of 1 eye. 100% 9. Permanent loss of lens in 1 eye. 50% 10. Loss of hearing in both ears. 75% 11. Loss of hearing in 1 ear. 25% 12. Permanent loss of speech. 50% Compensation Limit: a) The total amount payable for any 1 claim is limited to the sum insured stated in item 1 of the schedule of benefits. b) If the insured person is involved in an accident and suffers from a disability not stated in the above compensation table, but nevertheless suffers a permanent partial disability, the insured person may ask for an independent medical examination by a doctor to assess the degree of the disability and relate it, in terms of severity, to those permanent disabilities specifically mentioned in the Compensation Table above. Payment (if any) however will be made solely at our discretion. 2. Income Protection for additional sum to subsidize monthly income/expenses due to Permanent Total Disablement due to an accident. If the insured person is involved in an accident and suffers from Permanent Total Disablement as stated in the Compensation Table that occurs within 1 year from the date of loss, we will pay the insured person the amount specified in item 2 of the schedule of benefits. 3. Snatch Theft If the insured person is involved in an accident and suffers from a disability as a result of a snatch theft, we will pay the amount specified in item 3 of the schedule of benefits, provided that such incident is reported to the police and any claim must be accompanied by a written documentation issued by the police authorities. Our total liability under this section is limited to only 1 incident per 12 months period provided that our total liability under this section in respect of any period of insurance shall not exceed the maximum sum insured as specified in the schedule of benefits. 4. Settlement of Outstanding Phone Bill In the event of accidental death or permanent total disablement occurring to the insured person due to a covered accident where a sum of 100% is paid under the accidental death and permanent total disablement benefit, we shall pay for the settlement of all outstanding DiGi postpaid telephone bills equaling to the outstanding amount up to the date of loss, subject to the total limit as stated in item 4 of the schedule of benefits. Coverage for spouse and child/children If a family plan is purchased, the insured s spouse is covered for up to 100% and each child is covered for 20% of the amount specified in the schedule of benefits. 5

We will not pay benefits due to or expenses incurred for: PART 5 - EXCLUSIONS 1. sickness or disease cause by parasites, bacteria or virus unless this results from an injury; 2. Acquired Immune Deficiency Syndrome (AIDS); including Human Immunodeficiency Virus (HIV), HIV Wasting Syndrome and AIDS-related conditions (ARC). We reserve the right to require the insured person to undergo a blood test for HIV as a condition precedent to any processing of any claim; 3. war (declared or not); 4. flying unless the insured person is a fare-paying passenger; 5. taking a drug or drugs other than according to the manufacturer s instructions or taken as prescribed by a registered medical practitioner; 6. taking a drug or drugs for the treatment of drug addiction; 7. injuries that are intentionally self-inflicted; 8. committing or attempt to commit suicide; 9. violation of law; 10. where payment would violate a government prohibition, regulation or law or the insured person s involvement in an unlawful act irrespective of whether it is punishable by imprisonment; 11. deliberate or recklessly exposure to danger; 12. psychotic, mental and nervous disorders (including any neuroses and their physiological or psychosomatic manifestations); 13. whilst driving or in charge of a vehicle, with blood/urine alcohol level is above the legal limit stated in the laws of the country where the accident occurs; 14. activities related to racing of any kind that involves motorized vehicles; 15. participating, practicing or training for a sport as a professional and/or where an income is received; 16. involvement in activities relating to the armed forces, military, peacekeeping forces and similar groups. 17. we shall not be deemed to provide cover and we shall not be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose us, our parent company or our ultimate controlling entity to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union or the United States of America. PART 6 - GENERAL CONDITIONS 1. Duty of disclosure: You must take reasonable care to ensure that all your answers to the questions are full, complete, correct, honest and to the best of your knowledge. You also have a duty to inform AIG Malaysia of any change in the information given to us earlier before we issue the policy schedule to you, before you renew or change any of the terms of your policy. If you don t, we may: a) declare your policy void from inception (which means treating it as invalid) and AIG Malaysia may not return the premium or recover any unpaid premium; b) cancel this policy and return any premium less AIG Malaysia s cancellation charge or recover any unpaid premium; c) recover any shortfall in premium; d) not pay any claim that has been or will be made under the policy; or e) be entitled to recover from you the total amount of any claim already paid under the policy or any claim AIG Malaysia have to pay under any relevant legislation, plus any recovery costs. 2. Number of policies an insured can purchase: The insured is only allowed to purchase 1 policy. 3. Age to qualify for cover: The insured and spouse must be 18 years and above and below the age of 76 years. All children must be aged 1 year and above and up to 18 or 25 years, if they are financially dependent and in full-time education. All ages refers to the age as of the insured person s last birthday. If we find that the insured person is not within the age to qualify for cover, we will void the cover in respect of the insured person. 4. Claims procedure: The insured person or someone else authorized on the insured person s behalf must contact us within 30 days after any loss incurred by the insured person which is likely to lead to a claim. This can be done by telephone at 1 800 88 88 11, by e-mailing to AIGMYCare@aig.com or by writing to The Claims Department, Menara Worldwide, 198 Jalan Bukit Bintang, 55100 Kuala Lumpur, Malaysia. Any delay in notification may result in a rejection of the claim. Any delay must be supported by justifiable reasons for the delay and acceptance is at our sole discretion. We will not pay any claims that are notified to us after 1 year from the date of loss. A completed claim form along with supporting evidence (original copies, where applicable) must be supplied to us at the insured person s expense within 90 days from the date of loss. We have the right to ask for a post-mortem examination. It is the insured person s responsibility to prove that the loss did not in any way arise under or through any of the exclusion set in this policy. If we ask the insured person to have a medical examination, we will pay the cost of any examination. 5. Payment of claims: All claims payment will be made to the insured. In the event of the insured s death, we shall pay the claims proceeds to the nominee(s) named by the insured (if applicable) or to the 6

insured s estate. Upon payment we will be fully discharged of our obligations to the insured person under this policy. If the insured is incompetent or otherwise unable to give a valid release for the claim, we may make arrangements to pay claims to a trustee pursuant to Schedule 10 sub-paragraph 5(1) of the Financial Services Act 2013. Their receipt will discharge our liability under the policy. 6. Policy ownership: The policyholder owns this policy. We will not recognize any claim made by another party on this policy. The policyholder cannot assign the benefits covered in this policy for the insured persons to another person or entity. 7. Our rights to recovery: If we make a payment and subsequently are made aware that the claim is not payable, we have the right to recover the amount paid from the insured person. 8. Currency of payment: All payments will be made in Ringgit Malaysia. Settlement in foreign currencies will only be made if the insured person is not residing in Malaysia at the time of payment. The rate of exchange will be based on the prevailing exchange rate on the date of claim settlement as determined by Bank Negara Malaysia. The insured person will bear all the administration and costs of conversion. 9. Time: Refers to Malaysian time. 10. Legal proceedings: No legal proceeding against us is valid within 90 days from the date of loss. 11. Arbitration: All differences arising out of this policy shall be referred to the arbitration rules of the Kuala Lumpur Regional Centre for Arbitration of which an arbitrator shall be appointed in writing by the policyholder/ insured and us. In the event they are unable to agree on who is to be the arbitrator within 1 month of being required in writing to do so then both parties shall be entitled to appoint an arbitrator each who shall proceed to hear the differences together with an umpire to be appointed by both arbitrators. 12. Subrogation: Upon making a claim payment, we will acquire all of the insured person s rights to recover against any third party that may have resulted in the loss, at our own cost. The insured person must however give us their full cooperation to secure these rights and provide all assistance we require to institute legal proceedings against the third party. 13. Conformity with law: All the terms and conditions of this policy are in accordance to the Malaysian laws and/or directives issued by the Malaysian insurance regulatory bodies. 14. Rights of nominees: Nominees do not have any rights to make any changes to the policy. 15. Period of cover and renewal: This policy and certificate of insurance shall start on the effective date. The premium for the certificate of insurance is payable monthly and is due on the 1 st day of each calendar month. Each premium paid purchases cover for the following calendar month. 16. Changes: We can change the terms and provisions of this policy by giving the policyholder and insured person a 30 days prior notice. Any changes will be applicable from the next premium due date. No changes to this policy shall be valid unless authorized by us and is endorsed thereon. 17. Communication to us: All communication to us shall be in writing or other means acceptable by us. 18. Upgraded policies: If the insured increases coverage by choosing a higher plan and suffers from a disability prior to this change, we will pay the insured based on the limits prior to the upgrade. 19. Reinstatement: This policy and/or certificate of insurance can be reinstated with our consent provided that the policyholder and/or respective insured makes an application for reinstatement and provide us with all the information we require within 90 days from the defaulted premium due date. If accepted, we will reinstate the policy from the 1 st day of the calendar month following the receipt of the premium by us. For the avoidance of doubt, we will not however accept any premium payment for the period the policy was lapsed due to non payment of the premium. We will not pay for any claims which occur during the interval of time between lapsation date of the policy and reinstatement of the policy. 20. Cancellation: The policyholder and/or insured can cancel this policy by giving us a 30 days notice in writing The Customer Servicing Group, Menara Worldwide, 198 Jalan Bukit Bintang, 55100 Kuala Lumpur, Malaysia. We will continue to provide cover under this certificate of insurance for the remaining period for which the premium had been received and this policy shall terminate upon the expiry of such period. We can cancel this policy by giving the policyholder and/or insured a 30 days notice to the insured s last addresses as appears in the certificate of insurance or any alternative address that is notified to us in writing. We will continue to provide cover under this policy for the remaining period for which the premium had been received and this policy shall terminate upon the expiry of such period. 21. Residence outside the territory: Cover under this policy cannot continue if the insured person resides outside Malaysia for more than 365 consecutive days. Please inform us as soon as this happens so we can make a reassessment of your eligibility for cover. 22. Consent to use personal data: By submitting the application for coverage, the insured person consents to the collection of the insured person s personal information by AIG Malaysia (whether through the phone or otherwise obtained) and such information may be held, used and disclosed by AIG Malaysia to individuals, service providers and organizations associated with AIG Malaysia or any other selected third parties (within or outside of Malaysia, including reinsurance and claims investigation companies and industry associations) for the purpose of storing and processing this insurance and providing subsequent service(s) for this purpose, AIG Malaysia s financial products and services, data matching, surveys, and to communicate with the insured person for such purposes. The insured person reserves the right to obtain access, request correction or withdraw the insured person s consent to the use of any of the insured person s personal information held by AIG Malaysia. 23. Goods and Services Tax (GST): Please be informed that GST will be implemented by the Government of Malaysia with effect from 1 st April 2015 at a rate of 6%. AIG Malaysia reserves the right to collect from you an amount equivalent to the GST payable on the applicable premium for the policy period, or in the event that the policy period commences before but expires after 1 st April 2015, to collect from you an amount equivalent to the GST payable on the applicable premium calculated from 1 st April 2015 on a pro-rated basis. Your obligation to pay GST shall form part of the terms and conditions in your insurance policy. 7

For policies that commenced before 1 st April 2015, this amount will be exclusive of any applicable GST. We reserve the right to charge you GST in addition to the premium amount quoted for the period spanning across 1 st April 2015. For policies commencing after 1 st April 2015, the premium amount quoted will be subjected to GST. When AIG Malaysia makes a payment under this policy for the acquisition of goods, services or other supplies AIG Malaysia will reduce the payment by the amount of any input tax credit that you are or would be entitled to if you made a relevant acquisition. AIG Malaysia will pay the GST amount in addition to the limits of liability shown in the policy or in the schedule. Where the limits of liability shown in the policy or in the schedule are not sufficient to cover your loss, AIG Malaysia will only pay an amount for GST that relates to AIG Malaysia s proportion of the loss. Where you are registered for GST you must inform AIG Malaysia your correct input tax credit entitlement each time a claim is made under this policy. Any fines or penalties arising from your incorrect advice are payable by you. For the purposes of this condition: GST, credit for input tax, acquisition(s), and supply have the same meaning as given to those expressions in the Goods and Services Tax Act 2014 as amended from time to time and such related legislation. 8