GROUP LIFE & PERSONAL ACCIDENT INSURANCE POLICY HOLDER POLICY NO. DATE OF PROPOSAL & DECLARATION INSURED PERSONS DL/ As advised All actively at work, full time & permanent employees of the POLICYHOLDER. TOTAL NO OF EMPLOYEES SUM INSURED PER PERSON TOTAL SUM INSURED FREE COVER LIMIT As per the census provided by the Policyholder As per Attached AED AED PERIOD OF INSURANCE 01 year from the date advised SCOPE OF COVERAGE ANNUAL PREMIUM PER YEAR AGE LIMIT 24 hours worldwide AED From 18 to 65 years BENEFITS & RATES Death due to Any Cause BENEFITS RATE PML Accidental Death of Benefits Permanent Total Disability (Accident And/Or Sickness) Permanent Partial Disability due (Accident And/Or Sickness) Temporary Total Disablement (Accident And/Or Sickness) Accidental Medical Expenses Repatriation Expenses - 1 -
UNDERWRITING CONDITIONS 1 Premium is payable annually in advance 2 Coverage is mandatory for all eligible employees 3 Life and ancillary Benefits cover cease at age 65 next birthday 4 5 6 Any new joiner /member under the scheme on the renewal date must be actively at work failing which they must return to normal duties for a minimum of two weeks to validate cover (excluding the period of normal leave) The Annual Premium payable will be applicable for this renewal period only and the Company shall have the right to alter the rate at each scheme anniversary or otherwise specified under Condition & The Policy Insurance is on 24 hours basis and covers the member anywhere in the world. Cover is subject to Automatic Addition/Deletion of members under the Scheme on a pro-rata basis and adjustment carried out at each quarter Warranted that any request for Addition / Deletion of members under the Scheme to be notified to the Company within a period of 45 days from the date of joining or cessation of employment 7 8 If the Sum Insured of a new joiner / member on renewal date is in excess of the Free Cover Limit allowed under the policy, or in excess of the normal life insurance benefit, the cover for such new joiner / member shall be subject to individual medical underwriting assessment and prior written acceptance made by the company. Cover is subject to all members being Resident in the countries as declared to us, and any employee being insured in any other country apart from the declared ones, should have the prior written acceptance of the Company. 9 Insurance is on 24 hours basis and covers the member anywhere in the world Passive War cover is excluded if an insured is traveling to a country after war has been declared in that country or after it has been recognized as a war zone by the United Nations or where there are war like operations, as described below. Warlike Operations means hostilities, mutiny, riot, civil commotions, civil war, rebellion, revolution, insurrection, conspiracy, military or usurped power and martial law or state of siege. SPECIAL CONDITIONS Permanent Total Disability due to Accident means : The total and permanent inability of the insured, due to an accident occurring prior the 65 th anniversary, to perform any activity or occupation for which he will be reasonable fitted by experience, training or education. Permanent Total Disability due to Sickness means : The total and permanent inability of the insured, due to a sickness occurring prior the 65 th anniversary, to perform any activity or occupation for which he will be reasonable fitted by experience, training or education. Accidental Death will automatically terminate upon attainment of age 65 Medical expenses will automatically terminate upon attainment of age 65 Total temporary disability due to accident will automatically terminate upon attainment of age 65 Total temporary disability due to sickness will automatically terminate upon attainment of age 65 DUBAI INSURANCE CO.PSC THE POLICYHOLDER - 2 -
THE SCHEDULE OF BENEFITS DEATH (NATURAL/ACCIDENTAL) In the event of death (natural or accidental) of an INSURED PERSON, 100% of Sum Insured in respect of that person shall be paid. ACCIDENTAL DEATH BENEFIT In the event of accidental death of the life assured an amount equivalent to the PRINCIPAL SUM in respect of that person shall be paid in addition to the PRINCIPAL SUM PERMANENT TOTAL DISABILITY (ACCIDENT AND /OR SICKNESS) PERMANENT PARTIAL DISABILITY (ACCIDENT AND/OR SICKNESS) In the event of Permanent Total Disablement cause by an accident and/or Sickness of an INSURED PERSON, incapacitating him to follow his own or similar occupation, a lump sum amount equivalent to PRINCIPAL SUM shall be paid. In the event of Permanent Partial Disablement caused by an accident and/or Sickness of an INSURED PERSON, a percentage of the PRINCIPAL SUM, as per Continental Scale of Benefits, shall be paid. TEMPORARY TOTAL DISABILITY ( ACCIDENT & SICKNESS) MEDICAL EXPENSES (ACCIDENTAL) REPATRIATION EXPENSES In the event of temporary, total and continues disability caused by an accident or sickness of an INSURED PERSON, a weekly indemnity equivalent to 100% of actual weekly basic salary for a maximum period of 104 weeks shall be paid. (Waiting period = Nil due to Accident ) (Waiting Period = 14 days for sickness) In the event of bodily injuries is a result of an accident to an INSURED PERSON, the necessary, reasonable and customary medical expenses up to a maximum of AED 30,000/ per person per year shall be paid. In the event of death (natural or accidental) of an INSURED PERSON, the necessary, reasonable and customary expenses at actual subject to a maximum of AED 25,000 per person for transportation/burial of the body along with cost of one accompanying passenger shall be paid. - 3 -
ANCILLARY BENEFIT ENDORSEMENT ACCIDENTAL DEATH BENEFIT It is hereby declared that if the death of a member occurs as the result of an accident the Company shall pay an additional amount equivalent to the basic sum insured under the policy for that Member, provided that :- 1. The policy in force on the date of the accident and the deceased is a scheme member on the date. 2. The accident occurs prior to the attainment of the Member of the age 65. 3. Death results solely, directly and independently of all other causes from bodily injury effected through external, violent, visible and accidental means or from a surgical operation necessarily consequent thereto, within 90 days of such accident This Endorsement is subject to the special conditions contained in the schedule of exclusions applying to ancillary benefits. PERMANENT TOTAL DISABILITY (ACCIDENT & SICKNESS) BENEFIT It is hereby declared that in the event of a Member being totally and permanently disabled as a result of an accident and or sickness to the extent of being unable ever again to follow his own occupation or any other occupation for which he is reasonably fitted by reason of training, education or experience, the Company shall following 12 months continuous disability as herein defined, pay the sum insured equivalent to the basic life sum insured under the Policy, provided that: 1. The Policy is in force and the disabled person is a Scheme Member on the date of the event resulting in the claim. 2. The accident occurs prior to the attainment by the Member of age 65. 3. The disability result solely, directly and independently of all other causes from bodily injury affected through external, violent, visible and accidental means or from a surgical operation necessarily consequent thereto, within 90 days of such accident. 4. Acceptance by the company of a claim under this Endorsement will automatically terminate the life cover in the Policy and all benefits applying under any other E0ndorsement thereto in respect of the Member. 5. If the Member qualifies for payment under this Endorsement and under any Permanent Partial Disability Endorsement the total payment shall not exceed the greater sum insured under the Endorsements. Any payment made under this Endorsement will be reduced by the sum of Total Temporary Disability benefits payments already made. - 4 -
PERMANENT PARTIAL DISABILITY (ACCIDENT & SICKNESS) BENEFITS It is hereby declared that in the event of a Member suffering, as a result of an accident and or sickness, the loss by physical separation, or the total loss of use of, any limb or organ of the body or the total and irrecoverable loss of sight as set out in the attached Continental Scale of Benefits, the Company shall pay the respective percentage of the sum insured, provided that:- 1. The Policy is in force and the disabled person is a Scheme Member on the date of the event resulting in the claim. 2. The accident occurs prior to the attainment by the Member of age 65. 3. The disability results solely, directly and independently of all other causes from bodily injury affected through external, violent, visible and accidental means or from a surgical operation necessarily consequent thereto, within 90 days of such accident. 4. The Member survives the accident and is alive 30 days thereafter or when payment of the claim is effected by the Company, whichever is later. 5. Acceptance by the Company of a 100% claim under this Endorsement will automatically terminate the benefits applying under any other Endorsement to the Policy in respect of the Member. Any subsequent claim made under any Accident Death or Permanent Total Disability Endorsement to the Policy in respect of death or disability arising from the same accident as gives rise to the claim under this Endorsement will be reduced by any amount already paid hereunder. If the Member qualifies for payment under this Endorsement and under any Temporary Total Disability Endorsement the combined payment shall not exceed the sum insured under this Endorsement. 6. In no circumstances will the total amount payable under this benefit in respect of any one Member exceed 100% of the sum insured whether as a result of one accident or a number of accidents. This Endorsement is subject to the special conditions contained in the Schedule of exclusions applying to ancillary benefits. - 5 -
Nature of disability CONTINENTAL SCALE OF DISABILITY BENEFITS Benefits as a proportion of The Principal Sum Total and irrevocable Loss of sight of both eyes. 100% Loss of both arms or both hands. 100% Complete and permanent deafness of both ears, of traumatic origin. 100% Removal of the lower jaw 100% Permanent Loss of speech, of traumatic origin 100% Loss of use of one arm and one leg.. 100% Loss of use of one arm and one foot. 100% Loss of use of one hand and one foot.. 100% Loss of use of one hand and one leg 100% Loss of use of both legs. 100% loss of use of both feet 100% Head Loss of osseous substance of the skull in all its thickness Surface of at least 6 sq.cm.... 40% Surface of 3 to 6 sq.cm 20% Surface of less than 3 sq.cm. 10% Partial removal of the lower jaw, rising section in its entirety or half of the maxillary bone 40% Loss of use of one eye 30% Complete and Permanent deafness of one ear, of traumatic origin.. 40% Upper Limbs Right Left Loss of use of one arm or one hand.. 60% 50% Considerable loss of substance of the arm (definite and incurable lesion). 50% 40% Total paralysis of one arm (incurable lesion of the nerves). 60% 50% Total paralysis of the circumflex nerve. 20% 15% Extensive loss of osseous substance of the two bones of the forearm (definite & incurable lesion) 40% 30% Total paralysis of the median nerve. 45% 35% Total paralysis of the radila nerve at the torsion cradle.. 40% 35% Total paralysis of the forearm radial nerve 30% 25% Total paralysis of the cubital nerve. 20% 15% Total amputation of thumb.. 30% 25% Total amputation of forefinger. 20% 15% Amputation of two phalanges of forefinger. 15% 10% Amputation of the ungual phalanx of forefinger.. 10% 8% Simultaneous amputation of thumb and forefinger 5% 3% Amputation of thumb and a finger other that forefinger.. 35% 25% Amputation of two fingers other than thumb and forefinger.. 25% 20% Amputation of three fingers other than thumb and forefinger 12% 8% Amputation of four fingers including thumb.. 20% 15% Amputation of four fingers excluding thumb. 45% 40% Amputation of the median finger. 40% 35% Amputation finger other than thumb, forefinger and median.. 10% 8% Lower Limbs Amputation of leg from upper half of thigh 60% Amputation of leg from lower half of thigh.. 50% Total loss of use of foot (tibio-tarsal disarticulation).. 45% - 6 -
Total paralysis of a leg (incurable nerver lesion). 60% Complete paralysis of the external polplitic sciatic nerve.. 30% Complete paralysis of the internal polplitic sciatic nerve. 20% Complete paralysis of two nerves (polplitic sciatic nerve external & internal). 40% Considerable loss of osseous substance from the thigh or both bones of the leg (incurable condition) 60% Loss of osseous substance of the knee pan with considerable separation of the fragments and considerable difficulty of movements in stretching the leg.. Loss of osseous substance of the knee-pan while the movements are preserved 20% Shortening of a leg by 6 cm or more. 30% Shortening of a leg by at least 3 cm but less than 6 cm. 20% Shortening of a leg by less than 3 cm.. 10% Total amputation of all the toes of one foot.. 25% Amputation of four toes including the big toe.. 20% Amputation of four toes excluding the big toe. 10% Anchylosis of the big toe. 10% Amputation of two toes 5% Amputation of one toe, other than the big toe.. 3% 40% Anchylosis of the fingers (other than thumb and forefinger) and of the toes (other than the big toe) shall only entitle to 50% of the compensation, which is due for the loss of the said members. If the Insured Person is left-handed and has specifically mentioned this on the proposal form the percentages set out above for the various disabilities of the right upper limb and left upper limb will be transposed. TEMPORARY TOTAL DISABILITY (ACCIDENT & SICKNESS) BENEFIT It is hereby declared that in the event of a member being totally unable to follow his normal occupation as a result of being continuously and totally disabled by reason of accident and or sickness the Company shall pay a benefit of 100% of the weekly pre-disability earnings of the Member for as long as such disability continuous. The payment of benefits shall not in any event continue for more than 52 consecutive weeks. Benefits provided that:- The policy is in force and the disabled life is a scheme member on the date of the event resulting in the claim. The accident occurs prior to the attainment by the Member of age 65. The disability results solely, directly and independently of all other causes from bodily injury affected through external, violent, visible and accidental means or from surgical operation necessarily consequent thereto, within 90 days of such accident. This endorsement is subject to the special conditions contained in the schedule of exclusions applying to ancillary benefits. - 7 -
SCHEDULE OF EXCLUSIONS Notwithstanding anything contained in any of the Endorsement attached to the Policy, no benefit will be payable under any of those Endorsements if the insured event as set out below occurs either directly or indirectly as a result of any of the following causes. 1. THE FOLLOWING EXCLUSIONS ARE APPLICABLE TO GROUP LIFE (DEATH ANY CAUSE BENEFIT) ONLY. Active participation in a war or in warlike operations Coverage does not cease when terrorist activity is involved as long as the insured staff member is not an active participant. Active Participant in warlike operations means an active member of the Military Forces e.g. Army, Navy, Air Force, Territorial Army or Police or any other special forces activated by Government or other public authorities to defend law and order in case of warlike operation, or any other person who takes up arms in an active or defensive role. Warlike Operations means hostilities, mutiny, riot, civil commotion, civil war, rebellion, revolution, insurrection, conspiracy, military or usurped power and martial law or state siege. 2. THE FOLLOWING EXCLUSIONS ARE APPLICABLE TO THE ACCIDENT DEATH BENEFITS (ADB) AS AN ADDITIONAL BENEFIT AND TO ALL PERSONAL ACCIDENT ANCILLARY DISABILITY BENEFITS ONLY WAR EXCLUSION CLAUSE 2.1. A WAR RISK EXCLUSION This policy does not insure against loss or damage (including Death or Injury) and any associated cost or expense resulting directly or indirectly from any of the following, regardless of any other cause or event contributing concurrently or in any other sequence thereto: 2.1.A.1 Hostile or warlike action in time of peace or war, including but not limited to action in hindering, combating, or defending against an actual, impending, or expected attack: i) By military, naval or air forces; or ii) By any government or sovereign power (de jure or de facto) or by any authority maintaining or using military, naval or air forces; or iii) By an agent of such government, power, authority or forces 2.1. A.2 Insurrection, rebellion, revolution, civil war, usurped power or action taken by governmental authority in hindering, combating or defending against any of these. 2.1. B DESTRUCTIVE AGENTS EXCLUSION This policy does not insure against loss or damage (including Death or Injury) and any associated cost or expense resulting directly or indirectly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event contributing concurrently or in any other sequence thereto. - 8 -
2.1. C. TERRORISM EXCLUSIONS This policy does not insure against loss or damage (including Death or Injury) any and associated cost or expense resulting directly or indirectly from an act or multiple or related acts of Terrorism, regardless of any other cause or event contributing concurrently or in any other sequence thereto. The term Terrorism as used herein, shall mean an activity that: 2.1. C.1 Involves a violent act and act dangerous to human life, tangible or intangible property or infrastructure, causing damage to property or injury to persons, or a threat thereof, and 2.1. C.2 Appears to be intended to: i. Intimidate, coerce or incite a civilian population; or ii. Inflict economic loss or disrupt any segment of a local, national or global economy; or iii. Influence or protest against the policy or conduct of a government by any means, including mass destruction, murder, kidnapping, hijacking, hostage-taking, intimidation or coercion. 3. ATTEMPTED SUICIDE OR SELF INFLICTED INJURY WHILST SANE OR INSANE 4. ANY BREACH OF THE LAW BY THE MEMBER OF ANY ASSAULT PROVOKED BY HIM 5. ACCIDENTS CAUSE BY THE USE OF INTOXICATING LIQUOR OR DRUGS, OTHER THAN DRUGS TAKEN IN ACCORDANCE WITH TREAMENT PRISCRIBED AND DIRECTED BY A QUALIFIED MEDICAL PRACTITIONER, BUT NOT FOR THE TREATMENT OF DRUG ADDICTION. 6. AVIATION, GLIDING OF ANY OTHER FORMS OF FLIGHT OTHER THAN AS A FARE PAYING PASSENGER OF A RECOGNIZED AIRLINE OR CHARTER SERVICE. 7. PARTICIPATION IN, OR TRAINING FOR, ANY HAZARDOUS SPOT OF COMPETITION OR RIDING OR DRIVING IN ANY FROM OF RACE OR COMPETITION EXCEPT IN THE CASE FOR LEISURE / PLEASURE 8. INVOLVEMENT IN ANY PROFESSIONAL UNDERWATER ACTIVITY. 9. INJURY CAUSED BY NUCLEAR FUSION, NUCLEAR FISSION OR RADIOACTIVE CONTAMINATION. 10. SERVING IN ANY CAPACITY FOR ANY NAVY ARMY OR AIR FORCE 11. MENTAL ILLNESS AND DISEASE 12. PREGNANCY, CHILDBIRTH OR ABORTION OR ANY COMPLICATION ARISING THERE FROM 13. ANY DESEASE OR MEDICAL IMPAIRMENT FROM WHICH THE INSURED WAS SUFFERING OR HAD A SERIOUS PAST HISTORY AT THE COMMEMCEMENT OF THE COVER OR HIS DATE OF ENTRY IF LATER, APPLICABLE FOR NEW JOINERS ONLY 14. INFECTION FROM ANY HUMAN IMMUNO- DEFICIENCY VIRUS (HIV), ACQUIRED IMMUNO-DEFICIENCY SYNDROME (AIDS) OR ANY AIDS-RELATED CONDITION - 9 -
DEFINITION In this policy the following words and phrases shall have the meanings hereby assigned to them. THE POLICYHOLDER Shall mean the policyholder described in the schedule or any assignees of the proposed under or by virtue of an assignment of which the Company shall have notice. A MEMBER Shall mean a regular full time, permanent employee of the proposed who is regularly working in an established job, position or office in a territory designated by the Employer and accepted by insurance company for inclusion in the scheme. GEOGRAPHICAL SCOPE OF COVER Worldwide, however applicable to members who are resident of UAE and GCC gulf countries or any other designated countries where the company has specifically accepted it. MAXIMUM INSURABLE AGE THE NORMAL INCLUSION DATE THE DATE OF ENTRY THE POLICY THE POLICYHOLDER 64 Years next birthday Shall mean the date on which the member is first included in the scheme Shall mean the date on which the Member is first included in the Scheme Shall mean policy number DL 00 together with the endorsement issued by the company for attachments hereto Shall mean the policyholder described in the schedule or any assignees of the proposed under or by virtue of an assignment of which the Company shall have notice. A MEMBER Shall mean a regular full time, permanent employee of the proposed who is regularly working in an established job, position or office in a territory designated by the Employer and accepted by insurance company for inclusion in the scheme. GEOGRAPHICAL SCOPE OF COVER Worldwide, however applicable to members who are resident of UAE and GCC gulf countries or any other designated countries where the - 10 -
company has specifically accepted it. MAXIMUM INSURABLE AGE THE NORMAL INCLUSION DATE THE DATE OF ENTRY THE POLICY 64 Years next birthday Shall mean the date on which the member is first included in the scheme Shall mean the date on which the Member is first included in the Scheme Shall mean policy number DL 00 together with the endorsement issued by the company for attachments hereto In this policy, where the context admits, words importing the masculine gender shall include the feminine gender and words importing the singular member shall include the plural and vice versa. - 11 -
POLICY CONDITIONS 1- FREE COVER LIMIT A Member shall be included in this policy from the commencement date or normal inclusion date if later, and increases in sum insured for an existing member shall be included from the date of increase without the provision of medical or other evidence of insurability being required provided that :- a. Any sum insured for any member in excess of AED 1,500,000 Only or in excess of the normal insurance benefit applicable to the member in accordance with the provision of the schedule, will be subject to medical Underwriting by the company to confirm acceptance or otherwise of the excess amount or the increased sum insured. b. If any Member is not actively at work on the normal inclusion date due to ill health the sum insured on his life will not come into force until he has returned to work and has been actively employed for a continuous (excluding period of normal leave) period of at least two weeks. Similarly, if an existing member is not actively at work on the day his sum insured is due to increase then such increases will not come into force until he has returned to work and has been actively employed for a period of at least two weeks, excluding period of normal leave. c. If, in respect of any member, the date of his entry is not the normal inclusion date, such member shall be included in the policy subject to acceptance by the company. Acceptance by the Company will be subject to the production to the Company of such evidence of Member s insurability as the Company may require 2- ADDITION OF NEW MEMBER Any Member not acceptable to the company for insurance on normal terms in respect of the whole or any part of the cover provided herein on his life may be included in this policy on such special terms as may be agreed between the policyholder and the company. All Employee additions and changes in beneficiary designation should be reported through Enrollment Forms 3- MISSTATMENT Evidence of age of a Member satisfactory to the company shall be required before any benefit in respect of him is paid under this policy and if after commencement of the cover provided hereunder the date of birth of a member proves to have been incorrectly notified to the company, the company shall notify the policyholder of the adjustments to be made under the policy in respect of such incorrect notification. In the case of a member whose age has been understated the company shall not be liable to pay any greater benefit under this policy in respect of him than that which would have been secured pro-rata by the premiums paid hereunder in respect of each benefit had his date of birth been correctly stated at the outset. In the event that the age of the member has been understated to the extent that it actually exceeds the maximum insurable age, then the company shall not be liable to pay any benefit hereunder. - 12 -
4- PREMIUM RATE On each scheme anniversary date an annual premium shall be calculated by the company in respect of the policy year commencing on that date by applying the rate of premium set out in the schedule to the total sums insured in respect of all members who are insured under the policy on that scheme anniversary. The total annual premium in respect of any scheme year shall be payable annually in advance on the scheme anniversary date. Notwithstanding the above the extra premium payable in respect of any member accepted by the company other than at standard rates shall be determined by the company. 5- PREMIUM PAYMENTS Premiums are payable by the policyholder annually in advance, either to the company, at issuing office, at its head office or to an authorized agent of the Insurance Company. The first Premium shall be payable on the effective date of the contract and subsequent premiums shall be due and payable on the premium due dates as specified on the schedule. 6- GRACE PERIOD a) The grace period of thirty-one days, following the premium due date shall be allowed to the policyholder for the payment of any premium after the first. If any premium remains unpaid at the end of the grace period, this contract shall automatically terminate at the expiration of the grace period, except that if the policyholder shall have given the insurance company written notice in advance of an earlier date of termination, this contract shall terminate as of such earlier date. The policyholder shall be liable to the insurance company for the premium for the time the contract was in force during the grace period. b) The insurance company reserves the right to terminate this contract on any premium due date when fewer than total number of employees then eligible for insurance are insured hereunder. If the insurance plan is non-contributory, or less than seventy-five percent of the total number of employees then eligible, the insurance company may at its discretion give the policyholder at least sixty days notice of its intent to terminate or re-costing of the scheme. c) This contract shall terminate automatically as of the date when the policy to which to his contract is attached is terminated. Similarly when an employee's insurance under the policy is terminated his insurance under this contract shall terminate automatically as of the same date. The policyholder shall then pay a proportion of premium to cover the period to date of cancellation. 7- DATA REQUIRED The policyholder shall keep a record of the member containing for each member the essential particulars of the insurance. All records of the policyholder as have any bearing whatsoever on the insurance shall be open for inception by the company at any reasonable time. The policyholder shall periodically forward to the company on forms specified by the company comprising the following information. a. Name of the members eligible for insurance b. Particulars of the members appointed c. Particulars of the members whose salary has been changed d. Particulars of the members attaining their 65 th next birthday e. Particulars of members granted leave without pay f. Particulars of members terminated/ resigned - 13 -
Clerical errors of a minor nature in keeping records shall not invalidate insurance otherwise validly in-force, nor continue insurance otherwise terminated, but upon discovery of such minor error an appropriate adjustment of premium shall be made 8- RATE GUARANTEED The annual premium payable specified in the schedule shall be applicable until the revision date. On each revision date the company shall advise the policyholder of the rate of premium to apply during the ensuing period of one year subject always to provision number 7 above. 9-ADJUSTMENTS OF SCHEME / CHANGES IN BENEFIT The company reserves the right to vary the terms and provisions of this policy on any revision date provided that an amendment may be made at any time, in the event of any or all of the following occurring. a. If there is a change in the basis used for calculating the benefits under the scheme. b. If there is a change in the eligibility conditions for entry into the scheme. c. If any additional company is admitted as an employer a company ceased to be an employer or there is a change of company acting as the principal employer. In the event of an increase of insured benefits or new entries during any one year, the corresponding additional premium will be payable as from the date of such increase or new entries. In the event of termination of service of the member, the company will reimburse a corresponding pro-rata premium if termination of service does not coincide with the scheme anniversary. 10- TERMINATION OF INDIVIDUAL EMPLOYEES INSURANCE The insurance cover on a member under this policy shall automatically terminate on the date on which: a. He ceases to be actively employed by the employer (which means being in receipt of a regular salary from the employer and carrying out normal duties). b. He ceases to be a member of the class of employees eligible for insurance under the policy. c. The policy terminates. d. The premium payments for this policy are discontinued. e. The employee reaches his 65 th next birthday. 11- CLAIM NOTIFICATION In the event of any claim arising under this policy or any of the endorsements attached hereto, it shall be notified to the company as soon as possible but in any event not more than 30 days after the occurrence of the incident giving rise to the claim, and such and supporting evidence as is relevant to the claim and as mentioned in the claims documentation / checklist condition. - 14 -
12- ARBITRATION CLAUSE If any difference or dispute of any kind whatsoever shall arise between the policyholder and the company in respect of this policy or in respect of any claim or of any matter or thing or liability arising or alleged to have arisen hereunder or otherwise connected herewith directly or indirectly, the same be referred to the decision of two Arbitrators, one to be chosen by the company and the other by the policyholder, with power to the said Arbitrators to appoint an Umpire. The costs connected with the Arbitration shall be at the discretion of the Arbitrators or Umpire, who shall also have the power to take evidence and compel production or exhibition of documents. The Award under this Arbitration shall be final and binding upon both parties. 13- CANCELLATION CLAUSE This policy may be cancelled at any time at the request of the policyholder by giving 30 days notice to the company and the premium hereon shall be adjusted on the basis of the company retaining the customary short term premium. The company may also cancel this policy by giving thirty days notice in writing to the policyholder at their last known address and the premium hereon shall be adjusted on the basis of the company retaining pro-rata premium. It is also agreed that in case of there being any claim reported and / or paid under this policy the policyholder will not have the option to seek cancellation of the policy. Notice of cancellation shall be deemed to be duly received at the end of seven days after posting if sent by pre-paid registered letter. 14- JURISDICTION AND CHANGE OF LAW This policy is subject to and shall be construed in accordance with the law of the United Arab Emirates. If, following to an amendment of the applicable law, which has come into force after the effective date of this insurance policy, a conflict has arisen with the conditions of this insurance policy, the company may at its option, re-negotiate the conditions of this insurance policy from the date such amendment of the law becomes effective. 15- CURRENCY All monetary amounts specified in this policy are expressed in Dirhams, referred to herein as U.A.E.Dirhams. 16- DUTIES Any levies on the insurance policy, tax or stamp duty shall be borne exclusively by the Policyholder. - 15 -
Claims Documentation / Check List Conditions All the claims documentation for the relevant Benefit should be supported by : I. Any official letter signed by the Policyholder intimating the claim II. Duly completed Claim Form A. DEATH DUE TO ANY CAUSE BENEFIT: i) Death occurring in UAE : Original or true copy of Death Certificate Passport Copy of deceased with valid visa page at the time of Death Wherever legally possible, a Post Mortem Report will be required, along with a Police Report if Death was due to an Accident A detailed Medical Report is to be submitted if the actual cause of Death is not clearly mentioned on the Death Certificate Any other documents pertaining to the claim which the Company may require ii) Death occurring outside UAE : The original or verified true copy of the Death Certificate must be submitted duly notarized and attested by the UAE Embassy of the country where death took place. Subsequently the same should be attested by the Embassy of the country in the UAE and Ministry of Foreign Affairs in UAE. Passport Copy of deceased with valid visa page at the time of Death Wherever legally possible, a Post Mortem Report will be required, along with a Police Report of Death was due to an Accident. A detailed Medical Report is to be submitted if the actual cause of Death is not clearly mentioned on the Death Certificate Any other documents pertaining to the claim which the Company may require. B. DISABILITY BENEFIT (Permanent Total and / or Partial Disability by Accident or Sickness) Original Full and complete Medical Report showing Diagnosis, Future Prognosis and specifying any percentage of disability from the treating Doctor or Hospital/Clinic Original Discharge summary if In-Hospitalization was involved from the treating Doctor or Hospital Original Copies of results of any diagnostic tests Any other documents pertaining to the claim which the Company may require. - 16 -
C. DISABILITY BENEFIT (Temporary Total Disability by Accident or Sickness): Original Full and complete Medical Report showing Diagnosis, Future Prognosis and specifying any percentage of disability from the treating Doctor or Hospital/Clinic Original Discharge summary if In-Hospitalization was involved from the treating Doctor or Hospital Original copies of results of any diagnostic tests Copy of the last 3 monthly salary slips Any other documents pertaining to the claim which the Company may require D. MEDICAL EXPENSES : Original Full and complete Medical Report showing Diagnosis, Future Prognosis and specifying any percentage of disability from the treating Doctor or Hospital / Clinic Original Discharge Summary if In-Hospitalization was involved from the treating Doctor or Hospital Original Copies of results of any diagnostic tests Original bills pertaining to the claim Any other documents pertaining to the claim which the Company may require E. REPATRIATION EXPENSES : Airway Bill & Payment Receipt of Freight Charges Receipts for Embalming Charges / Collection of Body from the Morgue / Coffin Charges etc Copy of ticket jacket of person accompanying the body Receipt for cost of the ticket issued for accompanying person Any other charges pertaining to the repatriation of the body to native or home country All the above documents will have to be verified and accepted by the Company. - 17 -