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Product Benefits Summary
- Upon death of the Insured Member during the coverage period due to Accidental causes, 100% of the Group Life Accident Protection sum assured will be payable to the beneficiary(ies).
- In case the Insured Member suffers from dismemberment, loss of eyesight, hearing, or speech, the percentage (1) of the sum assured will be payable.
- In case the Insured Member becomes totally and permanently disabled due to accidental cause, the Company will pay compensation of 100% of the sum assured to the Insured Member.
Product Features Summary
| Insured’s age | From 15 to 70 years old |
| Sum assured | From $3,000 |
| Policy term | 1 year |
| Premium payment term | 1 year |
| Premium payment mode | Annually, semi-annually, quarterly and monthly |
Remarks
(1) Detail of the percentage is set out in the Terms and Conditions.
Product Detail
Part 1: Definitions
“Company” means Sovannaphum Life Assurance Plc. (Life Insurance Company)
“Policy” means life insurance policy which is a legal binding document issued by the Company stipulating major substance and detailed terms and conditions that are agreed between the Company, Policyholder and the Insured Member in the Insurance Contract.
“Insurance Contract” means the written agreement between the Company, Policyholder and the Insured Member which the Company agrees to accept any specific risk, and in return receives premium paid by the Policyholder and/or Insured Member. The Insurance Contract consists of the Policy, Life Insurance Certificate, riders, attachments, additional statement, endorsements, or requests for any changes by the Policyholder and/or Insured Member approved and signed by the Company, Insurance Application Form, a health report by physicians and health declaration, which all these documents are considered as the Insurance Contract between the Policyholder, Insured Member and the Company.
“Policy Schedule” means the schedule showing details of the Policy issued by the Company to accompany this Policy and is considered as part of this agreement.
“Policy Effective Date” means the date when the Insurance Contract begins.
“Policy Anniversary” means period of one year beginning from the Policy Effective Date or the date, otherwise specified in the Policy Schedule.
“Policy Year” means each period of one year beginning with the Policy Effective Date or subsequent Policy Anniversary.
“Members” means the persons defined in the Policy Schedule attached hereto.
“Eligible Member” means Members who, having completed the required waiting period (if any) and having all the qualifications as specified in the Policy Schedule attached hereto, are entitled to participate in the insurance plan under this Policy.
“Insured Members” means Eligible Members who, in accordance with the provisions of Part 3 Participation, are participating in the insurance plan under this Policy.
“Entry Date” means the date an Eligible Member become the Insured Members under this Policy.
“Loss of Eyesight” means complete blindness that cannot be cured.
“Dismemberment” means a loss of limb from wrist or ankle, including a complete loss of capability of such member with a medical indication that it would not be recovered.
“Accident” means sudden event caused by external factors with a result that is not the intention or determination of the Insured Member.
“Total Permanent Disability (TPD)” means the Insured Member suffers from complete loss or permanent paralysis and permanently irrecoverable of:
• Two arms; or
• Two legs; or
• One arm and one leg; or
• Two eyes; or
• One eye and one arm; or
• One leg and one eye.
In this definition, complete loss and permanently irrecoverable of (i) eye(s) means physical loss of eyes or complete blindness, (ii) arm(s) means loss above the wrist, and (iii) leg(s) means loss above the ankle.
In case of permanent paralysis, the Total and Permanent Disability condition must be certified by a registered hospital at provincial level or above no sooner than 180 days and not later than 270 days from the occurrence of the accident or the date the paralysis condition is verified.
In case of complete loss of arm(s) or leg(s) or eye(s), such certification could be carried out at any time.
Part 2: Benefit Provisions
1. Coverage
The Group Life Accident Protection covers Losses or Damages incurred from a bodily injury of the Insured Member arising from accident and leads the Insured Member’s death, Dismemberment, Loss of eyesight, hearing or speech, or Total Permanent Disability (TPD) within 180 days from the date of accident or such injury causes the Insured Member to be hospitalized consecutively as an inpatient of hospital, infirmary or dies due to such injury. If the Company receives sufficient evidence for claim assessment, to its reasonable satisfaction, in compliance with the format and method stipulated by the Company, the Company will pay compensation in accordance with the following items:
1.1 Accidental Death
Upon death of the Insured Member during the coverage period due to Accidental causes, 100% of the Group Life Accident Protection sum assured of that Insured Member will be payable to the beneficiary (ies).
1.2 Dismemberment or Loss of Eyesight, Hearing or Speech
Upon Dismemberment, or Loss of Eyesight, Hearing or Speech arising from the accident, the Company will pay compensation to the Insured Member as follows:
| Item | Percentage of Personal Accident Protection Rider Sum Assured | Description |
|---|---|---|
| 1.2.1 | 100% | In case of loss of both hands from the wrist joint or both feet from the ankle joint or sight of both eyes. |
| 1.2.2 | 100% | In case of loss of one hand from the wrist joint and one foot from the ankle joint. |
| 1.2.3 | 100% | In case of loss of one hand from the wrist joint and sight of one eye. |
| 1.2.4 | 100% | In case of loss of one foot from the ankle joint and sight of one eye. |
| 1.2.5 | 60% | In case of loss of one hand from the wrist joint. |
| 1.2.6 | 60% | In case of loss of one foot from the ankle joint. |
| 1.2.7 | 60% | In case of loss of sight of one eye. |
| 1.2.8 | 50% | In case of total and permanent loss of hearing (of both ears) or speech. |
| 1.2.9 | 15% | In case of total and permanent loss of hearing in one ear. |
| 1.2.10 | 25% | In case of total and permanent loss of a thumb (Both joints). |
| 1.2.11 | 10% | In case of total and permanent loss of a thumb (One joint). |
| 1.2.12 | 10% | In case of total and permanent loss of an index finger (three joints). |
| 1.2.13 | 8% | In case of total and permanent loss of an index finger (two joints). |
| 1.2.14 | 4% | In case of for total and permanent loss of an index finger (one joint). |
| 1.2.15 | 5% | In case of total and permanent loss of other fingers (not less than two joints) beside thumb and index finger. |
| 1.2.16 | 5% | In case of total and permanent loss of big toe. |
| 1.2.17 | 1% | In case of total and permanent loss of other toes (not less than one joint) beside big toe. |
The Company shall indemnify only one of the above items of the highest amount, unless in case of complete loss of finger or toe as indicated from item 1.2.10 to 1.2.17 and could not claim for any items from 1.2.1 to 1.2.7. In such later case, the Company shall indemnify the actual loss incurred for each item to the Insured Member, but not over the sum assured of that Insured Member which the Company covers as stated in the Policy Schedule.
1.3 Total Permanent Disability (TPD)
In case the Insured Member becomes totally and permanently disabled due to accidental cause, where the Total Permanent Disability is certified by a registered hospital at provincial or above no sooner than 180 days and not later than 270 days from the occurrence of the accident or the date the paralysis condition is verified, the Company will pay compensation to the Insured Member based on the sum assured of that Insured Member as stated in the Policy Schedule. In case of complete loss of arm(s) or leg(s) or eye(s), such certification could be carried out at any time.
1.4 Free Cover Limit
Amount of the sum assured in excess of the Free Cover Limit as stated in the Policy Schedule or as re-determined at any Policy Anniversary may be accepted. The Company reserves the right to require evidence of insurability, and the right to decline or stipulate conditions, for accepting any increase in amount of sum assured which is in excess of the Free Cover Limit. In the absence of evidence of insurability satisfactory to the Company, the amount of sum assured shall be limited to the Fee Cover Limit.
Part 3: Participation and Termination
1. Participation
1.1 All Eligible Members being covered under this Policy shall have all the Qualifications as specified in the Policy Schedule.
1.2 All Eligible Members on the Policy Effective Date shall be eligible for insurance under this Policy on the Policy Effective Date.
1.3 Additional requirement for the participation of all Eligible Member under Group Employee benefit:
1.3.1 All Eligible Members (employers and employees) have to be under the National Social Security Fund (NSSF).
1.3.2 All Eligible Members (employers and employees) must be actively-at-work and in good health before they are qualified to participate.
1.3.3 Any Eligible Member (employer and employee) who is not actively-at-work on the date s/he would otherwise become eligible for participation hereunder shall not eligible until s/he returns to active service and in good health.
1.4 Members not eligible as of the Policy Effective Date and new Members shall become eligible for participation hereunder on the day following the completion of the required Waiting Period and having all the Qualifications as specified in the Policy Schedule.
1.5 The Insured Member, whose insurance has been previously canceled, re-enrolling for membership shall be treated as a new member.
1.6 Every Member who fulfills the conditions necessary to participate as set forth in paragraphs 1.1 to 1.5 above must use their right within the Eligible Period as specified in the Policy Schedule from the date on which s/he becomes eligible. Otherwise, s/he shall be able to start participation only after s/he shall have furnished, at his/her own expense, evidence of his/her insurability satisfactory to the Company.
1.7 Each Eligible Member shall be insured hereunder on the first day on which s/he becomes eligible provided the condition set forth in paragraph 1.6 of this Section has been satisfied and the duly completed enrollment form is received, unless agreed otherwise, and coverage confirmed by the Company.
2. Member/Policy Termination
The coverage under this policy shall be terminated upon one of the following incurrence, whichever incurs first:
1. When this policy is no longer in force; or
2. When the Insured Member is jailed or imprisoned. The Company will refund the premium to the Policyholder; or
3. If there is no premium payment of this policy within the grace period of 31 days; or
4. When the Policyholder or the Company cancel this policy; or
5. When the benefit under this policy is paid except coverage in Part 2: 1.2.8 -1.2.17; or
6. When the total accumulated benefits paid for coverage in Part 2: 1.2.8 to 1.2.17 equal to the sum assured of this Policy; or
7. On the Policy Anniversary date of this Policy, which is applicable only to the Insured Member who attains the age of 71 years old.
The termination of this policy has no effect to any claim rights existing prior to such termination. If the Company receives any premium after the day of termination; it would not bind the Company to any liabilities but to refund such premium.
Part 4: General Provisions
1. Entirety of Insurance Contract
This Insurance Contract is based on the Company’s belief in the truth and accuracy of the Policyholder’s and Insured Member’s statement in the Group Insurance Application Form for the Policyholder, Insurance Application Form for the Insured Member, health declaration and any other additional declarations signed by the Insured Member; and that the premium has been duly paid in full. On this belief, the Company hereby enters into the Insurance Contract and issues the Policy.
In case that the Policyholder and/or the Insured Member knowingly misrepresents any statement or has known of or should have known of any material facts but fails to disclose any such fact to the Company which might cause any change to the subject to be insured, the Company reserves the right to charge extra premium or refuse to enter into the Insurance Contract. Any such misrepresentation or failure to disclose material facts to the Company shall render this Insurance Contract voidable. In such a case, the Company may void the contract and deny to pay a contractual claim.
The Company shall not deny any liabilities by relying on any statement other than that made by the Policyholder and/or Insured Member in the document stated under the first paragraph of Entirety of Insurance Contract clause in part 4.
A life insurance agent or broker has no power to correct or amend this insurance policy, or to extend premium payment anniversary date or to disclaim the submission of notice or evidence for claim processing according to the requirements of this Policy. Any amendment to this Policy shall be complete only after the Company accepts such amendment and issues its endorsement.
2. Applicable Law
This policy will be governed by and construed according to the laws of the Kingdom of Cambodia.
3. Currency
It is described under “Currency” in the Policy Schedule.
4. Incontestability of Insurance Contract
Unless stated as otherwise in this Policy, when the policy is in force, the Company shall not contest the entirety of the Insurance Contract after it has been in force for two years from the Policy Effective Date, except the Policyholder has no insurable interest in such insurance.
The Company shall not contest the insurance of any Insured Member after it has been in force for two years from the Enrollment Date, except the misstatement of age or gender of the Insured Member as to be outside the normal limit of business of the Company.
5. Insurance Application Form
The Policyholder shall submit an Insurance Application Form for Eligible Members applicants to the Company by using of the prescribed Company’s form.
6. Group Insurance Certificate
The Company shall issue the Group Insurance Certificate to each Insured Member to certify that such individual is entitled to receive coverage under this Policy.
7. Required Information
7.1 The Policyholder shall keep all documents related to each Insured Member under this Insurance Contract, filed by each individual. The document shall identify the Insured Member’s name, gender, age and date of birth, sum assured, policy effective date, policy expiry date, beneficiary and other details as necessary to act in compliance with the law, and conditions under this Insurance Contract.
7.2 The Policyholder shall submit documents and proofs related to the Policy to the Company as required by law or reasonably requested by the Company. The Policyholder shall allow the Company to inspect all documents relating to this Policy that were sent by any persons to the Policyholder, including the Company’s inspection of such documents as deemed appropriate.
8. Premium Rate
The Company shall have the right to change the rate at which the premiums shall be calculated:
8.1 On any Policy Anniversary, or
8.2 The date on which conditions, classification, number of Insured Members, sum assured, or risks is changed substantially from the original, and the Company notifies the Policyholder at least 31 days in advance.
In any event, the Company shall issue to the Policyholder the endorsement notifying such change.
9. Premium Adjustments
Premium adjustments (if any) shall be made on the Premium Due Date unless provided otherwise.
10. Premiums Payments
Premiums are payable by the Policyholder and/or Insured Member in accordance with the Mode of Payment as specified in the Policy Schedule, in advance or on the Premium Due Date, either at the Company’s Headquarters or at the Branch of the company or to an authorized agent of the Company.
The first premium shall be payable at the Policy Effective Date and subsequent premiums shall be due and payable on the Premium Due Dates determined by the Policy Schedule. The Company shall issue an official receipt for the payment of the premium.
If the Company allows to change the payment of premium by an installment less than a year, the amount of the premium of the Insured Member who was dead, to be paid to the Company and not yet completed a year shall be an indebtedness which the Company shall deduct it against the proceed under the Policy.
11. Grace Period
A grace period of thirty one (31) days following the Premium Due Date shall be allowed for the payment of any premium and not yet paid by the Policyholder, during which period this Policy shall remain in force. If any premium is not paid before the expiration of the grace period, this Policy shall automatically terminate on the day following the expiration of the grace period unless the Policyholder provides written notification in advance to terminate the Policy before such date. The Policyholder shall be liable to the Company for the premium for the time the Policy was in force during the grace period.
12. Renewal Policy
This Policy is issued for the term of one year and can be renewed at the end of each Policy Year that the Company issues an official receipt for the payment of the premium due on the following Policy Anniversary, to be paid by the Policyholder on that date.
13. Notification of Death
Upon the Insured Member’s death, the Policyholder or Insured Member’s beneficiary must notify the Company within thirty (30) days from the date of the Insured Member’s death, unless it can be proved that there is a reasonable cause for any delay in notifying the death, or they are not aware of the existence of this policy. In such case, the Company must be notified within thirty (30) days from the day the Beneficiary becomes aware of the existence of the policy.
The Policyholder or Insured Member’s beneficiary shall provide an official death report or an official evidence signifying the death of the Insured Member to the Company, and upon the Company’s reasonable request, the Beneficiary shall provide any additional documents to the Company at the Policyholder or the beneficiary’s own expense.
The Policyholder or Insured Member’s beneficiary shall consent and cooperate for the autopsy of the Insured Member when the Company deems it necessary, in compliance with the law and with respect to any applicable religious code.
The Company shall be liable as bound by this policy when the Policyholder or the Insured Member’s beneficiary act in compliance with the requirement(s) hereof.
14. Notification of Total Permanent Disability (TPD), Dismemberment, or Loss of Eyesight, Hearing or Speech
When there is a claim made upon the incurrence of Total Permanent Disability (TPD), dismemberment, or loss of eyesight, hearing or speech, the Policyholder or Insured Member must notify the Company within thirty (30) days after the day that the disability is diagnosed or the occurrence of the accident and submit the proof of physician’s diagnosis and additional proofs as required by the Company as necessary on their own expenses unless there is a proof that the Insured Member has other significant and acceptable reason for the absence but had informed the Company as soon as possible.
The Company has a right to request bodily examination of the Insured Member as it deems appropriate, during the claim underwriting process.
15. Required Documents for Claim
a. In case of death caused by accident
1. Completed Death Claim Form
2. Group Insurance Certificate (original copy) (if any)
3. Certified copies of Beneficiary’s or heir(s) ID card and family book and also along with the real ones
4. Certified copy of certificate of death and also along with the real one
5. The consent letter of Beneficiary or heir(s) to disclose personal data
6. Medical report from doctor in case of death in the registered hospital or registered clinic
7. Certified copy of daily record related to the case which is certified by detector
8. Certified copy of Autopsy examination report
b. In case of Total Permanent Disability (TPD), Dismemberment or Loss of Eyesight, Hearing, or Speech
1. Completed Claim Request Form of Total Permanent Disability (TPD)
2. Completed claim form for Injury/Illness
3. Physician report as determined by the Company
4. Group Insurance Certificate (original copy) (if any)
5. Certified copy of Insured Member’s ID card and also along with the real one
16. Beneficiaries
16.1 Each Insured Member shall designate to the Company a beneficiary or beneficiaries to whom the benefits under this Policy shall be payable in the event of death. If the Insured Member is dead, the Company shall pay the benefits in accordance with the terms of this Policy. If such beneficiary or beneficiaries predecease or decease simultaneously with such Insured Member and the Insured Member has not showed an intention to change the beneficiary, the benefits shall be payable to the heir(s) of the Insured Member. But if there are many beneficiaries and some of them predecease or decease simultaneously with the Insured Member, the benefits shall be payable to the beneficiaries who are alive by equals or by proportions as provided by the Insured Member in his enrollment form.
16.2 The Insured Member shall be entitled to change the beneficiary by providing written notice to the Company, such change shall take effect on receipt of such notice and be accepted by the Company.
17. Misstatement
17.1 If the age or date of birth or other relevant facts relating to an Insured Member shall be found to have been misstated and if such misstatement affects the scale of benefits or has anything to do with the terms and conditions of this Policy, the true age and facts shall be used in determining whether insurance is in force under the terms of this Policy and the benefits payable therefrom; and an equitable adjustment of premiums shall be made.
17.2 Where a misstatement of age has caused the Insured Member to be insured hereunder when he is otherwise ineligible for any insurance, or when he would otherwise be disqualified from the insurance, the Company shall return premiums paid in respect of such Insured Member.
18. Intentionally Killed by Beneficiary
If the beneficiary intentionally killed the Insured Member, the Company is bound only to return premiums paid of that Policy Year in respect of such Insured Member to the Company.
If there are more than one beneficiary, the Company may pay the proportional proceed to the beneficiary or beneficiaries who not taking part in intentionally killing the Insured Member, after deduct the proportion of the one who kills the Insured Member is entitled to receive. The Company shall not return all premiums in connection with this proportion.
19. Fraud
If any claim under this policy is in any respect fraudulent or if any fraudulent means or devices shall be used to obtain the benefit under this policy, the Company shall have no liability in respect of such claim.
20. Cancellation
The Company may cancel this policy by advance notice in writing of not less than 30 days, if it shows obvious evidence that the Policyholder or the Insured Member conducts fraud to make use of the benefits under this policy either for the Insured Member or others. In this case, the Company shall return premium to the Policyholder only for the part of coverage that has not been provided.
The Policyholder must give a written notice 10 days prior to the cancellation date specified in the letter to the Company if the Policyholder wishes to cancel this policy before expiry date. The cancellation will be effective on the date specified in the letter. Based on reasonable grounds, the Company will refund the premium to the Policyholder only for the part of coverage that has not been provided.
21. Change of Occupation
The Policyholder shall provide written notice immediately to the Company of any change in the Insured Member’s occupation and shall pay additional premium if required.
In case that the Policyholder does not notify the Company about the change of Insured Member’s occupation, if the Insured Member sustains injury while in the course of employment for compensation in an occupation that is more hazardous than the occupation originally stated, the Company shall pay compensation in the amount that the premium paid for the original occupation would have purchased for the new occupation. If the Insured Member changes occupation to one which the Company classifies as less hazardous, the Company shall reduce the rate of premium and shall return a proportion part of the premium from the date of change after receipt of proof of change.
22. Dispute Resolution
In the event of any dispute arising from the Insurance Contract, such dispute shall to be settled amicably between the parties to the dispute based on peaceful negotiation and reconciliation between the disputing parties. If such reconciliation fails to settle the dispute, the dispute parties may bring the case to MEF for mediation before filing a lawsuit to arbitration or a competent court.
23. Exclusions
This SMILE Group Life Accident Protection policy shall not provide coverage for the death, dismemberment, loss of eyesight or ability to hear or speak, or total permanent disability due to the accident as a result of the following situations:
a. Suicide or attempted suicide, self-inflicted injury, whether sane or insane within two years after this Policy Effective Date or the effective date of any reinstatement of this Policy , whichever is later; or
b. Committing or attempting to commit by the Insured Member or the Beneficiary a criminal offence; or
c. Miscarriage, pregnancy, birth-giving or pregnancy complications; or
d. Using drugs or stimulators, abusively using alcohol or driving vehicle under the influence of alcohol as defined in the current laws and regulations; or
e. Any form of mental or psychiatric disorder; or
f. Injuries are caused by insect bites including but not limited to mosquito bites and bee stings; or
g. Bacterial infection except infection or tetanus or rabies as a result of accidental wound; or
h. Participation in dangerous sports or activities such as (not limited to all these descriptions) diving in the water, climbing a mountain, parachute; or
i. Racing of all kinds, other than those on foot or bicycle and participation in professional or competitive sports where the Insured Member would or could earn financial gain in engaging in such sports; or
j. Being in an aircraft of any type, or boarding or descending from any aircraft, except as a fare-paying passenger in an aircraft that is on a regular scheduled route operated by a commercial airline; or
k. While the Insured Member is piloting or operating as a crew member in any aircraft; or
l. War, either declared or not, invasion or act of foreign enemy, civil war, revolution, rebellion, riot, terrorism; or
m. While the Insured Member is serving as a soldier, police or volunteer in a war or suppression; or
n. While the Insured Member is engaging in a brawl or taking part in inciting a brawl; or
o. Radiation or radio activity from any nuclear fuel arising from the combustion of nuclear fuel and self-sustaining process of nuclear fission.