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Product Benefits Summary
- Receive 100% of the sum assured of rider in case of death caused by accident; or
- Receive 100% of the sum assured of rider in case of total and permanent disability (TPD) caused by accident; or
- Receive up to 100% of the sum assured of rider in case of dismemberment, loss of sight, hearing or speech caused by accident.
Product Features Summary
| Insured’s age | From 18 to 60 years old |
| Expired age | 70 years old |
| Sum assured | From $3,000 |
| Policy term | 1 year renewable till reach age 69 or up to base policy’s term |
| Premium payment term | Equal to policy term |
| Premium payment mode | Annually, semi-annually, quarterly and monthly |
Product Detail
SMILE Life Accident Protection Rider is a rider that is attached to the base policy. If there are any conflicts between the base policy and this rider, the contents in this rider shall prevail.
1. Definition
“Company” refers to Sovannaphum Life Assurance Plc. (Life Insurance Company)
“Injury” refers to any physical injury directly caused by an accident and is separated and independent of other causes.
“Policy Effective Date” refers to the date when the insurance contract begins.
“Insurance Contract” refers to a written agreement between the Company and the insured in which the Company agrees to accept any specific risk, and in return receives premium paid by the insured. The insurance contract consists of the policy, life insurance certificate, riders (if any), attachments, additional statement, endorsements, or requests for any changes by the insured approved and signed by the Company, insurance application form, health report by physician and health declaration, which all these documents are considered as the insurance contract between the insured and the Company.
“Policy Anniversary” refers to the anniversary of the policy effective date, or the date the policy is renewed or the date otherwise specified in the life insurance certificate.
“Accident” refers to any sudden event caused by external , which is not illness, with a result that is not the intention or determination of the insured. Suicide, whether sane or insane, is not considered as an accident.
“Policy Year” refers to each period of 1 year after the policy becomes effective or from the anniversary date of the renewed policy years.
“Policy” refers to a life insurance policy which is a legally binding document issued by the Company stipulating major substance and detailed terms and conditions that are agreed between the Company and the insured in the insurance contract.
“Loss of Eyesight” refers to physical loss of eye or complete blindness that cannot be cured.
“Dismemberment” refers to a loss of limb from wrist or ankle, including a complete loss of capability of such member with medical indication that it would not be recovered.
“Premium” refers to the amount paid by an insured to the Company as consideration for the obligations assumed by the Company.
“Total Permanent Disability (TPD)” refers to the insured suffers from complete loss, 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 eye(s) 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.
“Hospital” refers to a legally constituted establishment which operates pursuant to the laws of the country in which it is based and registered as hospital and which:
1. can provide care and treatment of sick and injured persons on a resident inpatient basis;
2. has facilities for diagnosis, treatment and major surgery;
3. can provide full time nursing service;
4. is under the supervision of a registered practitioner;
5. is not primarily a clinic, a place for custodial care of the aged, persons with mental disorders, alcoholics or drug addicts, a nursing, rest or convalescent home.
“Life Insurance Certificate” refers to a document issued by the Company to certify the fact that an insured has purchased insurance from the Company.
“Insured” refers to the person identified as insured in the life insurance certificate or attachment, who would be covered under insurance contract.
“Beneficiary” refers to a person who is stated in the insurance application form by the insured to be a beneficiary, according to the insurance contract, and who would receive the benefits due under this policy upon the death of insured.
2. Subject Matter Insured
The subject matter to be insured under this rider are the insured’s body and life.
3. Scope of Coverage
SMILE Life Accident Protection Rider covers damages incurred from accident that leads to insured’s death; total and permanent disability (TPD); or dismemberment or loss of sight, hearing or speech.
4. Insurance Benefit
In case the insured dies; or suffers from total and permanent disability; or dismemberment or loss of sight, hearing or speech due to accident, the Company shall indemnify as follows:
a. Death
b. Total and Permanent Disability
c. Dismemberment, Loss of Sight, Hearing or Speech
4.1 Death Benefit Due to Accident
During the policy coverage term, the beneficiary (ies) will receive 100% of sum assured as stated in the Benefit Table point (a) in case the insured’s death caused by accident.
4.2 Total and Permanent Disability (TPD) Benefit Due to Accident
During the policy coverage term, the insured will receive 100% of sum assured as stated in the Benefit Table point (b) in case the insured suffers from total and permanent disability due to accident.
4.3 Dismemberment, Loss of Sight, Hearing or Speech Benefit Due to Accident
In case the insured suffers from dismemberment, loss of sight, hearing or speech caused by accident during the policy coverage term, the Company will pay compensation to the insured as shown in the following table:
| Item | Percentage of Personal Accident Protection Rider Sum Assured | Description |
|---|---|---|
| 4.3.1 | 100% | In case of total and permanent loss of both hands from the wrist joint or both feet from ankle joint or sight of both eyes |
| 4.3.2 | 100% | In case of total and permanent loss of one hand from the wrist joint and one foot from the ankle joint |
| 4.3.3 | 100% | In case of total and permanent loss of one hand from the wrist joint and sight of one eye |
| 4.3.4 | 100% | In case of total and permanent loss of one foot from the ankle joint and sight of one eye |
| 4.3.5 | 60% | In case of total and permanent loss of one hand from the wrist joint |
| 4.3.6 | 60% | In case of total and permanent loss of one foot from the ankle joint |
| 4.3.7 | 60% | In case of total and permanent loss of sight of one eye |
| 4.3.8 | 50% | In case of total and permanent loss of hearing or speech |
| 4.3.9 | 15% | In case of total and permanent loss of hearing in one ear |
| 4.3.10 | 25% | In case of total and permanent loss of a thumb (both joints) |
| 4.3.11 | 10% | In case of total and permanent loss of a thumb (one joint) |
| 4.3.12 | 10% | In case of total and permanent loss of an index finger (three joints) |
| 4.3.13 | 8% | In case of total and permanent loss of an index finger (two joints) |
| 4.3.14 | 4% | In case of total and permanent loss of an index finger (one joint) |
| 4.3.15 | 5% | In case of total and permanent loss of other fingers (not less than two joints) beside thumb or index finger |
| 4.3.16 | 5% | In case of total and permanent loss of big toe |
| 4.3.17 | 1% | In case of total and permanent loss of a toe (not less than one joint) beside big toe |
In case the insured is eligible for any items in 4.3.1 to 4.3.7, the Company shall indemnify only one of the highest amount, and the policy of this rider shall be terminated.
In case the insured is eligible for any items in 4.3.8 to 4.3.17 but not any items in 4.3.1 to 4.3.7, the Company shall indemnify the actual loss incurred for each item to the insured but not over than 100% of the sum assured as stated in the Benefit Table point (c).
In case the insured has claimed the benefits under point 4.3 (Dismemberment, Loss of Sight, Hearing or Speech Benefit Due to Accident), and the insured dies thereafter due to accident during the policy coverage term, the Company shall indemnify by deducting the amount that the insured has received.
5. Premium Payment
5.1 Premium Payment Method
The premium must be paid before, or on the due date on an annual, semi-annual, quarterly or monthly basis, at the Company’s Head Office or a branch of the Company or to the agent authorized in writing by the Company or other payment modes according to an agreement between the insured and the Company.
In case where the Company leniently allows the premium to be paid on the premium payment mode except annually, the portion of premium not yet paid to the Company, shall be a debt for which the Company will be entitled to deduct from the benefit payable under the policy in the event this policy is terminated as stated in point 11.2.
The insured can change the mode of payment by submitting a request for the change of the mode of premium payment in writing to the Company. The change will be effective when the Company approves such request.
The payment of premium shall be paid in cash. Any payments of the premium made by a promissory note, cheque, draft, or by any other means, will be regarded as payment being made only when such instrument has been cashed.
5.2 Initial Premium
The coverage shall become effective only after the initial premium has been paid and the Company has approved to issue the policy.
5.3 Renewal Premium
Renewal premium will be adjusted in each policy year according to the attained age of the insured.
The Company shall send the notification to the insured not less than 30 days before the end of the policy term. The renewal premium must be paid within the grace period (31 days) at the latest.
5.4 Grace Period
If the insured fails to pay the premium when it falls due, the Company will leniently allow a grace period of 31 days from the due date. During the grace period, the policy is still in force. If the insured dies or gets Total Permanent Disability; or dismemberment or loss of sight, hearing or speech during the grace period, the Company will deduct the outstanding premium in that policy year from the amount which the Company will pay under this policy without interest.
If the insured fails to pay the premium by the end of the grace period, the automatic premium loan from the surrender value (if any) of the base policy is not applicable to this rider.
6. Exclusions
Death, Total and Permanent Disability (TPD), Dismemberment, Loss of Sight, Hearing or Speech claim results, directly or indirectly, from any of the followings shall be excluded:
a. Suicide or attempted suicide, intentional self-inflicted injury, whether sane or insane; or
b. Committing or attempting to commit by the Insured or the beneficiary a criminal offence; or
c. Abortion
d. Miscarriage, Pregnancy or birth-giving or their complications, except the case is caused by accident; or
e. Using drugs or stimulators, abusively using alcohol or driving vehicle under the influence of alcohol as defined in the current laws and regulations; or
f. All forms of mental or psychiatric disorder; or
g. Injuries caused by insect bites including but not limited to mosquito bites and bee stings; or
h. Bacterial infection except infection or tetanus or rabies as a result of accidental wound; or
i. Participation in dangerous sports or activities including but not limited to diving in the water, climbing a mountain, parachute; or
j. Racing of all kinds, other than those on foot or bicycle and participation in professional or competitive sports where the insured would or could earn financial gain in engaging in such sports; or
k. 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
l. While the insured is piloting or operating as a crew member in any aircraft; or
m. War, either declared or not, invasion or act of foreign enemy, civil war, revolution, rebellion, riot, terrorism; or
n. While the insured is serving as a soldier, police or volunteer in a war or suppression; or
o. While the insured is engaging in a brawl or taking part in inciting a brawl; or
p. Radiation or radio activity from any nuclear fuel arising from the combustion of nuclear fuel and self-sustaining process of nuclear fission.
7. Insurance Coverage Area
The Company provides global coverage to the insured.
8. Qualification of Beneficiary
8.1 Beneficiary Under the Insurance Contract
Same as the base policy.
8.2 Change of Beneficiary
Same as the base policy.
9. Amendment of Insurance Contract
9.1 Change of Occupation
The insured shall provide written notice immediately to the Company of any change in the insured’s occupation and shall pay additional premium if required.
In case the insured fails to notify the Company about the change of insured’s occupation, and if the insured sustains injury or suffers from accident while in the course of employment in an occupation that is more hazardous than the occupation originally stated, the Company shall pay benefit in the amount that the premium, paid for the coverage with the original occupation, would have purchased for the coverage with the new occupation. If the insured changes occupation to one which the Company classifies as less hazardous, the Company shall reduce the rate of premium accordingly (if any) and shall return a proportion part of the premium from the date of change after receipt of proof of change.
9.2 Change of Other Information of Insured
In case other information of insured contained in the insurance application and other document changed, the insured shall notify the Company of the change with the acceptable reason. The change shall be effective after the Company approves the change.
10. Renewal of Insurance Contract
10.1 Renewal Privilege
The insured can renew the policy at the policy anniversary until the year s/he reaches the age of 69 or up to policy term of base policy, whichever expires first.
10.2 Reinstatement
In case this rider is terminated because the base policy is terminated, the insured could reinstate this rider upon the reinstatement of the base policy with the proof that insured is in good health and insurable condition.
In case this rider is terminated because there is no premium payment of this rider within the grace period of 31 days after the payment due date, the insured could reinstate this rider with the proof that insured is in good health and insurable condition.
However, the Company reserve the right to approve or deny the reinstatement proposal.
11. Termination of Insurance Contract
The coverage under this rider shall be terminated upon one of the following incurrence:
1. When the base policy that this Rider is attached to is no longer in force; or
2. When the benefit under this rider was paid (except coverage 4.3: 4.3.8 – 4.3.17); or
3. If there is no premium payment of this rider within the grace period of 31 days after the premium payment due date; or
4. When the insured attains the age 70 years old, this rider shall be terminated on the policy anniversary date of this rider.
The termination of this rider shall have no effect to any claim rights existing prior to such termination. If the Company receives any premium after the day of termination; it does not bind the Company to any liability but refund such premium without interest.
12. Cancellation of Insurance Contract
The Company may cancel this rider by advance notice in writing of not less than 30-day if it has obvious evidence that the insured or beneficiary conducts intentional fraud to make use of the benefits under this rider either for the insured or others. In such event, the Company will refund 90% of premium for the remaining period to the insured. In this case, the company may cancel the base policy, which this rider is attached to. In such event, the cancellation of the base policy shall be applied as stated in the policy wording of the base policy.
The insured shall give 10-day written notice to the Company in advance if the insured wishes to cancel the rider before expiry date. Based on reasonable grounds, the Company will refund 90% of premium for the remaining period to the insured.
13. Claim
13.1 Qualification of Claimants
The claimant can be insured, beneficiary or legal representative.
13.2 Claim Procedure
13.2.1 Notification of Death and Autopsy
Upon the insured’s death, the beneficiary (ies) must notify the Company within 30 days from the date of the insured’s death, unless there is evidence of a reasonable cause for the delay in notifying the death, or they are not aware of the existence of the policy of this rider. In such case, the Company must be notified within 30 days from the day the beneficiary becomes aware of the existence of the policy.
The beneficiary shall provide the Company with the death certificate or official evidence certifying the death of the insured, and upon the Company’s reasonable request, the beneficiary shall provide the Company with any additional documents at the beneficiary’s own expense.
The beneficiary shall consent and cooperate for the autopsy of the insured when the Company deems it necessary, in compliance with applicable laws and religious code.
The Company shall be liable as bound by this policy when the beneficiary or the insured’s party acts in compliance with the requirement(s) hereof.
13.2.2 Notification of Total and Permanent Disability (TPD), or Dismemberment, Loss of Sight, Hearing or Speech
When there is a claim made upon the incurrence of total and permanent disability (TPD) or dismemberment, loss of sight, hearing or speech, the insured or insured’s party must notify the Company within 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, and the expense is to be borne by the insured, unless there is a proof that the insured has other significant and acceptable reason for the absence but had informed the Company as soon as possible.
The Company reserve the right to request a physical examination of the insured as it deems necessary, during the claim assessment process.
13.3 Required Documents for Claim
a. In case of death caused by accident
1. Complete death claim form,
2. Life insurance certificate (original copy),
3. Certified copies of beneficiary’s ID card and family book, along with the original one,
4. Certified copy of death certificate and also along with the original one,
5. 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 accident report which is certified by investigator (police),
8. Certified copy of autopsy examination report,
9. Other documents as reasonably required by the Company.
b. In case of Total and Permanent Disability (TPD), or Dismemberment, Loss of Sight, Hearing or Speech
1. Complete claim request form of Total Permanent Disability,
2. Completed claim form for Injury/Illness,
3. Life insurance certificate (original copy),
4. Certified copy of insured’s ID card, along with the original one,
5. Medical report as determined by the Company,
6. Other documents as reasonably required by the Company.
13.4 Maximum Duration of Claim Payment
The Company shall pay the claim to the insured or beneficiary (ies) within 14 working days when the Company received sufficient claim documents and approved the claim.
13.5 Claim Payment Method
The claim payment can be made by a promissory note, cheque, draft, or by any other mean.
13.6 Fraud
If any claim under this rider is in any respect fraudulent or if any fraudulent means or devices is used to obtain the benefit under this rider, the Company shall have no liability in of such claim.
13.7 Condition Precedent
The Company shall not be liable to pay any compensation under this rider unless the insured or beneficiary have complied properly with the insurance and condition of this rider.
14. Confidentiality
The information provided to the Company shall be kept confidential, and no personal information shall not be disclosed to a third party without the insured’s content, unless it is required or authorized by applicable law and regulations.
15. Dispute Resolution
For all dispute arising from this contract which is relevant to the insurance business, any party of the dispute can submit the dispute to the Insurance Regulator of Cambodia for mediation and resolution before filling a lawsuit to arbitration or a competent court, except dispute related to criminal offence.
16. Jurisdiction
This contract shall be executed under the jurisdiction of the Kingdom of Cambodia.