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Product Benefits Summary
- Receive 100% of the sum assured in case the Insured gets diagnosed as suffering from Major Cancer.
- Receive 30% of the sum assured in case the Insured gets diagnosed as suffering from Minor Cancer.
- Additional Option “Hospital Daily Expense Benefit”: The Insured will get a daily cash benefit as the hospital daily expense if the Insured gets diagnosed with Major or Minor Cancer and is required to be admitted as an inpatient in a hospital.
Product Features Summary
| Insured’s age | From 18 to 60 years old |
| Expired age | 66 years old |
| Sum assured | From $5,000 |
| Policy term | 1 year Renewable the policy at the policy anniversary until the year that s/he reaches the age of 65. |
| Premium payment term | Equal to policy term |
| Premium payment mode | Annually, semi-annually, quarterly and monthly |
Product Detail
SMILE Life Cancer 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
“Physician” refers to contemporary physician who holds medical certificate recognized by the Ministry of Health and is legally registered with the Medical Council of Cambodia to practice medical treatments or surgical services, who is not the Insured, the Insured’s spouse or descendant.
“Diagnosis” refers to a clear evidence-based physician’s diagnosis as reference to the Major Cancer or Minor Cancer as defined in this Policy. In case of lack of such clear evidence, the replaceable evidence could be the report from radiological, clinical, histological, or laboratory examination.
“Major Cancer” is defined as the presence of a malignant tumor positively diagnosed with histopathological confirmation and characterized by the uncontrolled growth of malignant cells with invasion and destruction of normal tissue. The term malignant tumor includes leukemia, lymphoma and sarcoma.
The following are excluded under Major Cancer:
1. All tumours which are histologically classified as any of the following:
a) Pre-malignant;
b) Non-invasive;
c) Carcinoma-in-situ (CIS);
d) Having borderline malignancy;
e) Having any degree of malignant potential;
f) Having suspicious malignancy;
g) Neoplasm of uncertain or unknown behavior; or
h) Cervical Dysplasia CIN-1, CIN-2 and CIN-3;
2. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
3. Malignant melanoma that has not caused invasion beyond the epidermis;
4. All Prostate cancers histologically described as T1N0M0 (TNM Classification) or below; or Prostate cancers of another equivalent or lesser classification;
5. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
6. All tumours of the Urinary Bladder histologically classified as T1N0M0 (TNM Classification) or below;
7. All Gastro-Intestinal Stromal tumours histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs;
8. Chronic Lymphocytic Leukaemia less than RAI Stage 3.
“Minor Cancer” The following conditions are covered:
1. Carcinoma-in-situ (CIS) means the focal autonomous new growth of carcinomatous cells confined to the cells in which it originated and has not yet resulted in the invasion and/or destruction of surrounding tissues. The diagnosis of the CIS must always be supported by a histopathological report.
In the case of the cervix uteri, Pap smear alone is not acceptable and should be accompanied with cone biopsy or colposcopy with the cervical biopsy report clearly indicating presence of CIS. Cervical Intraepithelial Neoplasia (CIN) classification which reports CIN I, CIN II and CIN III (where there is severe dysplasia without Carcinoma-in-situ) does not meet the required definition and are specifically excluded;
2. Early chronic lymphocytic leukemia: Chronic lymphocytic leukaemia (CLL) RAI Stage 1 or 2. CLL RAI stage 0 or lower is excluded;
3. Malignant melanoma diagnosed based on biopsy report that has not invaded beyond epidermis. Non-melanoma skin conditions are specifically excluded;
4. Early prostate cancer: Prostate cancer that is histologically described using the TNM Classification as T1N0M0;
5. Early thyroid cancer: Thyroid cancer that is histologically described using the TNM Classification as T1N0M0 as well as papillary microcarcinoma of thyroid that is less than 2cm in diameter;
6. Early bladder cancer: Bladder cancer that is histologically described using the TNM Classification as T1N0M0 as well as Papillary microcarcinoma of bladder.
“Hospital” refers to 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.
“Inpatient” refers to the Insured admitted in a hospital for at least 6 consecutive hours and registered as an inpatient in the hospital registration, which is as a result of the physician’s diagnosis and recommendation under the medical standard and for a reasonable period considering the condition of each cancer.
“Medical Necessity” refers to medical services with the following conditions:
1. Justified as reasonable based on its diagnosis and treatment, according to the Insured’s condition of cancer;
2. Includes clear medical indicator based on modern medical standard;
3. Must not be for convenient purposes of any party, either the Insured, Insured’s family or the medical service provider; and
4. Must be an appropriate medical treatment based on clinical standard of care and as necessary to the Insured’s condition of cancer.
2. Coverage
While this rider is still in force, if the Insured is diagnosed as suffering from cancer, as defined under this document, and the Company receives sufficient evidence for claim assessment, to its reasonable satisfaction, in compliance with the format and method stipulated by the Company and applicable law, the Company will pay benefits in accordance with the following conditions:
2.1 Major Cancer Benefit
The Company will pay 100% of the sum assured to the Insured in case the Insured is diagnosed with Major Cancer after the waiting period 90 days from the policy effective date or the reinstatement effective date of the policy, and the Insured survives for at least 14 days from the date of diagnosis of Major Cancer. This Benefit is payable once during the lifetime of the policy. Renewal policy is considered as one policy.
2.2 Minor Cancer Benefit
The Company will pay 30% of the sum assured to the Insured in case the Insured is diagnosed with Minor Cancer after the waiting period 90 days from the policy effective date or the reinstatement effective date of the policy and the Insured survives for at least 14 days from the date of diagnosis of Minor Cancer. This Benefit is payable once during the lifetime of the policy. Renewal policy is considered as one policy.
2.3 Additional Option: Hospital Daily Expense Benefit
The Company shall pay a daily cash benefit as hospital daily expense to the Insured in case the Insured gets diagnosed with Major Cancer or Minor Cancer, which requires the Insured to be admitted as cancer inpatient in a hospital as required by its medical necessity after the waiting period 90 days from the Policy effective date or reinstatement effective date of the Policy, and the Insured survives for at least 14 days from the date of diagnosis of Major Cancer or Minor Cancer. The total hospital daily expense benefit shall not exceed 30 days for each cancer (Major or Minor) diagnosed per admission and shall not exceed 90 days per policy. Renewal policy is considered as one policy. This benefit shall be terminated when the Company has paid the total of 90 days of hospital daily expense benefit.
3. General Provision
3.1 Initial Premium
The initial premium must be paid immediately and the coverage shall become effective.
3.2 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 at the latest within the grace period.
3.3 Renewal Privilege
The Insured can renew the policy at the policy anniversary until the year that s/he reaches the age of 65. The Company will not enforce the waiting period condition for the renewal year.
3.4 Notification of Major Cancer or Minor Cancer
The Insured or the Insured’s Party shall notify the Company within 30 (thirty) days from the date of diagnosis of Major Cancer or Minor Cancer that is the subject of the claim under this rider unless it can be proved that there is a reasonable cause for any delay in the notification.
3.5 Delivery of Claim Evidence
The Insured or the Insured’s party must deliver the evidence within 30 days to the Company after the day the Insured leaves the hospital, where a copy of the receipt is acceptable in claim process. Failure to deliver the evidence within stated timeline would not result in loss of claim rights, if it could be proved to have reasonable cause for such failure; however, the evidence shall be delivered as soon as possible. The Insured or the Insured’s party must be responsible for any expenses incurred from obtaining such evidence.
3.6 Required Documents for Major Cancer or Minor Cancer Claim
1. Copy of Life Insurance Certificate
2. Completed Claim Form for Injury/illness
3. Claim Evidence Form/Physician Report
4. Biopsy or Histopathology result/report
5. Certified copy of Insured’s ID card and also along with the original one
6. Copy of Medical Receipt/Hospital Discharge Letter (for Hospital Daily Expense Benefit)
3.7 Termination of Rider
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 company has paid the aggregate of 130% of sum assured under all the cancer claims; 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 of 66 years old, this rider shall be terminated on the policy anniversary date of the 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 liabilities but to refund such premium.
3.8 Fraud
If any claim under this rider is in any respect fraudulent or if any fraudulent means or devices are used to obtain the benefit under this rider, the Company shall have no liability in respect of such claim.
3.9 Rider Cancellation
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 conducts intentional fraud to make use of the benefits under this rider either for the Insured or others. In such event, the Company shall return 90% (ninety percent) of the premium for the remaining period to the Insured.
The Insured shall give 10-day written notice to the Company in advance if the Insured wishes to cancel this rider before expiry date. Based on reasonable grounds, the Company will refund 90% (ninety percent) of the premium for the remaining period to the Insured.
3.10 Reinstatement
In case that this rider has ceased because the base policy was terminated, the Insured could reinstate this rider. However, reinstatement could be done only upon the reinstatement of the base policy with proof that the Insured is in good health and insurable condition. This rider coverage shall be effective 30 days after such reinstatement.
However, the Company reserves the right to approve or deny the reinstatement proposal.
3.11 Exclusions
The following events are excluded under this rider and no benefit will be payable:
1. Claim arises directly or indirectly as a result of a Pre-Existing condition related to cancer.
A Pre-Existing Condition is an illness, injury, condition or symptom:
a) That was known to the Insured prior to the policy effective date, or the reinstatement effective date of the policy, whichever is later; or
b) For which the Insured had consulted a Medical Practitioner prior to the policy effective date, or the reinstatement effective date of the policy, whichever is later; or
c) For which a reasonable person in the Insured’s position would have consulted a Medical Practitioner prior to the policy effective date, or the reinstatement effective date of the policy, whichever is later.
2. Claim arises directly or indirectly from any of the following:
a) HIV Infection and/or any AIDS related sickness; or
b) Suicide or attempted suicide, self-inflicted injury, whether sane or insane within two years after the policy effective date or the reinstatement effective date of the policy, whichever is later; which is applied to the policy that is renewed for the third year; or
c) Consumption of drugs (except under the proper direction of a Medical Practitioner), narcotic substances, poison or alcohol; or
d) Any symptoms, investigations, medical advice or diagnosis of cancer within 90 days of the policy effective date, or the reinstatement effective date of the policy, whichever is later.
3. No Major or Minor Cancer claim or hospital daily expense benefit (additional option) is payable if death occurs within 14 days from the date of diagnosis of either Major or Minor Cancer. The Insured can claim Major or Minor Cancer or cash benefit only if the diagnosis takes place before the expiration date of the policy even though the 14-day survival period ends after the expiration date of the policy.
3.12 Dispute Resolution
In the event of any dispute arising from the Insurance Contract, such dispute shall attempt 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 filling a lawsuit to arbitration or a competent court.