FAMILY AKSI PLAN PLAN

Product Manual on Non-Life FAMSI Plan (FAMily akSI Plan)

STANDARD INSURING PROVISIONS

PRODUCT DESCRIPTION

A renewable term insurance designed for cooperative members and their family under the Coop Assurance Center of the cooperative that offers non-life insurance by providing Accidental Death Benefit, Medical Reimbursement due to Accident, and Hospital Income Benefit due to Accident.

SCOPE OF COVERAGE

The plan offers 24 hours a day, 365 days a year, world-wide protection against accident which an insured person may be exposed to in the course of activities related to business or pleasure, whether on or off-the-job, occurring in the house or while travelling. Coverage includes but not restricted to flying as passenger (not as crew member) in any commercial airline, on any regular schedule, non-scheduled, chartered flight or any military transport operated by any government authority.

PROHIBITED RISK (Not acceptable occupation)

Acrobats, Army Personnel (member of the armed forces), Asylum Attendants, Automobile Racing Drivers, Aviators, Barangay Tanod/CVO, Boilerman, Detectives, Divers, Electrical Lineman, Explosive Makers, Firemen, Loggers, Policemen, Miners, Sailors, Sawmill Workers, Secret Service Personnel, Soldiers, Underground Workers, Window Cleaners, Wood-working Machinist, Person with Total Blindness, Total Deafness, Skull or spinal injuries, infirmities and diseases of the brain, heart, liver, lungs, or chest if the lungs are affected, Chronic Diseases, Venereal Diseases and Rheumatic fever.

ELIGIBILITY

• A single (1) policy only is allowed for the member every year
• Any natural person who is a member of the cooperative that could do the usual daily activities of livelihood and not suffering from any mental or physical disability

SCHEDULE OF BENEFIT, COVERAGE AND PREMIUMS

Note: For children benefit –If two or more children die in a year, the coverage will be divided equally to the number of children declared.

AGE REQUIREMENT

• 18-65 years old (exit age 66th birthday)
• 1-21 years old (children)

DATE OF EFFECTIVITY OF INSURANCE

The effectivity of insurance of an eligible individual shall commence upon payment of the premium.

MISSTATEMENT OF AGE

In the event the age of an insured has been incorrectly stated, CLIMBS may adjust the premiums or benefits or both according to the correct age of the member. If the insured is not eligible for coverage, CLIMBS shall refund all premiums paid by the insured.

WARRANTIES AND ENDORSEMENT

• War and Terrorism Endorsement
  Notwithstanding any provision to the contrary within this Insurance or any endorsements thereto it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss;
  • War, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not) civil war, rebellion, revolution, insurrection, civil commotion assuming the portion of or amounting to an uprising, military or unsurped power; or
  • Any act of terrorism
    For the purpose of this endorsement an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public,
    or any section of the public in fear.

    This endorsement also excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in way relating to (1) and/or (2) above.

    If the underwriters allege that by reason of this exclusion, any loss, damage, cost or expense is not covered by this Insurance the burden of proving the contrary shall be upon the Assured.

    In the event any portion of this endorsement is found to be invalid or unenforceable, the
    remainder shall remain in full force and effect.

SUBMISSION OF POLICY ISSUED REPORT

• Within 15 days of the following month for faster underwriting evaluation and claims settlement.
• Any collection submitted beyond the prescribed policy issued report schedule shall be:
  • Subject to verification/evaluation of the policy issued report proving its validity and correctness of the transaction.
  • In case that the transaction is not valid, the company is liable only to the refund of premium.

PAYMENT OF PAYMENT REQUIREMENTS

• Filled out Member Application Form and/or Listing – See Annex 1
• Proof of Payment: (Deposit slip) – See Annex 2
• Soft copy of the policy issued report – See Annex 3

OTHER EXCLUSIONS

• Standard exclusions & limitations of this policy shall apply.

CLAIMS GUIDELINES

• Endorsement letter from the Coop Assurance Center
• Photocopy of Insurance Policy/Endorsement (Attach copy-Group Master List)
• Proof of payment or official receipt (photocopy)
  • Accidental Death Claim
    • Fully accomplished Claimant’s Statement & Attending Physician Statement (Claim Application form)
    • Police report or Affidavit of Accident-Witness & Brgy. Certificate
    • Death Certificate (original or certified true copy from the original duly signed by the local civil registrar)
    • Copy of Affidavit of Eye Witness & Brgy. Certificate (If in call accident happened in remote area)
    • Photograph/Newspaper clipping (If any)
    • Proof of relationship to beneficiary (Birth Cert./Marriage Contract of the Assured)
    • Copy of Valid I.D. of the Assured and Beneficiary
    • Contact number of the Beneficiary
  • Accident Medical Reimbursement Claim
    • Fully accomplished Claimant’s Statement & Attending Physician Statement (Claim Application Form)
    • Original Copy of Medical Certificate
    • Hospital Billing Statement of Account
    • Original copy of Medical/Pharmacy Official Receipts(w/ Doctor’s prescription for medicines bought outside the hospital)
    • Copy of Birth Certificate of the Assured
    • Copy of Valid I.D. of the Assured and Beneficiary
    • Contact number of the Beneficiary
  • Hospital Income Benefit
    • Fully accomplished Claimant’s Statement & Attending physician statement (Claim App. Form)
    • Original Copy of Medical Certificate
    • Hospital Billing Statement of Accoun
    • Copy of Birth Certificate of the Assured
    • Copy of Valid I.D. of the Assured and Beneficiary
    • Contact number of the Beneficiary
  • For the purpose of identifying the legitimate and/ or designated beneficiaries, the following claims documents shall also be submitted:
    • Birth certificate of assured, if beneficiary is a parent or a child
    • Marriage contract of assured and spouse, if beneficiary is spouse
    • Affidavit of Legal Guardianship, if beneficiary is minor
    • Other documents as may be necessary to establish identity of claimants
  • Notice of Injury or Death – Written notice of the injury on which claim must be given to CLIMBS within (20) days after the date of accident. In case of Accidental Death, immediate notice thereof must be given to the CLIMBS. Failure to give notice within the time provided in the policy shall not invalidate any claim. If it can be shown that it was not reasonably possible to do so.
  • Payment of all indemnities – See copy of your policy under policy conditions.

SPECIAL CONDITION:

No ex gratia settlement

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