NATURAL ACCIDENT & LIFE WITH EARTHQUAKE (NATALIE)

CoopAssurance Center Products

PRODUCT DESCRIPTION:

A renewable term insurance designed for cooperative members under the CoopAssuranceCenter of the cooperative that offers both life and non-life insurance by providing Life andAccidental benefits, and Cash Assistance on Residential Fire including Earthquake Fire.

ELIGIBILITY:

• The cooperative must choose only one (1) option for the group.
• 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.
• Any natural person that is not suffering from any critical or terminal illness or life threatening
  diseases.

SCHEDULE OF BENEFITS AND PREMIUM

AGE REQUIREMENT

• 18 – 65 years old (exit age 66th birthday)

DATE OF EFFECTIVITY OF INSURANCE

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

DATE OF EFFECTIVITY OF INSURANCE

• A contestability period of one (1) year from the effective date of the individual’s coverage for
  pre-existing illnesses, as follows:
  • Cancer related
  • Hypertension
  • Diabetes (type 1 & 2)
  • HIV and AIDS
  • Other dreaded diseases which the company Medical Director may decide to deny, and have undergone major operation/hospitalization within six (6) months from date of application

SUICIDE CLAUSE

• Except for reason of insanity, CLIMBS shall not pay the death benefit if the insured member commits suicide within one (1) year from the effective date of his/her coverage. CLIMBS however, shall refund the premiums paid by the member.

MISSTATEMENT OF AGE

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

WARRANTIES AND ENDORSEMENT

• Residential Occupancy Warranties
  • Warranted that the premises to which this insurance applies shall be occupied solely as dwelling and that no manufacturing storage or trading of goods for commercial purposes shall be carried out within said premises.
• 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;
    1. 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
    2. 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.

• Earthquake Fire Endorsement

  This insurance covers loss or damage by fire occasioned by or through or in consequence of Earthquake may be covered under a separate policy or by endorsement upon the policy covering the ordinary fire risk.

SUBMISSION OF REMITTANCE REPORT

•  Within 15 days of the following month.
• Any collection submitted beyond the prescribed remittance schedule shall be:
  • Subject to verification/evaluation of the remittance report proving its validity and
  • correctness of the transaction.
  • Subject to 6% interest per annum deducted in the commission of the next remittance.
  • In case that the transaction is not valid, the CLIMBS is liable only to the refund of premium.

SUBMISSION OF REMITTANCE REPORT

•  Group Master Application Form (refer Annex 1)
• Summary Report (List of Members to be Insured with date of birth) (refer Annex 2)
• Individual Application Form (refer Annex 3)
• Proof of payment

SUBMISSION OF REMITTANCE REPORT

This Group Policy does not cover Accidental Death and Dismemberment, Total and Permanent Disability and Loss of Income as a result, either directly or indirectly, of any one of the following causes:

1. Riot, civil commotion, war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, insurrection or military usurped power, where the insured had not participated in any of the said causes.

2. Injury received while on police duty in any armed forces organization or civilian defense or local police forces;

3. Ionizing radiation or contamination by radioactivity from nuclear waste from process of nuclear fission, or from any nuclear weapons material which is due to the profession or line of work of the insured.

4. Self-destruction or attempted self-destruction, insanity, venereal disease, from having been under the influence of alcohol or drugs other than those prescribed by a registered physician;

5. Cosmetic surgery for beautification purposes, or plastic surgery for any condition existing on the effective date of the insurance, except for the repair or alleviation of damage caused solely by accidental bodily injuries;

6. Any dental treatment or surgery, except dental operation to repair injury sustained in an accident;
7. Commission or attempted commission of a felony or crime as defined under the Revised Penal Code or any special law.

8. While racing on wheels; or
9. In an accident occurring while or because the Member is under the influence of alcohol. Likewise, the Member is not covered for in-hospital income for the first twelve (12) months from the effective date or date of last reinstatement of the Group Policy for injury sustained or medical impairment existing prior to the effective date or date of last reinstatement of the Group Policy.

10. In an accident occurring while the Member is violating a law or ordinance.

CLAIM REQUIREMENTS

The following are the basic requirements on claiming the insurance benefit. CLIMBS have the right to require additional requirements on a case to case basis.

Life Insurance Benefit.

•  Endorsement Letter from the CoopAssurance Center
•  Original Certified true copy of Death Certificate
•  Claimant’s Statement
•  Attending Physician’s Statement
•  Marriage Certificate or Birth Certificate of the beneficiary
•  Affidavit of Two Disinterested Persons (if necessary)
•  CENOMAR (of both insured and claimant) and Barangay Certificate (indicating their years of living together), if claimant is a common-law-partner

Accidental Death Benefit.

•  Endorsement Letter from the CoopAssurance Center
•  Original / Certified true copy of Death Certificate
•  Claimants Statement
•  Marriage Certificate or Birth Certificate of the beneficiary
•  Affidavit of Two Disinterested Persons (if necessary)
•  Original Police Report or Barangay Accident Report
•  CENOMAR (of both insured and claimant) and Barangay Certificate (indicating their years of living together), if claimant is a common-law-partner

Accidental Dismemberment Benefit.

•  Endorsement Letter from the CoopAssurance Center
•  Claimant’s Statement
•  Original Police Report or Barangay Accident Report
•  Original Medical Certificate indicating final diagnosis

Loss of Income Benefit:

•  Endorsement Letter from the CoopAssurance Center
•  Original Medical Certificate indicating the number of days to rest
•  Police/Incident Report

Total and Permanent Disability Benefit:

•  Endorsement Letter from the CoopAssurance Center
•  Original Police/Incident Report
•  Original Medical Certificate indicating final diagnosis
•  Surgical Report (if a surgery was done)

Fire Claim (to be processed by Non-Life Claims Section)

•  Endorsement Letter from the CoopAssurance Center
•  Bureau of Fire Protection incident report
•  Original Copy Certification from the Barangay
•  Clear Pictures
•  Affidavit (fire victim /owner or renter) duly notarized
•  List and estimated cost of Damage
•  Coop application form
•  Area Ocular inspection report

GRACE PERIOD

• The grace period of forty-five (45) days after the due date is given to the cooperative, during
  which the policy remains in force.
• Non-payment of premium beyond the grace period automatically cancels the coverage

RENEWAL OF POLICY

• Renewal of policy will be on or before the expiry date of the existing policy.

CONDITION

• No ex-gratia settlement

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