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HOSPITAL INCOME BENEFIT (HIB)
HOSPITAL CASH ASSISTANCE
BENEFITS
In consideration of the issuance of this policy and the prior payment of the premium stated above, the company agrees to all the conditions, limitation and other terms of policy to insure the person or persons named in the schedule (herein called the insured) and to pay with respect to an insured, income during hospital confinement in the amounts and to the extent herein limited and provided and in accordance with the schedule.
RENEWAL
This policy may be renewed, subject to the consent of the company, for further consecutive period by the payment in advance of the premium at the Company’s premium rate at the time of renewal. Unless renewed as herein provided this policy shall terminate at the expiration of the period for which the premium has been paid.
TERMINATION OF COVERAGE
Upon any insured attaining the age of sixty-five years or upon the insured spouse ceasing to be the spouse of the insured, such person shall no longer be eligible for renewal and the coverage for such person shall terminate at the next renewal date; provided, if the Company accepts premium applicable wholly or in part to any period of eligibility provided of this policy, insurance provided hereunder will continue in force during such period and until the end of any period for which premium has been accepted. Default made in the payment of the renewal premium shall invalidate this policy.
ADDITION
Any such person becoming eligible after the effective date of this policy may be added from the time as covered member upon application by the insured, proof of eligibility and insurability satisfactory to the Company, and payment of the required additional premium. The date of this policy with respect to the insurance of such new covered member shall be the date such application has bee approved.
The provision and conditions printed with respect by the Company on the succeeding pages hereof form part of this contract as fully if stated over the signature hereto affixed.
PART I - DEFINITIONS
“Injury” wherever used in the policy means bodily injury caused by an accident occurring while this policy is in force as to the person whose injury is the basis of claim and resulting directly and independently of all the other causes in loss covered by this policy.
“Sickness” wherever used in this policy means illness or disease which causes loss covered by the policy, contracted and commencing after the effective date of the police as to the person whose illness or disease is the basis of claim.
“Physician” wherever used in this policy means a person legally licensed to practice medicine and surgery other than the insured or a member of the insured’s immediately family.
“Hospital” wherever used in this policy means an establishment which meets all of the following requirements; (1) hold a license as a hospital; (2) operate primarily for the reception, care and treatment of sick, ailing or injured persons as a; (3) provides 24-hour a day nursing service by registered or graduate nurses; (4) has a staff of one or more licensed physicians available at all times; (5) provides organized facilities for diagnosis and major surgical facilities; (6) maintains at least six(6) beds installed for 24 hour use by the patients; (7) is not primarily a clinic, nurse rest, or convalescent home or similar establishment and is not other than incidentally, a place for alcoholic or drug addicts.
“Insured” wherever used in this policy means eligible person named in the application and the accepted by the Company as insurance risks.
PART II – DAILY-IN HOSPITAL INDEMNITY
If, as result of covered sickness or injury, the insured shall be necessary confined continuously on a 24 hour basis commencing while this policy is in effect, within a hospital as a resident patient under the professional care of currently licensed physician or surgeon, the company will pay the Daily Hospital Income Benefits stated in the policy with respect to such Injured shall be so confined therein, up to Three Hundred Sixty Five (365) days.
Successive period of the Hospital confinement, due to the same related causes, shall be considered as one accident or sickness unless separated by at least six consecutive months during which the Insured is not Hospital confined as a result of such accident or sickness. No insurance provided by this shall become effective as to the insured if such person is hospital confined, disable or receiving payment for a claim when such insurance would otherwise take effect, and the insurance of such person shall take effect, and the insurance of such person shall take effect thirty-one days confinement or disability.
PART III – INCREASED INDEMNITY FOR CANCER
The In-Hospital Indemnity otherwise payable hereunder will be increased to one hundred fifty (150%) per cent during any period hospital confinement resulting from sickness caused by pathologically diagnosed cancer or leukemia including metastic tumor.
PART IV – EXCLUSIONS
This insurance under this policy shall not cover, and no payment shall be made for expenses incurred in connection with;
1. Pregnancy and resulting childbirth, miscarriage or diseases of the female organs of reproduction
2. Routine physician or any other examination where there are no objective indications or impairment in normal health, and laboratory diagnostic of X-ray examinations except in the course of a disability established by the prior call or attendance of a physical;
3. Intentionally self-inflicted injury or suicide while sane or insane or any attempt threat;
4. Cosmetic or plastic surgery, any dental work, dental treatment, eye examination, except as e result of accident;
5. Any mental and nervous disorder or rest cures
PART V – PRE-EXISTING CONDITIONS
The policy shall not cover any sickness contracted or injury sustained by any Covered Member before the effective date of coverage under this policy.
PART VI – GENERAL PROVISIONS
1. This policy includes the endorsements and attached papers, if any, and contains the entire contract of insurance. None of the provisions, conditions and terms of this policy shall be waived or altered except by endorsement signed or initiated by an authorized official of the Company and issued in accordance with the provisions of Section 50 of the Insurance Code.
2. The Policy is conditional upon the questioned contained in the application form forming the basis of the insurance having been truly answered, and if an untrue shall have been given to any of such questions or if any material fact touching the health habits and conditions of the insured has been or shall upon any renewal of the policy be suppressed or concealed from the knowledge of the Company, or any misinterpretation or suppression be made upon giving any notice of accident or sickness or upon in connection with claim hereunder, the policy will be void.
3. If default be made in the payment of the agreed premium by the Company or by any of its duly authorized agents shall re instate the policy, but only to cover loss resulting form accident injury sustained subsequent to the acceptance dated and loss due to such sickness as may begin more than 10 days after such acceptance date.
4. Written notice given to the Company within 30 days after the occurrence and commencement of any loss covered by the policy
5. Such notice given by of in behalf of the Insured to the Company at the City of Manila or to any authorized agent of the Company, with particulars sufficient to identify the insured, shall deemed to be notice to the Company. Failure to give notice within the time provided in this policy shall not invalidate any claim if it shall be shown not to have been reasonably possible to give such notice and was given as soon as was reasonably possible.
6. The Company, upon receipt of such notice, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not so furnished within thirty days after receipt of such notice, the claimant shall be deemed to have complied with the requirement s of this policy as to loss upon submitting within the time fixed in the policy for filing proofs of loss written proof covering the occurrence, character and extent of the loss for which claim is made.
7. Affirmative proof of loss must be furnished to the Company at is said office in case of claim for loss within ninety days after submission of notice referred to in No. 4
8. The Company shall have the right and opportunity to examine the person of an Insured when and as often as it may reasonably require during the pendency of claim hereunder
9. All indemnities provided in this policy for loss will be paid immediately after of due proof
10. All indemnities of this policy are payable to the insured. All indemnities unpaid at the time of the insured’s death shall be paid to the estate of the insured
11. All accrued indemnity will be paid at the expiration of each week during the continuance of the period for which the Company is liable, and any balance remaining unpaid at the expiration of such period will be paid immediately upon the receipt of due proof.
12. No action at law in equity shall be brought to recover on this policy prior to the expiration of sixty days after proof of loss has been filed in accordance with the requirement of this policy, nor shall such action be brought either in the Insurance Commission or any court of competent jurisdiction after two years from the expiration of the time within which proof of loss is required by the policy
13. This policy may not be canceled by the Company except upon prior notice thereof to the Insured, and no notice of cancellation shall be effective unless it is based on the occurrence, after the effective date of the policy, of one or more of the following:
a. non-payment of premium
b. conviction of a crime out of acts increasing the hazard insured against;
c. discovery of fraud or material misinterpretation
d. a determination by the Commissioner that the continue of the policy would violate or would place the Insurer in violation of the Code
All notices of cancellation shall be in writing, mailed or delivered to the Insured at the address shown in the policy, and shall state (a) which of the grounds set forth is relied upon and (b) that, upon written request of the Insured, the insurer will furnish the facts on which cancellation is based
If the insured cancels, earned premium shall be compute in accordance with the applicable percentage indicated below, but in no event less than the Company’s customary minimum premium.
14. No assignment of interest under the policy shall be binding upon the Company and until the original or duplicate thereof is filed at a branch of the home office of the Company. The Company does not assume any responsibility
for the validity of any assignment. No provision of charter, constitution or by-laws of the Company shall be used in defense of any claim arising under this policy such provision is incorporated in full in this policy.
15. This policy may be renewed with the consent of the Company from term to term, by payment of the premium in advance at the Company’s premium rate in force at time of renewals. The insured is, however entitled to renew the policy, upon payment of the premium due on the effective date of the renewals. The insured is, however entitled to renew the policy, upon payment of the premium due on the effective date of the renewal if the Company fails to mail or deliver to the insured at the address shown in the policy at least forty-five (45) days in advanced of the end of the policy period notice of its intention not to renew
ACCUMULATION LIMIT: Annual Aggregate limit of Php 75,000,000.00
RECEIPT OF PAYMENT CLAUSE
IT IS HEREBY DECLARED AND AGREED that notwithstanding anything to the contrary contained in this policy, this insurance will be deemed as valid and binding upon the Company only when the premium thereof has actually been in full and duly acknowledge in a receipt signed by an authorized official/ representative of the Company.