(a) Duty of disclosure:
(i) You must take reasonable care to disclose all material facts which you know or ought to know which could impact your risk profile and ensure that all your answers to the questions are full, complete, correct, honest and to the best of your knowledge as this information form the basis of your contract.
(ii) You also have a duty to inform the Company of any change in the information given to the Company earlier before the Company issues the Policy to you, before you renew or change any of the terms of your Policy. If you don’t, your Policy may be cancelled, or treated as if it never existed, or your claim rejected or not paid in full.
(b) Eligibility:
Age
i. Policyholder - Entry age for a Policyholder is 18 to 60 years of age (inclusive). Policy is renewable up to 75 years (inclusive).
ii. Employee - Entry age for an Employee is 18 to 60 years of age (inclusive). Policy is renewable up to 65 years (inclusive) or when the Insured Person ceases to be an Employee of the Policyholder, whichever is earlier.
iii. Child - Entry age for a Child is 15 days after birth up to 17 years of age (inclusive). Policy is renewable up to 17 years (inclusive).
Entry age and maximum age is determined based on Age at the Policy Effective Date.
Occupation
Persons engaged in the following occupations are not covered under this Policy:
i. Asbestos Workers, miners, tunnellers;
ii. Police, armed forces, military personnel and/or similar peace-keeping groups;
iii. Semi – professional and professional sports or where a periodic income is received in relation to such sports.
(c) Cash Before Cover:
The Company must receive the premium due on or before the Premium Due Date. No Benefits will be payable for any claim that occurs during a period for which premium was not received.
(d) Country of residence:
You must notify the Company if you will be out of Malaysia for more than 180 consecutive days upon which the Company will determine at its sole discretion whether to continue or terminate coverage of the Policy. Failure to do so will invalidate this cover.
(e) Claims:
i. The Company must be notified as soon as it is reasonably practical and in any event within 30 days after the date of event which could lead to a claim.
ii. The Company must be provided with all reasonable and necessary evidence required by the Company to support a claim within 90 days after the date of event which could lead to a claim.
iii. Failure to comply with the above may result in the rejection of all or part of the claim. Reasons include, but are not limited to, if it is made so long after the event that the Company is unable to investigate it fully or may result in the Insured Person not receiving the full amount claimed if the amount payable changes as a result of the delay.
iv. In the event the Insured Person is a Child, all dealings in relation to any claim will be between the Insured Person’s parent and the Company.
(f) Waiting period:
The Waiting Period applicable depends on the Critical Illness Diagnosed which is as specified in the Schedule of Benefits. The Waiting Period does not apply to Critical Illness caused by an Accident as defined.
(g) Overseas treatment:
i. is only allowed if the travel overseas is not for the purpose of seeking medical treatment;
ii. is excluded for the following:
- Non-emergency Hospitalisation or treatments i.e., where the treatment can reasonably be postponed until return to Malaysia; or
- Overseas Hospitalisation or treatments of a Critical Illness Diagnosed in Malaysia where treatment can reasonably be postponed until return to Malaysia.
(h) Free Look Period:
If this Policy does not meet your insurance requirements, you can return the Policy to the Company within 15 days from the date this Policy is delivered to you. You will receive a full premium refund as long as no claim has been made for that period.
(i) Contribution: If you are covered by any other policy, which covers the benefit in respect of ‘Home Alteration and Vehicle Modification’ Benefit, the Company will only reimburse the excess amount that is not recoverable by the other policies provided that the Benefit is payable by this Policy.
(j) Only one individual policy providing the same product underwritten by the Company is allowed. If more than one policy is held, the Company will consider the Insured Person to be insured under the policy with the highest Compensation or, where the Compensation under each policy is identical, under the policy that was first issued.
(k) Renewal:
This is an annual policy where the Policy may be renewed at the option of the Policyholder subject to the terms and conditions of the Policy and payment of the premium the Company requires for the renewal.
Where the Insured Person who is:
i. a Child ceases to be a Child; or
ii. an Employee ceases to be an Employee of the Policyholder;
the Policyholder can no longer renew the Policy under the expiry Policy Category. However, the Insured Person has an option to renew theirPolicy by switching to an individual Policy under the ‘Self’ Category where they will become the Policyholder.
In the event the Company elects to not renew this Policy due to underwriting reasons, the Company will notify the Policyholder in writing at least 30 days before their next Anniversary Date.
(l) Renewal Bonus:
The Insured Person is eligible for a 10% increase of the Compensation for ‘Critical Illness’ Benefit on every Anniversary Date up to a maximum of 5 consecutive years if the Policy is continuously renewed without interruption and the Policy remains Claims Free throughout the Policy Period.
Notes:
Refer to the terms and conditions under section ‘Renewal Bonus’ of this product in the policy wordings for further details on Renewal Bonus.
(m) It is important to note that in the event you wish to switch from one insurance plan to another, your application will be subject to evaluation based on the underwriting requirements of the new policy. The applicable Waiting Period(s) along with any applicable period for Pre-existing Condition(s) will apply afresh and any Renewal Bonus accumulated in your current Policy will be forfeited.
