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SMILE Term Life Protection
1. Definitions
“Company” means Sovannaphum Life Assurance Plc. (Life Insurance Company)
“Policy” means life insurance policy which is a legal binding document issued by the Company stipulating major substance and detailed terms and conditions that are agreed between the Company and the Insured in the Insurance Contract.
“Insurance Contract” means the written agreement between the Company and the Insured in which the Company agrees to accept any specific risk, and in return receives premium paid by the Insured. The Insurance Contract consists of the Policy, Life Insurance Certificate, riders, attachments, additional statement, endorsements, or requests for any changes by the Insured approved and signed by the Company, Insurance Application Form, health report by physician and health declaration, which all these documents are considered as the Insurance Contract between the Insured and the Company.
“Insured” means the person identified as Insured in the Life Insurance Certificate or attachment, who would be covered under Insurance Contract.
“Premium” means the amount paid by an Insured to the Company as consideration for the obligations assumed by the Company.
“Life Insurance Certificate” means document issued by the Company to certify the fact that an Insured has purchased insurance from company.
“Policy Effective Date” means the date when the Insurance Contract begins.
“Policy Year” means each period of 1 year after the policy becomes effective or from the anniversary date.
“Accident” means sudden event, caused by external factor with a result that is not the intention or determination of the Insured.
“Injury” means physical injury and is directly caused by an accident and is separated and independent of other causes.
“Beneficiary” means a person who is stated in the Insurance Application Form by the Insured to be a Beneficiary, according to the Insurance Contract, and who would receive the benefits due under this Policy upon the death of Insured.
“Total Permanent Disability (TPD)” means the Insured suffers from complete loss or permanent paralysis and permanently irrecoverable of:
• Two arms; or
• Two legs; or
• One arm and one leg; or
• Two eyes; or
• One eye and one arm; or
• One leg and one eye.
In this definition, complete loss and permanently irrecoverable of (i) eye(s) means physical loss of eyes or complete blindness, (ii) arm(s) means loss above the wrist, and (iii) leg(s) means loss above the ankle.
In case of permanent paralysis, the Total and Permanent Disability condition must be certified by a registered hospital at provincial level or above no sooner than 180 days and not later than 270 days from the occurrence of the accident or the date the paralysis condition is verified.
In case of complete loss of arm(s) or leg(s) or eye(s), such certification could be carried out at any time.
2. Entirety of Insurance Contract
This Insurance Contract is based on the Company’s belief in the truth and accuracy of the Insured’s statement in the Insurance Application Form, health declaration and any other additional declarations signed by the Insured; and that the premium has been duly paid in full. On this belief, the Company hereby enters into the Insurance Contract and issues the Policy.
In case that the Insured knowingly misrepresents any statement or has known of or should have known of any material facts but fails to disclose any such fact to the Company which might cause any change to the subject to be Insured, the Company reserves the right to charge extra premium or refuse to enter into the Insurance Contract. Any such misrepresentation or failure to disclose material facts to the Company shall render this Insurance Contract voidable. In such a case, the Company may void the contract and deny to pay a contractual claim.
The Company shall not deny any liabilities by relying on any statement other than that made by the Insured in the document stated under the first paragraph of Entirety of Insurance Contract clause in Part 2.
A life insurance agent or broker has no power to correct or amend this insurance policy, or to extend premium payment anniversary date or to disclaim the submission of notice or evidence for claim processing according to the requirements of this Policy. Any amendment to this Policy shall be complete only after the Company accepts such amendment and issues its endorsement.
3. Applicable Law
This policy will be governed by and construed according to the laws of the Kingdom of Cambodia.
4. Currency
It is described under “Currency” in the Life Insurance Certificate.
5. Incontestability of Insurance Contract
Unless stated as otherwise in this Policy, when the policy is in force, the Company shall not contest the entirety of the Insurance Contract after it has been in force for two years from the Policy Effective Date, or if the policy is reinstated, from the date of the last reinstatement, excepted the Insured has no insurable interest, or the misstatement of the Insured’s age as to be outside the normal limit of business of the Company.
6. Rights and Exercise of Rights under the Policy
The rights and the exercise of rights under this policy, unless specifically assigned to any other person, shall be regarded as solely belonging to the Insured.
Any assignment of rights and the exercise of rights in the policy to another person shall be made only on approval by the Company upon delivery of prior written notice.
7. Insurance Application Form
The Insured shall submit an Insurance Application Form to the Company by using of the prescribed Company’s form.
8. Beneficiary under the Policy
The Insured is entitled to specify the Beneficiary and upon the death of the Insured, the Company shall pay any benefits, specified in the policy. If the Insured has not specified a Beneficiary, the benefits will be paid to heir(s) of the Insured.
If only one Beneficiary is specified and the Beneficiary dies before the Insured or at the same time, the Insured must notify the change of Beneficiary to the Company in writing. If the Insured fails or is unable to notify the change of Beneficiary to the Company, when the Insured dies, the Company shall pay benefits to the Insured’s heir(s).
If more than one Beneficiary is specified and one of them dies before the Insured, the Insured must notify the change of Beneficiary or the conditions of benefit payment to the other Beneficiaries who are still alive, to the Company in writing. If the Insured fails or is unable to notify the change of the Beneficiary to the Company, when the Insured dies, the Company shall pay an equal amount of any remaining benefits of the late Beneficiary after debt repayment (if any) to each of the surviving Beneficiaries.
9. Change of the Beneficiary
In case the new Beneficiary is the Insured’s parent, spouse or child, the change of the Beneficiary will be effective from the day the Insured expresses such intention by notifying the Company in writing so that the Company will record the change in the policy or issue a policy endorsement. However, the Company will not be liable, if the amount payable under the policy has been paid to the original Beneficiary without its knowledge of the change in Beneficiary from the Insured.
In case the new Beneficiary is not the Insured’s parent, spouse or child, the change of the Beneficiary will be effective on the day the Company approves and records such change in the Policy or issue a Policy endorsement.
10. Intentionally Killed by Beneficiary
If the Insured is killed intentionally by a Beneficiary, the Company’s liability will be limited by returning the total actual paid premium, without interest, to the heir(s) of the Insured who is not a perpetrator, co-perpetrator, initiator or accomplice in the killing.
In case there are more than one beneficiary, if any of the Beneficiary (ies) has not taken part in the intentional murder of the Insured, the Company will pay the pro rata amount of sum assured to the Beneficiary who took no part in the murder of the Insured, after deducting the portion that the murderer should have been entitled thereto. The Company shall not return the entire amount of this portion of premium.
In returning the premium in case of murder by the Beneficiary, the Company shall be entitled to deduct therefrom the debt owed under this policy.
11. Amendment of policy
Any amendments to this policy will be valid only when the Company accepts the said amendment and will be effective when the Company has recorded it in the Policy or issued an endorsement thereto, by the person authorized to act for the Company.
12. Misstatement of Age or Gender
If the Insured has misstated age or gender to the Company, and thereby, the Company collected a lower premium than it would have collected; the amount that the Company must pay hereunder shall be reduced to the value of coverage that such premium could buy. In case the Insured has paid the premium exceeding the rate according to the actual age or gender, the Company will return all excess premiums.
If the Company can prove that at the time of conclusion of the Insurance Contract, the actual age of the Insured is outside the premium limit according to the Company’s general business practices, this Insurance Contract shall be voidable by the Company. In case the Company voids the Insurance Contract, the Company shall return premium after deducting the outstanding obligation (if any) to the Insured or the Beneficiary, whichever the case may be.
13. Premium Payment
The premium payment must be paid before, or on the due date by paying on an annual, semi-annual, quarterly or monthly basis at the Company’s Headquarters or a Branch of the Company or to the agent authorized in writing by the Company or other payment methods according to an agreement between the Insured and the Company. The Company will issue the premium receipt as evidence.
In case where the Company leniently allows the premium to be paid on the premium payment mode except annually, the portion of premium not yet paid to the Company, shall be a debt for which the Company will be entitled to deduct from the benefit payable under the policy.
The Insured can change the mode of payment by submitting a request for the change of the mode of premium payment in writing to the Company. The change will be effective when the Company approves such request.
The payment of premium shall be paid in cash. Any payments of the premium made by a promissory note, check, draft, or by any other means, will be regarded as payment being made only when such instrument has been cashed.
14. Grace Period
If the Insured fails to pay the premium when it falls due, the Company will leniently allow a grace period of 31 days from the due date. During the grace period, the policy is still in force. If the Insured dies or gets total Permanent Disability during the grace period, the Company will deduct the outstanding premium in that policy year from the amount which the Company will pay under this policy without charging interest.
15. Lapsation
If the Insured fails to pay the premium within the grace period under clause 14, this policy will be lapsed, as from the payment due date, except in a case that the policy remains in force by virtue of any other provisions contained in the policy.
16. Policy Cancellation
The Company may cancel this policy by advance notice in writing of not less than 30 days, if it shows obvious evidence that the Insured conducts fraud to make use of the benefits under this policy either for the Insured or others. In such event, the Company shall return 90% (ninety percent) of the remaining premium to the insured after deducting premium for the period that the policy has been in force.
The Insured shall give 10 days, written notice to the Company in advance if the Insured wishes to cancel the insurance before expiry date. Based on reasonable grounds, the Company will refund 90% (ninety percent) of the remaining premium to the Insured after deducting premium for the period that the policy has been in force.
17. Notice of Death and Autopsy
Upon the Insured’s death, the Beneficiary must notify the Company within 30 (thirty) days from the date of the Insured’s death, unless it can be proved that there is a reasonable cause for any delay in notifying the death, or they are not aware of the existence of the Policy. In such case, the Company must be notified within 30 (thirty) days from the day the Beneficiary becomes aware of the existence of the Policy.
The Beneficiary shall provide an official death report or official evidence certifying the death of the Insured to the Company, and upon the Company’s reasonable request, the Beneficiary shall provide any additional documents to the Company at the Beneficiary’s own expense.
The Beneficiary shall consent and cooperate for the autopsy of the Insured when the Company deems it necessary, in compliance with the law and with respect to any applicable religious code.
The Company shall be liable as bound by this Policy when the Beneficiary or the Insured’s party act in compliance with the requirement(s) hereof.
18. Notification of Total Permanent Disability (TPD)
When there is a claim made upon the incurrence of Total Permanent Disability (TPD), the Insured or Insured’s party must notify the Company within 30 days after the day that the disability is diagnosed or the occurrence of the accident and submit the proof of physician’s diagnosis and additional proofs as required by the Company as necessary on their own expenses, unless there is a proof that the Insured has other significant and acceptable reason for the absence but had inform the Company as soon as possible.
The Company has a right to request bodily examination of the Insured as it deems appropriate, during the claim underwriting process.
19. Required Documents for Claim
a. In case of death caused by sickness
1. Completed Death Claim Form
2. Life Insurance Certificate (original copy)
3. Certified copies of Beneficiary’s ID card and family book and also along with the original ones
4. Certified copy of certificate of death and also along with the original one
5. The consent letter of Beneficiary or heir to disclose personal data
6. Medical report from doctor in case of death in the registered hospital or registered clinic
In case of death caused by accident, the above documents are also required with two additional documents as follows:
1. Certified copy of daily record related to the case which is certified by detector
2. Certified copy of Autopsy examination report
b. In case of claim based on Total Permanent Disability (TPD)
1. Completed Claim Request Form of Total Permanent Disability
2. Medical report as determined by the company
3. Life Insurance Certificate (original copy)
4. Certified copy of Insured’s ID card and also along with the original one
20. Exclusions
Death or Total Permanent Disability (TPD) claims resulting directly or indirectly from any of the following shall be excluded:
a. Suicide or attempted suicide, self-inflicted injury, whether sane or insane within two years after the Policy Effective Date or the effective date of any reinstatement of this Policy, whichever is later; or
b. Committing or attempting to commit by the Insured or the Beneficiary a criminal offence; or
c. Using drugs or stimulators, abusively using alcohol or driving vehicles under the influence of alcohol as defined in the current laws and regulations.
If the death or Total Permanent Disability (TPD) claims of the Insured resulting directly or indirectly from the exclusions a to c, the Company will only refund the total actual premium, without interest, to the Beneficiary (ies) or heir(s) of the Insured or the Insured.
In returning the premium or paying the death or Total Permanent Disability (TPD) benefit, the Company is entitled to deduct any outstanding obligations owed under this Policy.
21. Free-Look Period
The Insured has the right, for any reasons, to return this Life Insurance Contract together with the written cancellation request within 21 days after the Company has delivered the Policy. If returned, the Policy will be considered void from the beginning.
The Company shall refund the paid premium, deducting the actual health exam fee, and any debts (if any) is owed to the Company by the Insured. The Company reserves right to charge the operation service fee.
An Insured who already claims any benefits from this Insurance Contract cannot cancel this Policy.
22. Dispute Resolution
In the event of any dispute arising from the Insurance Contract, such dispute shall 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 filing a lawsuit to arbitration or a competent court.
Personal Accident Protection Rider
Personal Accident Protection is a rider that is attached to the based policy. If there are any conflicts between the based policy and this rider, the content in this rider shall prevail.
Entire Contract Provision: This rider shall be completely effective once the Company appropriately receive the first premium and accept to insure accordingly to the contract provision stated under this document.
Coverage Table: The Personal Accident Protection rider will cover losses or damages incurred from a bodily injury of the Insured arising from accident and leads the Insured’s death or Total Permanent Disability (TPD) within 180 days from the day of accident while this rider is still enforced. Whenever, incident incurred, the Company shall indemnify as follows:
a. Accidental Death
b. Dismemberment and loss of sight, hearing, and speech
c. Total Permanent Disability
1. Coverage
The Personal Accident Protection rider covers Losses or Damages incurred from bodily of the Insured arising from accident and leads the Insured’s death, Dismemberment & Loss of sight, hearing and speech and Total Permanent Disability (TPD) within 180 days from the day of accident or such injury causes the Insured to be sustained by the Insured necessitates continuous treatment in a hospital as an inpatient and death occurs because of such injury. If the Company has received sufficient evidence for claim assessment, to its reasonable satisfaction, in compliance with the format and method stipulated by the Company, the Company will pay compensation in accordance to the following items:
1.1 Accidental Death
Upon death of the Life Insured during the coverage period due to Accidental causes, 100% of the Personal Accident Protection rider sum assured will be payable to the beneficiary (ies).
1.2 Dismemberment and Loss of Sight, Hearing and Speech
Upon Dismemberment and Loss of Sight, Hearing and Speech arising from accident, the Company will pay compensation to the Insured as follows:
| Item | Percentage of Personal Accident Protection Rider Sum Assured | Description |
|---|---|---|
| 1.2.1 | 100% | In case of loss of both hands from the wrist joint or both feet from ankle joint or sight of both eyes. |
| 1.2.2 | 100% | In case of loss of one hand from the wrist joint and one foot from the ankle joint. |
| 1.2.3 | 100% | In case of loss of one hand from the wrist joint and sight of one eye. |
| 1.2.4 | 100% | In case of loss of one foot from the ankle joint and sight of one eye. |
| 1.2.5 | 60% | In case of loss of one hand from the wrist joint. |
| 1.2.6 | 60% | In case of loss of one foot from the ankle joint. |
| 1.2.7 | 60% | In case of loss of sight of one eye. |
| 1.2.8 | 50% | In case of total and permanent loss of hearing or speech. |
| 1.2.9 | 15% | In case of total and permanent loss of hearing in one ear. |
| 1.2.10 | 25% | In case of total and permanent loss of a thumb (Both joints). |
| 1.2.11 | 10% | In case of total and permanent loss of a thumb (One joint). |
| 1.2.12 | 10% | In case of total and permanent loss of an index finger (three joints). |
| 1.2.13 | 8% | In case of total and permanent loss of an index finger (two joints). |
| 1.2.14 | 4% | In case of total and permanent loss of an index finger (one joint). |
| 1.2.15 | 5% | In case of total and permanent loss of other fingers (not less than two joints) beside thumb or index finger. |
| 1.2.16 | 5% | In case of total and permanent loss of big toe. |
| 1.2.17 | 1% | In case of total and permanent loss of a toe (not less than one joint) beside big toe. |
1.3 Total Permanent Disability (TPD)
In case the Insured becomes totally and permanently disabled due to accidental cause, where the total permanent disability is certified by a registered hospital at provincial or above no sooner than 180 days and not later than 270 days from the occurrence of the accident or the date the paralysis condition is verified, the Company will pay compensation as stated in the Coverage Table to the Insured.
2. Definitions
“Loss of Sight of Eyes” means physical loss of eyes or complete blindness.
“Dismemberment” means a loss of limb from wrist or ankle, including a completely loss of capability of such member with medical indication that it would not be recovered.
“Accident” means sudden event, caused by external factor with a result that is not the intention or determination of the Insured.
“Total Permanent Disability (TPD)” means the Insured suffers from complete loss or permanent paralysis and permanently irrecoverable of:
• Two arms; or
• Two legs; or
• One arm and one leg; or
• Two eyes; or
• One eye and one arm; or
• One leg and one eye.
In this definition, complete loss and permanently irrecoverable of (i) eye(s) means physical loss of eyes or complete blindness, (ii) arm(s) means loss above the wrist, and (iii) leg(s) means loss above the ankle.
In case of permanent paralysis, the Total and Permanent Disability condition must be certified by a registered hospital at provincial level or above no sooner than 180 days and not later than 270 days from the occurrence of the accident or the date the paralysis condition is verified.
In case of complete loss of arm(s) or leg(s) or eye(s), such certification could be carried out at any time.
3. General Provision
3.1 Notification of Death
Upon the Insured’s death, the Beneficiary or Insured party must notify the Company within thirty (30) days from the date of the Insured’s death, unless it can be proved that there is a reasonable cause for any delay in notifying the death, or they are not aware of the existence of this rider. In such case, the Company must be notified within thirty (30) days from the day the Beneficiary becomes aware of the existence of the Policy.
The Beneficiary or Insured party shall provide an official death report or official evidence signifying the death of the Insured to the Company, and upon the Company’s reasonable request, the Beneficiary shall provide any additional documents to the Company at the Beneficiary’s own expense.
The Beneficiary or Insured party shall consent and cooperate for the autopsy of the Insured when the Company deems it necessary, in compliance with the law and with respect to any applicable religious code.
The Company shall be liable as bound by this rider when the Beneficiary or the Insured’s party act in compliance with the requirement(s) hereof.
3.2 Notification of Total Permanent Disability (TPD) or Dismemberment, and Loss of Sight, Hearing and Speech
When there is a claim made upon the incurrence of Total Permanent Disability (TPD) or dismemberment, and loss of sight, hearing and speech, the Insured or Insured party must notify the Company within thirty (30) days after the day that the disability is diagnosed or the occurrence of the accident and submit the proof of physician’s diagnosis and additional proofs as required by the Company as necessary on their own expenses. Unless there is a proof that the Insured has other significant and acceptable reason for the absence but had informed the Company as soon as possible.
The Company has a right to request bodily examination of the Insured as it deems appropriate, during the claim underwriting process.
3.3 Renewal
This rider may be renewed at the policy anniversary date of the based policy. The payment shall be made on or prior to the due date applying the recent premium rate stipulated by the Company.
The Company reserves the rights to renew this rider in the next policy year.
3.4 Termination of the Rider
The coverage under this rider shall cease upon one of the following incurrence, whichever incurs first.
1. When the based policy that this Rider is attached to is matured, or surrendered; or
2. When the Insured is jailed or imprisoned. The Company will refund the premium to the Insured; or
3. When this rider has no premium payment submitted by the grace period; or
4. When the Insured or the Company cancel this rider; or
5. When the benefit under this rider was paid (except coverage 1.2: 1.2.8-1.2.17); or
6. When the Company indemnifies the sum assured of this rider.
The termination of this rider would not affect to any claim rights occurred prior to the termination date. If there is a premium payment submitted to the Company after the termination of this rider, it would not cause the Company any further responsibilities but to return such premium.
3.5 Fraud
If any claim under this rider shall be in any respect fraudulent or if any fraudulent means or devices shall be used to obtain the Benefit under this rider the Company shall have no liability in respect of such claim.
3.6 Rider Cancelation
The Company may cancel this rider by advance notice in writing of not less than 30-day, if it shows obvious evidence that the Insured conducts fraud to make use of the benefits under this rider either for the Insured or others. In such event, the Company shall return ninety (90) percent after deducting premium for the period that the rider has been in force to the Insured.
The Insured shall give 10-day written notice to the Company in advance if the Insured wishes to cancel the insurance before expiry date. Based on reasonable grounds, the Company will refund the premium to the Insured ninety (90) percent after deducting premium for the period that this rider has been in force.
3.7 Condition Precedent
The Company shall not be liable to pay any compensation under this rider unless the Insured shall have complied properly with the insurance contract and condition of this rider.
3.8 Change of Occupation
The Insured shall provide written notice immediately to the Company of any change in the Insured’s occupation and shall pay additional premium if required.
In case that the Insured does not notice the Company about the change of Insured’s occupation, if the Insured sustains injury while in the course of employment for compensation in an occupation that is more hazardous than the occupation originally stated, the Company shall pay compensation in the amount that the premium paid for the original occupation would have purchased for the new occupation. If the Insured changes occupation to one which the Company classifies as less hazardous, the Company shall reduce the rate of premium and shall return a proportion part of the premium from the date of change after receipt of proof of change.
3.9 Exclusions
This rider does not apply to any events, which is caused directly or indirectly by, or which results from:
a. Suicide or attempted suicide, self-inflicted injury, whether sane or insane within two years after this rider Effective Date or the effective date of any reinstatement of this rider, whichever is later; or
b. Committing or attempting to commit by the Insured or the Beneficiary a criminal offence; or
c. Abortion
d. Pregnancy or birth-giving or their complications; or
e. Using drugs or stimulators, abusively using alcohol or driving vehicle under the influence of alcohol as defined in the current laws and regulations; or
f. Any form of mental or psychiatric disorder; or
g. Injuries are caused by insect bites including but not limited to mosquito bites and bee stings; or
h. Bacterial infection except infection or tetanus or rabies as a result of accidental wound; or
i. Participation in dangerous sports or activities such as (not limited to all these descriptions) diving in the water, climbing a mountain, parachute; or
j. Racing of all kinds, other than those on foot or bicycle and participation in professional or competitive sports where the Insured would or could earn financial gain in engaging in such sports; or
k. Being in an aircraft of any type, or boarding or descending from any aircraft, except as a fare-paying passenger in an aircraft that is on a regular scheduled route operated by a commercial airline; or
l. While the Insured is piloting or operating as a crew member in any aircraft; or
m. War, either declared or not, invasion or act of foreign enemy, civil war, revolution, rebellion, riot, terrorism; or
n. While the Insured is serving as a soldier, police or volunteer in a war or suppression; or
o. While the Insured is engaging in a brawl or taking part in inciting a brawl; or
p. Radiation or radio activity from any nuclear fuel arising from the combustion of nuclear fuel and self-sustaining process of nuclear fission.
Critical Illness Cost Protection Rider
Critical Illness Cost Protection is a rider that is attached to the based policy. If there are any conflicts between the based policy and this rider, the content in this rider shall prevail.
Entire Contract Provision: This rider shall be completely effective once the Company appropriately receives the first premium and accepts to insure accordingly to the contract provision stated under this document.
1. Coverage
While this rider is still in force, if the Insured is diagnosed as suffering from critical illness, as defined under this document, the Company shall pay the sum assured of this rider as indicated on the life insurance policy or any endorsements to the Insured.
However, the amount paid in the above paragraph shall not exceed the sum assured amount under this rider.
2. Definitions
“Diagnosis” means a clear evidence-based physician’s diagnosis as reference to the critical illness as defined in this rider. In case of lack of such clear evidence, the replaceable evidence could be the report from radiological, clinical, histological, or laboratory examination.
“Physician” means contemporary physician who holds medical certificate recognized by 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 descendent.
“Critical Illness” means the Life Insured is diagnosed with critical illness that incurred 90 days after the Company accepts to insure or from the last reinstatement and the Insured survives for at least 30 days.
The Critical Illness covered by this rider are the following 5 diseases:
a) Cancer
Cancer is identified by the diagnosis of a malignant tumour characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue. The cancer must be confirmed by histological evidence of malignancy by a qualified oncologist or pathologist.
Cancer also includes: Leukemia, Lymphoma or Sarcoma.
The following are excluded:
1. Tumour which is histologically classified as pre-malignant, non-invasive, having either borderline malignancy or low malignancy potential, or carcinoma in situ including but not limited to cervical dysplasia, Cervix cancer CIN-1, CIN-2 & CIN-3;
2. Early prostate cancer, thyroid cancer, bladder cancer histologically classified as T1N0M0 or a lower stage according to TNM Classification or equivalent classification ;
3. Chronic Lymphocytic Leukemia classified as less than RAI Stage III;
4. All non-melanomas skin cancer and malignant melanomas of the skin histologically classified as less than Stage II according to the melanoma staging system of the American Joint Committee on Cancer (AJCC);
5. All tumours in the presence of HIV infection.
b) Stroke
A cerebrovascular incident caused by cerebral thrombosis or intracerebral haemorrhage or extracranial embolism which results in permanent neurological deficit lasting for at least 60 days. The diagnosis must be supported by new changes on a CT or MRI scan and confirmed by a neurologist.
The following are excluded:
1. Infarction of brain tissue or intracranial bleeding as a result of external injury;
2. Cerebral symptoms due to transient ischaemeic attacks;
3. Any reversible ischaemic neurological deficit;
4. Vascular disease affecting the eye or optic nerve or vestibular functions.
c) Heart Attack
Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. This diagnosis must be supported by three or more of the following four criteria which are consistent with a new heart attack:
1. History of typical chest pain;
2. New electrocardiogram (ECG) changes proving infarction;
3. Diagnostic elevation of cardiac enzyme CK-MB or Troponin (T or I) at level above the generally accepted laboratory levels of normal;
4. Left ventricular ejection fraction less than 50% measured 3 months or more after the event.
d) End Stage Lung Disease
The end stage of lung disease, causing chronic respiratory failure, as demonstrated by all of the following:
1. FEV1 test results consistently less than 1 liter,
2. Requiring permanent supplementary oxygen therapy for hypoxemia
3. Arterial blood gas analyses with partial oxygen pressures of 55 mmHg or less (PaO2 < 55 mmHg), and
4. Dyspnea at rest.
e) End Stage Kidney Disease
End stage kidney disease presenting as chronic irreversible failure of both kidneys to function. This must be evidenced by the undergoing of regular renal dialysis or renal transplantation carried out.
3. General Provision
3.1 Claim and Indemnity
The Insured or the Insured party shall inform the Company in writing within sixty (60) days after the day the Insured is diagnosed with critical illness. Unless it can be proved that there is a reasonable cause for any delay in notifying the claim, or they are not aware of the existence of the Policy or any other proper reasons for such absence. In such case, the Company must be notified as soon as possible; failure to act within such timeline shall not cause the loss of claim right.
When the Insured makes claim, they shall submit Physician’s diagnosis with other documents as indicated in the Diagnosis Definition at their own cost to the Company within 180 days after the day of diagnosis or surgical operation.
When the claim of critical illness is made, the Company reserves the right to additionally inspect the Insured as considered appropriate, which includes the HIV test, to assist in the claim underwriting process to identify whether the cause of illness is covered under this Rider or not.
3.2 Renewal
This rider may be renewed at the policy anniversary date of the based policy. The payment shall be made on or prior to the due date applying the recent premium rate stipulated by the Company.
The Company reserves the rights to renew this rider in the next policy year.
3.3 Termination of the Rider
This rider shall be terminated upon one of the following incurrence:
1. When the based policy that this rider is attached to is matured, or surrendered; or
2. If the Insured fails to pay the rider premium within the grace period; or
3. When the Company indemnifies the sum assured of this rider; or
4. When the Insured or the Company cancels this rider.
3.4 Fraud
If any claim under this rider shall be in any respect fraudulent or if any fraudulent means or devices shall be used to obtain the Benefit under this rider the Company shall have no liability in respect of such claim.
3.5 Rider Cancellation
The Company may cancel this rider by advance notice in writing of not less than 30-day, if it shows obvious evidence that the Insured conducts fraud to make use of the benefits under this rider either for the Insured or others. In such event, the Company shall return ninety (90) percent after deducting premium for the period that the rider has been in force to the Insured.
The Insured shall give 10-day written notice to the Company in advance if the Insured wishes to cancel the insurance before expiry date. Based on reasonable grounds, the Company will refund the premium to the Insured ninety (90) percent after deducting premium for the period that the rider has been in force.
3.6 Condition Precedent
The company shall not be liable to pay any compensation under this rider unless the Insured shall have complied properly with the insurance contract and condition of this rider.
3.7 Reinstatement
In case that this rider has ceased because the based policy is terminated, the Insured can reinstate this rider. However, such reinstatement can be done only upon the reinstatement of the based 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.
3.8 Exclusions
This rider would not cover any critical illness as a direct or indirect result of following causes:
a. Any Pre-existing Conditions which mean:
(i) which existed or was existing;
(ii) where its cause existed or was existing;
(iii) where the Life Insured had knowledge, signs or symptoms of the injury, sickness, disease or illness;
(iv) where any laboratory test or investigation showed the likely presence of the injury, sickness, disease or illness, prior to the relevant Policy Date or reinstatement date, whichever is later.
b. Suicide or attempted suicide, self-inflicted injury, whether sane or insane within two years after the Rider Effective Date or the effective date of any reinstatement of this Rider, whichever is later; or
c. Diagnosis of the listed critical illness is prior to the date the Company accepts this policy or within 90 days after such date or the last reinstatement date; or
d. The influence of alcohol, substance, drug; or
e. AIDS or HIV infection.
Hospital Daily Benefits Rider
Hospital Daily Benefits is a rider that is attached to the based policy. If there are any conflicts between the based policy and this rider, the content in this rider shall prevail.
Entire Contract Provision: This rider shall be completely effective once the Company appropriately receive the first premium and accept to insure accordingly to the contract provision stated under this document.
1. Coverage
If the Insured experiences accidental injury or becomes ill, which causes the Insured to be admitted as inpatient or requires physician’s advice in diagnosis process while this rider is still in forced and after the 30 days waiting period is ended for any illness causes; Company would pay benefits as follows.
1.1 In case the Insured is injured or ill, which causes the Insured to be admitted as inpatient of a hospital as required by its medical necessity; Company shall pay daily benefit to the Insured, where the daily benefit of each hospital confinement arising from one injury or illness shall not exceed 30 days.
1.2 In case the Insured need to be admitted as inpatient in Intensive Care Unit (ICU) of a hospital, Company would pay extra 100% of daily benefit, where the daily benefit of each hospital confinement arising from one injury or illness shall not exceed 7 days.
The total benefit payout per day in total of No. 1.1 and No. 1.2 shall not exceed two times the stated daily benefit.
The maximum length of staying as inpatient for No. 1.1 and No. 1.2 per one hospital confinement shall not exceed 30 days.
Moreover, any benefit payouts shall be made after the deduction of all unpaid loans and any other obligations.
2. Definitions
“Illness” means the symptom, abnormality, sickness or disease caused to the Insured.
“Physician” means contemporary physician who holds medical certificate recognized by 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 descendent.
“Medical Fees” means regular expenses that a hospital charges in exchange of medical service while the Insured is admitted as inpatient.
“Inpatient” means the Insured is admitted in a hospital for at least 6 consecutive hours and registered as inpatient of the hospital registration, which is as a result of physician’s diagnosis and recommendation under the medical standard and for a reasonable period considering the condition of each injury or illness.
“Hospital” means legally constituted establishment which operates pursuant to the laws of the country in which it is based and registered as hospital and which:
1. It can provide care and treatment of sick and injured persons on a resident inpatient basis;
2. It has facilities for diagnosis, treatment and major surgery;
3. It can provide full time nursing service;
4. It is under the supervision of a registered practitioner;
5. It is not primarily a clinic, a place for custodial care, the aged, persons with mental disorders, alcoholics or drug addicts, a nursing, rest or convalescent home.
“Medical Standard” means international medical guidelines or practices that results in an appropriate treatment plan for patient as identified medical necessity that also matches the conclusion taken from record on injury, detection, examination results, or others (if any).
“Medical Necessity” means medical services with following conditions:
1. Justified as reasonable based on its diagnosis and treatment accordingly to the Insured’s condition of injury or illness;
2. Includes clear medical indicator based on modern medical standard;
3. Must not be for convenient purposes of one 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 injury or illness
“Alternative Medicine” means medical diagnosis or prevention based on Khmer traditional medicine, Khmer indigenous medicine, traditional Chinese medicine or any other methods rather than modern medicine.
“Hospital Confinement” means an admission in hospital for treatment as inpatient. This also includes any number of hospital confinements arising from one same cause or due to any complications incurred on such cause that the gab of each confinement is not more than 90 days, such set of confinements would be considered as one confinement.
“AIDS” means Acquired Immune Deficiency Syndrome caused by AIDS virus and this also covers the symptomatic infection, Malignant Neoplasm, or any other infections or illnesses caused, according to the blood test with positive result, by HIV (Human Immune Deficiency Virus), the symptomatic infection includes, but not limited to, the Pneumocystis Carinii Pneumonia, Organism Or Chronic Enteritis, Virus and/or Disseminated Fungi Infection, Malignant Neoplasm. It also includes, but not limited to, Kaposi’s Sarcoma, Central Nervous System Lymphoma and/or any other critical illness known in modern medical that it was caused by Acquired Immune Deficiency Syndrome or was caused someone a sudden death, an illness or disability. AIDS includes HIV (Human Immunodeficiency Virus), Encephalopathy (Dementia) and virus prevalence
3. General Provision
3.1 Notification and Claim Process
The Insured or the Insured Party, whichever the case may be, shall notify the Company without delaying on injury or illness that could cause claim for coverage under this rider.
3.2 Delivery of Claim Evidence
The Insured or the Insured Party must deliver the evidence within 30 days to the Company after the day the Insured leaves the hospital, where copy of 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 absence; however, the evidence shall been delivered as soon as possible.
3.3 Medical Examination
Within a reasonable period, the Company holds a right to inspect the medical records of the Insured as necessary to this insurance. If the Insured denies giving consent to the Company for the inspection as part of claim underwriting process, the Company could deny providing the Insured the coverage.
3.4 Benefit Payout
All benefits in this rider shall be paid to the Insured and any payouts are considered as legal release of liabilities for the Company. In case the Insured dies during or after hospitalization, the Company shall pay this rider benefit to the beneficiary as stated in the based policy.
3.5 Renewal
This rider may be renewed at the policy anniversary date of the based policy. The payment shall be made on or prior to the due date applying the recent premium rate stipulated by the Company.
The Company reserves the rights to renew this rider in the next policy year.
3.6 Termination of the Rider
This rider shall be terminated upon one of the following incurrence:
1. When the based policy that this rider is attached to is matured, or surrendered; or
2. If the Insured fails to pay the rider premium within the grace period; or
3. When the Company indemnifies the sum assured of this rider; or
4. When the Insured or the Company cancels this rider.
The termination of this rider shall have no effect to any claim rights exists prior to such termination. The Company receives any premium after the day of termination; it would not bind the Company to any liabilities but to refund such premium.
3.7 Fraud
If any claim under this rider shall be in any respect fraudulent or if any fraudulent means or devices shall be used to obtain the Benefit under this rider the Company shall have no liability in respect of such claim.
3.8 Rider Cancellation
The company may cancel this rider by advance notice in writing of not less than 30-day, if it shows obvious evidence that the Insured conducts fraud to make use of the benefits under this rider either for the Insured or others. In such event, the company shall return ninety (90) percent after deducting premium for the period that this rider has been in force to the Insured.
The Insured shall give 10-day written notice to the Company in advance if the Insured wishes to cancel the insurance before expiry date. Based on reasonable grounds, the Company will refund the premium to the Insured ninety (90) percent after deducting premium for the period that the rider has been in force.
3.9 Condition Precedent
The company shall not be liable to pay any compensation under this rider unless the Insured shall have complied properly with the insurance contract and condition of this rider.
3.10 Reinstatement
In case that this rider has ceased because the based policy was terminated, the Insured could reinstate this rider. However, reinstatement could be done only upon the reinstatement of the based policy with proof that the Insured is in good health and insurable condition.
However, the Company reserves the right to approve or deny the reinstatement proposal.
3.11 Waiting Period
a. The Company shall not make any benefit payout accordingly to this rider for any illnesses incurred during the first 30 days after this rider become effective or reinstated, whichever case may occur last; or
b. The Company shall not make any benefit payout accordingly to this rider for the following illnesses incurred during the first 365 days after this rider becomes effective or reinstated, whichever case may occur last as follows:
1. All kinds of benign or malignant tumors
2. Hemorrhoids
3. Anal fistula
4. Hydroceles
5. Any kind of hernia
6. Hypertension or cardiovascular disease
7. Calculi of kidney or urethra
8. Hysterectomy
9. Cataracts
10. Prolapsed intervertebral disc
11. Cholecystitis
12. Sinus conditions or abnormalities of nasal passages, septum, or turbinates
13. Endometriosis
14. Thyroid dysfunction
15. Epilepsy
16. Tuberculosis
17. Gastric or duodenal ulcer
18. Varicoceles
19. Hallux valgus
20. Uterine fibroids
21. Tonsils and Adenoids Disease
3.12 Exclusions
This rider does not cover any expenses incurred from hospital treatment or any damages incurred from injuries or illnesses (including any complications), symptoms or abnormalities arising from:
1. Chronic decease, illnesses or injuries that was not treated prior to the contract is signed, congenital anomalies, or pervasive development disorders or genetic disorders; or
2. Cosmetic surgery or any other treatments for skin beauty purposes, pimple and blemish treatment, dandruff and hair fall treatment, or weight control, or elective surgeries, unless a skin grafting arising from accident that this rider covers; or
3. Pregnancy, miscarriage, abortion, childbirth, any pregnancy complications, infertility resolution (including diagnosis and treatment), sterilization or birth control; or
4. AIDS, venereal disease, or sexually transmitted diseases; or
5. Anti-aging treatment or prevention by consuming drugs or substances, pharmacology for skeletal disorders due to aging, male or female sexual malfunction, any sexual disorder treatments and sexual reassignment surgery; or
6. General or regular medical examinations, individual request for admission in hospital or clinic, individual request for surgery, rest recovery or rest cure, any diagnosis other than the original cause of treatment, diagnosis of injury or illnesses, any diagnosis considered not a medical necessary or not required by medical standard, and exclusive nurse service fees; or
7. Ophthalmic disorders diagnosis and treatment, LASIK, expenses on vision aids or treatment; or
8. Oral check, treatment or surgery, including denture, dental crown, root cannel treatment, dental filling, orthodontic, tooth scaling, dental extraction, dental implants unless necessitated by an accidental injury; however for such incident the coverage shall not be provided for the false tooth/teeth, dental crown and root cannel treatment or dental implants; or
9. Treatment or rehabilitation for narcotic drug, cigarette, alcohol or any psychotropic substances addiction; or
10. Diagnosis and treatment for mental illness or disorder, psychiatric or psychological illness, or behavior disorders or personality disorders, Attention Deficit Hyperactivity Disorder (ADHD), autism, stress, eating disorder; or Anxiety; or
11. Any types of treatment under experiment, treatment or diagnosis on obstructive sleep apnea symptom or illness, treatment or diagnosis on sleep disorder and snoring; or
12. Diagnosis and treatment other than modern medicine, including alternative medicine; or
13. Expenses incurred from the diagnosis and treatment that the insured is acting as his/her own physician, and also such expenses that the insured’s parent, spouse, or child is acting as the physician; or
14. Suicide or attempted suicide, self-inflicted injury, whether sane or insane within two years after this rider Effective Date or the effective date of any reinstatement of this rider, whichever is later. This shall include an incident when the insured eat, drink or inject drug or toxic substance into one’s body in excess of the doctor’s instruction; or
15. Using drugs or stimulators, abusively using alcohol or driving vehicles under the influence of alcohol as defined in the current laws and regulations; or
16. While under the influence of alcohol means the blood test shows alcohol level from 150 milligram or more.
17. Injuries arising while participating in a quarrel or causing the quarrel; or
18. Injuries arising under an incident where the insured intentionally committed a serious crime or while under arrest or absconding; or
19. Injuries arising while engaging in all boat or automobile speed racing, horse racing, skiing of any kind including jet-skiing, skating sport, boxing of any kind, parachuting (except for life saving purposes), ballooning, hang gliding, bungi-jumping, underwater activities that involves the use of breathing apparatus; or
20. Injuries arising while serving as a soldier, policeman or a volunteer; or
21. Any types of operation in a war or suppression, declared or undeclared war, aggression or an act of foreign enemy, a warlike action; civil war, rebellion, insurgent, riot, strike, insurrection, revolution, coup d’etat, declaration of martial law implementation, or any other situations that causes the implementation of martial law to continue; or
22. Any Pre-existing Conditions: which mean:
(i) Which existed or was existing;
(ii) Where its cause existed or was existing;
(iii) Where the Life Insured had knowledge, signs or symptoms of the injury, sickness, disease or illness
(iv) Where any laboratory test or investigation showed the likely presence of the injury, sickness, disease or illness, prior to the relevant Policy Date or reinstatement date, whichever is later.
Smart Saving Rider
Smart Saving is a rider that is attached to the based policy. If there are any conflicts between the based policy and this rider, the content in this rider shall prevail.
Entire Contract Provision: This rider shall be completely effective once the Company appropriately receive the first premium and accept to insure accordingly to the contract provision stated under this document.
1. Coverage
Insured is eligible for 100% of the Smart Saving Sum Assured if he/she survives at the end of the rider contract.
2. General Provision
2.1 Reinstatement
In case that this rider had ceased because the based policy was terminated, the Insured could reinstate this rider. However, such reinstatement could be done only upon the reinstatement of the based 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.
2.2 Renewal
This rider may be renewed at the policy anniversary date of the based policy. The payment shall be made on or prior to the due date applying the recent premium rate stipulated by the Company.
The Company reserves the rights to renew this rider in the next policy year.
2.3 Termination of the Rider
This rider shall be terminated immediately as follows:
1. When the based policy that this Rider is attached to is matured, or surrendered; or
2. If the Insured fails to pay the rider premium within the grace period; or
3. When the Company indemnifies the sum assured of this rider; or
4. When the Insured or the Company cancels this rider.
The termination of this rider shall have no effect to any claim rights exists prior to such termination. If the Company receives any premium after the day of termination; it would not bind the Company to any liabilities but to refund such premium.
2.4 Rider Surrender
Insured is entitled to terminate a rider contract by surrendering this rider and receiving the surrender value according to the amount prescribed in the Rider Surrender Value Schedule and other benefits entitled to receive (if any).
However, termination of this rider shall be completed after the Company consents to such termination in writing.
2.5 Condition Precedent
The company shall not be liable to pay any compensation under this rider unless the Insured shall have complied properly with the insurance contract and condition of this rider.