PRODUCT DISCLOSURE SHEET Hong Leong Assurance Berhad … · 2. Coronary Artery By-Pass Surgery 3....
Transcript of PRODUCT DISCLOSURE SHEET Hong Leong Assurance Berhad … · 2. Coronary Artery By-Pass Surgery 3....
PRODUCT DISCLOSURE SHEET Hong Leong Assurance Berhad
Read this Product Disclosure Sheet before you decide to take up the Credit Shield Premier. Be sure to also read the general terms and conditions.
Credit Shield Premier
Important Note: This product is underwritten by Hong Leong Assurance Berhad, an insurer licensed under the Financial Services Act 2013 and regulated by Bank Negara Malaysia.
1. What is this product about?
This is a non-participating group policy which provides death, Total and Permanent Disability (TPD),
Critical Illness or Temporary Total Disability (TTD) coverage, whichever occurs first.
2. What are the covers/benefits provided?
The duration of the coverage is up to the Assured Member attaining the age of 65 years or upon termination, whichever occurs first.
This policy covers:
Death Benefit
In the event of death of the Assured Member, the Death Benefit equivalent to the total outstanding balance of credit card account as at the event date, subject to a maximum of RM100,000 per Assured Member with gold or classic cards collectively held by the Assured Member or RM300,000 per Assured Member with platinum or higher cards collectively held by the Assured Member, shall be payable. For the purpose of clarification, where the Assured Member holds more than one type of card, the maximum limit that applies to the higher card held by the Assured Member shall be applicable.
In the event that the death occurs during the period when the Assured Member is suffering from Temporary Total Disability, Death Benefit payable shall be 20 times of the Temporary Total Disability Benefit minus any Temporary Total Disability Benefit paid up to the date of the death of the Assured Member.
Total and Permanent Disability Benefit (TPD) Benefit
In the event of TPD (prior to attaining age 65) of the Assured Member, the TPD Benefit equivalent to the total outstanding balance of credit card account as at the event date give rise to TPD, subject to a maximum of RM100,000 per Assured Member with gold or classic cards collectively held by the Assured Member or RM300,000 per Assured Member with platinum or higher cards collectively held by the Assured Member, shall be payable. For the purpose of clarification, where the Assured Member holds more than one type of card, the maximum limit that applies to the higher card held by the Assured Member shall be applicable. The TPD Benefit is further subject to the TPD provision as stated below:
TPD Provision The total TPD Benefit per life payable under all policies insuring the Assured Member shall not exceed the TPD Benefit Limit per life of RM 10,000,000. The Total TPD Benefit per life refers to TPD coverage of all in force policies for each Assured Member at the point of claim event.
If the total TPD Benefit does not exceed RM10,000,000.00, the Company shall pay an amount not exceeding RM4,000,000.00 in a lump sum and the balance shall be paid in two equal installments on the first anniversary and second anniversary of the date of first payment of the Total and Permanent Disability Benefit;
If the total TPD Benefit exceeds RM10,000,000.00, only RM10,000,000.00 is payable as Total and Permanent Disability Benefit in the manner stated above. The balance of Sum Assured, if any, will be paid upon the death of the Assured Member within the coverage period and premium will be waived.
The Assured Member shall no longer be entitled to claim TPD Benefit upon the Assured Member attaining the age of 65.
In the event that the TPD occur during the period when the Assured Member is suffering from TTD, TPD Benefit payable shall be 20 times of the Temporary Total Disability Benefit minus any Temporary Total Disability Benefit paid up to the date of TPD of the Assured Member.
Critical Illness Benefit
If the Assured Member is diagnosed with any one of the 36 Critical Illnesses covered, the Critical Illness Benefit equivalent to the total outstanding balance of credit card account as at the diagnosis date, subject to a maximum of RM100,000 per Assured Member with gold or classic cards collectively held by the Assured Member or RM300,000 per Assured Member with platinum or higher cards collectively held by the Assured Member, shall be payable. For the purpose of clarification, where the Assured Member holds more than one type of card, the maximum limit that applies to the higher card held by the Assured Member shall be applicable.
In the event that Critical Illness is diagnosed during the period when the Assured Member is suffering from TTD, Critical Illness Benefit payable shall be twenty (20) times of the Temporary Total Disability Benefit minus any Temporary Total Disability Benefit paid up to the date of diagnosis of Critical Illness of the Assured Member.
The following 36 Critical Illnesses are covered:
1 Stroke 19 Loss of Speech
2 Heart Attack 20 Brain Surgery
3 Kidney Failure 21 Heart Valve Surgery
4 Cancer 22 Loss of Independent Existence
5 Coronary Artery By-Pass Surgery 23 HIV Infection Due To Blood Transfusion
6 Serious Coronary Artery Disease 24 Bacterial Meningitis
7 Full Blown Aids 25 Major Head Trauma
8 End Stage Liver Failure 26 Chronic Aplastic Anemia
9 Fulminant Viral Hepatitis 27 Motor Neuron Disease
10 Coma 28 Parkinson's Disease
11 Benign Brain Tumor 29 Alzheimer's Disease/ Severe Dementia
12 Paralysis of Limbs 30 Muscular Dystrophy
13 Blindness 31 Surgery To Aorta
14 Deafness 32 Multiple Sclerosis
15 Third Degree Burns 33 Primary Pulmonary Arterial Hypertension
16 End Stage Lung Disease 34 Medullary Cystic Disease
17 Encephalitis 35 Cardiomyopathy
18 Major Organ / Bone Marrow Transplant
36 Systemic Lupus Erythematosus With Severe Kidney Complications
Temporary Total Disability (TTD) Benefit
In the event of the Assured Member suffers TTD, the TTD Benefit equivalent to five percent (5%) of the total outstanding balance of credit card account as at the date of event give rise to such TTD, subject to a maximum of RM5,000 for Assured Member with gold or classic card or RM15,000 for Assured Member with platinum or higher card, shall be payable.
The premium shall be waived during the disabled period. The TTD benefit is payable monthly provided the Assured Member continue to suffer a Temporary Total Disability up to a maximum of twenty (20) months.
The premium shall resume at the billing date following the recovery from TTD.
An application for Credit Shield Premier shall include all your existing credit cards with Hong Leong Bank Berhad. Upon approval, all subsequent credit cards will also automatically be covered. The coverage for subsequent credit cards will be subject to the same exclusions as stated in item (6). For the purpose of clarification, the Effective Date of the insurance coverage for each subsequent credit card shall be the activation date of each subsequent card.
3. How much premium do I have to pay?
The total premium that you have to pay varies depending on the total outstanding balance as per
Hong Leong Bank Berhad monthly credit card statement. Premium is auto debited from your credit card account on a monthly basis.
The monthly premium that you have pay shall be RM0.65 per RM100 of the outstanding balance on your credit card account. The Premium is payable as long as there is an outstanding balance in your credit card account. The premium rate is not guaranteed and Hong Leong Assurance Berhad
reserves the right to revise the premium rate with ninety (90) days prior written notice. Policy renewal is on monthly basis up to the Assured Member attaining the age of 65.
4. What are the fees and charges I have to pay?
Commission is applicable. 6% service tax is chargeable if the premium of the policy is contributed by corporates. Otherwise, there is no service tax chargeable if the premium of policy is contributed by individuals. Below is the commission paid to Hong Leong Bank Berhad, borne by you and paid from your premium:
Commission in Percentage of Premium (%) 10%
5. What are some of the key terms and conditions that I should be aware of?
Importance of disclosure – you must disclose all material facts such as medical condition, and
state your age correctly.
Free-look period – you may cancel your policy by returning the policy within fifteen (15) days from the date the policy is delivered to you. The premiums that you have paid inclusive of any applicable tax which has been paid (less any medical fee incurred) will be refunded to you.
You should satisfy yourself that this policy will best serve your needs and that the premium payable under this plan is an amount you can afford.
Note: This list is non-exhaustive. Please refer to the policy contract for the terms and conditions under this policy.
6. What are the major exclusions under this policy?
Death Benefit
No Death Benefit is payable if the Assured Member:
- while sane or insane commits suicide within twelve (12) months from the Effective Date; - dies due to non-accidental causes occurs within thirty (30) days from the Effective Date.
TPD/TTD Benefit
No TPD/TTD Benefit is payable:
i. if such disability has resulted directly or indirectly: a) from any self-inflicted bodily injury while sane or insane; b) from flying in an aircraft (except as an aircrew member of, or as an ordinary fare
paying passenger, on a regularly scheduled flight of a commercial airline);
c) from anything whatsoever while serving as a member of the armed forces, police and paramilitary forces as a result of declared or undeclared war, riots or civil commotion
ii. if TPD/TTD due to non-accidental causes occurs within thirty (30) days from the Effective Date.
Critical Illness Benefit
No Critical Illness Benefit is payable if:
i. the signs or symptoms of the Critical Illness is manifested prior to or: a) within sixty (60) days from the Effective Date, in respect of:
1. Cancer
2. Coronary Artery By-Pass Surgery
3. Heart Attack
4. Serious Coronary Artery Disease; or
b) within thirty (30) days from the Effective Date, in respect of all other Critical Illness not set out in Item (a) above;
ii. the Critical Illness is due to Pre-existing Illness/Condition; or
iii. the Critical Illness that is caused directly or indirectly due to Acquired Immuno-deficiency
Syndrome (AIDS) or infection by any Human Immuno-deficiency Virus (HIV). The only exception to
this is when the Critical Illness claimed for itself is Full-Blown AIDS or HIV Infection due to Blood Transfusion.
Note: This list is non-exhaustive. Please refer to the policy contract for the full list of exclusions under this policy.
7. Can I cancel my policy?
A written notice must be given to Hong Leong Assurance Berhad. Thereafter this insurance shall cease effective from the following billing date of your credit card. If the cancellation is within the fifteen (15) days free-look period, premium will be refunded inclusive of any applicable tax which has been paid (less any medical fee incurred). After the free-look period, no cash surrender value will be paid to you when you cancel the policy.
8. What do I need to do if there are changes to my contact details?
It is important that you inform us of any change in your contact details to ensure that all correspondences reach you in a timely manner.
9. Where can I get further information?
Should you require additional information about life insurance, please refer to the insuranceinfo booklet on ‘Life Insurance’, available at all our branches or you can obtain a copy from the Customer Service or visit www.insuranceinfo.com.my.
If you have any enquiries, please contact us at: Hong Leong Assurance Berhad Level 3, Tower B, PJ City Development No 15A, Jalan 219, Seksyen 51A 46100 Petaling Jaya, Selangor P.O.Box 120, 46710 Petaling Jaya
Tel: 03 – 7650 1288 Fax: 03 - 7650 1299
Website: www.hla.com.my
10. Other similar types of cover available
Please refer to our Customer Service for other similar types of cover available.
IMPORTANT NOTE: YOU SHOULD SATISFY YOURSELF THAT THIS POLICY WILL BEST SERVE YOUR NEEDS. YOU SHOULD READ AND UNDERSTAND THE INSURANCE POLICY AND CONTACT THE INSURANCE COMPANY DIRECTLY FOR MORE INFORMATION.
The information provided in this disclosure sheet is valid as at 17th
May 2019.
Important Notice to Prospective Policy Owner
- Before purchasing any Medical and Health Insurance (MHI) product, you are advised to seek explanation on the following from the company or its intermediary:
- The basic and salient features of MHI in general; and
- The basic and salient features of a particular MHI product that you intend to purchase.
- The objective of this exercise is to ensure that you understand the basic and important features of a MHI product so that you are able to make an informed decision before purchasing the product.
- You should ensure that important information regarding the policy is disclosed to you and that you understood
the information disclosed. Where there is ambiguity, please seek an explanation/clarification from the company
or its intermediary.
- Prior to making a decision to purchase any medical and health (MHI) policy, you should satisfy yourself that
this plan will best serve your needs and the premium payable under the policy is an amount that you can
afford.
- You are advised to refer to the sample policy contract for details on the important features of the plan that you intend to purchase.
- To find out more about the basic information of MHI, please refer to the consumer education booklet "The
Introduction to Medical and Health Insurance" issued by Bank Negara Malaysia available at most branches of
insurance companies. You may also log on to www.insuranceinfo.com.my for more information.
- If the policy shall have been issued and for any reason whatsoever you shall decide not to take up the policy,
you may return the policy to us for cancellation provided such request for cancellation is delivered by you to us
within 15 days from the date of delivery of the policy. You are entitled to the return of the full premium and any
applicable tax paid less deduction of medical expenses incurred by us in the issue of the policy.
Checklist
This checklist serves to guide you to seek an explanation on the essential features of a Medical and Health
Insurance (MHI) policy so that you are able to make an informed decision before purchasing the policy. When in
doubt or where there is ambiguity, you are advised to seek further clarification/information from your insurer or
sales intermediary.
- The booklet "The Introduction to Medical and Health Insurance Products" issued by Bank Negara Malaysia on the basic information of MHI.
- The policy documents for details of the important features of the policies purchased.
- Avenues where details of the important features of the policy are also available.
- Benefits payable under the policy.
- Significant medical or technical exclusions or restrictions available.
- Limits of benefits (e.g. % of costs covered by the policy, co-payment, ceiling to total claim costs and deductible amounts).
- Amount of premium payable and the payable term.
- Nature and extend of the insurer's right to review and revise the premiums payable, and the notice to be given by the insurer in the event of any revision.
- Pre-existing conditions, specified illnesses and qualifying period and the relevant periods applicable.
- For yearly renewable policies, whether policy renewal is guaranteed.
- Possible conditions that would lead to the following scenarios on policy renewal:
- A policy is renewed with a level premium;
- A policy is renewed with an increased premium; or
- A policy is not renewed.
- Likely implications of switching policy from one insurer to another or transferring from one type of MHI plan to another.
- A "free-look period" of 15 days given to review the suitability of the newly purchased MHI product. If the
product is returned to the insurer during this period, the full premiums and any applicable tax would be
refunded to the policy owner minus the expenses incurred for the medical examination.
- The right of an insurer to repudiate liability in the event that you failed to disclose relevant information that
would affect the decision of the insurer to accept or reject the risk, and on the premiums and terms to be
applied to you.
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1. DEFINITIONS AND INTEPRETATION 1.1 In this Policy, unless the context otherwise requires:
(a) "Accident" means a sudden, unintentional, unexpected, unusual, and specific event that has occurred at an identifiable time and place which is, independently of any other cause, the sole cause of Bodily Injury/Injury;
(b) “Assurance Certificate” means the certificate issued by the Company to the Policy
Owner for onward delivery to an Assured Member evidencing insurance coverage of that Assured Member under this Policy;
(c) “Assured Member” means an Eligible Member in respect of whom an application for
insurance coverage under this Policy has been submitted to the Company by the Policy Owner and in respect of whom insurance coverage has been provided under this Policy pursuant to the application;
(d) "Benefit(s)" means the benefits granted by this Policy in respect of each insurance
coverage provided by this Policy; (e) “Bodily Injury/Injury” means injury suffered or caused solely by an Accident or
violent, external and visible means and not by sickness, disease or gradual physical or mental deformity or infirmity;
(f) “Commencement Date" means the date as stated in the Assurance Certificate on
which the term of coverage commences or is deemed to have commenced pursuant to a request by the Policy Owner and is not the Effective Date;
(g) “Company” means Hong Leong Assurance Berhad and shall include its successors in
title and lawful assigns; (h) "Disability" means a sickness, disease, illness or the entire injuries arising out of a
single or continuous series of causes; (i) "Effective Date" means the date of commencement of the insurance coverage under
this Policy for an Assured Member and is the Effective Date as stated in the Assurance Certificate;
(j) “Easy Payment Scheme” refers to an installment facility offered by the Policy Owner
where the Assured Member is required to pay for his purchases to the Policy Owner over an agreed period of time with a fixed monthly installment amount;
(k) "Eligible Member“ means an individual who is granted and takes up a credit card
facility as a principal card member from the Policy Owner and who is, at the time of entry into the agreement with the Policy Owner for the credit card facility, upon attaining the age of eighteen (18) years to prior to attaining the age of sixty-five (65) years and is not suffering from any Disability;
(l) "Endorsement" means an endorsement, if any, attached to this Policy modifying,
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varying or adding any terms or conditions contained in this Policy; (m) “Expiry Date” means the date of expiry of that insurance coverage under this Policy
and is the date stated as such in the Assurance Certificate issued for that insurance coverage;
(n) "Medical Practitioner" means a registered doctor qualified and licensed to practise
western medicine in the geographical area of his practice to render medical care and treatment;
(o) “Outstanding Balance” means the balance in the latest credit card billing statement
for a particular credit card (principal credit card and supplementary credit card statements, if any) of the Assured Member, unbilled amounts (for Easy Payment Schemes, virtual cards, mobile money, balance transfer including but not limited to any other future facilities tied to the credit card of the Assured Member as may be agreed in writing by the Policy Owner and the Company), fees and charges (including late payment interest), retail or cash transaction and all other debit balances to the account.
(p) “Policy Owner” means and shall include its successors in title and lawful assigns; (q) “Policy” means this contract of insurance, as may be amended by any Endorsement
from time to time; together with the applications for the Policy from the Policy Owner, individual forms and medical information, if any, of the Assured Member constitutes the entire contract between the Policy Owner and the Company;
(r) “Pre-existing Illness/Condition” means any pre-existing illness and/or condition
which existed prior to the Effective Date and in respect of which an Assured Member had reasonable knowledge. An Assured Member shall be deemed to have reasonable knowledge of a pre-existing illness and/or condition where the illness and/or condition is one for which:
(a) the Assured Member had received or is receiving treatment; (b) medical advice, diagnosis, care or treatment has been recommended; (c) clear and distinct symptoms are or were evident; or
(d) its existence would have been apparent to a reasonable person in the
circumstances; (s) “Premium Due Date” means the date for monthly payment of premiums which is the
same as the billing date as stated in the monthly credit card billing statement of an Assured Member;
(t) "Sum Assured" means the amount payable by the Company either upon the death,
the occurrence of the Total and Permanent Disability or diagnosis of any covered Critical Illness of the Assured Member, as the case may be. For the purpose of clarification, this amount is the Outstanding Balance for that Assured Member either as at the time of death, the event date that give rise to Total and Permanent Disability, the event date that give rise to Temporary Total Disability or diagnosis of
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any covered Critical Illness of the Assured Member, as the case may be, subject to a maximum of RM100,000 per Assured Member for all gold or classic cards collectively held by the Assured Member or RM300,000 per Assured Member for all platinum or higher cards collectively held by the Assured Member. For the purpose of clarification, where the Assured Member holds more than one type of card, the maximum limit that applies to the higher card held by the Assured Member shall be applicable;
(u) “Temporary Total Disability (TTD)” means a Disability:
(a) which does not exist at the Effective Date and does not occur within thirty
(30) days from the Effective Date for any TTD due to non-accidental causes; AND
(b) which prevents an Assured Member from doing any duties relating to his
work, business, occupation or profession for a continuous period of at least thirty (30) days from the date the Assured Member is first diagnosed with Temporary Total Disability by a Medical Practitioner.
PROVIDED ALWAYS that such Disability must not have resulted directly or indirectly: (a) from any self-inflicted Bodily Injury while sane or insane;
(b) from flying in an aircraft (except as an aircrew member of, or as an ordinary fare paying passenger, on a regularly scheduled flight of a commercial airline); or
(c) from anything whatsoever while serving as a member of the armed forces, police and paramilitary forces as a result of declared or undeclared war, riots or civil commotion;
(v) “Temporary Total Disability Benefit” means five percent (5%) of the Sum Assured,
subject to a maximum of RM5,000 per Assured Member with gold or classic cards collectively held by the Assured Member or RM15,000 per Assured Member with platinum or higher cards collectively held by the Assured Member. For the purpose of clarification, where the Assured Member holds more than one type of card, the maximum limit that applies to the higher card held by the Assured Member shall be applicable;
(w) “Total and Permanent Disability” (TPD) means: (a) A Disability which:
(1) is total and permanent; AND (2) does not exist at the Effective Date or does not occur within thirty (30)
days of the Effective Date due to non-accidental causes; AND (a) is the sole cause of the person suffering such Disability having no
prospect (both then and at any time thereafter) of doing or following any work, business, occupation or profession, including but not limited to: (i) any work, business, occupation or profession whatsoever
which the person was not engaged in prior to such Disability;
AND
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(ii) any work, business, occupation or profession involving any
activity forming any part of any work, business, occupation
or profession which the person was engaged in prior to such
Disability;
to earn or to obtain any wages, compensation or profit , provided
such Disability must be permanent and must last for a minimum
period of six (6) consecutive months; or
(b) total and irrecoverable loss of the sight of both eyes; or (c) loss of use of two (2) limbs at or above wrist or ankle; or (d) total and irrecoverable loss of the sight of one (1) eye and loss of
use of one (1) limb at or above wrist or ankle. PROVIDED ALWAYS that such Disability must not have resulted directly or indirectly:
(a) from any self-inflicted Bodily Injury while sane or insane; (b) from flying in an aircraft (except as an aircrew member of, or as an
ordinary fare paying passenger, on a regularly scheduled flight of a commercial airline); or
(c) from anything whatsoever while serving as a member of the armed forces, police and paramilitary forces as a result of declared or undeclared war, riots or civil commotion.
Wherever the context requires, masculine form shall apply to the feminine and singular term shall include the plural.
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SECTION A : GENERAL PROVISIONS 1. Application 1.1 The Policy Owner shall submit to the Company an individual application for each Eligible
Member proposed to be covered under this Policy. 1.2 Subject to the individual application having been accepted by the Company, if an individual
application for an Eligible Member is received by the Company from the first (1st) to the fourteenth (14th) of a calendar month, the Effective Date of the insurance coverage for that Eligible Member should be on the fifteenth (15th) of the same calendar month; if an individual application for an Eligible Member is received by the Company from the fifteenth (15th) to the last day of a calendar month, the Effective Date of the insurance coverage for that Eligible Member should be on the first (1st) of the following calendar month.
1.3 All subsequent credit card facilities granted to and taken up by the Assured Member from
the Policy Owner shall automatically be covered under this Policy. The insurance coverage for each subsequent credit card shall be in accordance with and be SUBJECT TO the conditions set out in Section B: Benefits. For the purpose of clarification, the Effective Date of the insurance coverage for each subsequent credit card shall be the activation date of each subsequent credit card.
2. Premium Payment 2.1 Premium in respect of all insurance coverage under this Policy shall be calculated at a
predetermined rate of premium based on the Outstanding Balance in the monthly credit card billing statement of the Assured Member.
2.2 Premium must be paid to the Company on a monthly basis on the Premium Due Date. 3. Change in Rate of Premium 3.1 The Company has the right to change the rate of premium for this Policy provided that the
Company has given at least ninety (90) days’ notice in writing to the Policy Owner. The revised rate of premium shall apply to all insurance coverage under this Policy on the next Premium Due Date after the effective date of the revised rate.
4. Currency 4.1 All payments payable by and to the Company pursuant to this Policy shall be made in the
lawful currency of Malaysia, i.e., RINGGIT MALAYSIA (RM). 5. Power to Vary 5.1 No sales intermediary of the Company has the authority to make any alteration to or to
waive any provision of this Policy, to accept premiums in arrears, to waive any notice or
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proof of claim required by this Policy, or to extend the date before which any such notice or proof must be submitted.
5.2 No alteration or waiver of any provision o f this Policy shall be valid after the issuance of
this Policy unless such alteration or waiver is made by an Endorsement and signed by the Company’s authorised officer, or by an amendment hereto signed by the Policy Owner and by the Company.
6. Assurance Certificates 6.1 In respect of each insurance coverage provided by this Policy, the Company will issue an
individual Assurance Certificate to confirm that an Eligible Member has become an Assured Member of this Policy.
6.2 An Assurance Certificate shall set out the name of the Assured Member and, in respect of
the insurance coverage evidenced by the Assurance Certificate, the Effective Date. 6.3 An Assurance Certificate shall not create or give rise to any contractual relationship between
the Company and an Assured Member. 7. Information on Assured Member 7.1 In respect of each Assured Member, the Policy Owner shall maintain a record showing the
Assured Member’s name, sex, age or date of birth, amount of premium received under this Policy, the Effective Date, the date of termination of the insurance coverage, changes to the aforesaid information and the date of such changes, and any other pertinent information as mutually agreed by the Policy Owner and the Company.
7.2 Clerical error in keeping the records shall neither invalidate any insurance coverage which is otherwise validly in force nor continue any insurance coverage which has otherwise been validly terminated; however, upon the discovery of any such error, an equitable adjustment shall be made.
7.3 The Policy Owner shall furnish the Company with all information and evidence which the Company may reasonably require on any matters pertaining to this Policy and the insurance coverage provided by this Policy. All documents furnished to the Policy Owner by any Assured Member in connection with the insurance coverage or by any Eligible Member in connection with the application for such insurance coverage and any other records which may have a bearing on the same shall be made available for inspection by the Company at all reasonable times.
7.4 The Policy Owner confirms that it has obtained the relevant consent of all the Assured
Member to disclose their personal data to the Company. 7.5 The Company shall treat all information furnished by the Policy Owner as confidential in
perpetuity and will not use the information furnished for any other purpose other than to ensure the performance of this Policy nor disclose the confidential information to third parties without the prior written consent of the Policy Owner.
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7.6 The Company shall ensure that all Personal Data (as defined under the Personal Data Protection Act 2010 (PDPA)) disclosed to the Company arising out of or in connection with the coverage provided under this Policy shall at all times be held secure and in compliance with the PDPA and any guidelines issued in connection thereto as well as such other data protection legislation or guidelines prevailing in the jurisdiction where the services may be provided. The Company shall ensure that the Company and its representatives do not do anything to the Personal Data which could cause the Policy Owner to be in breach of any of its requirements under the PDPA.
8. Misstatement of Age 8.1 The age of an Assured Member stated in an Assurance Certificate or any
Endorsement is the age calculated in accordance with the date of birth of the Assured Member in the individual application.
8.2 If the age of the Assured Member has been misstated, the Benefits payable under this
Policy shall be adjusted in accordance with the Financial Services Act 2013 or any other applicable law.
8.3 If the Assured Member was not eligible for insurance coverage under this Policy because of
his true age, the Company will avoid the insurance coverage and refund to the Policy Owner and/or Assured Member (as the case may be), free of interest, any premium inclusive of any applicable tax which may have been paid less any expenses which may have been incurred by the Company for any medical examination of the Assured Member.
8.4 If the Company has not previously verified or confirmed the age of the Assured Member to
be correct, the Company shall have the right to require proof of the age of the Assured Member before making any decision on payment under this Policy.
9. Misstatement of Sex
9.1 The sex of an Assured Member as stated in an Assurance Certificate or any Endorsement is believed to be the true sex of the Assured Member.
9.2 If the sex of the Assured Member has been misstated, the Benefits payable under this
Policy shall be adjusted to such as would have been payable if the true sex had been stated.
9.3 If the Assured Member was not eligible to be covered by this Policy because of the
Assured Member’s true sex, the Company will avoid the insurance coverage and refund to the Policy Owner any premium inclusive of any applicable tax which has been paid without interest less any expenses which may have been incurred by the Company for any medical examination of the Assured Member.
10. Condition Precedent to Liability 10.1 The due observance and fulfillment of the provisions of this Policy, particularly in relation to
anything to be done or not to be done by the Policy Owner, any Assured Member or any
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person making a claim under this Policy, shall be a condition precedent to any liability of the Company to make any payment under this Policy.
11. Amounts Due to the Company 11.1 Before making any payments under this Policy, the Company shall be entitled to deduct any
charges or other amounts due to the Company under this Policy. 12. Residence, Travel and Occupation 12.1 Subject to provisions to the contrary, if any, in any Endorsement to this Policy, the insurance
coverage provided by this Policy shall be free from restrictions in relation to residence, occupation or travel.
13. Incontestability 13.1 The Company will not contest the validity of an insurance coverage in respect of an Assured
Member if the insurance coverage has been in force and effect during the life time of the Assured Member for more than two (2) full years from the Effective Date unless there has been a fraudulent suppression of a material matter or a material fact in the individual application for insurance coverage on the life of the Assured Member under this Policy.
14. Governing Law 14.1 This Policy and all rights, obligations and liabilities arising hereunder shall be governed by
the laws of Malaysia and the parties hereto submit to the exclusive jurisdiction of the courts of Malaysia.
15. Government Taxes and/ or Statutory/ Regulatory Imposed Charges, Fees, etc.
15.1 For the purpose of this Clause:
“Tax” means any present or future, direct or indirect, Malaysian or foreign tax, levy, impost, duty, charge, fee, deduction or withholding of any nature, that is imposed by any Appropriate Authority, including, without limitation, any consumption tax such as the goods and services tax ("GST") and other taxes by whatever name called, and any interest, fines or penalties in respect thereof. “Appropriate Authority” means any government or taxing authority.
15.2 The premium and all other monies to be paid by the Policy Owner to the Company under this Policy, including any amount representing reimbursements to be paid by the Policy Owner to the Company, is exclusive of any Tax, and shall be paid without any set-off, restriction or condition and without any deduction for or on account of any counterclaim or any deduction or withholding.
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15.3 In the event the Policy Owner is required by law to make any deduction or withholding from the premium and/or all other monies payable to the Company under this Policy in respect of any Tax or otherwise, the sum payable by the Policy Owner in respect of which the deduction or withholding is required shall be increased so that the net premium and/or the net amount of monies received by the Company is equal to that which the Company would otherwise have received had no deduction or withholding been required or made.
15.4 The Policy Owner shall in addition to the premium and all other monies payable, pay to the Company all applicable Tax at the relevant prevailing rate and/or such amount as is determined by the Company to cover any Tax payments/liabilities/obligations in connection therewith, without any set-off, restriction or condition and without any deduction for or on account of any counterclaim or any deduction or withholding, apart from any Taxes which may be required under any laws to be paid by the Policy Owner directly to any Appropriate Authority, which the Policy Owner shall remit directly to the Appropriate Authority .
15.5 If at any time an adjustment is made or required to be made between the Company and the relevant taxing authority on account of any amount paid as Tax as a consequence of any supply made or deemed to be made or other matter in connection with this Policy by the Company, a corresponding adjustment may at the Company's discretion be made as between the Company and Policy Owner and in such event, any payment necessary to give effect to the adjustment shall be made.
15.6 All Tax as shall be payable by the Policy Owner to the Company as herein provided shall be paid at such times and in such manner as shall be requested by the Company, failing which the Policy Owner shall pay to the Company interest at the rate of ten per centum (10%) per annum calculated on a day to day basis on the amount of Tax unpaid from the due date until payment.
15.7 The Policy Owner hereby agrees to do all things reasonably requested by the Company to assist the Company in complying with its obligations under any applicable legislation under which any Tax is imposed. In the event a new Tax is introduced and such Tax is required to be charged on the transaction contemplated in this Policy, the Policy Owner agrees to provide its fullest cooperation to the Company in assisting the Company in complying with its obligations under the relevant laws.
15.8 The Policy Owner shall indemnify the Company and shall hold the Company harmless from any liability arising as a result of any breach of obligation on the part of the Policy Owner to pay the Tax as set out herein, together with all loss, costs and expenses resulting from such breach. Nothing in this Policy requires the Company to pay any amount of fine, penalty, interest or other amount for which the Policy Owner is liable for.
15.9 For the avoidance of doubt, the parties agree that any sum payable or amount to be used in the calculation of a sum payable expressed elsewhere in this Policy has been determined without regard to and does not include amounts to be added on under this clause on account of Tax.
16. Free Look Period 16.1 If the Policy Owner is not satisfied with this Policy for whatever reasons, the Policy Owner
may return the Policy to the Company directly by hand, by registered post or electronically
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(subject to the Company’s prevailing administrative rules and procedures at the time of application) within fifteen (15) days from the date of delivery of the Policy to the Policy Owner.
16.2 If the Assured Member is not satisfied with the insurance coverage, for any reason whatsoever, the Assurance Certificate must be returned to the Company within fifteen (15) days from the date of delivery of the Assurance Certificate to the Assured Member.
16.3 Upon return of this Policy pursuant to Clause 16.1 above and/or the cancellation of the
Assurance Certificate pursuant to Clause 16.2 above (as the case maybe), the Company shall refund to the Policy Owner or Assured Member (as the case may be) any premium inclusive of any applicable tax which has been paid without interest less any expenses which may have been incurred by the Company for any medical examination of the Assured Member.
16.4 Upon the refund to the Policy Owner or the Assured Member (as the case maybe), this Policy
will be deemed to have been cancelled and the Company shall cease to be liable to the Policy Owner and/or the Assured Member (as the case maybe) under this Policy.
17. Termination of the Policy
17.1 The Company may terminate this Policy provided always that the Company shall give at least
ninety (90) days’ written notice to the Policy Owner of its intention to terminate this Policy. The Policy Owner may also terminate this Policy by giving at least ninety (90) days’ notice in writing to the Company which notice shall state the date of termination.
17.2 The Policy shall terminate on the date of termination stated in the notice. Any insurance
coverage which is still in force and effect if and when the Policy is terminated shall continue to be in force and effect until the first Premium Due Date after the date of termination of this Policy.
18. Termination of an Assured Member 18.1 Regardless of anything else stated in this Policy, the insurance coverage on the life of an
Assured Member shall automatically terminate and cease to be in force and effect upon the occurrence of the earliest of the following:
(a) the Assured Member’s entry into the military, naval or air force of any country at
war, declared or undeclared; (b) the Assured Member’s death; (c) upon payment of 100% of the Sum Assured; (d) the Assured Member has attained the age of sixty-five (65) years; (e) the cancellation of the insurance coverage by the Assured Member; (f) the Assured Member cancels the credit card facility taken from the Policy Owner;
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(g) on the Expiry Date.
19. Inability to Charge Premium 19.1 For any credit card from which premium could not be collected due to the classification of
the said card as delinquent (more than 60 days) or non-performing loan or blocked by the Policy Owner, no insurance coverage will be extended to the Outstanding Balance of the said card during the period in which the said card was classified as such.
20. Non-Participating Policy 20.1 This Policy shall not participate in the divisible profits of the Company.
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SECTION B : BENEFITS 1. Death Benefit 1.1 Upon the death of an Assured Member, and provided that the insurance coverage in respect
of that Assured Member under this Policy is still in force and effect and that there has been no breach of any of the provisions of this Policy, the Company will pay a Death Benefit equivalent to the Sum Assured to the Policy Owner. In the event that the death occur during the period when the Assured Member is suffering from TTD, Death Benefit payable shall be twenty (20) times of the Temporary Total Disability Benefit minus any Temporary Total Disability Benefit paid up to the date of death of the Assured Member.
1.2 The aforesaid Death Benefit is payable subject to the provisions of this Policy and only if:
(a) notice of the death of the Assured Member has been given to the Company not later than sixty (60) days after the date of death of the Assured Member;
(b) a valid death certificate in respect of the Assured Member, together with any other
documents reasonably required by the Company, has been submitted to the Company free of the Company’s expense;
(c) death of the Assured Member due to non-accidental causes occurs after thirty (30)
days from the Effective Date; 1.3 No Death Benefit is payable if the death of an Assured Member results from an act of suicide,
whether while sane or insane, within twelve (12) months from the Effective Date; in such an instance, the insurance coverage shall be avoided and the Company shall refund any premium paid inclusive of any applicable tax, free of interest. The Company’s liability shall be limited to a refund of the premium and any applicable tax paid, provided the amount returned shall not exceed the Sum Assured at the time of death of the Assured Member.
2. Total and Permanent Disability Benefit 2.1 If an Assured Member who has not yet attained the age of sixty-five (65) years suffers a TPD
while the insurance coverage in respect of that Assured Member under this Policy is still in force and effect, and if such Disability persists for a continuous period of at least six (6) months from the date the Assured Member is first diagnosed with TPD, and there has been no breach of any of the provisions of this Policy, the Company will make an advance payment of the Sum Assured to the Policy Owner. In the event that the TPD occur during the period when the Assured Member is suffering from TTD, TPD Benefit payable shall be twenty (20) times of the Temporary Total Disability Benefit minus any Temporary Total Disability Benefit paid up to the date of TPD of the Assured Member.
The Company will pay an advance payment of the Total and Permanent Disability Benefit in
the following manner: if the Total Payable (i.e., the total of TPD Benefit of each Assurance Certificate and any other policies insuring the Assured Member and already issued by the Company, excluding accumulated income or cash payment, if any, and accumulated dividend, if any):
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(a) does not exceed RM10,000,000.00, the Company shall pay an amount not exceeding RM4,000,000.00 in a lump sum and the balance shall be paid in two equal installments on the first anniversary and second anniversary, respectively, of the date of first payment of the Total and Permanent Disability Benefit;
(b) exceeds RM10,000,000.00, only RM10,000,000.00 is payable as Total and Permanent
Disability Benefit in the manner set out in Clause 2.1 (a). The balance of Sum Assured, if any, will be paid upon the death of the Assured Member within the coverage period.
2.2 The aforesaid Total and Permanent Disability Benefit is payable subject to the provisions of
this Policy and the following conditions:
(a) The Company must be notified in writing within ninety (90) days upon the occurrence of a TPD at its head office of the full particulars of the Assured Member together with the latest address and whereabouts of the Assured Member;
(b) Evidence of Disability must be given to the Company at the sole cost and expense of
the Assured Member within ninety (90) days of the happening of the TPD and to the satisfaction of the Company;
(c) TPD of the Assured Member due to non-accidental causes occurs after thirty (30)
days from the Effective Date; and
(d) Any Medical Practitioner appointed by the Company must be allowed to examine the Assured Member in respect of any alleged Disability in the manner and at such times as the Medical Practitioner may require.
2.3 Upon the approval by the Company of a claim for TPD where the Total Payable exceeds RM
10,000,000 limit, the Company shall waive payment of all future premiums due and payable on the Policy and all other policies in force, if any, insuring the Assured Member issued by the Company and which provides cover for TPD. Such waiver shall begin from the first (1st) billing date immediately following the event giving rise to TPD and, where applicable, on the next following policy anniversary dates of the other policies.
2.4 In the event that the Company is of the sole opinion and view that the Assured Member no longer suffers TPD (collectively, “Cessation of Disability”), all subsequent Total and Permanent Disability Benefit payment shall forthwith automatically cease without prior notice and any Total and Permanent Disability Benefit payment paid after the Cessation of Disability shall be required to be refunded to the Company together with an interest calculated at five per centum per annum (5% p.a.) computed from the date the Total and Permanent Disability Benefit is paid up after the Cessation of Disability to the debt settlement date. The insurance coverage for the Assured Member will cease to be in force and all other Benefits granted as stated in the Assurance Certificate of that Assured Member will not apply or be payable.
2.5 For the purpose of clarification, the insurance coverage for the Assured Member will cease
to be in force and all other Benefits granted as stated in the Assurance Certificate of that Assured Member will not apply or be payable upon approval by the Company of a claim for the Total and Permanent Disability Benefit save for the Total and Permanent Disability Benefit itself and the balance, if any, of the Sum Assured payable upon the death of the Assured Member.
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3. Temporary Total Disability Benefit 3.1 If an Assured Member who has not yet attained the age of sixty-five (65) years suffers a TTD
while the insurance coverage in respect of that Assured Member under this Policy is still in force and effect, and if such Disability persists for a continuous period of at least thirty (30) days from the date the Assured Member is first diagnosed with TTD, and there has been no breach of any of the provisions of this Policy, the Company will pay a Temporary Total Disability Benefit every month provided the Assured Member continue to suffer a TTD up to a maximum of twenty (20) months.
3.2 The premium payable shall be waived during the period the Assured Member is suffering
from TTD, with the first (1st) premium waiver commencing on the first (1st) billing date immediately following the event giving rise to TTD, and shall resume at the billing date following the recovery of the Assured Member from TTD.
3.3 The aforesaid Temporary Total Disability Benefit is payable subject to the provisions of this
Policy and the following conditions:
(a) The Company must be notified in writing within ninety (90) days upon the occurrence of a Temporary Total Disability at its head office of the full particulars of the Assured Member together with the latest address and whereabouts of the Assured Member;
(b) Evidence of Disability must be given to the Company at the sole cost and expense of
the Assured Member within ninety (90) days of the happening of the Temporary Total Disability and to the satisfaction of the Company;
(c) TTD of the Assured Member due to non-accidental causes occurs after thirty (30) days from the Effective Date;
(d) In any event the Company will not be liable to pay any Temporary Total Disability benefits for more than twenty (20) months in total during the entire term of this insurance for any one Assured Member; and
(e) Any Medical Practitioner appointed by the Company must be allowed to examine
the Assured Member in respect of any alleged Disability in the manner and at such times as the Medical Practitioner may require.
3.4 For the purpose of clarification, the insurance coverage for the Assured Member will cease to be in force and all other Benefits granted as stated in the Assurance Certificate of that Assured Member will not apply or be payable upon the payment of Temporary Total Disability Benefit of twenty (20) months in total by the Company.
4. Critical Illness Benefit 4.1 Upon the Assured Member being diagnosed with any one (1) of the thirty-six (36) Critical
Illness (as defined below), and the insurance coverage in respect of that Assured Member under this Policy is still in force and effect and that there has been no breach of the terms
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and conditions of this Policy, the Company will pay a Critical Illness Benefit equivalent to the Sum Assured. In the event that Critical Illness is diagnosed during the period when the Assured Member is suffering from TTD, Critical Illness Benefit payable shall be twenty (20) times of the Temporary Total Disability Benefit minus any Temporary Total Disability Benefit paid up to the date of diagnosis of Critical Illness of the Assured Member.
4.2 The aforesaid Critical Illness Benefit is payable subject to the provisions of this Policy and the
following conditions:
(a) The Company must be notified in writing within ninety (90) days upon the initial diagnosis of a Critical Illness (as defined below) at its head office of the full particulars of the Assured Member together with the latest address and whereabouts of the Assured Member; and
(b) Evidence of the Critical Illness (as defined below) must be given to the Company at the sole cost and expense of the Assured Member supported by acceptable clinical, radiological, histological and laboratory evidence confirmed by a Medical Practitioner.
4.3 For the purposes of this Policy, AND NOTWITHSTANDING any other definition which may be found elsewhere, “Critical Illness” means any of the condition or illness defined as follows:
(a) STROKE – resulting in permanent neurological deficit with persisting clinical symptoms
Death of brain tissue due to inadequate blood supply, bleeding within the skull or
embolization from an extra cranial source resulting in permanent neurological deficit with persisting clinical symptoms. The diagnosis must be based on changes seen in a CT scan or MRI and certified by a neurologist. A minimum Assessment Period of three (3) months applies.
For the above definition, the following are not covered:
i. Transient ischemic attacks ii. Cerebral symptoms due to migraine
iii. Traumatic injury to brain tissue or blood vessels iv. Vascular disease affecting the eye or optic nerve or vestibular functions
(b) HEART ATTACK – of specified severity
Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:
i. A history of typical chest pain ii. New characteristic electrocardiographic changes; with the development of
any of the following: ST elevation or depression, T wave inversion, pathological Q waves or left bundle branch block and
iii. Elevation of the cardiac biomarkers , inclusive of CPK-MB above the generally accepted normal laboratory levels or Troponins recorded at the following levels or higher:
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- Cardiac Troponin T or Cardiac Troponin I >/ = 0.5 ng/ml The evidence must show the occurrence of a definite acute myocardial infarction
which should be confirmed by a cardiologist or physician.
For the above definition, the following are not covered: i. occurrence of an acute coronary syndrome including but not limited to
unstable angina. ii. a rise in cardiac biomarkers resulting from a percutaneous procedure for
coronary artery disease
(c) KIDNEY FAILURE – requiring dialysis or kidney transplant
End-stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular dialysis is initiated or kidney transplantation is carried out.
(d) CANCER – of specified severity and does not cover very early cancers
Any malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma. For the above definition, the following are not covered:
i. All cancers which are histologically classified as any of the following: a. pre-malignant b. non-invasive c. carcinoma in situ d. having borderline malignancy e. having malignant potential
ii. All tumours of the prostate histologically classified as T1N0M0 (TNM classification)
iii. All tumours of the thyroid histologically classified as T1N0M0 (TNM classification)
iv. All tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification)
v. Chronic Lymphocytic Leukemia less than RAI Stage 3 vi. All cancers in the presence of HIV vii. Any skin cancer other than malignant melanoma
(e) CORONARY ARTERY BY-PASS SURGERY
Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by way of coronary artery by-pass grafting. For the above definition, the following are not covered:
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i. angioplasty; ii. other intra-arterial or catheter based techniques;
iii. keyhole procedures; iv. laser procedures
(f) SERIOUS CORONARY ARTERY DISEASE The narrowing of the lumen of Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Circumflex Artery (not inclusive of their branches) occurring at the same time by a minimum of sixty percent (60%) in each artery as proven by coronary arteriography (non-invasive diagnostic procedures are not covered). A narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of the Left Anterior Descending Artery (LAD) and Circumflex Artery. This covered event is payable regardless of whether or not any form of coronary artery surgery has been performed.
(g) FULL-BLOWN AIDS
The clinical manifestation of AIDS (Acquired Immuno-deficiency Syndrome) must be supported by the results of a positive HIV (Human Immunodeficiency Virus) antibody test and a confirmatory test. In addition, the Assured Member must have a CD4 cell count of less than two hundred (200)/ μL and one or more of the following criteria are met:
(1) Weight loss of more than 10% of body weight over a period of six (6) months
or less (wasting syndrome) (2) Kaposi Sarcoma (3) Pneumocystis Carinii Pneumonia (4) Progressive multifocal leukoencephalopathy (5) Active Tuberculosis (6) Less than one-thousand (1000) Lymphocytes/ μL (7) Malignant Lymphoma
(h) END-STAGE LIVER FAILURE
End-stage liver failure as evidenced by all of the following:
(1) Permanent jaundice; (2) Ascites (excessive fluid in peritoneal cavity); and (3) Hepatic encephalopathy.
Liver failure secondary to alcohol or drug abuse is not covered.
(i) FULMINANT VIRAL HEPATITIS
A sub-massive to massive necrosis (death of liver tissue) caused by any virus as evidenced by all of the following diagnostic criteria:
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(1) A rapidly decreasing liver size as confirmed by abdominal ultrasound; (2) Necrosis involving entire lobules, leaving only a collapsed reticular framework; (3) Rapidly deteriorating liver functions tests; and (4) Deepening jaundice.
Viral hepatitis infection or carrier status alone (inclusive but not limited to Hepatitis B and Hepatitis C) without the above diagnostic criteria is not covered.
(j) COMA – resulting in permanent neurological deficit with persisting clinical symptoms
A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously for at least ninety six (96) hours, requiring the use of life support systems and resulting in a permanent neurological deficit with persisting clinical symptoms. A minimum Assessment Period of thirty (30) days applies. Confirmation by a neurologist must be present. The following is not covered:
(1) Coma resulting directly from alcohol or drug abuse
(k) BENIGN BRAIN TUMOR – of specified severity
A benign tumour in the brain or meninges within the skull, where all of the following conditions are met: (1) It is life threatening. (2) It has caused damage to the brain. (3) It has undergone surgical removal or has caused permanent neurological
deficit with persisting clinical symptoms; and (4) Its presence must be confirmed by a neurologist or neurosurgeon and
supported by findings on MRI, CT or other reliable imaging techniques. The following are not covered: (1) Cysts (2) Granulomas (3) Malformations in or of the arteries or veins of the brain (4) Hematomas (5) Tumours in the pituitary gland (6) Tumours in the spine (7) Tumours of the acoustic nerve
(l) PARALYSIS OF LIMBS
Total, permanent and irreversible loss of use of both arms or both legs, or of one arm and one leg, through paralysis caused by illness or injury. A minimum Assessment
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Period of six (6) months applies.
(m) BLINDNESS - Permanent and Irreversible
Permanent and irreversible loss of sight as a result of accident or illness to the extent that even when tested with the use of visual aids, vision is measured at 3/60 or worse in both eyes using a Snellen eye chart or equivalent test and the result must be certified by an ophthalmologist.
(n) DEAFNESS - Permanent and Irreversible
Permanent and irreversible loss of hearing as a result of accident or illness to the extent that the loss is greater than 80 decibels across all frequencies of hearing in both ears. Medical evidence in the form of an audiometry and sound-threshold tests result must be provided and certified by an Ear, Nose, and Throat (ENT) specialist.
(o) THIRD DEGREE BURNS – of specified severity
Third degree (i.e. full thickness) skin burns covering at least twenty percent (20%) of the total body surface area.
(p) HIV INFECTION DUE TO BLOOD TRANSFUSION
Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the following conditions are met:
(1) The blood transfusion was medically necessary or given as part of a medical
treatment; (2) The blood transfusion was received in Malaysia or Singapore after the
commencement of the policy; (3) The source of the infection is established to be from the institution that
provided the blood transfusion and the institution is able to trace the origin of the HIV tainted blood;
(4) The Assured Member does not suffer from hemophilia; and (5) The Assured Member is not a member of any high risk groups including but
not limited to intravenous drug users.
(q) END-STAGE LUNG DISEASE
End-stage lung disease causing chronic respiratory failure.
All of the following criteria must be met:
(1) The need for regular oxygen treatment on a permanent basis; (2) Permanent impairment of lung function with a consistent Forced Expiratory
Volume (FEV) of less than 1 liter during the first second;
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(3) Shortness of breath at rest; and (4) Baseline Arterial Blood Gas analysis with partial oxygen pressures of
55mmHg or less.
(r) ENCEPHALITIS – resulting in permanent inability to perform Activities of Daily Living
Severe inflammation of brain substance, resulting in permanent functional impairment. The permanent functional impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. A minimum Assessment Period of thirty (30) days applies. The covered event must be certified by a neurologist.
Encephalitis in the presence of HIV infection is not covered.
(s) MAJOR ORGAN/ BONE MARROW TRANSPLANT
The receipt of a transplant of:
(1) Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or
(2) One of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end-stage failure of the relevant organ.
Other stem cell transplants are not covered.
(t) LOSS OF SPEECH
Total, permanent and irreversible loss of the ability to speak as a result of injury or illness. A minimum Assessment Period of six (6) months applies. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be supplied by an Ear, Nose, and Throat specialist. All psychiatric related causes are not covered.
(u) BRAIN SURGERY
The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy (surgical opening of skull) is performed. For the above definition, the following are not covered:
(1) Burr hole procedures (2) Transphenoidal procedures (3) Endoscopic assisted procedures or any other minimally invasive procedures (4) Brain surgery as a result of an accident
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(v) HEART VALVE SURGERY
The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities. For the above definition, the following are not covered:
(1) Repair via intra-arterial procedure (2) Repair via key-hole surgery or any other similar techniques
(w) LOSS OF INDEPENDENT EXISTENCE
Confirmation by an appropriate specialist of the loss of independent existence and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living. A minimum Assessment Period of six (6) months applies.
(x) BACTERIAL MENINGITIS - resulting in permanent inability to perform Activities of Daily Living
Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent functional impairment. The permanent functional impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. A minimum Assessment Period of thirty (30) days applies. The diagnosis must be confirmed by:
(1) an appropriate specialist; and (2) the presence of bacterial infection in the cerebrospinal fluid by lumbar
puncture. For the above definition, other forms of meningitis, including viral meningitis are not covered.
(y) MAJOR HEAD TRAUMA - resulting in permanent inability to perform Activities of Daily Living
Physical head injury resulting in permanent functional impairment verified by a neurologist. The permanent functional impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. A minimum Assessment Period of three (3) months applies.
(z) CHRONIC APLASTIC ANEMIA - resulting in permanent Bone Marrow Failure
Irreversible permanent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring at least two (2) of the following treatments:
(1) Regular blood product transfusion;
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(2) Marrow stimulating agents; (3) Immunosuppressive agents; or (4) Bone marrow transplantation.
The diagnosis must be confirmed by a bone marrow biopsy.
(aa) MOTOR NEURON DISEASE - permanent neurological deficit with persisting clinical symptoms
A definite diagnosis of motor neuron disease by a neurologist with reference to either spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis. There must be permanent neurological deficit with persisting clinical symptoms.
(bb) PARKINSON’S DISEASE - resulting in permanent inability to perform Activities of
Daily Living
A definite diagnosis of Parkinson's Disease by a neurologist where all the following
conditions are met:
(1) Cannot be controlled with medication; (2) Shows signs of progressive impairment; and (3) Confirmation of the permanent inability of the Assured Member to perform
without assistance three (3) or more of the Activities of Daily Living
Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of
Parkinsonism are not covered.
(cc) ALZHEIMER’S DISEASE/ SEVERE DEMENTIA
Deterioration or loss of intellectual capacity confirmed by clinical evaluation and imaging tests arising from Alzheimer's Disease or Severe Dementia as a result of irreversible organic brain disorders. The covered event must result in significant reduction in mental and social functioning requiring continuous supervision of the Assured Member. The diagnosis must be clinically confirmed by a neurologist. From the above definition, the following are not covered:
(a) Non organic brain disorders such as neurosis (b) Psychiatric illnesses (c) Drug or alcohol related brain damage
(dd) MUSCULAR DYSTROPHY
The definite diagnosis of a Muscular Dystrophy by a neurologist which must be supported by all of the following:
(a) Clinical presentation of progressive muscle weakness
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(b) No central / peripheral nerve involvement as evidenced by absence of sensory disturbance
(c) Characteristic electromyogram and muscle biopsy findings No benefit will be payable under this Covered Event before the Assured Member has reached the age of 12 years next birthday.
(ee) SURGERY TO AORTA
The actual undergoing of surgery via a thoracotomy or laparotomy (surgical opening
of thorax or abdomen) to repair or correct an aortic aneurysm, an obstruction of the
aorta or a dissection of the aorta. For this definition, aorta shall mean the thoracic
and abdominal aorta but not its branches.
For the above definition, the following are not covered:
(a) angioplasty; (b) other intra-arterial or catheter based techniques; (c) other keyhole procedures; (d) laser procedures
(ff) MULTIPLE SCLEROSIS
A definite diagnosis of multiple sclerosis by a neurologist. The diagnosis must be supported by all of the following: (a) Investigations which confirm the diagnosis to be Multiple Sclerosis; (b) Multiple neurological deficits resulting in impairment of motor and sensory
functions occurring over a continuous period of at least 6 months; and (c) Well documented history of exacerbations and remissions of said symptoms
or neurological deficits
(gg) PRIMARY PULMONARY ARTERIAL HYPERTENSION – of specified severity
A definite diagnosis of primary pulmonary arterial hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of cardiac impairment. Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following: Class III: Marked limitation of physical activity. Comfortable at rest but less than
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ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
(hh) MEDULLARY CYSTIC DISEASE
A progressive hereditary disease of the kidney characterized by the presence of cysts in the medulla, tubular atrophy and interstitial fibrosis with the clinical manifestations of anemia, polyuria and renal loss of sodium, progressing to chronic kidney failure. Diagnosis must be supported by a renal biopsy.
(ii) CARDIOMYOPATHY – of specified severity
A definite diagnosis of cardiomyopathy by a cardiologist which results in permanently impaired ventricular function and resulting in permanent physical impairment of at least Class III of the New York Heart Association's classification of cardiac impairment. The diagnosis has to be supported by echocardiographic findings of compromised ventricular performance. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following: Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
Cardiomyopathy directly related to alcohol or drug abuse is not covered.
(jj) SYSTEMIC LUPUS ERYTHEMATOSUS WITH SEVERE KIDNEY COMPLICATIONS
A definite diagnosis of Systemic Lupus Erythematosus confirmed by a rheumatologist.
For this definition, the covered event is payable only if it has resulted in Type III to Type V Lupus Nephritis as established by renal biopsy. Other forms such as discoid lupus or those forms with only hematological or joint involvement are not covered. WHO Lupus Classification:
Type III - Focal Segmental glomerulonephritis
Type IV - Diffuse glomerulonephritis
Type V - Membranous glomerulonephritis
GENERAL TERMS
i) Irreversible means cannot be reasonably improved upon by medical treatment
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and/or surgical procedures consistent with the current standard of the medical services available in Malaysia.
ii) Permanent means expected to last throughout the lifetime of the Assured Member. iii) Permanent neurological deficit with persisting clinical symptoms means symptoms
of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the lifetime of the Assured Member. Symptoms that are covered include numbness, paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, dementia, delirium and coma.
iv) Assessment Period means the period during which the insurer will assess a
condition before deciding whether or not the condition qualifies as being permanent. The assessment period will be for the minimum period time frame stated in the relevant definition and will not be longer than twelve (12) months (provided all required evidence has been submitted).
4.4 For the purposes of this Policy, AND NOTWITHSTANDING any other definition which may be found elsewhere, “Activities of Daily Living” means any of the following:
(a) Transfer - getting in and out of a chair without requiring physical assistance.
(b) Mobility - the ability to move from room to room without requiring any physical
assistance. (c) Continence - the ability to voluntarily control bowel and bladder functions such as to
maintain personal hygiene. (d) Dressing - putting on and taking off all necessary items of clothing without requiring
assistance of another person. (e) Bathing/Washing - the ability to wash in the bath or shower (including getting in or
out of the bath or shower) or wash by any other means. (f) Eating - all tasks of getting food into the body once it has been prepared.
4.5 The Critical Illness Benefit excludes the following occurrences: (a) The signs or symptoms of the Critical Illness is manifested prior to or:
A. within sixty (60) days from the Effective Date in respect of: i. Cancer
ii. Coronary Artery By-Pass Surgery iii. Heart Attack iv. Other Serious Coronary Artery Disease; or
B. within thirty (30) days from the Effective Date in respect of all other Critical
Illness not set out in Item A above;
27
(b) Pre-existing Illness/Condition; and
(c) Critical Illness that is caused directly or indirectly due to Acquired Immuno-deficiency Syndrome (AIDS) or infection by any Human Immuno-deficiency Virus (HIV). The only exception to this is when the Critical Illness claimed for itself is Full-Blown AIDS or HIV Infection due to Blood Transfusion.
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SCHEDULE A
ASSURANCE SCHEDULE Master Policy Number : GL20151398413 Name of Policy Owner : Hong Leong Bank Berhad Address of Policy Owner : Menara Hong Leong, 6 Jalan Damanlela, Bukit Damansara, 50490 Kuala Lumpur Frequency of Premium : Monthly in respect of each Assured Member Assured Member : All individuals having a credit card facility with the Policy
Owner and who are insured under this Policy Premium Rate : RM0.65 per RM100 of Outstanding Balance per month
HONG LEONG ASSURANCE BERHAD
THE HONG LEONG ASSURANCE BERHAD (“HLA”) NOTICE ON PERSONAL
DATA
This Notice on Personal Data is issued pursuant to the requirements of the Personal Data
Protection Act 2010 (“PDPA”) to all individuals dealing with HLA (“Relevant Person(s)”),
from whom personal data have been and/or may in future be collected. The term “personal
data” refers to information relating directly or indirectly to the Relevant Persons from which
they can be identified or are identifiable and includes any sensitive personal data and
expression of opinion about them.
1. Collection of personal data
In order to provide or offer to provide the Relevant Persons with facilities/services/products
from HLA, it is necessary for the Relevant Persons to supply HLA with personal data on
themselves or persons named in the Relevant Persons’ application or proposal for the
facilities/services/products. Such personal data which may be collected from the Relevant
Persons include the Relevant Persons’ name, NRIC number/passport number (if the Relevant
Person is not a Malaysian), address(es), email address, contact numbers, employment
information, financial information, personal information including medical information,
information on the Relevant Persons’ immediate relatives and personal information about
such immediate relatives and where applicable, information on the Relevant Persons’
directors, shareholders, authorized signatories or such other persons specified by HLA in
connection with the provision of the facilities/services/products, which includes personal
information about such persons.
Such personal data may be provided by the Relevant Persons or the Relevant Persons’
beneficiary(ies) or may be obtained by HLA from publicly available sources, from existing
HLA records, from any medical or health professionals or establishments or laboratories,
from any credit reference agency or from any other sources as HLA considers appropriate.
2. Consequences of not providing personal data
If the Relevant Persons do not provide the personal data which HLA has advised as
mandatory or required to be given, this may result in HLA being unable to provide the
facilities/services/products applied for or proposed.
3. Purpose of collecting personal data
HLA respects the privacy of the Relevant Persons’ personal data and the personal data
provided by the Relevant Persons shall be used or processed by HLA or on its behalf for the
following purposes:
the daily operation of the insurance services provided to the Relevant Persons
including but not limited to:
o processing and evaluating the Relevant Persons’ applications;
o administering and providing services in relation to the insurance products;
o investigating and processing claims;
o invoicing and collecting premiums; and
o contacting the Relevant Persons for any of the above purposes,
carrying out matching procedures;
ensuring the Relevant Persons’ on going credit worthiness;
researching, designing, launching banking, financial, insurance services or related
products for the Relevant Persons’ use and monitoring the provision, operation and
use of such services or products;
marketing services (including direct marketing), products, publicity materials and
other subjects;
determining amounts owed to or by the Relevant Persons;
the enforcement of the Relevant Persons’ obligations, including without limitation
collection of amounts outstanding from the Relevant Persons;
complying with the obligations, requirements or arrangements for disclosing and
using data that apply to HLA or that it is expected to comply according to:
o any law binding or applying to it within or outside Malaysia existing currently
and in the future;
o any guidelines or guidance given or issued by any legal, regulatory,
governmental, tax, law enforcement or other authorities, or self-regulatory or
industry bodies or associations of insurance services providers within or
outside Malaysia existing currently and in the future;
o any present or future contractual or other commitment with local or foreign
legal, regulatory, governmental, tax, law enforcement or other authorities, or
self- regulatory or industry bodies or associations of insurance services
providers that is assumed by or imposed on HLA by reason of its business or
other interests or activities in or related to the jurisdiction of the relevant local
or foreign legal, regulatory, governmental, tax, law enforcement or other
authority, or self- regulatory or industry bodies or associations;
complying with any obligations, requirements, policies, procedures, measures or
arrangements for sharing data and information within the Hong Leong Group and/or
any other use of data and information in accordance with any group-wide programmes
for compliance with sanctions or prevention or detection of money laundering,
terrorist financing or other unlawful activities;
to enable a party to evaluate any actual or proposed assignment, transfer, participation,
sub-participation and/or novation of HLA’s rights and/or obligations;
to enable the management, development and or administration of HLA’s agency force;
provision of reference (status enquiries);
to allow HLA, HLA’s related and/or affiliated companies, service providers and
business partners to promote their products and services;
for audit and risk management;
for any transfer or proposed transfer of any part of HLA’s interests, obligations,
business and/or operations;
for such other purposes as permitted by applicable law or with the Relevant Person’s
consent;
for evaluation and due diligence purposes;
in connection with corporate restructuring or re-organisation including, but not
limited to, mergers, acquisitions, divestitures, consolidation, amalgamation, joint
ventures, formation of partnerships, voluntary liquidation and takeovers; and
for all other purposes incidental and associated with any of the above.
4. Disclosure of personal data
The personal data provided by the Relevant Persons or which will be provided by the
Relevant Persons in respect of the facilities/services/products may be disclosed by HLA to
the following parties, within or outside Malaysia
any financial institution granting or intending to grant any credit/financing facilities to
the Relevant Persons, the Central Credit Bureau or any other central credit bureau
established by Bank Negara Malaysia, Cagamas Berhad, Dishonoured Cheques
Information System, Credit Guarantee Corporation Malaysia Berhad, any other
relevant authority as may be authorized by law to obtain such information,
authorities/agencies established by Bank Negara Malaysia and/or any other person as
may be authorised by law or any governmental authority and/or regulatory authority
and/or any industry related association;
any insurance company, takaful operators, re-insurance company, re-takaful operators,
insurance broking company, takaful broking company and any association or
federation of insurance companies, takaful operators, re-insurance companies, re-
takaful operators, insurance broking companies, takaful broking companies (whether
or not based in Malaysia);
any person under a duty of confidentiality to HLA or to companies related to or
affiliated to HLA;
companies related to or affiliated to HLA (whether such company operates in
Malaysia or elsewhere);
any of Relevant Person’s security providers or any party intending to provide security
in respect of the facilities/services /products applied for or proposed;
HLA’s auditors, solicitors and/or other agents, and to doctors, medical specialists,
hospitals and clinics in connection with HLA’s facilities/services/products;
HLA’s professional advisers, medical advisors, claims investigators, service providers,
nominees, agents, contractors or third party service providers who are involved in the
provision of facilities/products/ services to or by HLA and its related or associated
companies;
any person or corporation to whom HLA assigns or proposes to assign, transfers or
proposes to transfer, novates or proposes to novate, any part of its interests,
obligations, business or operations;
any third party financial institutions, insurers, credit card companies, securities and
investment service providers;
any external service providers (including but not limited to mailing houses,
telecommunication companies, telemarketing and direct sales agents, call centres, data
processing companies and information technology companies) that HLA engages for
the purposes set out in paragraph 3(e) above;
any nominee, trustee, co-trustee, centralised securities depository or registrar,
custodian, estate agent, solicitor or other person who is involved with the provision of
services or products by a member of the Hong Leong Group to that Relevant Person;
any credit reference agency or debt collection agencies;
any person to whom HLA is required by applicable legal, governmental or regulatory
requirements to make disclosure; or to any other person reasonably requiring the same
in order for HLA to carry out the activities set out in the above purposes.
5. Accuracy of personal data
To help HLA provide a better service to the Relevant Persons, please ensure that the personal
data of such Relevant Persons such as contact details, including the Relevant Persons’ home
and office addresses, contact numbers (including mobile numbers), email address and other
details registered with HLA are up to date.
6. Right to access and correct personal data
If the Relevant Persons wish to request for access to or correction of the Relevant Persons’
personal data held by HLA, please contact HLA by:
accessing HLA’s website at www.hla.com.my; or
forwarding the Relevant Persons’ request to HLA’s Data Protection Officer at 03-
76501660 (telephone number ) , 03-76501817 (Fax Number) or by way of email to
Any inquiries or complaints should also be addressed to the Data Protection Officer.
7. Other information
If the Relevant Person does not want HLA to use his/her personal data in direct marketing as
described above, please notify HLA in writing. No fee will be charged. HLA may amend this
Notice on Personal Data at any time by way of notification at the HLA website or such other
appropriate means as determined by HLA.
DASAR PRIVASI
NOTIS DATA PERIBADI HONG LEONG ASSURANCE BERHAD (" HLA ")
Notis mengenai Data Peribadi dikeluarkan selaras dengan keperluan Akta Perlindungan Data
Peribadi 2010 ("PDPA") kepada semua individu yang berurusan dengan HLA ("Orang
Relevan"), yang data peribadi telah dan/atau mungkin akan dikumpulkan pada masa depan.
Istilah "data peribadi" merujuk kepada maklumat yang berkaitan secara langsung atau secara
tidak langsung kepada Orang Relevan dari mana mereka boleh dikenal pasti dan termasuklah
apa-apa data peribadi sensitif dan ungkapan pendapat tentang mereka.
1. Koleksi data peribadi
Dalam usaha untuk menyediakan atau menawarkan untuk menyediakan kemudahan /
perkhidmatan / produk daripada HLA kepada Orang Relevan , adalah perlu untuk Orang
Relevan untuk membekalkan HLA dengan data peribadi tentang diri mereka sendiri atau
orang yang dinamakan dalam permohonan atau cadangan Orang Relevan untuk kemudahan /
perkhidmatan / produk . Data peribadi yang mungkin dikutip dari Orang Relevan termasuk
nama Orang Relevan, nombor kad pengenalan / pasport ( jika Orang Relevan bukan
warganegara Malaysia ), alamat, alamat e-mel, nombor telefon, maklumat pekerjaan ,
maklumat kewangan , maklumat peribadi termasuk maklumat perubatan, maklumat mengenai
saudara-mara serta-merta Orang Relevan dan maklumat peribadi tentang saudara-mara serta-
merta itu dan jika berkenaan, maklumat mengenai pengarah, pemegang saham ,
penandatangan yang diberi kuasa Orang Relevan atau mana-mana orang lain yang ditentukan
oleh HLA berkaitan dengan peruntukan kemudahan / perkhidmatan / produk , termasuk
maklumat peribadi mengenai orang-orang tersebut.
Data peribadi tersebut mungkin akan dibekalkan oleh Orang Relevan atau waris Orang
Relevan atau boleh didapati oleh HLA daripada sumber-sumber yang boleh didapati secara