(a) Duty of Disclosure:
Where the Policyholder and Insured Person(s) have applied for this insurance for purposes related to their trade, business or profession, the Policyholder and Insured Person(s) have a duty to disclose any matter that they know to be relevant to the Company’s decision in accepting the risks and determining the rates and terms to be applied, and any matter a reasonable person in the circumstances could be expected to know to be relevant, otherwise it may result in the cancellation of their contract of insurance, refusal or reduction of claim(s), change of term(s) or termination of the contract of insurance. The Policyholder and Insured Person(s) also have a duty to inform the Company immediately if at any time after the contract of insurance has been entered into, varied or renewed with the Company, any of the information given in the Proposal Form or any other document related to this insurance is inaccurate or has changed.
Failure to do so may:
1. void this Policy from inception (which means treating it as invalid) and the Company may not return the premium or recover any unpaid premium;
2. result in refusal or reduction of claims that has been or will be made under the Policy;
3. change the terms of this Policy;
4. terminate this Policy and return any premium less the Company’s cancellation charge or recover any unpaid premium;
5. entitle the Company to recover any shortfall in premium;
6. entitle the Company to recover from Policyholder and Insured Person(s) the total amount of any claim already paid under the Policy or any claim the Company have to pay under any relevant legislation, plus any recovery costs.
(b) Eligibility:
Age
(i) Entry age for an Insured Person under this Policy is 18 to 75 years of age (inclusive).
(ii) The renewable age for each Insured Person is up to the age of 75 years (inclusive).
Note: Age means the Insured Person’s age as on their last birthday.
Residency
To be eligible for cover under this Policy, the Insured Person must be a:
(i) Malaysian citizen;
(ii) Malaysian permanent resident; or
(iii) Holder of a valid employment pass (of which the place of employment must be in Malaysia during the Period of Insurance
Occupation
This Policy is only offered to the following occupation classes:
(i) Occupational Class 1 & 2 – Persons engaged in professional, managerial, administrative, supervisory or clerical work and not involved in any manual labour or any work which is hazardous in nature.
(ii) Occupational Class 3 – Persons engaged in occasional or regular manual work that is not hazardous in nature but involving the use of tools or light machinery.
(c) Maximum Sum Insured
Where there is a specific maximum Sum Insured provided in the Benefits of this Policy, the specific maximum Sum Insured shall prevail. In event the sum insured for any Insured Person exceeds the maximum Sum Insured as stated in this clause, the Company’s liability on the amount over and above the maximum Sum Insured is limited to the refund of the premium paid on the amount exceeding maximum Sum Insured.
(d) Premium Warranty
The premium due must be paid and received by the Company within sixty (60) days from the Policy Start Date of this Policy/Endorsement/renewal. If this condition is not complied with then this Policy is automatically cancelled, and the Company shall be entitled to the pro-rata premium for the period the Company have been on risk.
(e) Claims:
(i) The Company must be notified as soon as it is reasonably practical and in any event within 30 days after the date of the Accident or Illness which leads to a claim.
(ii) The Company must be provided with all reasonable and necessary evidence required by the Company to support a claim within 90 days after the date of Accident or Illness which leads to a claim.
(iii) Failure to comply with (i) above may result in the Company’s rejection of all or part of the claim. Reasons include, but are not limited to, if it is made so long after the event that the Company is unable to investigate it fully, or may result in the Insured Person not receiving the full amount claimed if the amount payable changes as a result of the delay.
(iv) All indemnities of this Policy are payable to the Policyholder or at the Policyholder’s written request to an Insured Person.
(f) Number of policies:
No person shall be insured under more than one Policy issued by the Company under this product. In the event the person is insured under more than one such Policy, the Company shall consider that person to be insured under the Policy with the highest Sum Insured or, where the Sum Insured under each Policy is identical, under the Policy that was first issued. The Company shall refund any duplicated Premium payment which may have been made by or on behalf of that Insured Person.
(g) Renewal:
This is an annual policy where the Policy may be renewed at the option of the Policyholder subject to the agreement of the Company and payment of premium the Company requires for renewal.
(h) Renewal Bonus:
(i) This is only applicable to Core Module: 1. ‘Accidental Death Benefit’ and subject to the conditions therein.
(ii) A renewal bonus is applicable upon continuous renewal of this Policy without interruption.
(iii) Renewal Bonus will be calculated as per table below on the current year's ‘Accidental Death’ Sum Insured.
Renewal Year Renewal Bonus %
Year 1 - 3 : 10%
Year 4 onwards : 20%
Please refer to section 'Renewal Bonus' in the policy wordings for details on the terms and conditions and calculation of the same.
(i) Addition and Deletion
Additional Insured Person(s) will be automatically covered by this Policy from the first day of qualification for coverage.
However, automatic addition will not be applicable for:
(i) Categories where the occupation has changed from occupations declared at the inception of the Policy; or
(ii) any Category or inclusions from any new acquisition or subsidiary where the nature of business differs from the declared nature of business of the Policyholder; or
(iii) any increase in the total number of employees by more than 20% or 5 persons (whichever higher) of the current headcount.
No refund will be accorded for the deletion of any Insured Person who ceases to qualify for coverage under this Policy.
(j) Basis of Declaration:
This policy is arranged on employee headcount basis. The declaration must include the Employee’s Category and the Sum Insured they are covered for.
