A benefit up to 100% (one hundred percent) of the Sum Insured for Coverage will be paid to the Insured due to diagnosed risks with the following each categories : Category 1 : Cancer
Cancer means diagnosed Cancer as defined below Cancer
Malignant tumors are characterized by the uncontrolled growth of malignant cells in the presence of attack and destruction of normal tissue, as well as invasion of surrounding tissue. This diagnosis must be based on the presence of histological evidence of malignancy (through biospsy) and diagnosed by a doctor tumor specialist (oncologist) or pathologist. This Policy covers invasive cancer only.
Sum insured based on Cancer stage:
a. 25% of the Sum insured will be paid for early-stage cancer (such as, but not limited to: T1-T2, RAI 1 –RAI 2 or Binet A - B). The 25% of Sum insured early cancer benefit can only be paid once in the Policy lifetime.
b. The remaining 75% of the sum insured will be paid if the cancer has advanced to late stage (such as, but not limited to : T3-T4, RAI 3 – RAI 4 or Binet C).
If cancer is detected directly at a late stage (such as but not limited to : T3-T4, RAI 3 - RAI 4 or Binet C) then the value of benefit paid is 100%.
Once paid an accumulated of 100% of Sum insured the Policy will automatically stop.
The term Cancer also includes:
- Leukemia, - Lymphoma, - Sarcoma
Category 2: Neurological disorders
Diagnosed a Neurological disorders means Coma (Category 2), Cerebral Aneurysm, Alzheimer’s Disease or Parkinson’s disease as defined below.
Coma (Category 2)
a Coma as defined on this Policy in Section 1: Definitions.
Cerebral Aneurysm
a Diagnosis confirmed by cerebrovascular angiogram from a Neurologist specifying that the Insured has a cerebral aneurysm requiring brain surgery by craniotomy for clamping, repairing, or removing an aneurysm. The Insured must be treated by a neurosurgeon.
Alzheimer’s Disease
a Diagnosis from a Neurologist specifying that the Insured has Alzheimer’s disease together with a neurological impairment, causing a permanent inability to perform three or more Activities of Daily Living by themselves.
Parkinson’s Disease
a Diagnosis from a Neurologist specifying that the Insured has Parkinson’s disease occurring from an idiopathic cause and meets all the following conditions:
1. The Insured’s disease state cannot be controlled by any drug or clinical measures;
and
2. The Insured cannot perform three or more Activities of Daily Living by themselves for a continuous period of at least 180 calendar days from the date of Diagnosis, except if the Insured dies before the end of the 180-day period from this Parkinson’s Disease or as a direct consequence of having this Parkinson’s Disease.
Activities of Daily Living (ADL) are as follows:
a. Bathing and washing
The ability to wash in the bath or shower (including getting in or out of the bath or shower) or to wash oneself by any other means.
b. Continence
The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
c. Dressing
Means The ability to put on, take off, secure, and unfasten all garments and, as appropriate, any braces, artificial limbs, or other surgical appliances.
d. Eating
Means All tasks of getting food into the body once it has been prepared.
e. Mobility
Means The ability to move from place to place without requiring any physical assistance.
f. Transferring
Means The ability to move from a bed to an upright chair or a wheelchair and vice versa.
Category 3: Cardiovascular illnesses
Cardiovascular illness means diagnosed an Ischemic or Hemorrhagic Stroke, Acute Heart Attack or Coronary Artery Disease as defined below.
Ischemic or Hemorrhagic Stroke (Major Stroke)
A Diagnosis from a Specialist Physician specifying that the Insured has suffered a sudden neurological deficit caused by cerebrovascular disease resulting from cerebral thrombosis, intracerebral hemorrhage, or extracranial embolism and meets all the following conditions:
1. The Insured has suffered continuous neurological disability (excluding numbness) for a period of at least 60 calendar days since the Diagnose date, except if the Insured dies before the end of the 60 calendar days period from the date of Diagnosis from this ischemic or hemorrhagic stroke or as a direct consequence of having this ischemic or hemorrhagic stroke; and
2. The Diagnosis has been confirmed by Computed Tomography (CT Scan) or Magnetic Resonance Imaging (MRI).
Acute Heart Attack
a Diagnosis from a Cardiologist specifying that the Insured has suffered a heart attack which meets all the following conditions:
1. The Insured has a record of angina pain which is a specific characteristic of Ischemic Heart Disease;
2. The Insured’s Cardiac Troponin increases (T or I increase by at least three times the upper limit of the average range, or the CKMB increases by at least two times the upper limit of the average range); and
3. The Insured’s Electrocardiogram has changed and shows new characteristics of a heart attack.
Coronary Artery Disease
A Diagnosis from a Cardiologist specifying that the Insured has coronary artery disease requiring a surgery by thoracotomy or coronary artery by-pass graft surgery.
Category 4: Chronic Kidney Failure Chronic Kidney Failure
a Diagnosis from a Specialist Physician that the Insured has chronic kidney disease or end-stage kidney failure of both kidneys whose functions cannot be restored effectively, resulting in a need to perform dialysis regularly or to perform a kidney transplantation.
SECTION III
GENERAL TERMS AND CONDITIONS
1. Policy
This Policy arises from the representation of the Insured that the Insurer relies upon in the insurance application, as well as additional statements (if any). Hence, this Policy, summary document, coverage agreement, and exclusions are issued by the Insurer.
If the Insured knowingly misrepresents in the statements mentioned in paragraph one, or knowingly conceals any fact from the Insurer that could have caused the
Insurer to demand higher premium or refuse to enter into the Policy, this Policy will be voidable pursuant to section 1266 of the Indonesia Civil Code. The Insurer has the right to rescind the Policy.
The Insurer shall not deny its liability based on any statements other than the statements stated in paragraph one of this document.
2. Entirety of the Policy and change of wording in the Policy
This Policy as well as coverage agreement and endorsements form an entire insurance contract Policy. Any change of wording in the Policy requires consent of the Insurer and shall be recorded in this Policy or endorsement before such change becomes valid.
3. Disputes are regulated in this Policy at Section 6: Provision of compulsory standard agreement
4. Premium payment
The Insured must pay the premium paid off for settled immediately, prior to the commencement of the Policy. The Policy shall be effective on the date stated in the schedule.
The Insurer is confirmed to have received the Premium payment, when:
- receipt cash payments, or
- The premium has already paid to the the Insurer’s bank account, or - The Insurer has agreed to pay the relevant Premium in writing.
4.a. Grace period of premium payment
The Insurer will allow a grace period for Premium payment at the latest 30 (thirty) calendars day from effective date of the Policy.
If payment is not within these 30 (thirty) calendars day period, The Insurer will cancel Insured Plan and will not pay for any Treatment or Benefit entitlement arising after the date that the premium became due.
Where a payment is received after the grace period, The Insurer have the right to reinstate the Plan at Our sole discretion and may be subject to the alternation in terms or may be subject to a medical questionnaire or declaration.
5. Misrepresentation of declared information
Without prejudice to the Insurer’ right to rescind the Policy pursuant to clause 1 above Section 3, if any of the information declared by the Insured which is used by the Insurer for calculating the premium or deciding whether to enter into this Policy insurance with the Insured is incorrect and untrue so that:
1. The Insurer receives less premium than required:
The sum insured that the Insured will receive under this Policy shall be equal to the amount of premium paid. The Insured can re-purchase coverage based on the corrected information. If the Insured’s corrected information falls outside of the Insurer’s underwriting footprint so that the Insurer would not have entered into the Policy with the Insured under this Policy given the corrected information, the Insurer will not pay compensation but will instead return the premium that has been paid.
2. The Insurer receives more premium than required:
The Insurer shall refund the excess premium to the Insured. However, this condition shall not be applied retroactively to adjust the premium for the past period of insurance.
6. Waiting period
The Insurer shall not pay the compensation specified in the schedule in case that the Insured displays symptoms of a critical illness chosen by the Insured under this Policy, or is Diagnosed to have a critical illness chosen by the Insured under this Policy, during the first 90 (ninety) calendars day after the Policy start date specified in the schedule. The Insurer shall be entitled to terminate the Policy with an immediate effect and refund all the received premium to the Insured.
7. Policy renewal
Policy renewal is based on the Insurer decision as follows:
1. In case the Insurer accepts to renew the Insured’s Policy, the Insurer shall reserve the rights to adjust the renewal premium in accordance with the risk, and change the underwriting terms and conditions and coverage agreement of the renewal Policy as necessary, in which case the Insurer shall inform the Insured of the main terms and conditions of the Policy which have been changed.
2. The Insurer reserves the right to reject the renewal of the Policy by informing the Insured in writing at least 30 (thirty) calendars day before the end date specified in the schedule of the Policy.
3. The maximum policy renewal is up to 5 (five) consecutive years from the first start of coverage.
8. Policy Cancellation
8.1 Cancellation by the Insurer
The Insurer may cancel this Policy by one of the following methods:
1. The Insurer may cancel this Policy by sending advance notice of not less than 30 calendar days by registered mail to the Insured at the last address informed to the Insurer. The Policy will cease to be in force after the above date.
2. The Insurer may cancel this Policy by electronic means with advance notice of not less than 30 calendar days. The Insurer shall comply with the safety level prescribed by electronic transaction law, and affix its electronic signature, which is reliable according to the electronic transaction law. The information of policy cancellation shall be sent to the data system specified by the Insured only. In any case, the Insured must agree with the Insurer to proceed accordingly, and the Insurer must provide a notification to the Insured once the Policy cancellation by electronic means has proceeded.
In such event, the Insurer shall return to the Insured the premium after deducting the premium for the period that the Policy has been in force on a pro-rate basis.
8.2 Cancellation by the Insured
The Insured may cancel this Policy by one of the following methods:
1. The Insured may cancel this Policy by giving notice in writing to the Insurer. The Policy will immediately cease to be in force on the date and time the Insurer receives the cancellation notice, or the date and
time specified in the notice, whichever comes after.
2. The Insured may cancel this Policy by electronic means. In this regard, the Insurer shall comply with the safety level prescribed by electronic transaction law and notify the Insured of such means. The Policy will cease to be in force on the date the cancellation information is sent to the data system specified by the Insurer, or the date specified in the notice, whichever comes after.
In such event, the Insurer shall be entitled to refund the premium at the rate specified below.
Premium Rate Refund