Manulife Boribo
The details of the products and conditions of the insurance contract
Subject of insurance
Manulife Boribo is a life insurance product which subject of insurance is life and physical (Total and Permanent Disability).
1. Eligible
• Life Insured: 18 years old - 60 years old
2. Premium Payment
• Premium Payment
All Premiums applicable under this Policy shall be paid during the Premium Term as stated on the Insurance Certificate or subsequent Endorsement (if any).
Premium mode is available in annual and semi-annual modes. Monthly and quarterly modes shall be available upon special request from the Policyowner. The Company reserves the rights to accept or decline the request.
All Premium shall be paid to the Company on or before the Premium Due Date by the method specified by the Company.
• Grace Period
A Grace Period of thirty-one (31) days from the Premium Due Date will be allowed for each Premium payment, the Policy will remain in force during this period. If by at the end of the Grace Period and the Premium is still unpaid, the Policy will lapse.
•Policy Reinstatement
After the Policy is lapsed due the default in Premium payment after the Grace Period, all benefit(s) payable under this Policy shall be lapsed , except Surrender Benefit (if any). The Policyowner can request to reinstate the Policy within two (2) years from the date the Policy is lapsed. At the Company’s own discretion, this Policy can be reinstated if:
a) a written request or any form as prescribed by the Company is made by the Policyowner; and
b) subject to the underwriting rules, the Life Insured is within the eligible age limits at the time of reinstatement; and
c) evidence(s) of insurability satisfactory to the Company; and
d) payment of all overdue premiums with fee(s) (if any).
After the Company receives the required document(s) and the listed requirements above are fulfilled, the Company shall process to evaluate the Policy Reinstatement Request. The Company reserves the rights to ask for additional document(s) as necessary for the underwriting process. In the event the Company approves this request, the Policy shall be reinstated. However, if the Company reject this request, the Policy shall not be reinstated and remain lapse, then the Company shall refund back to the Policyowner of:
a) any overdue Premium paid and fee(s) (if any) paid to the Company for the reinstatement purpose, plus
b) Surrender Benefit (if any) ; minus
c) Medical examination expense for reinstatement paid by the company (if any
3. Insurance Benefits
• Death Or Total Disability Benefit Not Caused By Accident
Subject to this Policy’s provisions, the Company shall pay the Death or Total Disability Benefit in the event of the Life Insured’s death or total disability, whichever happens first, upon receipt of acceptable proof and approval by the Company of the Life Insured’s death or of the total disability of the Life Insured that meets the definition of Total Disability described under Definition (Section 1). The Death Benefit proceed will be paid to the beneficiary while the Total Disability Benefit proceed will be paid to the Life Insured. The Death or Total Disability Benefit proceeds shall be the amount specified in the Insurance Certificate or as subsequently endorsed in the Policy.
• Death Or Total Disability Benefit Caused By Accident
Subject to this Policy’s provisions, the Company shall pay the Death or Total Disability Benefit in the event of the Life Insured’s death or total disability, whichever happens first, upon receipt of acceptable proof and approval by the Company that the Life Insured’s death or total disability meets the definition of Death or Total Disability Caused by Accident described under Definition (Section 1). The Death Benefit proceed will be paid to the beneficiary while the Total Disability Benefit proceed will be paid to the Life Insured. The proceeds from the Death or Total Disability Benefit Caused by Accident shall be the amount specified in the Insurance Certificate or as subsequently endorsed in the Policy.
• Major Critical Illness Benefit:
Subject to this Provision, the Company shall pay the Major Critical Illness Benefit to the Life Insured upon receipt of due proof satisfactory to the Company if the Life Insured, during his lifetime, is diagnosed by a Medical Practitioner acceptable to the Company of having any one of the Critical Illnesses descripted in this section subject to any exclusion and claim procedures mentioned in their descriptions and any other provisions herein. The Major Critical Illness Benefit proceeds shall be 100% of Face Amount for Critical Illness Benefit, subject to a maximum amount of USD 200,000. The Policy will be terminated when Major Critical Illness Benefit is paid.
The following Critical Illnesses are covered under the Major Critical Illness Benefit:
a) Major Cancer – of specified severity and does not cover very early cancers. A malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells with invasion and destruction of normal tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma.
For the above definition, the following are excluded:
i. All tumours which are histologically classified as any of the following:
· Pre-malignant;
· Non-invasive;
· Carcinoma-in-situ;
· Having borderline malignancy;
· Having any degree of malignant potential;
· Having suspicious malignancy;
· Neoplasm of uncertain or unknown behavior; or
· Cervical Dysplasia CIN-1, CIN-2 and CIN-3;
ii. Any non-melanoma skin carcinoma unless there is evidence of metastases
to lymph nodes or beyond;
iii. Malignant melanoma that has not caused invasion beyond the epidermis;
iv. All Prostate cancers histologically described as T1N0M0 (TNM Classification) or below; or Prostate cancers of another equivalent or lesser classification;
v. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification)
or below;
vi. All tumours of the Urinary Bladder histologically classified as T1N0M0
(TNM Classification) or below;
vii. All Gastro-Intestinal Stromal tumours histologically classified as T1N0M0
(TNM Classification) or below and with mitotic count of less than or equal
to 5/50 HPFs;
viii. Chronic Lymphocytic Leukemia less than RAI Stage 3; and
ix. All tumours in the presence of HIV infection.
b) Heart Attack - of Specified severity
Death of heart muscle due to obstruction of blood flow, that is evident by at
least three of the following criteria proving the occurrence of a new heart
attack:
i. 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;
iii. Elevation of the cardiac biomarkers, inclusive of CKMB above the generally
accepted normal laboratory levels or Cardiac Troponin T or I at 0.5ng/ml
and above;
iv. Imaging evidence of new loss of viable myocardium or new regional wall
motion abnormality. The imaging must be performed by a consultant
cardiologist specified by The Company.
The evidence must show the occurrence of a definite acute myocardial
infarction, which should be confirmed by a consultant cardiologist.
For the above definition, the following are excluded:
· Angina or other acute coronary syndrome;
· Heart attack of indeterminate age; and
· A rise in cardiac biomarkers or Troponin T or I following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty.
Explanatory note: 0.5ng/ml = 0.5ug/L = 500pg/ml
c) Coronary Artery Bypass Surgery
The actual undergoing of open-chest surgery or Minimally Invasive Direct
Coronary Artery Bypass surgery to correct the narrowing or blockage of one (1)
or more coronary arteries with bypass grafts. This diagnosis must be
supported by angiographic evidence of significant coronary artery obstruction
and the procedure must be considered medically necessary by a consultant
cardiologist.
Coronary arteries herein refer to left main stem, left anterior descending,
circumflex and right coronary artery.
Angioplasty and all other intra-arterial, catheter based techniques, ‘keyhole’
or laser procedures are excluded.
d) Open 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:
i. Angioplasty
ii. Other intra-arterial or catheter based techniques
iii. Other keyhole procedures
iv. Laser procedures.
Major Stroke – resulting in permanent neurological deficit with persisting clinical
symptoms
A cerebrovascular incident includes infarction of brain tissue, cerebral and subarachnoid
hemorrhages, intracerebral embolism and cerebral thrombosis resulting in permanent
neurological deficit with persisting clinical symptoms.
This diagnosis must be supported by all of the following conditions:
· Evidence of permanent clinical neurological deficit confirmed by a neurologist at
least 3 months after the event; and
· Findings on Magnetic Resonance Imaging (MRI), Computerized Tomography (CT), or
other reliable imaging techniques consistent with the diagnosis of a new stroke.
The following are excluded:
· Transient Ischaemic Attacks;
· Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease;
· Vascular disease affecting the eye, optic nerve or vestibular functions;
· Ischaemic disorders of the vestibular system; and
· Cerebral symptoms due to migraine
Permanent means expected to last throughout the lifetime of the insured.
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 Life Insured. Symptoms that are covered include numbness, paralysis, localized 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.
End Stage Liver Failure
End stage liver failure as evidenced by all of the following:
· Permanent jaundice;
· Ascites; and
· Hepatic encephalopathy.
Liver disease secondary to alcohol or drug abuse is excluded.
End Stage Lung Disease
End stage lung disease, causing chronic respiratory failure. This diagnosis must be supported by evidence of all of the following:
· FEV1 test results which are consistently less than 1 liter;
· Permanent supplementary oxygen therapy for hypoxemia;
· Arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 <=55mmHg); and
· Shortness of breath at rest.
The diagnosis must be confirmed by a respiratory specialist.
Kidney Failure
Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation.
Major Organ Transplantation
The receipt of a transplant of one of the following human organs:
· Heart
· Lung
· Liver
· Kidney
· Pancreas
that resulted from irreversible end failure of the relevant organ.
Stem cell transplants, islet cell transplants and/or transplants of part of an organ are excluded.
Daily Hospitalization Benefit (Manulife Medicash)
(1)Daily Cash Benefit
This benefit is equal to the Face Amount of Daily Hospitalization Benefit (Manulife
Medicash) as specified on Insurance Certificate and is payable to the Life Insured for each
day of the Hospitalization.
(2) Daily ICU Benefit
This benefit is equal to the Face Amount of Daily Hospitalization Benefit (Manulife
Medicash) as specify on Insurance Certificate and is payable for each day within the same
Hospitalization while the Life Insured is being treated in an Intensive Care Unit (ICU) for a
minimum of 6 hours. This benefit is payable in addition to Daily Cash Benefit in section (1).
For example, if the Life Insured is hospitalized in ICU, the total benefit payable is double
of Face Amount (Daily Cash Benefit plus (+) Daily ICU Benefit).
(3) The general limit and payment conditions
The following limits and payment conditions will be applied when considering the benefits
payable under this Policy.
(3.1) Face Amount Limit
The total Face Amount for all of Daily Hospitalization Benefit (Manulife Medicash)
with the same Life Insured shall not exceed USD 200. If the Life Insured is
unemployed or has no regular income, this maximum amount is USD 50.
(3.2) Maximum stay per Hospitalization
The maximum number of days that the benefits under this provision are payable for
a single Hospitalization is 20 days or the number of days required for Medically
Necessary treatment for the medical condition; whichever is shorter.
The Company shall consider paying for actual Hospitalization in excess of 20 days if
the treatment is Medically Necessary. In these cases, the Life Insured must inform
the Company to get its consultancy and guidelines.
When considering the maximum stay per Hospitalization, any Hospitalization within
30 days of a previous Hospitalization and due to the same medical condition shall
be considered as a single Hospitalization.
(3.3) Annual Limit
Within each Policy Year, the maximum number of days of Hospitalization payable by the Company shall not exceed ninety (90) days.
(3.4) Lifetime Limit
The maximum number of days of Hospitalization payable by the Company to the Life Insured shall not exceed nine-hundred (900) days.
(3.5) Co-ordination of Benefits
If the Life Insured is, or has previously been, covered under more than one (1) of Daily Hospitalization Benefit (Manulife MediCash) plan, benefits may be pro-rated among the plans according to the face amount of each plan, and the total benefits payable are subject to the limits in sections (3.2), (3.3), and/or (3.4).
(3.6) Examples of Treatment Which Are Not Medically Necessary
Examples of treatment which are Not Medically Necessary include but are not limited to:
1. Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness.
2. Dental conditions including dental treatment or oral surgery except as necessitated by Accident to sound natural teeth occurring wholly during the insurance period.
3. Hospitalization primarily for investigatory of experimental purposes, diagnosis, X-ray examination, general physical or medical examinations, and any preventive treatments, preventive medicines or examinations or screenings carried out by a Physician, and treatments specifically for weight reduction or gain.
4. Routine physical examinations, health check-ups or tests not incidental to treatment or diagnosis of the Life Insured’s sickness or injury.
5. Erectile dysfunction and tests or treatment related to impotence or sterilization.
6. Drug therapy or traditional medicine methods.
7. Vaccination and immunization injections.
8. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bone setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
9. The treatment of common diseases unless surgery is required: a. Back pain, arthralgia, arthritis, myositis, degenerative spine; conjunctivitis, Pterygium; or b. Hemorrhoids; or c. Chapped skin, soft tissue trauma, closed fracture or dislocation of finger or toe; or d. Physical breakdown, neurasthenia.
10. Medical treatment for sex changes.
11. Medical treatment involving the donation of any body organ by the Life Insured.
4. Exclusion
The Company shall not be responsible to pay benefits defined in this Provision if the claim of Life Insured results directly from any of the following:
Exclusions for Death Benefits Not Caused by Accident
a) Attempted suicide or any self-inflicted injury, whether sane or insane.
b) The Life Insured being under the influence of alcohol or the taking of any drug, except under the direction of a registered medical practitioner.
c) War or any act of war, whether declared or not, riot, insurrection, civil commotion, strikes terrorist activities, whether or not the Life Insured was participating therein.
d) Commitment or attempted commitment of a criminal offense by the Policyowner, Life Insured or Beneficiary. Beneficiaries not involved in the aforementioned criminal activity will remain eligible to receive their benefits.
e) Acquired Immune Deficiency Syndrome (AIDS) or any complication associated with infection by the Human Immunodeficiency Virus (HIV).
Exclusions for Death Benefit or Total Disability Benefit Caused by Accident
a) The Life Insured committed suicide or attempted suicide, whether the Life Insured is sane or insane.
b) The Life Insured’s death results directly or indirectly from a committed criminal offense, or an attempted commitment of a criminal offense by the Policyowner, Life Insured, or beneficiaries. Beneficiaries not involved in the aforementioned criminal activity will remain eligible to receive their benefits.
c) Any unprescribed drug, alcoholic substance, poison, gas or fumes, voluntarily taken, administered, absorbed or inhaled.
d) Any loss sustained by the Life Insured while resisting arrest by a law enforcement officer or violation of alcohol intake and/or speed limits as prescribed by the applicable traffic law at the time of accident.
e) Bodily or mental infirmity or illness or disease of any kind or any infection, other than infections occurring simultaneously with and in consequence of an accidental wound.
f) Travelling or flight in any vehicle or device for aerial navigation, except as a passenger on an aircraft operated by a regular airline.
g) Engaging in or taking part in driving or riding in any kind of race, underwater activities or other hazardous pursuit such as mountaineering or potholing or parachuting or bungee jumping.
Exclusions for Major Critical Illness Benefits
a) All Pre-existing conditions and the complications arising from the Pre-existing Conditions; or b) All Major Critical Illness presenting or diagnosed within the Waiting Period,
c) Congenital diseases or birth defects; or
d) Disease/s resulting from Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex or infection by Human Immune Deficiency Virus (HIV) (except in cases of HIV due to blood transfusion/ Occupationally acquired AIDS)
e) Attempted suicide and Self-inflicted injuries while sane or insane
f) The Life Insured being under the influence of alcohol or the taking of any drug, except under the direction of a registered medical practitioner
Exclusions for Daily Hospitalization Benefit (Manulife MediCash)
a) All Pre-existing conditions and the complications arising from the Pre-existing Conditions; or b) Any Hospitalization due to Illness within the Waiting Period,
c) Any Hospitalization for which the underlying Medical Condition or any number of days of Hospitalization which is Not Medically Necessary, as determined by the Company; or
d) Any treatment or surgical operation performed due to either internal or external congenital abnormalities or deformities including hereditary conditions; or
e) Pregnancy or complications from pregnancy; or
f) Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilization, venereal disease and its sequelae, AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related diseases, and any communicable diseases required quarantine by law; or
g) Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations); or
h) Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes; or
i) Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane; or j) Commitment or attempted commitment of a criminal offense by the Policyowner, Life Insured or Beneficiary; or
k) War or any act of war, whether declared or not, riot, insurrection, civil commotion, strikes terrorist activities, whether or not the Life Insured was participating therein.
5. Free Look Period
Refer to the duration of twenty-one (21) calendar days from the Policy Issue Date. During this Free Look Period, the Policyowner can surrender the Policy upon a written request to the company with the Original Insurance Contract attached (For E-Contract, Policyowner is required to attach Insurance Certificate only). After the Company received all the required documents, the Company will terminate the Policy then refund back to the Policyowner as the following:
a) total Premium paid; less,
b) any expenses occured for the underwriting process (if any); less,
c) any amount owed to the company (if any).
6. Grace Period
A Grace Period of thirty-one (31) days from the Premium Due Date will be allowed for each Premium payment, the Policy will remain in force during this period. If by at the end of the Grace Period and the Premium is still unpaid, the Policy will lapse .
7. Dispute Mediation
•Complaint Procedures
Any complaint received will be resolved or provided clarification to the complainant within five (5) working days to determine the root cause and the appropriate course of action in accordance with regulatory requirements and the Company’s standard operating procedures.
•Dispute Resolutions
For any dispute arising in relation to the conduct of insurance business, the disputing parties may bring the case to the Insurance Regulator of Cambodia for mediation before filing a lawsuit to arbitration or a competent court, except a criminal case
8. Incontestability
The Company can cancel or void the Policy if the Company discovers any inaccurate statement or suppression of a material fact by the Policyowner or any of the Life Insureds on a material matter within two (2) years from the Policy Effective Date, or Policy Issue Date (whichever is later) that impacts the underwriting decision on this Policy. Such non-disclosure or misrepresentation could be found in the application for this Policy, any medical evidence forms, or any written statements and answers provided as evidence of insurability. However, this clause shall not apply to a misstatement of age or gender.
9. Termination
This Policy will be automatically terminated on the earliest of the following:
a) Death of the Life Insured (Minor); or
b) Policyowner’s request to surrender the Policy; or
c) The Policy has reached the Policy Expiry date.
10. How to claim
Are you looking for how to process a claim? Click here:
https://www.manulife.com.kh/en/services/claims.html, or You can also call our hotline 1800 211 211 for free of charge.