wwtip sulit coc - Worldwide Travel Insurance

WOLDWIDE TRAVEL INSURANCE PLANS
SUMMARY OF TERMS AND CONDITIONS
SUPER TIPID PLAN
For Out-Patient Maximum Limits
A. DEFINITIONS
INSURED PERSON: - THE “INSURED” REFERRED TO IN THIS POLICY SHALL REFER
TO THE PERSON WHO HAS APPLIED AND BEEN DECLARED WITH ORIENTAL
ASSURANCE CORPORATION FOR COVERAGE WHOSE AGE IS 6 TO 75 YEARS OLD,
SINGLE OR MARRIED, WIDOW OR WIDOWER, AND WHO ARE ELIGIBLE FOR
COVERAGE UNDER THE TERMS AND CONDITIONS OF THIS POLICY
Inner Limits
PUBLIC UTILITY VEHICLE: - SHALL MEAN ALL FORMS OF COMMERCIAL
TRANSPORTATION EITHER BY LAND, SEA, OR AIR, LICENSED TO CARRY FARE
PAYING PASSENGERS.
Coverage shall commence from the estimated time of departure from the Insured Person’s
normal residence or place of business or the effective date of the policy whichever occurs
last, and shall finish upon arrival to point of destination or expiry of the policy whichever
occurs first.
1)
Trip Termination
If the trip is terminated and forced you to return to your country of
residence due to the death, sickness or injury of the insured person or
relatives which require urgent medical treatment, the plan will pay for
the unused portion of travel and accommodation expenses which are
paid in advance and non-refundable, up to the maximum limit specified
in the Schedule of Benefits.
Loss of the limbs
Loss of both hands, or all fingers & thumbs of both
hands
Loss of both feet
Total loss of sight of both eyes
Total and irrecoverable loss of sight of one eye and
loss of one limb
Injuries resulting in being permanently bedridden
Any other injury causing permanent total disablement
Loss of arm at or above elbow
Loss of arm between elbow and wrist
Loss of hand
Loss of four fingers and thumb of one hand
Loss of four fingers
Loss of thumb
Loss of index finger
Loss of middle finger
Loss of ring finger
Loss of little finger
Loss of metacarpals – first or second ( additional
Third, fourth or fifth (additional)
Loss of leg at or above knee
Loss of leg below knee
Loss of one foot
Loss of toes – all of one foot
Loss of big toe
Loss of any toe other than big toe, each
Loss of sight of one eye
Loss of hearing – both ears
- one ear
2)
3)
Percentage of the Sum
Insured
100%
100%
100%
100%
100%
100%
100%
70%
50%
45%
45%
35%
15%
10%
6%
5%
4%
3%
2%
60%
40%
50%
15%
5%
1%
50%
50%
25%
Permanent Total Disability Indemnity:
When as a result of injury and commencing within one hundred eighty
(180) days from the date of accident, the Insured is totally and
permanently disabled such that:
a.
the Insured is unable to engage in any occupation or employment
for compensation or profit for twelve (12) consecutive months and;
b.
such disability is diagnosed by a duly licensed physician to be
total, continuous and permanent,
The Company will indemnify the Insured the Principal Sum, less any
amount paid or payable under the Schedule of Indemnity.
The underwriter shall not be liable for disablement directly and
indirectly resulting from disease or natural cause or medical or
surgical treatment unless caused by accidental bodily injury
covered hereunder.
Medical Reimbursement
Reimburses the actual, necessary, and eligible expenses incurred for
hospitalization, surgery, medicines, tests, etc. for the treatment of
injury, illness or disease occurring during the travel up to the maximum
amount stated in the Schedule of Benefits, subject to inner limits as
stated in the said Schedule.
4)
Loss of Travel Documents
Pays for the transportation and communication expenses necessary in
getting a replacement of lost passport and travel tickets including the
cost of such replacement, up to the maximum limit stated in the
Schedule of Benefits.
8)
Baggage Loss/Damage
Pays for the actual cost of your baggage due to accidental loss, theft or
damage up to the maximum amount stated in the Schedule of Benefits.
Baggage as defined herein shall mean trunks, suitcases and the likes,
hand-carried or check-in, used to contain/hold numerous personal
properties or belongings.
9)
Baggage Delay
The plan will reimburse the insured for the purchase of essential
clothing and personal items if his/her checked-in baggage is delayed
for more than 12 hours from arrival at the scheduled destination, up to
the amount stated in the Schedule of Benefits.
10)
Flight Delay
If the scheduled flight was delayed for twelve (12) hours and the
insured was denied boarding the aircraft due to overbooking, adverse
weather conditions, technical problems and the like, and no alternative
transportation was arranged by the airline company, the plan will
reimburse all reasonable and valid expenses such as hotel
accommodations, restaurant meals and refreshments, up to the
maximum amount stated in the Schedule of Benefits.
11)
Weekly Hospital Income
The plan will pay a flat benefit as stated in the policy, for each week the
insured is hospitalized for more than 24 hours as a result of covered
accident or illness occurring during the trip, up to a maximum of 2
weeks per confinement.
10)
Funeral and Burial Expense
Reimburses for the funeral and burial expenses if death due to
accident or disease occurs while traveling, but such reimbursement is
limited to the benefit stated in the Schedule of Benefits.
11)
Unprovoked Murder or Assault
This plan is extended to cover death or permanent disablement caused
by unprovoked murder or assault, or any attempt thereat, but such
benefit is limited to 50% of the accidental death benefit as stated in the
Schedule of Benefits.
SCHEDULE OF INDEMNITY
Description of Disablement
500
6)
7)
Accidental Death and Disablement
Pays a lump sum amount as stated in the
schedule for accidental death or disablement resulting from bodily
injury occurring in the duration of the travel and while the policy is in
effect. The maximum sum insured for persons with ages from 6 to 18
years old and 70 years old and above is limited to 50% of the Personal
Accident coverage (AD&D & Disability coverage’s only).
4,300
P
Trip Cancellation
If the trip is cancelled within 30 days prior to scheduled departure date
due to death, life-threatening sickness or injury requiring urgent
medical treatment of the insured or his relative, the plan will pay for the
non-refundable portion of the travel and accommodation expenses up
to the maximum limit stated in the Schedule of Benefits.
EXTENT OF COVERAGE: - Covers the insured person whenever he or she is in the stage
of boarding any public utility vehicle and he or she is located within the premises or vicinity
of boarding areas such as airports, seaports, railway stations, or bus stations and stops.
C. COVERAGES:
P
Deductible
5)
B. TRAVEL PERSONAL ACCIDENT COVERAGE
SCOPE OF COVERAGE: This policy shall cover the Insured:
while anywhere outside the Philippines.
while traveling as a fare paying passenger on
board any sea, air or land public utility vehicle
outside the Philippines.
while a fare paying passenger in any inter island
public utility vehicle within the Philippines.
SUPER TIPID PLAN
Outpatient Benefit
D. MAIN EXCLUSIONS:
Cash, bank notes, traveler’s checks, travel documents, except those
covered under the loss of Travel Documents Benefit, fragile items and
household effects.
Baggage loss without a supporting Baggage Irregularity Report from
the Airline or Police Report if such loss occurred outside the custody of
the Airline. Loss of personal properties not contained in the baggage is
not claimable.
Persons younger than 6 years or older than 75 years.
Delay, detention, confiscation by customs or other authorities.
All professional and hazardous sports, engaging in any occupation of a
manual or technical nature.
The insured’s relatives except those with whom the insured’s degree of
relationship is up to the 2nd degree by consanguinity or 1st degree by
affinity, under the Trip Cancellation and Termination Benefit.
Pre-existing Conditions contracted before the effectivity of insurance,
or any medical condition/s arising from or contributed to by such preexisting medical conditions. The following among others when
occurring during or after the effectivity of the coverage shall be
considered as pre-existing and permanent exclusions: Cancer or
Tumor of the Internal organs including brain and thyroid glands,
Endometriosis, Pathological abnormalities of nasal septum & turbinate,
Hyperthyroidism / goiter, epilepsy, Asthma, Cirrhosis of the liver,
Tuberculosis, Diabetes Mellitus, Hypertension, All tumors of the skin,
muscular tissues, breast, bone or malignancies of the blood or bone
marrow, Cardiovascular diseases.
Traveling for the purpose of obtaining medical treatment or contrary to
the doctor’s recommendation.
Rehabilitation treatment, routine care, private nursing, mental or
nervous conditions.
War and warlike risks, unlawful or criminal acts.
Psychological conditions, AIDS or related diseases, sexually
transmitted diseases, childbirth, self-injury or suicide, the use of drugs
not prescribed by a physician, intoxication and other epidemic diseases
whether known or unknown.
This benefit shall be reduced to 10% of the covered limit for continuous
treatment upon return to the Philippines.
E. EXAMINATION
Out-Patient Benefit
OAC at its expense shall have the right and opportunity to have the INSURED PERSON,
whose surgery or other condition is the basis of a claim be:
1.
examined by a physician of the Underwri ter’s choice, and/or
2.
interviewed by an authorized representative of the Underwriter;
and/or
3.
examined or interviewed as often as reasonably required while the
claim is being considered or paid.
Reimburses the actual and eligible expenses incurred for
consultation/treatment in the hospital emergency room or Doctor’s
clinic and for required Diagnostic Laboratory Fees, X-rays, Prescribed
Medicines, Outpatient Surgery, Surgical Appliances, devices and
dressing. The maximum reimbursement is subject to deductible as
stated in the Schedule of Benefits (ANNEX B).
Treatment and/or consultation for the same or related illness shall not
entitle the insured person for a new benefit amount unless such
treatment and/or consultation is separated by at least two (2) weeks,
and such illness occurred during the travel period.
F. GENERAL PROVISIONS AND CONDITIONS
1.
2.
3.
Inner Limits: For In-Patient Accident and Illness
Inner Limits
SUPER TIPID PLAN
Hospital Room & Board (15 days)
P 500 / day
Miscellaneous
P
10,000
Surgical Fee
P
20,000
Doctors Daily Visit (15days)
P 375 / day
Inner Limits: For In-Patient Accident and Illness
4.
If an INSURED PERSON’S trip is not completed within the Period of Insurance
specified in the Policy due to hi-jack, kidnap, terrorism or criminal act, the
coverage provided by this policy will automatically continue until such completion
without additional premium up to a maximum of 12 months, and 30 days for any
other circumstances.
It is a General Condition for this Insurance Cover that the trip for which the cover
is taken into effect, was not booked or commenced contrary to medical advice or
receipt of a terminal prognosis. (uberimae fidei )
With regard to flying, this policy covers loss incurred by the insured when riding
solely
as a passenger and not as an operator or crew of the aircraft. Cover
also includes while boarding or alighting. Type of aircraft shall be limited to:
A certified commercial passenger aircraft on any regular, scheduled or non-scheduled,
special or chartered flight and operated by a properly certified pilot flying between
duly established and maintained airports.
Exposure and Disappearance: when the insured suffers a loss due to exposure to
the elements as a result of an accident covered by this policy, the Company will
indemnify the insured in accordance with the terms of the policy.
If the body of the insured has NOT been found within one year after the date of
accident causing the disappearance, sinking or wreckage of the vehicle the
insured was riding on, it will be presumed that the insured lost his life as a result
of such accident.
G. CLAIMS PROCEDURE
A. Written notice of claim:
1. For accidental death and disablement, permanent total disability and unprovoked
murder and assault and other benefits, notice of claim must be submitted to the
Company within 7 days from date of accident. The Company reserves the right to
deny any claim where notices are filed beyond 7 days.
B. Claim Forms – Upon receipt of a notice claim, Worldwide Travel will furnish the claimant
a claim form which must be accomplished and then submitted to Company within the
period stated under letter A. The Company reserves the right to deny any claim where claim
forms and other required documents are filed beyond 30 days.
C. Claim Requirements – Together with the claim form and the insured’s copy of the
travel insurance certificate, the following documentary requirements must be submitted to
the Company.
1. For Accidental Death and Disablement, Permanent Total Disability and
Unprovoked Murder and Assault,
Hospital and physician’s report indicating the nature of the loss and extent and
period of disability.
Police reports when relevant
In case of death, a copy of the coroner’s report
2.
o
o
o
o
o
o
o
o
For Medical Treatment Benefit,
Physician’s report indicating the diagnosis of the conditions treated
All medical bills and receipts directly related to the conditions treated such as:
Accomplished Claim Form
Hospital Statement of Account with Room & Board Charges
Hospital Official Receipt of Payment
Hospital Itemized Receipt and/or Charge Slips
Physician’s Fee Official Receipts
Doctor’s Prescriptions and Drug Store Invoice of Medicines Purchased
Affidavit of Accident/Police Report
Medical Certificate
* Worldwide Travel, thru SOS may advance payment of medical expenses on a case
to case basis after the claim has been evaluated and approved by Oriental and the
necessary LOA issued. Oriental shall reimburse Worldwide Travel of the approved
advanced payment, to include a service free for accidental cases only.
3. For Trip Cancellation and Termination Benefits,
Physician’s Report on the emergency treatment made on the insured or his
relative within the degree of relationship specified in this policy or in case of death, a
copy of the death certificate.
Any document satisfactory to the company establishing the degree of relationship
between the insured and his or her relative, if necessary.
Any document satisfactory to the company evidencing cancellation and indicating
the non-refundable portion of the travel and accommodation expenses.
4.
the
For Funeral and Burial Expense Benefit,
Death Certificate
Receipts for the funeral and burial expenses
In case of death due to covered sickness, a copy of physician’s report indicating
cause of death
5. For Baggage Loss/Damage and Delay Benefit,
A baggage irregularity report issued by the carrier, in case the loss occurred
while baggage is in the custody of such carrier or should there be a delay in the
delivery of checked-in baggage at destination
A copy of the police report, in case the loss or damage occurred beyond the
custody of the carrier.
In case or baggage loss, all details including receipts as to the date of purchase,
price model and type of items lost or damaged.
6. For Loss of Travel Documents,
Any document issued by the carrier, satisfactory to the company recognizing
such loss of travel tickets
Any document issued by the embassy, satisfactory to the company recognizing
such loss of passport
Irregularity report issued by the carrier or police report if such loss occurred
outside the custody of the carrier
Receipts of the travel, communication expenses incurred in getting a replacement
passport and/or travel tickets
Receipts of replacement costs of passport and/or travel tickets
7. For Flight Delay Benefit,
Any document issued by the airline company recognizing and stating the reason
for such flight delay and indicating the time of the original flight schedule and the time
of the actual flight departure.
Official receipts on Hotel accommodation, restaurant meals, and refreshment
expenses
8. Weekly Hospital Income Benefit,
A properly specified statement or bill showing the exact duration of hospital
confinement.
In all cases of claim and if applicable, a copy of the claimant’s passport and travel
tickets must be submitted to the company together with the appropriate claim
documents stated above.
H. STANDARD POLICY EXCLUSIONS
This Policy does not cover:
a. Death or Disablement occasioned by or happenings through:
i.
war, invasion, act of foreign enemy, hostilities or warlike operations (whether
war be declared or not), mutiny, riot, civil commotion, strike, civil war, rebellion,
revolution, insurrections, conspiracy, military or usurped power, martial law or
state of siege, seizure, quarantine; or any weapon or instrument employing
atomic fission or radioactive force whether in time of war or peace:
ii.
murder, provoked assault;
iii. suicide or attempted suicide (sane or insane);
iv. congenital anomalies and conditions arising therefrom;
v.
earthquake, volcanic eruption or tidal wave;
b. Death or Disablement occurring whilst the Insured is traveling is an aircraft other
than one licensed for public passenger service and operated by a regular Air Line
on a published scheduled flight and in which the Insured traveling as a ticket
holding passenger;
c.
Death or disablement consequent upon the Insured engaging in hunting, racing
of all kinds, steeple chasing, polo playing, mountaineering, winter sports, ice
hockey, football, motorcycling, yachting, speed testing, aqua-living, pot holing,
parachuting, hang-gliding, professional sports;
d. Any bacterial infections, except phylogenic infections which occurred
through accidental cut or wound; (covered under Hospital weekly Daily
Cash Benefit.)
e. Any medical or surgical treatment, except such is necessary in the treatment of
injuries covered by the policy and performed within the time provided in the
policy; (covered under Hospital weekly Daily Cash Benefit)
f.
Any pre-existing conditions;
g. Death, disablement, bodily injury or sickness while the covered person is
intoxicated or under the influence of liquor (whether or not the alcohol contents
on the blood exceeded the level permitted by the law of the country ) or drugs
(unless administered under the orders of a hospital or qualified medical
practitioner );
h. Death, disablement, bodily injury or sickness while the insured person is in the
state of insanity;
i.
Death, disablement, bodily injury, or any expenses/ charges attributable directly
or indirectly to HIV or related illness including AIDS or any mutant derivative or
variation thereof, and any sexually transmitted diseases, SARS ( Severe Acute
Respiratory Syndrome); and other epidemic diseases whether known or
unknown.
j.
Any plastic or reconstructive surgery, unless as a result of an accidental bodily
injury;
k.
Death, disablement, bodily injury or sickness resulting from any criminal acts or
unlawful activities;
l.
Death, disablement, bodily injury or sickness caused by poison or any poisonous
substances accidentally or otherwise taken, administered, absorbed or inhaled;
self-destruction, self-inflicted injury or any attempt threat, while sane or insane;
m. Hernia (resulting from any cause),congenital or hereditary defects, mental or
nervous conditions;
n. Routine eye test, dental treatment or other examination or test not incidental to
treatment or diagnosis of an insured injury, sickness or disease;
o. Death, disablement, injury or sickness resulting from underground exploration, or
underwater activities involving the use of compressed air or gas;
p. Death, disablement, injury or sickness occurring while the insured is held in penal
or correctional facility;
q. Death, disablement, injury, sickness or any instances resulting from insured’s
failure to follow proper medical advice and treatment.
r.
Death, disablement or injury consequent upon the insured engaging in
motorcycle riding or driving, without a sidecar.
s.
Death, disablement, surgery, condition, or any illness caused directly or indirectly
by pregnancy, childbirth or miscarriage.
ORIENTAL
ASSURANCE CORPORATION
ORIENTAL ASSURANCE CORPORATION
Oriental Bldg. San Miguel Ave. Ortigas Center
Mandaluyong City
TIN 798-742-000
WORLDWIDE TRAVEL INSURANCE PLANS
"CONFIRMATION OF COVERAGE"
COC Number: ST-00001-11000
WORLDWIDE TRAVEL INSURANCE PLANS
2D 2/F LYDIA BLDG.
39 Polaris St. Makati City
Tel: 890-4916 / Fax: 897-7795 / TIN 006-785-399
SUPER TIPID PLAN - ASIA AND DOMESTIC COVERAGE ONLY
SUPER TIPID - Schedule of Benefits
BENEFIT LIMITS (In Philippine Peso)
BENEFITS
Accidental Death Coverage*
Disability Coverage
Unprovoked Murder and Assault
MEDICAL COVERAGE**
Weekly Hospital Income
Trip Cancellation
Trip Termination
Flight Delay
Baggage Loss / Damage
Baggage Delay
Loss Documents Advice & Replacement
Funeral & Burial Services
Reimbursable
500,000.00
500,000.00
250,000.00
250,000.00
3,500.00
17,500.00
17,500.00
1,000.00
5,000.00
750.00
5,000.00
10,000.00
Note* - The maximum sum insured for persons from 6 to 18 yrs old and 70 years old and above is limited to 50% of the Accidental Death and Disability coverage.
Note** - Inner limits apply for IN-PATIENT HOSPITALIZATION for both accident & Illness.
Note: Medical consutations are "SELF-PAY and reimburseable for Illness & Accident with Inner limits
This Worldwide Travel Insurance Certificate is arranged under Oriental Assurance Corporation Policy No: H07AD00403/R01. This provides all the benefits and limits of your travel insurance
coverage. A copy of Policy is available for verification at the WWTIP office during office hours specified. Please read and keep this COC during your travel and in case of claims. A summary of the
policy terms and conditions is printed at the reverse side of this certificate. The signature below is an authorized agent of Oriental Assurance Corporation and this signature validates the COC.
In considration of the premium paid by the insured and subject to the terms and conditions and exclusions of this poolicy, the insurer agrees to indemnify the insured person named herein against
losses occurring during the period of travel specified. The certificate holder has warranted that to the best of his knowledge and belief, no insured person is traveling contrary to the advice of a
physician or for the purpose of obtaining medical treatment and that the insured knows of any condition, cause or circumstances existing at the date of the issue of this Travel Insurance Certificate
that may necessitate the cancellation or curtailment of the planned trip.
Authorized Signature - WWTIP
Authorized Signature - OAC
(Not Valid without Signature and the Approval Number)
IMPORTANT NOTICE: The Insurance Commission with offices in Manila, Dagupan, Cebu and Davao is the government office in-charge of the faithful execution and enforcement of all laws
relating to insurance and has supervision over all insurance companies. It is ready at all times to render assistance in settling any controversy between the insurance company and a policy
holder relating to insurance matters