I. Description
ProtectMax is a Group Term Life Insurance with Death Benefit, Accident or Sickness Emergency Cash Assistance, Accidental Dismemberment and/or Disablement, Murder and Unprovoked Assault and Residential Fire Reconstruction cash assistance.
ProtectMax is underwritten by Pioneer Insurance and Surety Corporation (PISC).
II. Table of Premiums and Benefits
III. General Provisions
a) Target Market are clients of Cebuana Lhuillier branches, corporations, institutions, and organizations outside Cebuana network.
b) Age eligibility is from 7 to 70 years old.
c) Insured can have a maximum of five (5) active COC’s at any given time.
d) Death Benefit covers death of any cause nor any restrictions in the place death.
e) Death due to illness or sickness under the pre-existing conditions is not covered within the first four (4) consecutive months from the initial date of coverage.
f) Insured’s coverage is incontestable if he/she is enrolled or with active COC for more than four (4) months continuously with no gap(s).
g) Accident or Sickness Emergency Cash Assistance will have a thirty (30) days waiting period starting from the COC effectivity date.
h) Accident or Sickness Emergency Cash Assistance will only allow a maximum of Php1,500 per incident even if the insured has more than one COC.
EXCLUSIONS:
No benefit will be payable if death or Injury results from any one of the following causes:
a) Planned or expected treatments.
b) Treatment or surgery for congenital anomalies.
c) Treatments related to HIV, STD’s, AIDS.
d) Claims caused by alcoholism and/or illegal drugs.
e) Self-inflicted injuries, suicide, attempted threats while sane or insane.
f) Treatment of mental and nervous disorders.
g) Long-term rehabilitation and psychiatric care.
h) Treatment for Obesity, weight reduction, or weight improvement.
i) Chiropractic care, acupuncture, alternative medicine or any experimental procedures.
j) Cosmetics, plastic surgery, dental care, eye and ear examinations.
k) Hazardous and dangerous sports or activities.
l) Any act that violates the law.
m) Murder, assault, brawl or any attempted threat.
n) Losses caused by escort or security service.
o) Voluntary taking of poison, gas, nuclear or radioactive materials.
p) Hostilities or warlike operations
q) Any act of terrorism.
IV. Definition of Coverage
ACCIDENTAL DEATH BENEFIT
Provides payment to the beneficiaries if the cause of death of the insured is due to an accident.
ACCIDENTAL DISABLEMENT OR DISMEMBERMENT BENEFIT
Provides Payment to the insured if cause of dismemberment and/or disability is due to an accident.
MURDER and UNPROVOKED ASSAULT
Provides payment to the beneficiary if the insured’s cause of death is due to murder and unprovoked assault arising from robbery, hold up, assault, or other unlawful acts done to the insured.
FIRE/LIGHTNING CASH ASSISTANCE BENEFIT
Provides cash assistance to the insured in the event of loss or damage to the insured’s property due to fire.
DEATH BENEFIT (Accidental or Sickness)
Provides payment to the beneficiaries in case of insured’s death due to an accident or illness.
ACCIDENT OR SICKNESS EMERGENCY CASH ASSISTANCE
Provides Emergency Cash Assistance to injuries sustained from an accident or sudden sickness that requires treatment to a hospital facility.
V. Claims
CLAIM REQUIREMENTS
1. Accidental Death
a. Original Confirmation of Cover (COC)
b. Birth/Death Certificate (CTC)
c. Police Report/ Incident Report (Original)
d. Insured’s & Claimants Valid ID (with Photo and Signature)
e. Legal Supporting Document of claimant/beneficiary
2. Accidental Dismemberment, and/or Disablement
a. Photocopy of Confirmation of Cover (COC)
b. Police Report
c. Picture of Affected Body Part
d. Medical Certificate
e. Insured’s Valid ID (with Photo and Signature)
3. Murder and Unprovoked Assault
a. Original Confirmation of Cover (COC)
b. Death Certificate
c. Police Report
d. Insured’s & Claimants Valid ID (with Photo and Signature)
e. Legal Supporting Document of claimant/beneficiary
4. Fire/Lightning Cash Assistance
a. Photocopy Confirmation of Cover (COC)
b. Picture(s) of burnt declared home address
c. Barangay Certificate
d. Insured Valid ID (with Photo, Signature, and Declared Address)
5. Death Benefit (Accidental or Sickness)
a. Original Confirmation of Cover (COC)
b. Birth/Death Certificate (CTC)
c. Police Report/ Incident Report (Original)
d. Insured’s & Claimants Valid ID (with Photo and Signature)
e. Legal Supporting Document of claimant/beneficiary
f. Medical Certificate
6. Accident or Sickness Emergency Cash Assistance
a. Photocopy Confirmation of Cover (COC)
b. Emergency Expense Benefit Claim Slip (bottom of COC)
c. Medical Certificate
d. Clinical Abstract
e. Insured’s Valid ID (with Photo and Signature)