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GREAT Comprehensive Care

Policy Terms and Conditions

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SECTION I-GENERAL DEFINITIONS

In this Policy where the context so admits, the masculine gender shall be deemed to include the feminine, and likewise, the singular word shall be deemed to include the plural and vice versa, and the following words and expressions shall be deemed to have the following meanings:

1) “Accident” or “Accidental” means an event which results in a loss to the Life Insured caused solely and directly by accidental, violent, external and visible means and independently of all other causes.

2) “Accidental Death” means deaths resulting solely from an Accident.

3) “Accidental Injury” means any bodily injury caused solely and directly by Accident, and independently of any other cause, and such injury shall result in the death or disability of the Life Insured within 30 days from the date of Accident.

4) “Age Next Birthday” means Life Insured’s age at a particular time with addition of 1 year. In this Policy where the context so admits the age shall be deemed to be Age Next Birthday.

5) "Any One Hospitalisation" means Hospitalisation due to same cause, including any and all complication therefrom. Subsequent recurrence or relapse from the same cause shall be treated as a new Hospitalisation if it is separated by 30 calendar days following the latest discharged from the Hospital of the Life Insured.

6) “Certificate of Insurance” means a certificate of insurance issued by the Company to a Life Insured which provides confirmation of insurance cover for the Life Insured under the Policy.

7) “Claims Event(s)” refers the date of death of the Life Insured, the date of Total and Permanent Disability, or the date of Hospitalisation of the Life Insured confirmed by a Registered Medical Practitioner and accepted by the Company.

8) “Country of Issue” refers to the country in which this Policy is issued.

9) “Coronavirus Disease (COVID-19)” refers to unequivocal, final and confirmed diagnosis by a Registered Medical Practitioner in accordance with prevailing clinical guidelines published by Ministry of Health, where available, supported by acceptable clinical, radiological, histological and laboratory evidence.

10) “Daily Cash Benefit in Intensive Care Unit” means a daily allowance that shall be payable for Any One Hospitalisation occurring within 36 hours of an Accident or Illness and requiring Hospital confinement in the Intensive Care Unit of the Hospital in Singapore for at least 12 hours.

11) “Daily Hospital Cash” means a daily allowance that shall be payable for Any One Hospitalisation occurring within 36 hours of an Accident or Illness and requiring Hospital confinement in Singapore for at least 12 hours.

12) “Death due to Coronavirus Disease (COVID-19)” means deaths resulting solely from Coronavirus Disease (COVID-19) infection. The death must have happened in Singapore.

13) “Effective Date” means the date from which the insurance coverage of the Life Insured has become effective as specified under the Certificate of Insurance.

14) "Eligible Member" shall mean Doctor Anywhere members; and who is between 16 and 65 Age Next Birthday at the Effective Date; and who is a Singaporean or Singapore Permanent Resident or with a valid employment pass (EP holders or S Pass holders) / dependant’s pass; and is residing in Singapore.

15) “Expiry Date” means the date from which the insurance coverage under the Certificate of Insurance becomes no longer effective.

16) “Hospital” means an establishment constituted and registered in Singapore as a hospital for the care and treatment of sick and injured persons as bed-paying patients and which:

i) has facilities for diagnosis and major surgery, provides 24 hours a day nursing services by registered nurses and is under the constant supervision of a Registered Medical Practitioner;

ii) is a Government/ restructured/ private specialist medical centre.

However, the term “Hospital” does not refer to a clinic, an alcoholic or drug rehabilitation centre, a nursing, rest or convalescent home, a spa or a hydroclinic, a community hospital or similar establishment.

17) “Hospitalisation” means confinement of the Life Insured in a Hospital:

i) for 12 consecutive hours or longer;

ii) for which a room and board charge is made in connection with such confinement; or

iii) is required because of a surgical procedure.

18) “Illness” means a physical condition marked by a pathological deviation from normal healthy state.

19) “Intensive Care Unit” shall mean an accommodation or part of a Hospital for the seriously ill patient providing extra services and equipment prescribed by the attending the Registered Medical Practitioner and billed as a specified charge by the Hospital.

High Dependency Unit (HDU) or Coronary Care Unit (CCU) is not considered as Intensive Care Unit.

20) “Life Insured” shall include Eligible Member in respect of whom insurance under this Policy has been effected.

21) “Limb” means a hand at or above the wrist or a foot at or above the ankle.

22) “Loss” means total, permanent and irrecoverable loss of use or loss by physical severance.

23) “Medically Necessary” means a treatment which is ordered by a Registered Medical Practitioner which is:

i) provided for the direct treatment of a medical condition;

ii) appropriate and consistent with the symptoms and findings or diagnosis and treatment of that

medical condition;

iii) provided in accordance with generally accepted medical practice;

iv) the most appropriate supply or level of service which can be provided on a cost effective basis; and

v) not of an experimental nature, not of an investigative nature and not in the nature of research.

24) “Period of Insurance” means a period of 12 consecutive months starting from the Effective Date.

25) "Policy" shall mean this agreement, any rider or endorsement therein, any amendment signed by the Company, the application of the Policyholder, and any individual proposal form, consent form or any other form signed by the Life Insured or the Policyholder constituting the entire contract.

26) “Policy Period” means a period of one calendar year or such other periods as may be agreed in writing between the Company and the Policyholder, starting from the Policy Commencement Date for the first Policy Period and from the respective Renewal Dates for subsequent Policy Periods.

27) “Pre-Existing Condition” means any condition, illness, disease, disability or defect for which:

i) the Life Insured has sought medical advice, been investigated, diagnosed, hospitalised, received medical treatment, undergone surgical operation, or been prescribed drugs at any time prior to the Effective Date; or

ii) signs and symptoms manifested prior to the Effective Date, which would have caused a prudent person to seek medical advice or counselling, undergo investigation or diagnostic tests, receive medical treatment, undergo surgery, be hospitalised, or be prescribed drugs.

28) “Prohibited Person” means a person or an entity (as the case may be) who is subject to any sanction(s) pursuant to any laws and/or regulations, administered by any governmental or regulatory authority or any competent authority or law enforcement agency, in any country.

29) “Registered Medical Practitioner” means a person qualified by degree in western medicine and legally licensed and authorised to practise medicine and surgery in Singapore, other than the Policyholder, the Life Insured or a family member of either.

30) “Renewal Date” means the date immediately following the last day of any Policy Period as stated in the Policy.

31) "Sum Insured" in respect of any Life Insured shall mean the amount of insurance as stated in the Certificate of Insurance.

32) “Total and Permanent Disability”

i. For actively working Life Insured between 16 to 65 Age Next Birthday

"Total and Permanent Disability" means that the disability must be total and permanent due to Accidental Injury and that there is neither at the point of commencement of the disability nor at any time thereafter any work, occupation or profession that the Life Insured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit.

ii. For Life Insured with no gainful occupation between 16 to 65 Age Next Birthday

"Total and Permanent Disability" means that the disability must be total and permanent due to Accidental Injury and inability of the Life Insured to perform at least 3 out of 6 activities of daily living as defined below, even with the aid of special equipment, and will always to require the physical assistance of another person throughout the entire activity.

The activities of daily living are:

1) Washing

The ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash by other means.

2) Dressing

The ability to put on, take off, secure and unfasten all garments and as appropriate, any braces, artificial Limbs or other surgical or medical appliances.

3) Feeding

The ability to feed oneself food after it has been prepared and made available.

4) Mobility

The ability to move indoors from room to room on level surfaces.

5) Toileting

The ability to use the lavatory or manage bowel and bladder function through the use of protective undergarments or surgical appliances so as to maintain a satisfactory level of personal hygiene.

6) Transferring

The ability to move from a bed to an upright chair or wheelchair and vice versa.

iii. Presumptive definition of Total and Permanent Disability - For Life Insured between 16 to 65 Age Next Birthday

An Life Insured shall be regarded as being totally and permanently disabled under the following definition of disability if that Life Insured, due to Accidental Injury, has been subject to one (or more) of the following impairments:

1) The total and irrecoverable Loss of sight of both eyes; or

2) The Loss by severance or Loss of permanent use of both hands at or above the wrists or both feet at or above the ankles; or

3) The Loss by severance or Loss of permanent use of one hand at or above the wrist and one foot at or above the ankle; or

4) The Loss by severance or Loss of permanent use of one Limb at or above the wrist or ankle and loss of sight of one eye.

For (i) and (ii), the Total and Permanent Disability must be deemed permanent in the opinion of a Registered Medical Practitioner.

The Total and Permanent Disability shall have lasted for not less than six (6) months duration and upon receipt of satisfactory proof of such Total and Permanent Disability, the Sum Insured shall become payable to the Life Insured.

33) “Waiting Period” means a period of 30 days starting from the Effective Date as specific under the Certificate of Insurance.

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SECTION II-GENERAL PROVISIONS

1. Eligibility and Commencement of Insurance

1.1. A person shall be eligible for insurance only if he duly satisfies and completes the eligibility requirements agreed between the Company and the Policyholder as stated in the prescribed form(s) proposed by the Company, on the date the prescribed form(s) is received and accepted by the Company whichever is the later date.

1.2. The insurance coverage under this Policy for each Life Insured will commence on the Effective Date of each Life Insured subject always to the fulfilment of the eligibility requirements and the terms and conditions of this Policy.

1.3. In any event where the Eligible Member and/or the Policyholder is required to provide data on the Eligible Member to be insured particularly within any time frame specified under this Policy but fails to do so, insurance shall not be effected on the Eligible Member unless the Company advises so in writing.

1.4. The Company reserves the right to impose additional terms and conditions on any Eligible Member or the entire customer base.

1.5. The Company reserves the right to amend the eligibility requirements for future Eligible Members on any Renewal Date(s).

2. Termination

2.1. The coverage of any Life Insured shall automatically be terminated on the earliest of the following dates:

2.1.1. The date of expiration of the period for which the last premium payment is made in respect of his coverage;

2.1.2. After the Expiry Date of issue of his Certificate of Insurance;

2.1.3. The date the Life Insured dies;

2.1.4. When the Life Insured and/or Policyholder is/becomes a Prohibited Person;

2.1.5. The end of the Period of Insurance during which the Life Insured reaches his 65th birthday;

2.1.6. The date of the Life Insured’s notification to us that he wishes to withdraw from his insurance coverage under this Policy; or

2.1.7. When the Life Insured:

a) is not a citizen or permanent resident of the Country of Issue;

b) has resided outside the Country of Issue for more than 180 days, whether continuously or otherwise;

c) is still residing outside the Country of Issue.

2.1.8. When the Life Insured is working in Singapore under employment pass (EP holders or S Pass holders) issued by the Ministry of Manpower, and the contract of employment is terminated.

The Life Insured shall notify the Company in writing of any changes to the citizenship or residency status as soon as practicable. If the Life Insured fails to notify the Company, and there is a claim for any Claim Event(s) occurring on or after the Effective Date following the change of citizenship or residency status, the Company may reject such claim or, at its discretion, adjust the benefits payable.

2.2. This Policy shall be terminated on the date notified to the Policyholder by the Company to terminate the Policy by virtue of war (declared or undeclared) or act of war (whether or not there has been a declaration of war) where such date shall be at the discretion of the Company.

2.3. For the avoidance of doubt, in the case of termination of the Policy due to expiry of the Policy, the insurance cover for the Life Insured may be continued until the expiry date of his Certificate of Insurance.

2.4. All benefits shall cease to be payable after termination of Certificate of Insurance:

If this Policy has been terminated in accordance with clauses 2.1.1., 2.1.2, 2.1.5., 2.1.6., 2.1.7., or 2.1.8, above, the Company will not pay any benefits under this Policy for any Claim Event(s) occurring on or after the date of such termination.

2.5. Cancellation by the Company or Policyholder

This Policy may be terminated by either the Company or the Policyholder by giving thirty (30) days’ notice in writing. Termination of this Policy by the Policyholder or by the Company shall be without prejudice to any claim arising prior to such termination. If the Company or the Policyholder terminates the Policy, insurance coverage for Life Insured shall continue until the Expiry Date of This Certificate of Insurance with no premium refund.

2.6. Cancellation by Certificate of Insurance

This Certificate of Insurance may be terminated by either the Company or the Life Insured by giving thirty (30) days’ notice in writing. Termination of this Certificate of Insurance by the Life Insured or by the Company shall be without prejudice to any claim arising prior to such termination. If the Certificate of Insurance is terminated by the Company, premiums paid under this Policy will be refunded (prorata premium without interest). If the Certificate of Insurance is terminated by the Life Insured, no premium will be refunded.

3. Geographically Limit

This Policy only covers treatment received in Singapore for Accident or Illness.

4. Premium

4.1. This Certificate of Insurance will continue in force as long as the annual premiums are paid in advance.

4.2. The annual premium rate payable will be based on the Life Insured's Age Next Birthday at Effective Date.

4.3. The Company reserves the right to change the rate at which the premiums are calculated on any Renewal Date or when the risks being insured under this Policy have substantially increased and provided further that the Company notifies the Policyholder at least thirty (30) days in advance.

5. Assignment

No benefit under the Certificate of Insurance can be assigned.

6. Evidence of Age

6.1. Documentary evidence of age satisfactory to the Company shall be required before any benefit in respect of any coverage under this Policy shall be payable.

6.2. If the age of the Life Insured has been stated wrongly in the proposal form for this Policy or declared wrongly to the company by the Policyholder, the premium shall be adjusted based on the correct age of the Life Insured. Any excess premium paid shall be refunded by the Company and any shortfall in premium shall be made up by the Life Insured.

6.3. If correctly declared , the Life Insured at that age would not have been eligible for insurance under this Policy, no benefits will be payable, and all premiums paid will be refunded in full.

7. Non Participating Policy

This is a non-participating Policy with no surrender or cash values.

8. Free Look Period

Life Insured have 14 days Free Look after he have received the documents for his insurance cover. The Life Insured may cancel this insurance by writing to us. In this case, the Company will refund premium he has paid after deducting the medical fees (if applicable) which the Company incurred in assessing his application for this insurance.

9. Change of Plan Type

The Company will not allow any change of plan type of the Life Insured during the Period of Insurance unless the change is expressly agreed to by the Company upon receipt of evidence of insurability acceptable to the Company and endorsed on this Certificate of Insurance. The Company may refuse an application for such a change of plan type.

10. Duplication of Cover

No Life Insured shall be covered under more than 1 (one) of this GREAT Comprehensive Care Policy with the Company. If any Life Insured is covered under more than one such Policy, the Company will consider the Life Insured covered under the Policy with the highest benefits only and the cover of the Life Insured under such other Policy(ies) will be cancelled. Where the benefits of the additional Policy(ies) are identical, We will consider that Life Insured to be insured under the Policy first issued only and the cover of the Life Insured under such other Policy(ies) will be cancelled. The Company will refund any duplicated premium paid without interest.

11. Misstatement

Where a misstatement of age or other relevant facts has caused an Life Insured to be insured hereunder when he is otherwise ineligible for insurance coverage, or where such statement has caused an Life Insured to remain insured when he would otherwise be disqualified for further insurance coverage in accordance with the terms and limitations of this Policy, his insurance coverage shall be void and there shall be a refund of premiums paid in respect of the Life Insured, provided always that where there is fraud on the part of the Policyholder or Life Insured, no premiums paid are to be refunded.

12. Contract

12.1. All statements made by the Life Insured shall, in the absence of fraud, be deemed representations and not warranties and no such statement shall void this Policy or be sued in defense of a claim, unless it is in writing.

12.2. No change to this Policy shall be valid unless approved by the Company as evidenced by an endorsement, or by an amendment made on this Policy and signed by the Company.

13. Alteration of Contract

The terms of the Policy may be amended by the Company from time to time upon the Company giving a 30 days prior notice to the Policyholder. Any amendments to this contract shall be binding on all Life Insured whether insured under this Policy prior to or on or after the effective date of the amendment.

14. Absolute Owner

14.1. The Company is entitled to treat the Life Insured as the absolute owner of his Certificate of Insurance.

14.2. The Company will not recognise any equitable or other claim to or interest in the Certificate of Insurance.

14.3. The receipt by the:

a) Life Insured; or

b) Life Insured’s legal personal representative(s).

of any payment made by the Company in respect of a claim made under this Policy will be in full and final discharge of the Company in respect of any liability under such a claim.

15. Arbitration

All differences arising out of the Policy or incidental thereto or to the assurance hereby effected shall be referred to a single arbitrator to be appointed in writing by the Policyholder and the Company, or if they cannot agree upon a single arbitrator, to two arbitrators, one to be appointed in writing by each party and such arbitrators shall before commencing their investigations elect an umpire. In all other respects the arbitration shall be subject to the statutory provisions for the time being in force relating to arbitration. Unless and until an award has been made, no action or other legal proceedings shall be commenced in respect of any claim or by virtue of this Policy. After the expiration of two years from the date of an event giving rise to a claim under this Policy, the Company shall not be liable in respect thereof unless the Company shall have admitted liability in respect of such claim or the claim shall in the meantime have been referred to arbitration.

16. Operation of Law

This Policy shall be construed according to and governed by the laws of Singapore.

17. Policy Shall be Void

17.1. Misrepresentation or Non-disclosure of Material Facts

17.1.1. If any written statements made by the Policyholder or the Life Insured on proposal for insurance is untrue in any respect or if any material fact affecting the risk is incorrectly stated or represented in or is omitted from these documents (“Misrepresentation or Nondisclosure”), the Company may, at its sole discretion:

a) declare this Policy or Certificate of Insurance, as applicable, void; or

b) impose such conditions or vary the terms of this Policy or Certificate of Insurance, as applicable, as it would have had the Misrepresentation or Non-disclosure not been made.

17.1.2. If the Company opts to declare this Policy void under Clause 17.1.1(a) above, this Policy is treated as void:

a) on the Policy Commencement Date of Insurance if the Misrepresentation or Nondisclosure was made to the Company on a proposal for insurance; or

b) on the applicable Renewal Date, if the Misrepresentation or Non-disclosure was made to the Company on an application for reinstatement.

17.1.3. If the Company opts to declare this Certificate of Insurance void under Clause 17.1.1(a) above, this Certificate of Insurance is treated as void:

a) on the Effective Date if the Misrepresentation or Non-disclosure was made to the Company on a proposal for insurance; or

b) on the applicable Certificate Renewal Date, if the Misrepresentation or Non-disclosure was made to the Company on an application for reinstatement.

17.2. Refund of Premium

Except in the case of fraud, all premiums paid for all insurances which became effective on or after the date on which the insurance becomes void will be refunded to the Life Insured, except for the Prohibited Person.

17.3. Fraudulent Claim

The Company may terminate this Certificate of Insurance by immediate notice if the Life Insured makes any claim which is fraudulent or exaggerated or if the Life Insured makes any false declaration or statements in support of any claim. In this case, there will be no refund of premiums by the Company.

18. Exclusion of Contracts (Rights of Third Parties) Act 2001

A person who is not a party to the Contract of Insurance shall have no rights under the Contracts (Rights of Third Parties) Act 2001 and any subsequent amendments to the Act, to enforce its terms. This Policy, the Certificate of Insurance, schedules, endorsements, proposal forms and declarations by the Lives Insured and all subsequent written notices by the Company to the Policyholder and Lives Insured make up the whole of the Contract of Insurance.

19. Data Use

The Policyholder hereby confirms and represents to the Company, its related corporations (collectively, the "Companies"), as well as their respective representatives and agents ("Representatives") that each Life Insured has agreed and consented to the disclosure of his personal data to the Companies and their Representatives, and further, that for the Companies and their Representatives' collection, use and/or disclosure of the personal data of the Lives Insured, and disclosing such personal data to the Companies' authorised service providers and relevant third parties for purposes reasonably required by the Companies to provide the insurance coverage under this Policy. In respect of the Lives Insured who are subsequently enrolled into this Policy, the Policyholder further undertakes that it shall ensure and procure that each of such Lives Insured has provided such agreement and consent in relation to his personal data for such purposes.

These purposes are set out in the Company's Privacy Statement, which is accessible at https://www.greateasternlife.com/sg/en/privacy-and-security-policy.html and which the Policyholder hereby confirms that both the Policyholder and the Lives Insured are have read and understood.

20. Governing Law and Jurisdiction

This Policy will be construed according to and governed by the laws of Singapore and the Courts of Singapore shall have exclusive jurisdiction for any disputes arising out and in connection with this Policy.

21. Policy Owners’ Protection Scheme

This Policy is protected under the Policy Owners’ Protection Scheme which is administered by the Singapore Deposit Insurance Corporation (SDIC). Coverage for this Policy is automatic and no further action is required from the Policyholder. For more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact the Company or visit the Life Insurance Association (LIA) or SDIC websites (www.lia.org.sg or www.sdic.org.sg).

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SECTION III-BENEFIT PROVISIONS

The benefits of this Policy are set out in the Certificate of Insurance.

Any Claim Event(s) while covered under this Policy and occurring within 30 days from the date of the Claims Event(s), the Company shall make payment of such claim for the Sum Insured specified in the Certificate of Insurance, and such payment made shall release the Company from that respective liability in relation to the claim under the Policy.

1. Group Personal Accident

1.1. Accidental Death Benefit

Subject always to all the terms, conditions, exclusions and provisions of this Policy, upon receipt of proof of age and satisfactory documentary proof that the Life Insured, prior to attaining age sixty-six (66), died as a result of Accident while insured under this Certificate of Insurance, a lump sum payment equivalent to the Sum Assured as stated in his Certificate of Insurance, shall be payable to the Life Insured’s estate (if there is no will) or Life Insured’s executor (if there is a will), and this Certificate of Insurance shall terminate immediately.

1.2. Accidental Total and Permanent Disability Benefit

Subject always to all the terms, conditions, exclusions and provisions of this Policy, upon receipt of proof of age and satisfactory documentary proof that the Life Insured, prior to attaining age sixty-six (66), becomes Totally and Permanently Disabled as a result of Accident while insured under this Certificate of Insurance, a lump sum payment equivalent to the Sum Assured as stated in his Certificate of Insurance, shall be payable to the Life Insured or Life Insured’s legal personal representative(s), and this Certificate of Insurance shall terminate immediately.

1.3. Death Due to Coronavirus Disease (COVID-19) Benefit

Subject always to all the terms, conditions, exclusions and provisions of this Policy, upon receipt of proof of age and satisfactory documentary proof that the Life Insured has, prior to attaining age sixty-six (66) died solely due to Coronavirus Disease COVID-19 while insured under this Policy, a lump sum payment equivalent to the Sum Assured as stated in his Certificate of Insurance, shall be payable to the Life Insured’s estate (if there is no will) or Life Insured’s executor (if there is a will), and this Certificate of Insurance shall terminate immediately.

2. Group Hospital & Surgical

2.1. Daily Hospital Cash

Subject always to all the terms, conditions, exclusions and provisions of this Policy, upon receipt of proof of age and satisfactory documentary proof that the Life Insured has, prior to attaining age sixty-six (66) been hospitalised as a result of Accident or Illness and requiring Hospital confinement in Singapore, a daily allowance for each full day (24 hours) as stated in his Certificate of Insurance, shall be payable to the Life Insured or Life Insured’s legal personal representative(s). The maximum benefit limit and maximum number of days per Any One Hospitalisation as stated in the Certificate of Insurance.

2.2. Daily Cash Benefit in Intensive Care Unit

Subject always to all the terms, conditions, exclusions and provisions of this Policy, upon receipt of proof of age and satisfactory documentary proof that the Life Insured has, prior to attaining age sixty-six (66) been hospitalised as a result of Accident or Illness and requiring confinement the Intensive Care Unit of the Hospital in Singapore on the recommendation of a Registered Medical Practitioner for the treatments, a daily allowance for each full day (24 hours) as stated in his Certificate of Insurance, shall be payable in addition to the Daily Hospital Cash to the Life Insured or Life Insured’s legal personal representative(s). The benefit is payable in addition to the Daily Hospital Cash subject to the maximum benefit limit and maximum number of days per Any One Hospitalisation as stated in the Certificate of Insurance.

All such confinements consequent upon Illness or an Accident for bodily injury and provided that the Hospitalisation must be considered Medically Necessary by a Registered Medical Practitioner. 

The Company will not pay the benefit if the Life Insured undergoes Hospitalisation during the Waiting Period as a result of suffering from an Illness.

3. Outpatient Care Benefit

3.1. Doctor Anywhere Video Consultations Service

Subject always to all the terms, conditions, exclusions and provisions of this Policy, upon receipt of proof of age and satisfactory documentary proof that the Life Insured is below sixty-six (66) years, the Life Insured shall, during the Period of Insurance, be entitled to a maximum number of video consultations with Doctor Anywhere, as stated in the Certificate of Insurance. This benefit only covers the cost of the Registered Medical Practitioner video consultations on Doctor Anywhere platform and does not include any medical tests, treatments, medications and delivery costs.

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SECTION IV-EXCLUSIONS

1. Group Personal Accident

1.1. Suicide or any attempted suicide or self-inflicted injury or illness, whether the Life Insured is sane or insane;

1.2. Any Pre-Existing Condition or disability which existed prior to the Life Insured becoming insured under this Policy;

1.3. War (declared or undeclared), hostilities, civil war or any warlike operations; military or naval or air-force service while under orders for warlike operations;

1.4. Participation in riot or commission of an assault or act of crime;

1.5. Participation in competitive racing of any kind other than on foot;

1.6. Insane or mental disorder;

1.7. The Life Insured being under the influence of alcohol or drugs except drugs prescribed by Registered Medical Practitioner for the purpose of treatment;

1.8. Violation or attempted violation of the law or resistance to lawful arrest or any resultant imprisonment;

1.9. The Life Insured being in or on an aircraft of any type or boarding or descending from any aircraft, except as a fare-paying passenger or a crew member on an aircraft on a regular scheduled route operated by a recognized airline;

1.10. Routine general physical or any other examination not directly related to admission, diagnosis, injury or treatment which is not Medically Necessary;

1.11. Congenital anomalies;

1.12. Acquired Immune Deficiency Syndrome (AIDS), AIDS related complications and all illnesses or diseases associated with the Human Immunodeficiency Virus (HIV);

1.13. Childbirth, pregnancy and complication thereof;

1.14. Bodily injury sustained as a result of the Life Insured parachuting or sky diving or engaging in any kind of aerial flight;

1.15. Accidents that arise in the course of work or at the worksite of the following occupational activities shall be excluded:

a) engaging in active military duties such as commando or bomb disposal duties/training, maintenance of civil order, engagement in hostilities whether war be declared or not and travel by military aircraft or waterborne vessel;

b) working from heights of 20 metres above the ground; or in confined spaces such as vessels, tunnels, underground civil works;

c) as professional sports;

d) operating, servicing and/or installing heavy machinery;

e) providing protective services (including bouncers, life guards, wardens and firemen);

f) work related to martial arts and the like; or as performing artists (including stuntmen);

g) work in the maritime industry (including deep sea diving and sea crews);

h) work in the aviation industry (pilots and aircrew); or

i) working on railway tracks, ships or shipyards, working in warehouses, power stations, chemical factories, industrial plants, offshore rigs, timber camps; or working in the building trade (including construction workers, cable installers, electricians); or working with wood, metal, glass or bleach.

2. Group Hospital & Surgical

2.1. Any Pre-Existing Conditions as defined, including any treatment and complication arising from the Pre-Existing Conditions;

2.2. Hospitalisation for treatment of any Illness commencing within 30 (thirty) days from the commencement of cover of the Life Insured concerned under the Policy, or after the 30 (thirty) days period which were follow-up medical treatment(s), consultation(s) or further investigation(s) of the Life Insured for the same condition for which he/she received medical treatment or consultation or investigation during that 30 (thirty) days period, and consequences or complications related to such conditions;

2.3. Routine medical examinations or check-ups, routine eye or ear examinations where there is no objective indication of impairment of normal health or any treatment or investigation of a preventive nature, vaccinations, cosmetic surgery or plastic surgery, treatment for obesity, weight reduction (including liposuction) and weight improvement programmes, rest cures and services or treatment in any home, spa hydro-clinic, sanatorium or long term care facility that is not a Hospital as defined, or any treatment which is not Medically Necessary;

2.4. Birth defects, congenital Illness;

2.5. Pregnancy or childbirth or miscarriage/abortion;

2.6. Tests or treatment related to infertility, contraception, sterilisation(or its reversal), varicocele, impotence or erectile dysfunction, sexual dysfunction, treatment relating to sex change, sexually transmitted diseases and any treatment or test in connection with HIV, including AIDS or any HIV/AIDS related conditions or diseases;

2.7. Circumcision operations unless Medically Necessary;

2.8. All types of Sleep Disorders including Sleep Apnoea;

2.9. Behavioral or Developmental Delay and/or learning disabilities in children;

2.10. Treatment of mental Illness, psychiatric disorders, self-inflicted injury, misuse or over dosage or excessive use of drugs/medicine, treatment for alcoholism, or abuse of alcohol or drug abuse or drug addiction, suicide or attempted suicide;

2.11. Refractive defects of the eye, such as nearsightedness and astigmatism;

2.12. All dental treatment or oral surgery related to teeth;

2.13. Treatment provided to an Life Insured by the Life Insured or a family member of the Life Insured, or self treatment by the Life Insured, including the dispensation of medication and/or any medical tests/procedures carried out;

2.14. War (declared or undeclared), hostilities, civil war or any warlike operations; military or naval or air-force service while under orders for warlike operations;

2.15. Participation in riot or commission of an assault or act of crime;

2.16. The Life Insured being under the influence of alcohol or drugs except drugs prescribed by Registered Medical Practitioner for the purpose of treatment; or

2.17. Violation or attempted violation of the law or resistance to lawful arrest or any resultant imprisonment.

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SECTION V-CLAIMS

1. Notification

The Life Insured, his legal representative, parent or estate must, within 31 days after the occurrence of any event likely to give rise to a claim under this Policy, notify the Company of the claim and give written proof of the claim.

2. Submission and Documentation

The Life Insured, his legal representative, parent or estate will be required to submit documentary proof which is satisfactory to the Company for consideration of eligibility of claims. Any cost incurred in acquiring documentary proof will be borne by Life Insured, his legal representative, parent or estate.

3. Compensation

No compensation stated in the Certificate of Insurance shall be payable until the total amount of compensation shall have been ascertained and agreed.

4. Payment of Benefit

4.1. All benefits shall be paid only when the claim shall have been proven to the satisfaction of the Company and the total amount of compensation shall have been ascertained and agreed upon by the Company and Policyholder.

4.2. Upon receipt and approval of due proof of claim of a Life Insured from the claimant (i.e. the Life Insured or Life Insured’s legal representative(s)), the Company shall make payment of such claim to Life Insured or Life Insured’s legal representative, and such payment made shall release the Company from all liabilities under this Policy for that Life Insured.

4.3. In the event of death of the Life Insured, we pay to:

i) the Life Insured’s estate if there is no will; or

ii) the Life Insured’s executor if there is a will.

4.4. In the event of Total and Permanent Disability of the Life Insured, we pay to the Life Insured or Life Insured’s legal representative(s).

5. Termination

Upon payment by the Company of any claim under Group Personal Accident by a Life Insured or a Life Insured’s personal legal representative, the Life Insured’s Certificate of Insurance shall terminate.

6. Fraudulent Claims

If any claim under this Policy is in any respect, fraudulent or if any fraudulent means or devices shall be used by the Policyholder or an Life Insured or any one acting on behalf of the said parties to obtain a benefit under this Policy, the Company shall be under no liability in respect of such claims and shall be entitled to recover any payment made prior to the discovery of fraud.

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SECTION VI-TERMS AND CONDITIONS

All other terms, conditions and provisions of the Policy to which this Contract is attached shall apply to and be incorporated into this Contract as far as they are not inconsistent with this Contract.

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SECTION VII-PREMIUM RATES

Annual Premium per Life Assured, S$ (inclusive 7% GST)

Age Next Birthday BASIC DELUXE

Annual Premium per Life Assured, S$ (inclusive 7% GST)
Age Next Birthday BASIC DELUXE
16 to 40 $263.22 $445.12
41 to 50  $317.79 $500.76
51 to 55 $399.11 $636.65
56 to 60 $498.62 $786.45
61 to 65 $535.00 $839.95

Premium rates are non-guaranteed and may be adjusted, from time-to-time based on future experience, by giving at least 30 days’ notice to Policyholder.

 

No wording or wordings below this line will be construed as being part of this Policy Terms and Conditions unless approved by a duly authorised personnel of the Company.

GCC_20200512_v1.1

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Great Eastern Holdings Ltd | Great Eastern Life Assurance Co Ltd | Great Eastern General Insurance Ltd
Great Eastern Holdings Ltd | Great Eastern Life Assurance Co Ltd | Great Eastern General Insurance Ltd