Download product summary for myjoyfulbundle

PRODUCT SUMMARY FOR
MYJOYFULBUNDLE
ABOUT MYJOYFULBUNDLE
This product is exclusively for newborn babies delivered at Thomson Medical Centre, and their birth
mothers.
The plan consists of a health policy (Basic Medical with Rider) for the newborn baby(ies), as well as
life insurance (Group Term Life) for the birth mother.
Coverage commences when the newborn is 15 days old, or upon discharge, whichever is later.
At the end of the coverage period, the plan will automatically terminate, without further notice.
ELIGIBILITY
(i) Newborn babies born at Thomson Medical Centre on or after 1 December 2016, and their birth
mothers; and
(ii) Sign up for this coverage must have been done before the newborn baby(ies) is/are 45 days old;
and
(iii) Singaporean citizen or Singapore Permanent Resident or who holds a valid employment pass in
Singapore; and
(iv) Residing in Singapore (not out of Singapore for more than 90 continuous days during the
coverage period).
DECLARATION
All answers declared in every respect should be true and correct and that no material information has
been withheld nor any relevant circumstances omitted.
Any non-disclosure, misrepresentation or fraud shall entitle Aviva to avoid all liabilities existing under
this Policy in respect of that Insured person.
1.
BASIC MEDICAL WITH RIDER
1.1.
PRODUCT INFORMATION
Basic Medical with Rider is a medical expense insurance plan that seeks to reimburse the
expenses incurred by specified dependants as a result of hospitalisation and/or surgery while
providing a nominal death benefit at the same time.
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1.2.
BENEFITS
1.2.1. Benefit Schedule
Benefits
Claim Limit (S$)
Hospital Confinement Benefits
Daily Room & Board (max. 90 days per Disability*)
80
Daily Intensive Care Unit (max. 45 days per Disability*)
160
In hospital Doctor's Visit (max. 90 days per Disability*)
70
Surgical Fees subject to surgical schedule (per Disability*)
1,600
Annual Inpatient Limit
16,000
Additional Benefit
Outpatient Kidney Dialysis (Annual limit)
10,000
Outpatient Cancer Treatment (Annual limit)
10,000
Organ Transplant (Annual limit)
10,000
Lump Sum Benefits
First Major Cancer Diagnosis Benefit
5,000
Death Benefit
1,000
* “Disability” refers to all complications and conditions arising from the same illness or
from the same bodily injury caused by an accident. If a recurrence or relapse occurs
after 30 days since discharge, it will be considered a new condition.
Annual Benefit limits shall be pro-rated if the period of coverage period is 6 months (i.e.
the birth mother is not an existing member of Thomson Medical’s First Born Incentive
(FBI) or Subsequent Born Incentive (SBI)).
1.2.2. Hospital Confinement Benefits
Benefits will begin when the Insured Person is:
(i) hospitalised for at least 6 consecutive hours and room and board charges made
(ii) undergoing a surgical intervention
(a) Daily Room and Board Benefit
The daily room and board charges incurred by an Insured Person while in Hospital
Confinement shall be payable up to the maximum amount and for a maximum no.
of days per Disability specified in the Benefit Schedule.
(b) Intensive Care Unit Benefit
In the event that an Insured Person is confined to the Intensive Care Unit of the
Hospital, the scheme will reimburse up to a maximum amount and for a maximum
no. of days per Disability specified in the Benefit Schedule.
(c) Surgical Benefit
A surgical benefit equal to the sum actually charged for any operation performed by
one or more Registered Medical Practitioners shall be payable, provided that the
maximum benefit for all surgical operations performed per Disability shall not
exceed the aggregate amount obtained by multiplying the respective percentages
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shown for the operations listed in the Surgical Schedule of Fees by the maximum
Surgical Benefit shown in the Benefit Schedule.
(d) In-Hospital Doctor Consultation
Fees charged by the Registered Medical Practitioner for consultation while an
Insured Person is in Hospital Confinement shall be payable up to the maximum
daily limit shown in the Benefit Schedule. If a surgery has been performed, the
consultation fee shall be payable under the Surgical Benefit instead.
1.2.3. Additional Benefits
(a) Outpatient Kidney and Cancer Treatment
The cover may be extended to reimburse expenses incurred for outpatient kidney
and/or cancer treatments received at institutions or premises approved by
government health authorities according to the benefit limits specified in the policy.
(b) Organ Transplant
The cost of operations for the transplantation of the kidneys, heart, liver, lung or
bone marrow where the Insured Person is the recipient.
We do not pay for the costs of acquiring the organ or expenses incurred by the
donor. No other type of benefit insured by the Policy provides cover in connection
with Organ Transplantation.
1.2.4. Lump Sum Benefits
(a) First Major Cancer Diagnosis Benefit
First Major Cancer Diagnosis Benefit is a one-time lump sum payment upon first
diagnosis that the Life Insured has cancer. Major Cancer means 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:
•
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; Cervical Dysplasia CIN-1, CIN-2
and CIN-3;
•
Any non-melanoma skin carcinoma unless there is evidence of metastases to
lymph nodes or beyond;
•
Malignant melanoma that has not caused invasion beyond the epidermis;
•
All Prostate cancers histologically described as T1N0M0 (TNM Classification) or
below; or Prostate cancers of another equivalent or lesser classification;
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•
All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or
below;
•
All tumours of the Urinary Bladder histologically classified as T1N0M0 (TNM
Classification) or below
•
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;
•
Chronic Lymphocytic Leukaemia less than RAI Stage 3; and
•
All tumours in the presence of HIV infection.
(b) Death Benefit
Upon receipt of due proof of death of an Insured Person, a lump sum amount shall
be payable.
1.3.
KEY PRODUCT PROVISIONS
1.3.1. Exclusions
The following are some key provisions found in the policy contract of this plan. This is
only a brief summary and you are advised to refer to the actual terms and conditions in
the policy contract. Please consult your financial adviser representative or an Aviva
Relationship Consultant should you require further explanation.
(i) Pre-existing conditions which have existed at any time prior to the commencement
of insurance coverage.
(ii) Congenital anomalies or genetic defects
(iii) Non-medical expenses
(iv) Treatments which are not medically necessary, routine medical check-ups
(v) Disabilities resulting from direct participation in a strike, riot or civil commotion,
insurrection, or any act of war (whether declared or undeclared)
(vi) When an Insured Person is entitled to benefits payable under any group or
individual insurance, the benefits payable under this Policy shall be limited to the
balance of expenses not covered by benefits payable under such legislation,
programme or other insurances, or that computed in accordance with the Benefit
Schedule of this Policy, whichever is lesser
(You are advised to read the policy contract for the full list of exclusions)
1.3.2. Terms of Coverage
12 months coverage commencing from the eligibility to participate in the insurance plan
for Thomson Medical Centre’s First Born Incentive (FBI) or Subsequent Born Incentive
(SBI) members, or 6 months for non-members.
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1.3.3. Termination Clause
We may terminate this Policy by giving you at least 30 days’ prior written notice of
termination. The termination of coverage shall be without prejudice to payment of claims
arising prior to the date of termination.
1.3.4. Waiting Period
Not applicable.
1.3.5. Misstatement
(i)
If the age or date of birth or other relevant facts relating to any Insured Person is
misstated and this affects the scale of benefits or other terms and conditions of this
Policy, then we will use the true age and facts to determine whether insurance
coverage is in force and the benefits payable under this Policy and if, in our opinion
is necessary, an equitable adjustment of premiums will be made and notice of the
adjustment will be given to you.
(ii) Where a misstatement of age or other relevant facts has caused a person to be
insured under this Policy when he is otherwise ineligible for any insurance, or where
such statement has caused a person to remain insured when he would otherwise
be disqualified in accordance with the provisions of this Policy, his entire insurance
coverage shall be void and there shall be a refund of premiums paid. However, if
there is a fraud on the part of the Insured Person, premiums paid shall not be
refunded.
1.3.6. Free Look Period
Not applicable.
1.4.
CLAIMS
For health policy claims, please submit the following:
(i) Duly completed Medical Claim Form (Section 1 – by Claimant; Section 2 – by attending
Physician/ Surgeon)
(ii) All original and final hospital, doctor’s bill and receipts. For admission / surgery at Private
Hospital / clinics, please provide Original Final Summary Hospital Bill and Original Final
Itemised Hospital Bill.
(iii) Other additional supporting documents (if any) on the medical condition that can assist in
the assessment of the claims:
• Inpatient Discharge Summary
• Ambulatory Form / Pre Admission Form
• Referral Letter from General Practitioner (GP) to Specialist / Hospital
• Any referral form for Laboratory / Blood Test
(iv) Certified true copy of Birth Certificate of the newborn covered under MyJoyfulBundle
(v) Copy of First Born Incentive / Subsequent Born Incentive (FBI/SBI) member card
Note: The Insured Member is required to furnish us the above documents within one month of
discharge from the hospital.
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2.
GROUP TERM LIFE INSURANCE
2.1.
PRODUCT INFORMATION
This is an insurance protection that seeks to provide a lump sum benefit in the event of death or
terminal illness. There is no cash value attached to this plan.
2.2.
BASIS OF SUM ASSURED
Sum assured: S$25,000
2.2.1. Death Benefit
Upon receipt of proof of death of an Insured Person, a lump sum amount shall be
payable.
2.2.2. Terminal Illness Benefit
In the event an Insured Person diagnosed as suffering from any disease which, in the
opinion of a specialist consultant, is highly probable to lead to death within the next 12
months, an advanced benefit of the sum assured will be payable.
2.3.
KEY PRODUCT PROVISIONS
2.3.1. Exclusions
Pre-existing conditions which have existed at any time prior to the commencement of
insurance coverage.
2.3.2. Terms of Coverage
12 months coverage commencing from your eligibility to participate in the insurance
plan.
2.3.3. Termination Clause
We may terminate this Policy by giving you at least 30 days’ prior written notice of
termination. The termination of coverage shall be without prejudice to payment of
claims arising prior to the date of termination.
2.3.4. Waiting Period
Not applicable.
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2.3.5. Misstatement
(i)
If the age or date of birth or other relevant facts relating to any Insured Person is
misstated and this affects the scale of benefits or other terms and conditions of this
Policy, then we will use the true age and facts to determine whether insurance
coverage is in force and the benefits payable under this Policy and if, in our opinion
is necessary, an equitable adjustment of premiums will be made and notice of the
adjustment will be given to you.
(ii)
Where a misstatement of age or other relevant facts has caused a person to be
insured under this Policy when he is otherwise ineligible for any insurance, or
where such statement has caused a person to remain insured when he would
otherwise be disqualified in accordance with the provisions of this Policy, his entire
insurance coverage shall be void and there shall be a refund of premiums paid.
However, if there is a fraud on the part of the Insured Person, premiums paid shall
not be refunded.
2.3.6. Free Look Period
Not applicable.
2.4.
CLAIMS
For life insurance claims, please submit the following:
(i)
Death/ Terminal Illness Claim Form
• Claimant’s Statement (to be completed and signed by claimant)
• Physician’s Statement (to be completed by the attending Physician who attended the
deceased in his last illness or accident. Cost of the Physician’s Statement is to be
borne by the claimant.)
(ii)
Certified true copy of the claimant’s NRIC/passport (front & back)
(iii) Certified true copy of the NRIC/passport of the deceased (for death claim only)
(iv) Certified true copy of the Death Certificate (for death claim only)
(v)
Certified true copy of the Birth Certificate of the newborn covered under MyJoyfulBundle
(vi) Copy of First Born Incentive / Subsequent Born Incentive (FBI/SBI) member card
Note: The Insured Member is required to furnish us the above documents within one month of death/
terminal illness diagnosis.
IMPORTANT NOTICE
This is only product information provided by us and is designed to serve as a guide only. In the
event of clarification or dispute, the prevailing terms and conditions of the Group Insurance contract
with Thomson Medical Centre shall apply.
This policy is protected under the Policy Owners’ Protection Scheme which is administered by the
Singapore Deposit Insurance Corporation (SDIC). Coverage for your policy is automatic and no
further action is required from you. 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 your insurer
or visit the GIA/LIA or SDIC websites (www.gia.org.sg or www.lia.org.sg or www.sdic.org.sg)
Aviva Ltd 4 Shenton Way #01-01 SGX Center 2 Singapore 068807 Company Reg. No. 196900499K
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