Claims General Knowledge

Benefits

Maturity Benefit

Sum Insured will be paid as lum sum payment to the policy holder when the policy has reached its expiration date.

Paid-up Policy Benefit

The policy can be changed as paid up policy when the policy is in force if the insured wants to terminate the policy.

Surrender Value Benefit

The surrender value will be paid if the insured want to terminate the policy when the policy is in force. Surrender value will be calculated base on surrender rating table.

Loan Benefit

Loan benefit can be requested when the policy is in force.

Total Permanent Disability

Sum Insured will be paid as lump sum payment to the policy holder if the insured was total permanently disable during the policy period. If the policy was changed as paid-up policy, the paid-up amount will be paid to the policy holder.

Death Benefit

Sum Insured will be paid as lump sum payment to the beneficiary if the insured died during policy period. If the policy was changed as paid-up policy, the paid-up amount will be paid to the beneficiary.

EXCLUSIONS

Commit Suicide within 1 year from the date of policy commencement
Due to disease that have been undisclosed when proposed to purchase policy
Abuse of Narcotic drugs
Abuse of harmful drugs
Intentional self-harm
Become total and permanent disable due to commit suicide
Become total and permanent disable due to commit in a criminal case
Become total and permanent disable due to disease that have been undisclosed when proposed to purchase policy

Education Benefit

25% of Sum Insured each year starting at the end of the premium term for 4 years.

Premium Waiver Benefit

If the policyholder become total and permanent disable or die, all future premium will be waived.

Total Permanent Disability Benefit

If the insured whose age is under 3 years become total and permanent disable during the policy period, only 25% of Sum Insured will be paid to the policy holder. If not, 100% of Sum Insured will be paid to the policy holder.

Loan Benefit

Policyholder can take loan for his/her policy when the policy is in force. The Loan amount is 90% of Surrender value.

Surrender Value Benefit

Policyholder can withdraw the cash vaule from his/her in-force policy when he/she choose to terminate policy before maturity date. The surrender value will be calculated base on surrender rating table.

Paid-up Benefit

Policyholder can change his/her policy as paid-up policy when the policy is in-force.

Death Benefit

If the insured whose age is under 3 years die during the policy period, only 25% of Sum Insured will be paid to the policy holder. If not, 100% of Sum Insured will be paid to the policy holder.

EXCLUSIONS

Commit suicide within 1 year from the date of policy commencement
Due to the disease that have been undisclosed when proposed to purchase policy
Intentional self-harm within 1 year from the date of policy commencement.
Abuse of Narcotic drugs
Abuse of harmful drugs
Commit in a Criminal case

Basic Benefit Plan

Education Benefit
20% of Sum Insured each year starting at the end of the premium term for 5 years.
Premium Waiver
If the insured become total and permanent disable or die, all future premium will be waived.
Loan Benefit
Policyholder can take loan for his/her policy when the policy is in force. The Loan amount is 90% of Surrender value.
Surrender value Benefit
Policyholder can withdraw the cash vaule from his/her in-force policy when he/she choose to terminate policy before maturity date. The surrender value will be calculated base on surrender rating table.
Paid-up Benefit
Policyholder can change his/her policy as paid-up policy when the policy is in-force.

Double Benefit Plan

Education Benefit
20% of Sum Insured each year starting at the end of the premium term for 5 years.
Premium Waiver
If the insured become total and permanent disable or die, all future premium will be waived.
Total and Permanent Disability Benefit
If the policyholder purchased Double Benefit Plan, Sum Insured will be paid to the beneficiary when the insured become total and permanent disable.
Loan Benefit
Policyholder can take loan for his/her policy when the policy is in force. The Loan amount is 90% of Surrender value.
Surrender value Benefit
Policyholder can withdraw the cash vaule from his/her in-force policy when he/she choose to terminate policy before maturity date. The surrender value will be calculated base on surrender rating table.
Paid-up Benefit
Policyholder can change his/her policy as paid-up policy when the policy is in-force.
Death Benefit
If the policyholder purchased Double Benefit Plan, Sum Insured will be paid to the beneficiary when the insured dies.

EXCLUSIONS

Commit suicide within 1 year from the date of policy commencement
Due to the disease that have undisclosed when proposed to purchase policy
Intentional self-harm within 1 year from the date of policy commencement.
Abuse of Narcotic drugs
Abuse of harmful drugs
Commit in a Criminal case

Basic coverage

Hospital cash
MMK 10,000 per unit for 1 day hospitalization up to maximum 60 days
Death benefit
MMK 1,000,000 per unit will be paid as lump sum based on purchased unit to the beneficiary if the insured died during policy period.

Additional coverage-1

Surgical cash
Major operation (MMK 500,000 per unit up to purchased units)

Additional coverage-2

Out-patient care
MMK 2,500 per unit up to purchased unit

EXCLUSIONS

Pre-existing diseases or having existing symptoms prior to the date of policy commencement.
Childbirth or C-section but hospitalization or surgery is eligible due to pregnancy related diseases (Preeclampsia, gestational hypertension, gestational diabetes, etc.) that caused by pregnancy during policy period. Miscarriage benefits is eligible if the insured has purchased optional coverage (1).)
Due to Psychiatric/mental disorder
Hospitalization due to medical checkup purpose
IVF (In Vitro Fertilization) treatment.
Dental treatment except due to an accident
Optical treatment such as eye testing, loss of sight, eye operations except due to accident
Cosmetic/plastic surgery
Provision for hearing aids
Physical defect or infirmity
Abuse of narcotic drugs
Commit in a criminal case
AIDS/HIV
Involvement in violence, destruction, riots or war, war like terrorism, civil unrest
Hospitalization is less than 3 days except due to accident
Fraudulent claims
Suicide or injuries due to self-injury

Treatment of Critical Illness or Death due to Critical Illness

MMK 1,000,000 per unit when the insured take a treatment for the below critical illness diseases up to purchased unit.

Heart attack
Stroke
Cancer (Life Threatening)
Renal Failure
Major Organ Transplant
Heart valve replacement or repair
Coronary artery bypass surgery
Severe Burns
Coma
Bacterial Meningitis

Death Benefit

MMK 1,000,000 per unit will be paid as lump sum based on purchased unit to the beneficiary if the insured died due to critical illness during the policy period. The death benefit will not be eligible if the critical illness treatment benefit is already paid to the insured.

EXCLUSIONS

Pre-existing diseases or having existing symptoms prior to the date of policy commencement.
Due to Psychiatric/mental disorder
Hospitalization due to medical checkup purpose
Cosmetic/plastic surgery
Provision for hearing aids
Physical defect or infirmity
Abuse of narcotic drugs
Commit in a criminal case
AIDS/HIV
Involvement in violence, destruction, riots or war, war like terrorism, civil unrest
Fraudulent claims
Suicide or injuries due to self-injury
Treatment of Malignant Tumor within 90 days from the date of policy commencement
Carcinoma in situ/Intraepithelial Neoplasm (Malignant Tumor occurs under epithelial layer of Respiratory track, Gastrointestinal track or Urogenital track)

Injury Benefit

Injury benefit will be calculated based on doctor’s recommedation and Medical report.

Total Permanent Disability benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured was total permanently disable due to accident and unable to work in any capcity in any occupation.

Death Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured died due to accident.

EXCLUSIONS

Intentionally self-inflicted injury causing permanent disability, death
Death, permanent disability, injury due to intoxicating drugs
Death, permanent disability due to disease
Protest, War risk (declare or not), War-like terrorism
Strike, Riot and Civil commotion, Civil unrest, Military coup
Injury, permanent disability and death due to Military coup, Civil riot and their consequences
Death, permanent disability, injury due to crimes
Death, permanent disability, injury caused by other inflicted injury or attempted inflict injury.

Accidental Injuries

Injury benefit will be calculated based on doctor’s recommedation and Medical report.

Total and Permanent Disability Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured was total permanently disable due to accident or illness and unable to work in any capcity in any occupation.

Hospitalization due to accident

20% of Sum Insured per day up to 5 days and 3 times within policy term due to accident.

Death Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured died due to accident or disease.

EXCLUSIONS

Commit suicide
Death or injury or hospitalization due to commit in a criminal case
Death or injury of hospitalization due to abuse/withdrawal of narcotic drugs/alcohol
Provision for hearing aids
Fraudulent claims
Expenses due to medical checkup
Expenses due to IVF (In Vitro Fertilization) treatment
Expenses due to dental treatment except accident
Expenses due to optical treatment except accident
Expenses due to cosmetic/plastic surgery
congenital incapacity, Abnormalities/abnormalities from birth
Request benefits of death or total permanent disability or injury or hospitalization over 1 year from the date of loss

Accidental Injuries Benefit

Injury benefit will be calculated based on doctor’s recommedation and Medical report.

Total and Permanent Disability Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured was total permanently disable due to accident during training or competition.

Death Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured died due to accident during training or competition.

EXCLUSIONS

Intentional self-harm
Injury due to abuse narcotic drugs/ alcohol directly or indirectly or commit in a criminal case
Minor injury due to competing in Boxing, Judo, Karate, Kung Fu

Basic coverage

Hospital cash
MMK 10,000 per unit for 1 day hospitalization up to maximum 60 days
Death benefit
MMK 1,000,000 per unit will be paid as lump sum based on purchased unit to the beneficiary if the insured died during policy period.

Additional coverage-1

Surgical cash
Major operation (MMK 500,000 per unit up to purchased units)

Additional coverage-2

Out-patient care
MMK 2,500 per unit up to purchased unit

EXCLUSIONS

Pre-existing diseases or having existing symptoms prior to the date of policy commencement.
Childbirth or C-section but hospitalization or surgery is eligible due to pregnancy related diseases (Preeclampsia, gestational hypertension, gestational diabetes, etc.) that caused by pregnancy during policy period. Miscarriage benefits is eligible if the insured has purchased optional coverage (1).)
Due to Psychiatric/mental disorder
Hospitalization due to medical checkup purpose
IVF (In Vitro Fertilization) treatment.
Dental treatment except due to an accident
Optical treatment such as eye testing, loss of sight, eye operations except due to accident
Cosmetic/plastic surgery
Provision for hearing aids
Physical defect or infirmity
Abuse of narcotic drugs
Commit in a criminal case
AIDS/HIV
Involvement in violence, destruction, riots or war, war like terrorism, civil unrest
Hospitalization is less than 3 days except due to accident
Fraudulent claims
Suicide or injuries due to self-injury

Treatment of Critical Illness or Death due to Critical Illness

MMK 1,000,000 per unit when the insured take a treatment for the below critical illness diseases up to purchased unit.

Heart attack
Stroke
Cancer (Life Threatening)
Renal Failure
Major Organ Transplant
Heart valve replacement or repair
Coronary artery bypass surgery
Severe Burns
Coma
Bacterial Meningitis

Death Benefit

EXCLUSIONS

Pre-existing diseases or having existing symptoms prior to the date of policy commencement.
Due to Psychiatric/mental disorder
Hospitalization due to medical checkup purpose
Cosmetic/plastic surgery
Provision for hearing aids
Physical defect or infirmity
Abuse of narcotic drugs
Commit in a criminal case
AIDS/HIV
Involvement in violence, destruction, riots or war, war like terrorism, civil unrest
Fraudulent claims
Suicide or injuries due to self-injury
Treatment of Malignant Tumor within 90 days from the date of policy commencement
Carcinoma in situ/Intraepithelial Neoplasm (Malignant Tumor occurs under epithelial layer of Respiratory track, Gastrointestinal track or Urogenital track)

Injury Benefit

Injury benefit will be calculated based on doctor’s recommedation and Medical report.

Total Permanent Disability benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured was total permanently disable due to accident and unable to work in any capcity in any occupation.

Death Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured died due to accident.

EXCLUSIONS

Intentionally self-inflicted injury causing permanent disability, death
Death, permanent disability, injury due to intoxicating drugs
Death, permanent disability due to disease
Protest, War risk (declare or not), War-like terrorism
Strike, Riot and Civil commotion, Civil unrest, Military coup
Injury, permanent disability and death due to Military coup, Civil riot and their consequences
Death, permanent disability, injury due to crimes
Death, permanent disability, injury caused by other inflicted injury or attempted inflict injury.

Accidental Injuries benefit

Injury benefit will be calculated based on doctor’s recommedation and Medical report.

Total and Permanent Disability Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured was total permanently disable due to accident or illness and unable to work in any capacity in any occupation.

Death Benefit

Sum Insured will be paid as lump sum to the beneficiary if the insured died due to accident or disease.

EXCLUSIONS

Commit suicide
Abuse of Narcotic drugs
The benefits (Injury/death/Total permanent disability) will not be eligible for the employee after resignation
Commit in a criminal case
Intentional self-harm