Shp Contract

GREAT EASTERN LIFE

SUPREMEHEALTH PLAN POLICY VERSION 07/09 (AS CHARGED)

In THIS POLICY,"THE COMPANY" is THE GREAT EASTERN LIFE ASSURANCE COMPANY LIMITED and "THE POLICYHOLDER" is the Policyholder named in Schedule A. "LIFE INSURED" refers to any person named as the Life Insured in Schedule A or in an endorsement on this Policy. SCHEDULE A defines the scope of the insurance under this Policy, including the Plan Type for the Life Insured, and all clauses and conditions must be read in conjunction with this Schedule. Schedule A may be varied by endorsements on this Policy. From time to time, the Company may issue a fresh Schedule A which consolidates all variations made since the last Schedule A was issued. Upon issue, the new Schedule A will take effect from the stated Effective Date and all previous Schedules A will be void from that date. THIS (a) Policy; (b) the written Proposal and Declarations (which form the basis of this Contract); (c) all subsequent written notices given by the Company to the Policyholder; and (d) all subsequent written statements given by the Policyholder to the Company, will make up the whole of the Contract of Insurance between the Company and the Policyholder. NOW, THIS POLICY confirms that, if at any time during a Period of Insurance, the Life Insured incurs any Eligible Expenses as described in this Policy as a result of Injury, illness or disease THEN the Company will reimburse the Hospital (as defined in this Policy), the Policyholder, or the Policyholder's legal personal representative(s), the benefits as stated in this Policy. THIS SUPREMEHEALTH PLAN Insurance is subject to the clauses contained in this Policy and in endorsements, if any, attached to this Policy. No change in or endorsement on this Policy is valid unless approved by a duly authorised representative of the Company.

DIRECTOR

DIRECTOR

SupremeHealth Plan Policy Version 07/09 1

GREAT EASTERN LIFE SUPREMEHEALTH PLAN

POLICY VERSION 07/09 (AS CHARGED) CONTENTS

DESCRIPTION PAGE Schedule A and Endorsements (if any) Attachments Schedule B 2 Clauses and Conditions 1 POLICY DEFINITIONS 4

1.1 Special Definitions 1.2 Expenses 1.3 In-hospital Psychiatric Treatment

2 LIFE INSURED JOINTLY INSURED 9 UNDER MEDISHIELD 3 LIMITS ON ELIGIBLE EXPENSES 9

4 BENEFITS 9

4.1 Subject to Clauses and Conditions 4.2 Reimbursement of Eligible Expenses 4.3 Benefit Computation 4.4 Benefit Limits 4.5 Indemnity

5 EXCLUSIONS 12

5.1 General Exclusions 5.2 Pre-existing Conditions 5.3 Expenses Falling under Exclusion

6 TERRITORIAL FACTORS 15

6.1 Overseas Emergency Medical Treatment 6.2 Currency Exchange

7 TERMINATION 15

7.1 Termination on Renewal Date 7.2 Death of Policyholder or Life Insured 7.3 Cancellation By Policyholder 7.4 Not Citizen or Permanent Resident : Residence Overseas 7.5 Life Insured Insured under Another Shield Plan 7.6 No Benefits Payable after

Termination of Insurance

DESCRIPTION PAGE 8 RENEWAL 17

8.1 When No Renewal Allowed 8.2 Renewal Upon Payment of Premium 8.3 Grace Period 8.4 Rate of Premium 8.5 Company May Amend Clauses and

Conditions and Premium Rates 8.6 Upgrading/Downgrading of Plan Type

9 REINSTATEMENT OF POLICY 18 9.1 Clauses and Conditions 9.2 Reinstatement Premium Rate 9.3 When No Reinstatement Allowed 10 CLAIM 20

10.1 Notification 10.2 Submission and Documentation 10.3 Medical Examiner's Certificate 10.4 Medical Examination 10.5 Expiration of Liability

11 POLICY - WHEN VOID 20

11.1 Misrepresentation or Non-disclosure of Material Facts

11.2 Refund of Premium 11.3 Fraudulent Claim 11.4 Cheque Dishonoured

12 OTHER CONDITIONS 21 12.1 Form of Notices 12.2 Alteration of Policy 12.3 Errors of Age 12.4 Absolute Owner 12.5 Law of the Republic of Singapore 12.6 Exclusion of the Contracts (Rights of Third Parties) Act 2001

The table of contents, headings and sub-heading in this Policy are inserted merely for convenience of reference and will be ignored in the interpretation of the clauses and conditions contained in this Policy.

2 SupremeHealth Plan Policy Version 07/09

GREAT EASTERN LIFE

SUPREMEHEALTH PLAN (SHP) SCHEDULE B: BENEFIT LIMITS (inclusive of MediShield Basic Limits)

LIMITS ON ELIGIBLE EXPENSES (All Amounts in S$) Plan Type P Plus A Plus B Plus

Hospital/Ward Class Entitlement to As Charged Reimbursement Private Hospitals

Restructured Hospitals, Class A Wards

Restructured Hospitals, Class B1 Wards

EXPENSE ITEM AMOUNT LIMIT AMOUNT LIMIT AMOUNT LIMIT

1. INPATIENT BENEFITS Room & Board

As Charged(1) As Charged(1) As Charged(1)

Intensive Care Unit (ICU)


Miscellaneous Hospital Services As Charged(1) As Charged(1) As Charged(1)

Daily In-Hospital Physicians Visit As Charged(1) As Charged(1) As Charged(1)

Pre-Hospital Specialists Consultation (within 90 days before Hospitalisation) As Charged

(1) As Charged(1) As Charged(1) Examination and Laboratory Tests (During Hospitalisation and within 90 days before Hospitalisation)


Post Hospital Follow - up Treatment (within 90 days from Hospital discharge) As Charged

(1) As Charged(1) As Charged(1)

Accidental Dental Treatment As Charged(1) As Charged(1) As Charged(1)

Surgery As Charged(1) As Charged(1) As Charged(1)

Surgical Implants / Approved Medical Consumables As Charged

(1) As Charged(1) As Charged(1)

Gamma Knife As Charged(1) As Charged(1) As Charged(1) Confinement in Community Hospital $325 per day $300 per day $275 per day

2. FINAL EXPENSES BENEFIT $ 7,000 $ 6,000 $3,600

3. OUTPATIENT BENEFITS

Erythropoietin As Charged(1) As Charged(1) As Charged(1) 1. Cyclosporin ; or 2. Tacrolimus ; or 3. Other immunosuppressants prescribed for

treatment of organ transplants


Kidney Dialysis As Charged(1) As Charged(1) As Charged(1) Cancer Treatment: 1. Radiotherapy 2. Chemotherapy 3. Immunotherapy 4. Stereotactic Radiotherapy


4. OTHER BENEFITS

Emergency Medical Treatment outside Singapore

As Charged(1) (But limited to

Singapore Private Hospital charges)

As Charged(1) (But limited to Singapore Restructured Hospitals, Class A Ward charges)

As Charged(1) (But limited to Singapore Restructured Hospitals, Class B1 Ward charges)

(1) As Charged means all Eligible Expenses incurred by the Life Insured in the Hospital and Ward Class of the Life Insureds entitlement under the Plan Type insured.


PRO-RATION FACTORS(2) P Plus A Plus B Plus Pro-ration Factor to apply to Private Hospital charges NA 70% 50%

Pro-ration Factor to apply to Restructured Hospital, Class A Ward charges NA NA 80%

(2) Please refer to Clause 4.2.2.1 and Clause 4.2.2.2 Does not apply to the Expenses incurred in a Restructured Hospital for the following treatment provided to the Life Insured on an outpatient basis: Kidney Dialysis Treatment, Cancer Treatment, Erythropoietin or Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment of organ transplant.

DEDUCTIBLE (3) P Plus A Plus B Plus Per Period of Insurance (Up to age 85 years next birthday on Renewal Date)

Ward: C: $1,000 B2: $1,500 B1: $2,000 A: $3,000

Private Hospital (all ward types) and Hospitals outside Singapore:

$3,000 Day Surgery: $3,000

Ward: C: $1,000 B2: $1,500 B1: $2,000 A: $3,000


$3,000 Day Surgery: $3,000

Ward: C: $1,000 B2: $1,500 B1: $2,000 A: $3,000


$3,000 Day Surgery: $2,000

Per Period of Insurance (above age 85 years next birthday on Renewal Date)

Ward: C: $1,500 B2: $2,250 B1: $3,000 A: $4,000


$4,000 Day Surgery: $4,000

Ward: C: $1,500 B2: $2,250 B1: $3,000 A: $4,000


$4,000 Day Surgery: $4,000

Ward: C: $1,500 B2: $2,250 B1: $3,000 A: $4,000


$4,000 Day Surgery: $3,000

(3) Does not apply to the Expenses incurred for the following: Kidney Dialysis Treatment, Cancer Treatment, Erythropoietin or Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment of organ transplant.

CO-INSURANCE P Plus A Plus B Plus

10% 10% 10%

LIMITS ON BENEFITS PAYABLE P Plus A Plus B Plus In-hospital Psychiatric Treatment $6,000 per

Period of Insurance $5,000 per

Period of Insurance $2,000 per

Period of Insurance Living Organ Donor Transplant (Kidney / Liver) (4) $50,000 per Transplant $30,000 per Transplant $20,000 per Transplant Annual Benefit Limit $500,000 $350,000 $200,000 Lifetime Benefit Limit Unlimited Unlimited Unlimited

(4) The recipient must be a family member (parents, siblings, children or spouse) of the Life Insured.


GREAT EASTERN LIFE SUPREMEHEALTH PLAN

POLICY VERSION 07/09 (AS CHARGED) 1. POLICY DEFINITIONS The following clauses are defined as stated below and apply wherever they appear in this Policy: 1.1 Special Definitions

1.1.1 Physician Any physician qualified by degree in Western medicine and legally licensed and authorised to

practise medicine and surgery in the geographical area of his practice, other than the Policyholder, the Life Insured or a family member of either.

1.1.2 Hospital An establishment constituted and registered as a hospital for the care and treatment of sick and

injured persons as bed-paying patients and which: (a) Has facilities for diagnosis and major surgery, provides 24 hours a day nursing services

by registered graduate nurses and is under the constant supervision of a Physician; or (b) Is a Government / restructured 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.

1.1.3 Hospitalisation Confinement of the Life Insured in a Hospital: (a) for 12 consecutive hours or longer; or (b) for which a room and board charge is made in connection with such confinement; or (c) is required because of a surgical procedure. 1.1.4 Accident An event involving the Life Insured which is caused solely and directly by accidental, violent,

external and visible means and independently of all other causes. 1.1.5 Injury Bodily injury of the Life Insured caused solely and directly by an Accident. 1.1.6 Emergency

A serious Injury or illness or the onset of a serious medical condition which, in the opinion of the Company, requires urgent remedial treatment to avoid death or serious impairment to the Life Insureds immediate or long-term health.

1.1.7 Period of Insurance The Period of Insurance stated in Schedule A or any subsequent Period of Insurance as

effected in accordance with Clauses 8.2.1 and 9.1.2. 1.1.8 Effective Date of Cancellation

The date of cancellation advised in the notice of cancellation or date of receipt of the notice of cancellation by the Company, whichever is later.

1.1.9 Renewal Date The date immediately following the last day of any Period of Insurance. 1.1.10 Commencement Date of Insurance of the Life Insured The date (this date) on which this SupremeHealth Plan insurance on the Life Insured first

began, whether under this Policy or any policy for which insurance under this Policy is a


subsequent renewal or reinstatement. This date shall be the first day of the month of successful deduction from the Policyholders Medisave account and/or during which the full premium is paid by the Policyholder, or such date as determined and advised by the Company.

1.1.11 Eligible Expenses Eligible Expenses are Expenses (as defined under Clause 1.2) incurred for medically necessary

treatment provided to the Life Insured for Injury, illness or disease during the Period of Insurance.

1.1.12 Aggregate Eligible Expenses The Aggregate Eligible Expenses for the Life Insured is the sum of all Eligible Expenses

incurred by the Life Insured during the Period of Insurance, subject to the limits as stated in Clause 3 of this Policy. On the Commencement Date of Insurance of the Life Insured and on each subsequent Renewal Date of this Policy, the Aggregate Eligible Expenses for the Period of Insurance which follows that date is nil.

1.1.13 Deductible The amount of the Aggregate Eligible Expenses (other than Eligible Expenses for Kidney

Dialysis, Cancer Treatment, Erythropoietin and Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment of organ transplants) incurred during the Period of Insurance which will be borne by the Policyholder before any benefit becomes payable under this Policy.

1.1.14 Co-insurance The share of the Aggregate Eligible Expenses incurred during the Period of Insurance in excess

of the Deductible which is borne by the Policyholder. 1.1.15 Country of Issue The Country in which this Policy is issued as stated in Schedule A. 1.1.16 The Act refers to the Central Provident Fund Act (Chapter 36). 1.1.17 The Regulations refer to the Central Provident Fund (MediShield Scheme) Regulations 2005

and any other revised future edition of the Regulations. 1.1.18 MediShield refers to the plan operated by the Central Provident Fund (CPF) Board, which is

governed by the Act and the Regulations. 1.1.19 Policyholders Medisave Account refers to the Policyholders Central Provident Fund (CPF)

Medisave account. 1.1.20 Community Hospital

Any approved community hospital defined in regulation 2 of the Regulations. 1.1.21 Reasonable & Customary Charges

Charges applicable for similar or comparable treatment or services provided in the Class of Ward in accordance with the Plan Type insured for the Life Insured to individuals of the same sex and comparable age for similar illness, disease, disability or injury.

1.1.22 Government

The government of the Republic of Singapore.

1.1.23 Restructured Hospital A Hospital that is run as a private company and is wholly-owned by the Government through the

Ministry of Health, Singapore, and that receives a government subsidy for the provision of subsidised medical services to its patients.


1.1.24 Foreigner A person who is not a citizen nor a permanent resident of Singapore.

1.2 Expenses The Expenses incurred by the Life Insured in respect of the following items are defined as Expenses:

1.2.1 Daily Room & Board

Accommodation in a Hospital including meals and general nursing during confinement as a bed-paying patient. This excludes deluxe rooms, luxury suites or other special rooms that are available in the Hospital.

1.2.2 Intensive Care Confinement in the intensive care ward of a Hospital. 1.2.3 Miscellaneous Hospital Services Drugs and medicines, dressings, splints and plaster casts, intravenous infusions and blood

transfusions, anaesthetics (other than that required for surgery) and oxygen and their administration.

1.2.4 Surgery Surgical operations in a Hospital (regardless of whether the Life Insured is Hospitalised or not)

and performed by a duly qualified Physician and involving local or general anaesthesia. Surgery Expenses include the fees and charges for anaesthetics and oxygen and their administration and use of operating theatre and facilities. Surgery excludes Accidental Dental Treatment as defined in Clause 1.2.9

1.2.5 Daily In-Hospital Physicians Visit Consultation by a Physician during confinement in a Hospital. 1.2.6 Pre-Hospital Specialists Consultation

Consultation by a specialist Physician (such consultation) upon recommendation by a non-specialist Physician (general practitioner) and in connection with a medical condition which results in: (a) Hospitalisation; or (b) Surgery; or (c) Kidney Dialysis Treatment; or (d) Cancer Treatment,

within 90 days of such consultation, which includes the day on which such consultation took

place. Such consultation must take place in a Hospital or in a medical clinic where the specialist Physician customarily provides such consultations. However, such consultation would exclude consultations while the Life Insured is Hospitalised or which is provided after discharge from a Hospital.

1.2.7 Examination & Laboratory Tests

Examinations using instruments and laboratory tests (such examinations) ordered by a Physician and performed: (a) during the period of Hospitalisation; or

(b) in the course of diagnosis of a condition resulting in Hospitalisation, Surgery, Kidney Dialysis Treatment or Cancer Treatment within 90 days of such examinations including the day on which such examinations took place.


1.2.8 Post Hospital Follow-Up Treatment

Medical treatment received after discharge from a Hospital (post Hospital treatment) provided the treatment is prescribed by a Physician and resulted directly from the condition for which Hospitalisation was required and includes: (a) General Outpatient services provided by a non-specialist Physician (general practitioner);

or (b) Specialist Outpatient services provided by a specialist Physician; or

(c) Instrument Examinations and Laboratory Tests ordered by a Physician, in a Hospital or in a medical clinic where the Physician customarily provides such services or in

a duly licensed medical laboratory where such instrument examinations and laboratory tests are conducted. The post Hospital treatment must take place within 90 days of the discharge from a Hospital including the day of the discharge. Post Hospital Follow-up Treatment excludes Kidney Dialysis Treatment and Cancer Treatment as defined in Clauses 1.2.10 and 1.2.11 respectively below. Administration of Erythropoietin and Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment of organ transplants are also excluded.

1.2.9 Accidental Dental Treatment Dental procedures performed by a duly qualified dental surgeon necessary to restore or replace

sound natural teeth lost or damaged during an Accident. Such dental procedures must take place during Hospitalisation of the Life Insured.

1.2.10 Kidney Dialysis Treatment In-hospital and outpatient kidney dialysis performed in a Hospital or a legally registered dialysis

centre including examinations and tests ordered by a Physician during the course of the treatment.

1.2.11 Cancer Treatment Chemotherapy, radiotherapy, immunotherapy and/or stereotactic radiotherapy provided by a

Hospital or a legally registered cancer treatment centre, including examinations and tests ordered by a Physician during the course of the treatment.

1.2.12 Surgical Implant/Approved Medical Consumables

Surgical Implant refers to an implant inserted into the body of the Life Insured during surgery and remains in the body of the Life Insured on completion of the surgery. Approved Medical Consumables includes any of the following: (a) intravascular electrodes used for electrophysiological procedures; (b) Percutaneous Transluminal Coronary Angioplasty (PTCA); or

(c) inter-aortic balloons (or balloon catheters). 1.2.13 Human Immunodeficiency Virus (HIV) Due to Blood Transfusion and Occupationally Acquired

HIV 1.2.13.1 Infection with the HIV through a blood transfusion, provided that all of the

following conditions are met:

(a) The blood transfusion was medically necessary or given as part of a medical treatment;

(b) The blood transfusion was received in Singapore after the Commencement Date of Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading, whichever is the latest date;

(c) The source of the infection is established to be from the Hospital that provided the blood transfusion and the Hospital is able to trace the origin of the HIV tainted blood; and


(d) The Life Insured does not suffer from Thalassaemia Major or Haemophilia.

1.2.13.2 Infection with HIV which resulted from an Accident occurring after the

Commencement Date of Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading, whichever is the latest date, whilst the Life Insured was carrying out the normal professional duties of his or her own occupation in Singapore, provided that all of the following are proven to the Companys satisfaction:

(a) Proof of the Accident giving rise to the infection must be reported to the

Company within 30 days of the accident taking place; (b) Proof that the Accident involved a definite source of the HIV infected

fluids; (c) Proof of sero-conversion from HIV negative to HIV positive occurring

during the 180 days after the documented Accident. This proof must include a negative HIV antibody test conducted within 5 days of the Accident; and

(d) Proof that the Life Insured is a medical practitioner, a houseman in a Hospital, medical student, registered nurse, medical laboratory technician, dental surgeon, dental nurse or paramedical worker, working in a medical centre or medical clinic in Singapore.

1.2.14 Pregnancy Complications

Complications arising from pregnancy or childbirth after 10 months from the Commencement Date of Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading, whichever is the latest date, even if it results in Caesarean section, vacuum extraction or forceps delivery.

1.2.15 Congenital Abnormalities Treatment relating to birth defects, including hereditary conditions, and congenital sickness or

abnormalities first diagnosed after 2 years from the Commencement Date of Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading, whichever is the latest date.

1.2.16 Living Organ Donor Transplant (Kidney / Liver)

All Expenses incurred by the Life Insured arising from transplanting his kidney or liver where the recipient of the kidney or liver is the Life Insureds family member, and where the recipients kidney or liver failure is only first diagnosed after 2 years from the Commencement Date of Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading, whichever is the latest date. For the purposes of this Expense only, the Life Insureds family members are deemed to be his parents, siblings, children and spouse.

1.2.17 Stem Cell Transplant

All Expenses incurred by the Life Insured arising from the treatment of an illness or a medical condition. Outpatient therapy such as an injection or extraction where there is no Surgery or Hospitalisation involved will not be covered. Related costs including costs of harvesting, storage, transportation and cell culture will also not be covered.

1.2.18 Final Expenses Benefit In the event of the Life Insureds death during Hospitalisation or after discharge from Hospital, the Deductible and Co-insurance which applies to the Eligible Expenses (or proportionately reduced Eligible Expenses under Clause 4.2.2) will be waived and Eligible Expenses (or proportionately reduced Eligible Expenses) incurred during the Period of Insurance in which death occurs which will otherwise not have been reimbursed due to the application of the Deductible and Co-Insurance provisions will be reimbursed up to the limits stated in Schedule B for the Plan Type insured, except if the Life Insured dies as a result of self-inflicted injuries, suicide or attempted suicide, whether sane or insane.


1.3 In-hospital Psychiatric Treatment Psychiatric treatment provided by a Physician duly qualified in psychiatry during full-time confinement in

a Hospital. 2 LIFE INSURED JOINTLY INSURED UNDER MEDISHIELD

The Life Insured is also jointly insured under MediShield operated by the Central Provident Fund Board which is governed by the Act and the Regulations, provided the Life Insured meets the eligibility conditions as specified in the Act and the Regulations. The Life Insured, if insured under MediShield, shall enjoy all benefits of MediShield as provided under the Act and the Regulations.

3 LIMITS ON ELIGIBLE EXPENSES

Eligible Expenses are: (a) limited to the Reasonable and Customary Charges for such Expenses; and (b) subject to the limits as stated in Schedule B of this Policy in accordance with the Plan Type insured

at the time such Expenses are incurred.

4 BENEFITS

4.1 Subject to Clauses and Conditions 4.1.1 Subject to the clauses and conditions of this Policy, the Company will pay benefits under this

Policy for any Eligible Expenses incurred by the Life Insured during the Period of Insurance. If the benefits payable under MediShield are higher than the benefits payable for the Eligible Expenses according to Clause 4.2 to 4.5 below, the Company will pay the benefits under MediShield.

4.1.2 Subject to the clauses and conditions of this Policy, any claim for Eligible Expenses incurred after

the Commencement Date of Insurance of the Life Insured shall only be paid after the Company receives the full payment of the premium for the Period of Insurance during which the Eligible Expenses are incurred.

4.2 Reimbursement of Eligible Expenses

4.2.1 The Company will pay benefits under this Policy by way of reimbursement of Eligible Expenses incurred subject to the limits as stated in Clause 3 above.

4.2.2 Pro-ration Factor 4.2.2.1 A Plus

Subject to clause 4.2.2.4, if the Life Insured is insured under A Plus as indicated in Schedule A of this Policy and incurs Eligible Expenses while warded in:

(a) a private Hospital; or

(b) any Class or type of Ward of a Restructured Hospital (X Hospital) for

which X Hospital does not receive any subsidy from the Government for the provision of medical services to the Life Insured while confined in that Class or type of Ward (other than the Class A Ward of X Hospital), which the Company may at its discretion include under this Clause 4.2.2.1 from time to time,

all such Eligible Expenses will first be proportionately reduced by multiplying the Pro-ration Factor shown for A Plus in Schedule B with the original amounts of


such Expenses. The proportionately reduced Expenses will then be subject to the Deductibles, Co-insurance and Limits stated in Schedule B. For the avoidance of doubt, all Expenses in excess of the proportionately reduced Expenses will not be reimbursed by the Company.

4.2.2.2 B Plus

Subject to clause 4.2.2.4, if the Life Insured is insured under B Plus as indicated

in Schedule A of this Policy and incurs Eligible Expenses in:

(a) a private Hospital; or

(b) a Class A Ward of a Restructured Hospital; or (c) any Class or type of Ward of a Restructured Hospital (Y Hospital) for

which Y Hospital does not receive any subsidy from the Government for the provision of medical services to the Life Insured while confined in that Class or type of Ward, which the Company may at its discretion include under this Clause 4.2.2.2 from time to time; or

(d) any Class or type of Ward of a Restructured Hospital (Z Hospital) for

which Z Hospital receives a lower subsidy from the Government for the provision of medical services to the Life Insured while confined in that Class or type of Ward than the subsidy Z Hospital receives for the provision of the same services for a patient confined in a Class B1 Ward of Z Hospital, and which the Company may at its discretion include under this Clause from time to time,

any such Eligible Expenses will first be proportionately reduced by multiplying the Pro-ration Factor shown for B Plus in Schedule B with the original amounts of such Expenses. The proportionately reduced Expenses will then be subject to the Deductibles, Co-insurance and Limits stated in Schedule B. For the avoidance of doubt, all Expenses in excess of the proportionately reduced Expenses will not be reimbursed by the Company.

4.2.2.3 Subject to clause 4.2.2.2 and clause 4.2.2.4, if the Life Insured:

(a) is insured under B-Plus as indicated in Schedule A of this Policy; and

(b) incurs Eligible Expenses in a class B1 ward or lower ward in a Restructured Hospital; and

(c) the Life Insured is a Singaporean Permanent Resident or Foreigner when

such Eligible Expenses were incurred, any such Eligible Expenses will first be proportionately reduced by multiplying the Pro-ration Factor shown in the table below applicable to his citizenship status when such Eligible Expenses were incurred, with the original amounts of such Expenses. The proportionately reduced Expenses will then be subject to the Deductibles, Co-insurance and Limits stated in Schedule B. For the avoidance of doubt, all Expenses in excess of the proportionately reduced Expenses will not be reimbursed by the Company.

Singapore Permanent Resident

Pro-ration Factor Foreigner

Pro-ration Factor

90% 80%


4.2.2.4 Expenses incurred in a Restructured Hospital for any of the following treatments provided to the Life Insured on an outpatient basis will not be pro-rated in accordance with Clauses 4.2.2.1, 4.2.2.2 and 4.2.2.3:

(a) Kidney Dialysis Treatment; or (b) Cancer Treatment; or (c) Erythropoietin; or (d) Cyclosporin/Tacrolimus; or other immunosuppressants prescribed for

treatment of Organ Transplant.

4.2.2.5 If the Life Insured undergoes Hospitalisation in a Restructured Hospital but, during the Hospitalisation, transfers from a Class or type of Ward to another Class or type of Ward for which the Restructured Hospital receives a higher or lower or no subsidy from the Government for the provision of medical services to the Life Insured, the Pro-ration Factor which applies to the Expenses incurred during the whole period of Hospitalisation will be that applicable to the Class or type of Ward for which the Restructured Hospital receives the lowest subsidy from the Government, in accordance with Clauses 4.2.2.1 or 4.2.2.2.

4.2.3 For any benefits payable under this Policy, the Company will make payment to the Hospital with

which it has a payment arrangement. Otherwise, the Company will make payment directly to the Policyholder.

4.2.4 If the Life Insured has undergone Hospitalisation in a Hospital (that Hospital) and:

(a) is discharged from that Hospital; and

(b) a Physician in that Hospital has recommended in writing that the Life Insured is to be

confined as an in-patient in a Community Hospital for further medical treatment arising from the same Injury, illness or disease that resulted in the Life Insureds Hospitalisation in that Hospital,

the Company will reimburse Eligible Expenses incurred arising from the Life Insureds confinement in the Community Hospital including expenses for accommodation, meals and general nursing during the Life Insureds confinement as a bed-paying patient in the Community Hospital subject to the limits as stated in Schedule B of this Policy in accordance with the Plan Type insured at the time such Eligible Expenses were incurred.

4.3 Benefit Computation

4.3.1 The Company will not pay benefits in respect of the Life Insured unless the Aggregate Eligible Expenses (other than Eligible Expenses for Kidney Dialysis Treatment, Cancer Treatment, Erythropoietin or Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment of organ transplant) incurred during any Period of Insurance exceeds the Deductible effective during that Period of Insurance. If there are two or more Deductibles that can be applied, the Company will apply the highest Deductible.

4.3.2 If the Aggregate Eligible Expenses (other than the Eligible Expenses for Kidney Dialysis

Treatment, Cancer Treatment, Erythropoietin or Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment of organ transplants) exceeds the Deductible, the benefit payable shall be the reimbursement of the Aggregate Eligible Expenses in excess of the Deductible, less the Co-insurance applicable to that Period of Insurance.

4.3.3 The Company will pay benefits in respect of the Eligible Expenses incurred for Kidney Dialysis

Treatment, Cancer Treatment, Erythropoietin, Cyclosporin/Tacrolimus or other


immunosuppressants prescribed for treatment of organ transplants, without deducting the Deductible but after deducting the Co-insurance applicable to that Period of Insurance.

4.4 Benefit Limits

4.4.1 The Company will pay benefits in respect of Eligible Expenses incurred for treatment provided to the Life Insured during the Period of Insurance up to the Annual Benefit Limit as stated in Schedule B, in accordance with the Plan Type insured for the Life Insured at the time such Expenses are incurred.

4.4.2 The Annual Benefit Limit in Schedule B on benefits payable for In-hospital Psychiatric Treatment

will apply to the total of all Eligible Expenses incurred in respect of and in connection with such Treatment.

4.4.3 The Benefit Limit per Transplant in Schedule B on Expenses of Living Organ Donor Transplant

(Kidney / Liver) will apply to the total of all Expenses incurred in respect of and in connection with such Living Organ Donor Transplant (Kidney / Liver).

4.5 Indemnity

Benefits payable under this Policy, together with reimbursement of Expenses paid or payable from other sources, other insurance policies and employment benefit provisions, will not exceed the Expenses actually incurred in respect of any claim made under this Policy. 4.5.1 Co-ordination

If the Policyholder is entitled to reimbursement from other sources of the Expenses incurred in respect of any claim and if the total reimbursement from all sources including benefits payable under this Policy when taken independently exceeds the Expenses so incurred, the Company reserves the right to reduce the benefits payable under this Policy having regard to the other sources such that the total actual reimbursement does not exceed the total of the Expenses actually incurred.

4.5.2 Contribution When the Policyholder is entitled to reimbursement from group or individual insurance policy(ies) or under any legislation (these other sources) of the Eligible Expenses incurred by the Life Insured, the Company will pay the lower of : (a) the benefits under this Policy; or (b) the balance of the benefits not reimbursed by these other sources.

5 EXCLUSIONS

5.1 General Exclusions Under this Policy, the Company will not pay any benefit in reimbursement of Expenses incurred for, or

for the consequences of, the following:

(a) Pregnancy and childbirth (including Caesarean section, vacuum extraction or forceps delivery and the consequences thereof) except for Pregnancy Complications defined under clause 1.2.14.

(b) Elective abortion, spontaneous miscarriage occuring within first trimester of pregnancy, birth control*, sterilization*, infertility*, sub-fertility* or impotence treatment. * for male or female

(c) Routine physical or any other examinations not related to the treatment or diagnosis of an Injury,

illness or disease.


(d) Instrument examinations and laboratory tests not ordered by a Physician or not resulting in a diagnosis of a condition leading to Hospitalisation, Surgery, Kidney Dialysis Treatment, Cancer Treatment or Accidental Dental Treatment.

(e) All Dental Treatment not defined as Accidental Dental Treatment.

(f) Elective cosmetic or plastic surgery performed during the Period of Insurance unless for Injury

sustained as a result of an Accident which occurs at any time after the Commencement Date of Insurance of the Life Insured (or after the last Date of Reinstatement of insurance of the Life Insured, if the insurance had ended and was subsequently reinstated).

(g) Treatment of psychiatric, emotional, personality, mental and nervous disorders including

depression (except for In-hospital Psychiatric Treatment if covered under this Policy as indicated in Schedule B).

(h) Treatment of alcoholism or drug abuse. (i) Treatment provided to the Life Insured by the Policyholder, or a family member of the Life

Insured or the Policyholder, or self-treatment by the Life Insured, including the prescription of drugs.

(j) Transport for trips made for the purpose of obtaining medical treatment. (k) Purchase and rental of prostheses, corrective devices and medical appliances unless the

prostheses, corrective device or medical appliance satisfies the definition of a Surgical Implant or of Approved Medical Consumables. Medical appliances include but are not limited to kidney dialysis machines, iron lung, and durable medical equipment (e.g. wheelchairs and hospital beds) used at home.

(l) Acquisition of the organ itself for an organ transplant, (except for the procurement costs incurred

directly by the Hospital for the procurement of the organ for transplantation into the Life Insured where the donor of the organ is already dead at the time of the removal of any of the organs in the Country of Issue or outside the Country of Issue).

(m) All Expenses incurred by the donor for an organ transplant except for Living Organ Donor

Transplant (Kidney / Liver) defined under clause 1.2.16. (n) Self-inflicted injuries or suicide or attempted suicide, whether sane or insane. (o) Treatment relating to birth defects, including hereditary conditions, and congenital sickness or

abnormalities first diagnosed before or within 2 years after the Commencement Date of Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading, whichever is the latest date.

(p) AIDS and all illnesses or diseases caused by or related to the Human Immuno-deficiency Virus

(HIV) except for Human Immunodeficiency Virus (HIV) Due to Blood Transfusion and Occupationally Acquired HIV defined under clause 1.2.13.

(q) Sexually-transmitted diseases. (r) Violation or attempted violation of law and resistance to lawful arrest or any resultant

imprisonment. (s) War (whether declared or not), invasion, terrorist activities, rebellion, revolution, civil war or any

warlike operations. (t) Being in or on an aircraft of any type, or boarding or descending from any aircraft, except as a

fare-paying passenger or crew member on an aircraft on a regular scheduled route operated by a recognised airline.

(u) The Life Insured engaging in any sport in a professional capacity or where the Life Insured

would or could earn income or remuneration or win monetary rewards from engaging in such sport.


(v) Medical treatment, Hospitalisation, Surgery and consultation provided to and investigation of the Life Insured commencing: (i) Before the Commencement Date of Insurance of the Life Insured for any condition; (ii) On or after the Commencement Date of Insurance of the Life Insured which are follow-up

medical treatment(s), consultation(s) or further investigation(s) of the Life Insured for that condition for which he received medical treatment, consultation or investigation before the Commencement Date of Insurance.

(w) Any treatment provided to the Life Insured after the Renewal Date of this Policy unless the

insurance has been renewed on or before that date in accordance with Clause 8 of this Policy. (x) Private nursing charges and nursing home services.

(y) Medical or surgical treatment outside Singapore except in the case of an Emergency.

(z) Treatment for obesity, weight reduction or weight improvement regardless of whether it is

medically necessary or otherwise. (aa) Ambulance fee. (bb) Vaccination. (cc) Correction for refractive errors of the eye, routine eye and eye examinations, costs of

spectacles, costs of contact lenses and costs of hearing aids.

(dd) Mountaineering, diving, bungee jumping, racing other than racing on foot, wakeboarding, hang-gliding, rock climbing, parachuting, ballooning, handling of explosives or firearms and all activities which are potentially life-threatening or where there is a risk of bodily injury to the Life Insured.

(ee) Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from

process of nuclear fission or from any nuclear weapons material. 5.2 Pre-existing Conditions

5.2.1 Any pre-existing illnesses, diseases or impairments (Pre-existing Conditions) from which the Life Insured is suffering prior to the Commencement Date of Insurance of the Life Insured are excluded, unless declared in the proposal for (or in the application for reinstatement of) insurance of the Life Insured and expressly accepted by the Company.

5.2.2 Subject to Clause 5.2.3 below, any Pre-existing Condition which qualifies under any exclusions

under Clause 5.1 above is automatically excluded regardless of whether a declaration has been made of that condition in the proposal for, or in the application for the reinstatement of, the insurance under this Policy and accepted by the Company.

5.2.3 However, Pre-existing Conditions which had been covered under MediShield immediately

before the Commencement Date of Insurance of the Life Insured will continue to be covered under MediShield provided that :

(a) the Life Insured was insured under :

(i) MediShield; or (ii) any policy included in the Integrated Private Medical Insurance Scheme (IPMIS) under

which the Life Insured was jointly insured under MediShield, immediately before the Commencement Date of Insurance of the Life Insured; and


(b) the Life Insured is now jointly insured under MediShield in accordance to Clause 2 above.

5.3 Expenses Falling under Exclusion

Expenses incurred for medical treatment and consultation provided to and investigation of the Life Insured under any of the exclusions as listed in Clauses 5.1 and 5.2 above will not be part of Eligible Expenses, and will not be added to the Aggregate Eligible Expenses, if no benefit payment is made in respect of these Expenses.

6 TERRITORIAL FACTORS 6.1 Overseas Emergency Medical Treatment

If the Life Insured requires medical or surgical treatment as a result of an Emergency while outside Singapore, the Company shall reimburse the Expenses incurred up to the Limits stated in Schedule B subject to the following conditions:

(a) If the Life Insured is insured under P Plus at the time such Expenses were incurred, the Company

will reimburse the Expenses incurred or the Reasonable and Customary Charges which would have been incurred for similar medical or surgical treatment in any private Hospital in Singapore, whichever is lower.

(b) If the Life Insured is insured under A Plus at the time such Expenses were incurred, the Company

will reimburse the Expenses incurred or the Reasonable and Customary Charges which would have been incurred for similar medical or surgical treatment in any Class A Ward of a Restructured Hospital in Singapore, whichever is lower.

(c) If the Life Insured is insured under B Plus at the time such Expenses were incurred, the Company

will reimburse the Expenses incurred or the Reasonable and Customary Charges which would have been incurred for similar medical or surgical treatment in any Class B1 Ward of a Restructured Hospital in Singapore, whichever is lower.

6.2 Currency Exchange Expenses incurred as a result of an Emergency while outside Singapore in any currency other than the

Singapore Dollar will be converted to Singapore currency at the prevailing exchange rate as determined by the Company to be in effect on the date the Expenses were incurred.

7 TERMINATION

7.1 Termination on Renewal Date On any Renewal Date of this Policy, insurance on the Life Insured under this Policy will end unless the

insurance has been renewed in accordance with Clause 8 below.

7.2 Death of Policyholder or Life Insured 7.2.1 If the Policyholder dies and the Policyholder is not the Life Insured, this Policy will continue for

the Life Insured until the Renewal Date of this Policy following the date of the death. On the Renewal Date, the Company will insure the Life Insured under a new Policy for the same Plan Type insured for the Life Insured effective on the day before the Renewal Date without requiring fresh evidence of insurability, subject to the following conditions:

(a) A party must submit a fresh proposal before the Renewal Date and; (i) that party must be allowed to deduct premiums for the Life Insured from that partys

Medisave account with the Central Provident Fund (CPF) Board (that partys Medisave account) if the premium for the new policy is to be paid entirely or partially from that partys Medisave account; or

(ii) if the premium for the new policy is to be paid entirely in cash, that party must have

valid insurable interest on the Life Insured;


(b) The new policy issued in accordance with Clause 7.2.1 will be issued on the clauses and conditions of the Policy Version existing as at the Renewal Date; and

(c) Any endorsement on or variation to this Policy authorised by the Company will also apply

to the new policy issued unless otherwise agreed by the Company. 7.2.2 Insurance on the Life Insured will end upon the death of the Life Insured. The Policyholder [or

the Policyholder's legal personal representative(s)] is entitled to a pro-rated refund of premium (if paid) in respect of the insurance on the deceased Life Insured for the period remaining up to the Renewal Date, after the date of death.

7.3 Cancellation By Policyholder

7.3.1 The Policyholder may cancel this Policy by submitting a notice of cancellation to the Company upon which this Policy will be treated as ended on the Effective Date of Cancellation.

7.3.2 The insurance on the Life Insured will end on the Effective Date of Cancellation. 7.3.3 Upon termination of this Policy by cancellation, the Policyholder is entitled to a full refund of

premium, if the Effective Date of Cancellation falls within the first two calendar months after the Commencement Date of Insurance of the Life Insured.

7.3.4 If the Effective Date of Cancellation falls outside the first two calendar months as mentioned

in clause 7.3.3 above, the premium will be refunded on a pro-rated basis allowing for the actual number of days this Policy was in force from the:

(a) Commencement Date of Insurance of the Life Insured; or (b) Renewal Date,

preceding the Effective Date of Cancellation, where applicable, except for a pro-rated amount of the corresponding premium for MediShield for the Life Insured under the Act and the Regulations. After the Effective Date of Cancellation, the Life Insured will be covered under MediShield provided the Life Insured meets the eligibility conditions as specified in the Act and the Regulations.

7.3.5 If no Effective Date of Cancellation is specified in the notice of cancellation, the Company will

assume the Effective Date of Cancellation to be the date of receipt of the notice of cancellation by the Company.

7.4 Not Citizen or Permanent Resident : Residence Overseas Insurance for the Life Insured will end on the Renewal Date (that Renewal Date) of this Policy and will

not be renewed if, on that date, the Life Insured: (a) Is not a citizen or permanent resident of the Country of Issue; and (b) Has resided outside the Country of Issue for more than 180 days, whether continuously or

otherwise during the Period of Insurance immediately prior to that Renewal Date; and (c) Is still residing outside the Country of Issue.

7.5 Life Insured Insured Under Another Shield Plan

The insurance under this Policy will terminate immediately, when the Life Insured is subsequently insured under a similar plan issued under the Regulations by another insurance company.

7.6 No Benefits Payable after Termination of Insurance

7.6.1 The Company will not pay any benefit in reimbursement of any Expenses incurred by the Life Insured whose insurance has ended in accordance with Clauses 7.3, 7.4 or 7.5 above for treatment provided to the Life Insured on or after the effective date of such termination.


7.6.2 The Company will not pay any benefit for any Expenses incurred by the Life Insured for treatment provided to the Life Insured on or after a Renewal Date of this Policy unless insurance for the Life Insured was renewed in accordance with Clause 8 below.

8 RENEWAL

8.1 When No Renewal Allowed The Company will not renew insurance under this Policy for the Life Insured whose insurance has ended in accordance with Clauses 7.3, 7.4 or 7.5 above.

8.2 Renewal upon Payment of Premium

8.2.1 Subject to clause 8.1, if the required premium for renewal is paid on or before a Renewal Date, the Company will guarantee the renewal of this Policy for a further Period of Insurance. The further Period of Insurance will begin on the Renewal Date.

8.2.2 Where the premium is to be paid from the Policyholders Medisave account, the Company shall

request for deduction of the premium from the Policyholders Medisave account, subject to the limits under the Central Provident Fund (Private Medical Insurance Scheme) Regulations (PMIS regulations) effective at the time of request.

8.2.3 The excess of the premium for the Life Insured over the PMIS regulations limit, and any shortfall

in the deduction of premium resulting from the Policyholders CPF Medisave account being inadequate, must be paid by the Policyholder before the end of the Grace Period described in Clause 8.3.1 below.

8.2.4 All endorsements on or variations to this Policy authorised by the Company and any premium

loading imposed will also apply to the insurance granted on this Policys renewal unless otherwise agreed in writing by the Company.

8.3 Grace Period

8.3.1 The Policyholder has a period of 60 days (the Grace Period) from the Renewal Date including the Renewal Date, to pay the required renewal premium. If the full renewal premium is not paid on or before the last day of the Grace Period, insurance under this Policy will be treated as ended on the Renewal Date and may only be reinstated with the consent of the Company.

8.3.2 If the Life Insured receives treatment for which Eligible Expenses are incurred during the Grace

Period and a claim is submitted and there is still an amount of renewal premium to be paid (the balance unpaid premium) or the renewal premium (outstanding renewal premium) has not been paid yet, the Company will not pay any benefits for any claim submitted until the balance unpaid premium or the outstanding renewal premium is paid before the end of the Grace Period.

8.3.3 If during the Grace Period, insurance on the Life Insured begins under any policy of insurance

with the Company which also provides benefits payable as defined in this Policy, then Clause 8.3.2 will immediately be void on the date of commencement of such other insurance.

8.3.4 Clauses 8.3.1 and 8.3.2 will not apply to the Life Insured if insurance on the Life Insured will not

be renewed in accordance with Clause 8.1 above.

8.4 Rate of Premium The required renewal premium for the Life Insured whose insurance is renewed will be calculated at the rate of premium applicable on the Renewal Date to:

(a) the Plan Type insured for the Life Insured and effective on the day before the Renewal Date (or for

any other Plan Type subject to the agreement of the Company); and (b) the age next birthday of the Life Insured on the Renewal Date,

unless otherwise agreed in writing by the Company.

8.5 Company May Amend Clauses and Conditions and Premium Rates


8.5.1 The Company may amend the clauses and conditions of the insurance at renewal provided that the amendments apply to all policies of this class of insurance and the Policyholder has been informed of the amendments at least 30 days before the Renewal Date at which time the amendments will apply.

8.5.2 The Company may amend the rates of premium at renewal provided that the amended rates

apply to all policies of this class of insurance and the Policyholder has been informed of the amended rates at least 30 days before the Renewal Date at which time the amended rates will apply.

8.6 Upgrading/Downgrading of Plan Type

8.6.1 The Policyholder may apply to:

(a) upgrade the insurance under this Policy to a Plan Type with higher limits on Eligible Expenses and Benefits on renewal of this Policy, subject to receipt of evidence of insurability on the Life Insured acceptable to the Company;

(b) downgrade the insurance under this Policy to a Plan Type with lower limits on Eligible

Expenses and Benefits on renewal of this Policy. The Policyholder must submit the application for upgrading or downgrading at least 30 days

before the Renewal Date. The Company may refuse such an application.

8.6.2 If the Company accepts the Policyholders application, any endorsement on or variation to this Policy authorised by the Company and any premium loading imposed will also apply to the insurance granted upon the renewal and upgrading/downgrading, unless otherwise agreed in writing by the Company.

8.6.3 For medical treatment, Hospitalisation, Surgery and consultation provided to and investigation of

the Life Insured commencing :

(a) before the effective date of upgrading or downgrading ("upgrading/downgrading date") of benefits for any condition; and

(b) on or after the upgrading/downgrading date which were follow-up medical treatment(s),

consultation(s) or further investigation(s) of that Life Insured for the same condition for which he received medical treatment, consultation or investigation before the upgrading/downgrading date,

benefits will be payable in accordance with the Limits of the Plan Type insured under this Policy immediately prior to the upgrading/downgrading date.

9. REINSTATEMENT OF POLICY

9.1 Clauses and Conditions 9.1.1 If insurance under this Policy ends on the Renewal Date in accordance with Clause 7.1 above

and is not renewed in accordance with Clause 8 above, the Policyholder may apply for the insurance to be reinstated by submitting evidence of insurability acceptable to the Company within 15 days of the last date of the Grace Period (excluding the last date of the Grace Period) described in Clause 8.3.1 above. The Company may refuse such an application.

9.1.2 If the Company accepts the Policyholder's application to reinstate the insurance under this

Policy, such insurance will be reinstated only if the required premium for reinstatement (the reinstatement premium) is paid in accordance with one of the following applicable modes:

(a) If the reinstatement premium is paid entirely in cash, the reinstatement premium must be

paid to the Company within 15 days of the last date of the Grace Period (excluding the last


date of the Grace Period) described in Clause 8.3.1 above. The date of reinstatement (Date of Reinstatement) is the date when the application of reinstatement is approved or when the reinstatement premium is received by the Company, whichever is the later date; or

(b) If the reinstatement premium is paid entirely from the Policyholders Medisave account, the

reinstatement premium must be successfully deducted from the Policyholders Medisave account. The date of reinstatement (Date of Reinstatement) is the date on which the premium was successfully deducted from the Policyholders Medisave account; or

(c) If the reinstatement premium is paid partly in cash and partly from the Policyholders

Medisave account (the CPF portion), the: (i) CPF portion of the reinstatement premium must be successfully deducted from the

Policyholders Medisave account; and (ii) cash portion of the reinstatement premium must be paid by the date of the

successful deduction of the CPF portion, and

the date of reinstatement (Date of Reinstatement) is the date on which the premium was successfully deducted from the Policyholders Medisave account.

The Period of Insurance upon reinstatement will begin on the Renewal Date on which the insurance had ended in accordance with Clause 7.1.

9.1.3 Insurance granted upon reinstatement excludes medical treatment, Hospitalisation, Surgery and

consultation provided to and investigation of the Life Insured commencing :

(a) Before the Date of Reinstatement for any condition; (b) On or after the Date of Reinstatement which are follow-up medical treatment(s),

consultation(s) or further investigation(s) of the Life Insured for that condition for which he received medical treatment or consultation or investigation before the Date of Reinstatement.

9.1.4 All endorsements on and variations to this Policy authorised by the Company and any premium

loading imposed will also apply to the insurance granted upon the reinstatement unless otherwise agreed in writing by the Company.

9.2 Reinstatement Premium Rate

The required reinstatement premium for the Life Insured whose insurance is to be reinstated will: (a) Be calculated at the rate of premium applicable on the Date of Reinstatement according to the:

(i) Plan Type of the insurance granted on reinstatement; and

(ii) Age next birthday reached by the Life Insured on the Renewal Date of this Policy described in Clause 9.1.2; and

(b) Include any extra premium loading imposed on this Policy, unless otherwise agreed in writing by the Company.

9.3 When No Reinstatement Allowed The Company will not allow reinstatement of insurance for the Life Insured whose insurance had ended

in accordance with Clauses 7.2.2, 7.3, 7.4 or 7.5 above.

10 CLAIM

10.1 Notification


10.1.1 The Policyholder must, within 90 days after the happening of any event likely to give rise to a

claim, notify the Company and give written proof of such claim except where there is an electronic filing submission of a claim under this Policy made on behalf of the Policyholder by a Hospital or medical clinic or other medical establishment using the electronic submission system.

10.1.2 However, a claim will still be valid if it was not reasonably possible for the Policyholder to give

such proof within this period. 10.2 Submission and Documentation

The Policyholder must (at the Policyholders own expense) give to the Company all certificates and forms, bills and receipts and information and evidence required by the Company and submit only original bills, receipts and other documents required to support a claim, unless otherwise agreed in writing by the Company except where such certificates, forms, bills and receipts, information and evidence required by the Company are electronically submitted on behalf of the Policyholder by a Hospital or medical clinic or other medical establishment using the electronic submission system.

10.3 Medical Examiner's Certificate The Policyholder must (at the Policyholders own expense) submit a certificate signed by a Physician

who attended to the Life Insured for whom the claim is submitted. Otherwise, the Company will not pay any benefit under this Policy. The medical certificate must be in a form prescribed by the Company.

10.4 Medical Examination The Life Insured, for whom a claim has been submitted, must whenever reasonably required to do so (at

the Companys expense) submit to medical examinations by a Physician or Physicians appointed by the Company.

10.5 Expiration of Liability If the Company denies liability to the Policyholder for any claim, the Company will not be responsible for

that claim after 12 months have passed from the date of the disclaimer unless the claim is the subject of pending mediation before a mediation authority or body.

11 POLICY - WHEN VOID

11.1 Misrepresentation or Non-disclosure of Material Facts

11.1.1 The Company may declare this Policy void if the Proposal and Declarations made by the Policyholder or any written statement given by the Policyholder or the Life Insured on proposal for (or application for reinstatement of) 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.

11.1.2 This Policy is treated as void:

(a) On the Commencement Date of Insurance of the Life Insured if the misrepresentation, omission or fraudulent statement was made to the Company on a proposal for insurance; or

(b) On the applicable Renewal Date described in Clause 9.1.2, if the misrepresentation, omission or fraudulent statement was made to the Company on an application for reinstatement of insurance.

11.2 Refund of Premium

Except in the case of fraud, when this Policy is treated as void under Clause 11.1 above: (a) If there are no claims made under this Policy, all premiums paid for insurance which became

effective on or after the date on which this Policy is treated as void will be refunded. (b) If there were claims made under this Policy, only the premiums paid for the Periods of Insurance

following the Period of Insurance in which the last claim was made will be refunded.


11.3 Fraudulent Claim The Company may declare this Policy void if the Policyholder makes any claim which is fraudulent or

exaggerated or if the Policyholder makes any false declaration or statements in support of any claim. In this case, this Policy will be void immediately and there will be no refund of premiums.

11.4 Cheque Dishonoured This Policy will be void if the cheque issued for the payment of the premium due on this Policy is

dishonoured. The Company reserves the right not to grant or reinstate insurance unless evidence of insurability acceptable to the Company is given.

12 OTHER CONDITIONS

12.1 Form of Notices 12.1.1 Any request, notice, instruction or correspondence required under this Policy whether to the

Company or the Policyholder has to be in writing and will be delivered personally or sent by courier, or by post, or facsimile transmission or electronic mail addressed to the addressee or by any other means as may be approved or adopted or accepted by the Company. For the Policyholder, the mailing address is that stated in the proposal or any other address that the Policyholder has informed the Company in writing.

12.1.2 The Companys notice, request, instruction or communication is presumed to be received:

(a) In case of a letter, on the 7th day after posting if posted locally, and on the 14th day after posting, if posted overseas;

(b) In the case of personal delivery or delivery by courier, on the day of delivery; (c) In the case of a facsimile transmission or electronic mail, on the business day

immediately following the day of despatch; or (d) In the case of other means as approved, adopted or accepted by the Company, as when

the Company decides when it is reasonable to be received.

12.2 Alteration of Policy No alteration in the clauses of this Policy or any endorsement will be valid unless the alteration or

endorsement is signed or initialled by an authorised representative of the Company. 12.3 Errors of Age

If the age of the Life Insured has been stated wrongly in the proposal for this Policy, the premium shall be adjusted based on the correct age of the Life Insured. Any excess premium paid shall be refunded and any shortfall in premium made up. If at the correct age, the Life Insured would not have been eligible for insurance under this Policy, no benefits will be payable, and all premiums paid will be refunded in full.

12.4 Absolute Owner 12.4.1 The Company is entitled to treat the Policyholder as the absolute owner of this Policy. 12.4.2 The Company will not recognise any equitable or other claim to or interest in this Policy.

12.4.3 The receipt by the: (a) Policyholder; (b) Policyholders legal personal representative(s); or (c) Hospital in which Eligible Expenses were incurred by the Life Insured, of any payment made will be a full and final discharge.

12.5 Law of the Republic of Singapore

12.5.1 This Policy will be construed according to and governed by the laws of the Republic of Singapore.


12.5.2 The laws of the Republic of Singapore will apply in the event of any conflict or dispute with regard to this Policy and the parties to the conflict or dispute agree to submit themselves to the exclusive venue and jurisdiction of the courts of the Republic of Singapore for the resolution of any conflict or dispute.

12.6 Exclusion of the Contracts (Rights of Third Parties) Act 2001

A person who is not a party to this Policy shall have no right under the Contracts (Rights of Third Parties) Act 2001 to enforce any of its terms.

Documents

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