General Information on PGEA Members' Personal Insurance Policy Coverage

GEOGRAPHICAL LIMIT : WORLDWIDE 

 

COVERAGE SCOPE OF COVERAGE

 

The plan covers 24 hours a day (on and off the job), within cover period, against loss of life or bodily injury resulting solely, directly and independently of all other causes from an accident caused by external, violent and visible means. 

 

POLICY CONDITIONS: 

 

1. The persons eligible to participate in this Group PA insurance are the actively at work Regular, Full-time, Probationary and Project Employees of the above-captioned assured, whose names declared in the policy and insurance ages between 18 but not over 65 years old. In good health, physical and mental condition, no infirmities of the sight or sense of hearing; no physical deformity or handicap such as absence of one or both hands, feet or eyes and is not declined for life insurance or any form of Personal Accident cover. 

 

2. All benefits payable under this policy shall be paid to individuals named insured¿s declared beneficiary/ies or compulsory heirs as their interest may appear. 

 

3. Subject to the following Extension of Cover:

 -Accidental Food and Drinks Poisoning (presence of deleterious matter on food and drinks and not as a result of spoilage/expiration) 

-Accidental Drowning 

-Commercial flying (as fare paying passengers) 

 

4. Subject to the following Warranties, Clauses and Endorsement: 

-Age Limit Clause 

-Policy Covers/Benefits 

-Termination of Accident Contract Endorsement 

-Medical Expense Reimbursement 

-Murder and Assault Endorsement 

-Accident Burial Assistance Warranty 

-Sabotage and Terrorism Exclusion Endorsement 

-Sanction Limitation Clause 

-Payment of Documentary Stamps Tax Warranty 

 

5. Subject to the Mercantile Insurance Co., Inc. standard PA terms and conditions, clauses and warranties. 

 

6. Subject to Accumulation Loss Limit of Php200,000,000.00 anyone Group. 

 

GENERAL EXCLUSIONS: 

 

The Policy does not cover: Death, disablement or injuries occasioned by or happening through:

 

a) (i) War, Invasion, Act of Foreign Enemy, Hostilities (whether war be declared or not). Civil war, Rebellion, Insurrection, Terrorism, Mutiny or Crowd disturbances, Military or Usurped Power or Popular Uprising; or any war like operations, Riot, Strike and Civil Commotion.

(ii) Intentionally self-inflicted injuries, Suicide or Attempted suicide (whether felonious or not),

while sane or insane; Alcoholism or under the influence of alcohol, drug addiction; HIV,

AIDS, sexually transmitted and venereal diseases.

(iii) Earthquake, Volcanic Eruption, or Tidal Wave.

(iv) Ionising radiations or contaminations by radioactivity.

(v) Bacterial infections (except pyogenic infections which shall occur through an accidental cut or wound).

 

b) Whilst the Insured is traveling in an aircraft other than one licensed for public passenger service and operated by a regular Airline on a published schedule flight over a regular air route between two definitely established airports and in which the Insured is traveling as ticket-holding passenger;

(extended to be covered in Commercial Flying as fare paying passenger)

 

c) Consequent upon the Insured engaging in hunting, racing of all kinds, steeple chasing, polo playing, motorcycle riding or driving, trekking/climbing and mountaineering, winter sports, ice hockey, football, yachting, or using woodworking machinery driven by mechanical power, scuba diving and other offshore activities, mountain biking, off road biking, parachuting, hang-gliding, professional sports with the exception of basketball, or racing other than on foot, participating in any dangerous sports and contact sports such taekwondo, boxing, muay thai and alike;

 

d) Murder and Assault or any attempt thereat; (extended to be covered ¿ if unprovoked¿)

 

e) Caused directly or indirectly by the bad faith of the Insured, by his/her participation in criminal acts, or as a result of his/her fraudulent, seriously negligent or reckless actions. The consequences of the actions of the Insured in a state of derangement or under psychiatric treatment are not covered either;

 

f) Whilst engaging in military duty;

 

g) Illegal acts or violations of the law;

 

h) Whilst the Insured takes part in bets, challenges, or brawls, save in the case of legitimate defense or necessity;

 

i) Activities engaged in any duty directly or indirectly pertaining to the following occupations: Aviator, steward/ess, individual connected with the military and police, missionaries, miners and

underground workers, individual involved in the manufacturing processing of nuclear materials and explosives, individual with constant contact with hazardous chemicals, individuals connected with politics, detective, bodyguards, bullfighters, divers, equestrians and jockeys, firemen, fishermen, fishing crew and any offshore activities/trainings, logging workers, circus workers, stuntmen, quarry workers, loggers, sawmill workers, racers, sailors, and window cleaners of a high rise buildings;

 

j) Any Pre-existing conditions. Pre-existing conditions are illnesses or injury for which the person has been under the care of a physician and has received medical care or advice or a condition for which a reasonable person should have sought treatment;

 

k) Congenital anomalies and conditions;

 

l) Pregnancy, childbirth and miscarriage or any related conditions with respect to woman.

 

m) Hospital confinement for:

(i) Rest cures

(ii) Periodic check ups

(iii) Cosmetic or plastic surgery

(iv) Any dental work, dental treatment or eye examination except as result of bodily injury

(v) Mental or nervous disorders

(vi) Any Rehabilitation treatments. Prostheses, orthopedic material or orhesis and osteosynthesis material, as well as spectacles;

(vii) Insect / mosquito bites.

 

DEFINITIONS OF BENEFITS:

 

1. ACCIDENTAL DEATH - Pay the full amount of the Principal Sum for accidental death occurring within twelve (12) months from the date of accident

 

PERMANENT DISABLEMENT - Pays the corresponding percentages as stated in the Table of Permanent Disablement if bodily injury as aforesaid shall within twelve (12) calendar months from the date of accident result in permanent and total disablement and not followed within twelve (12) calendar months from the date of accident result in permanent and total disablement and not followed within twelve (12) calendar months of the said bodily injury by the death of the Insured member.

 

TABLE OF PERMANENT DISABLEMENT BENEFITS

Loss of both hands, or fingers and thumbs of both hands 100%

Loss of both feet 100%

Loss of sight of both eyes 100%

Injuries resulting in being permanently bedridden 100%

Any other injury causing permanent total disablement 100%

Loss of arm at or above elbow 70%

Loss of arm between elbow and wrist 50%

Loss of hand 42.5%

Loss of four fingers and thumb of one hand 42.5%

Loss of finger 35%

Loss of thumb 15%

Loss of index finger 10%

Loss of middle finger 6%

Loss of ring finger 5%

Loss of little finger 4%

Loss of metacarpals - first or second (additional) 3%

Third, fourth or fifth (additional) 2%

Loss of leg or above knee 50%

Loss of leg below knee 40%

Loss of one foot 40%

Loss of toes - all one foot 15%

Loss of big toe 5%

Loss of any toe other than big toe, each 1%

Loss of sight of one eye 30%

Loss of hearing - both ears 50%

One ear 25%

The aggregate of all percentages payable in respect of any one accident shall not exceed 100%.

 

2. MEDICAL REIMBURSEMENT - Pay the cost of all necessary medical or surgical treatment, hospital care, nursing service, x-rays and dressings and all other reasonable medical expenses incurred within three months from the date of accident, up to the limit stated in the schedule of benefit.

 

3. UNPROVOKED MURDER AND ASSAULT - Pays the Insured of the Lump Sum benefit in the event of death resulting from murder and assault, up to the limit of benefit, subject to territorial limit occurring in the following geographical areas, including their cities, towns, barrios and barangays:

a. Lanao Del Norte f. Zamboanga Del Norte

b. Lanao Del Sur g. Sultan Kudarat

c. North Cotabato h. Sulu Archipelago

d. South Cotabato i. Basilan

e. Zamboanga Del Sur j. Mindanao including Maguindanao area

 

4. ACCIDENTAL BURIAL BENEFIT - Pays the Insured, in addition to all other benefits, the amount selected if death was due to accident.

 

5. BEREAVEMENT ASSISTANCE - Pays the insured in addition to all other benefits, the amount selected if death was due to natural death.

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Insurance coverage shall take effect thirty (30) working days from the date of your membership ID issuance. For any claim, a written advice should be sent to PGEA within fifteen (15) days.