DWATCH

RIDERS
D.W.A.T.C.H
RIDERS DWATCH
D - Disability
W - Waiver
A - Accident
T - Term
C - Critical Illness
H - Hospitalization 2
RIDERS
Because Savings and Protection Go
Hand in Hand
3
1
DISABILITY
RIDERS
4
“ DID YOU KNOW?
Stroke is the leading cause of

disability in the Philippines.
5
2 Types of Disability Riders
▰ Accelerated Total and Permanently Disability

▰ Non-accelerated Total and Permanently Disability
Disability riders are benefits that pay a lump sum cash benefit
If the Insured becomes totally and permanently disabled due to
Bodily injury or disease.
6
What is
Total & Permanent Disability?
If the life Insured is working at the time of disablement, disability is
considered total and permanent when the Life Insured is prevented
from engaging in any occupation or from performing any work for
compensation or profit.
The disability must be present and must have existed continuously for
not less than six consecutive months, during such time the Policy
Owner/Insured is/are required to keep the Policy in force.
7
What is
Total & Permanent Disability?
If the Life Insured is NOT working at the time of disablement, the
disability is considered total and permanent when the Life Insured is
permanently unable to undertake without assistance three or more
Activities of Daily Living.
The complete and irrevocable loss of sight of both eyes, or the total
and permanent loss by removal or disease of both hands or both feet,
or of one hand and one foot is considered as total and permanent
disability. 8
6 Activities of Daily Living
1. Transferring 2. Mobility
The ability to move in or out The ability to move from one room to
of a chair, including a an adjoining room or from one side of
wheelchair, bed or other the room to another.
stationary position , or to If a person can move with the help of
walk. equipment such as a cane, walker,
crutches, grab bars or other support
devices, then he or she will be
considered mobile. 9
3. Feeding 4. Continence
The ability to take any form The ability to voluntarily control bowel
of nourishment once it has or bladder function or to cleanup or
been prepared and made perform external care of a catheter or
available with or without use appliance.
of adaptive utensils.
10
5. Bathing 6. Dressing
The ability to wash one self The ability to put on or take off
completely in the bath or garments and/or medical appliances
shower or by other means to usually worn with or without the use of
maintain personal hygiene modified clothing or adaptive devices
with or with out the aid of such as tape fastener or zipper pulls.
special equipment
or adapted device.
11
Accelerated
Total & Permanent Disability
Pays lump sum cash benefit, forming part of the basic Sum
Assured, If the Insured becomes Totally and Permanently Disabled
due to bodily injury or disease.
Rider Limitations:
Issue age: 5 to 65
Benefit expiration: 70
Maximum sum assured: 100% of the basic
sum assured 12
Non - Accelerated
Pays lump sum cash benefit if the Insured becomes Totally and
Permanently Disabled due to bodily injury or disease. This rider shall
not affect the Policy's Sum Assured incase of a claim from this
benefit.
Rider Limitations:
Issue age: 5 to 65
Benefit expiration: 70
Maximum sum assured: 100% of the basic
sum assured 13
Basic Claim Requirements
1. Claimant's Statement
2. Attending Physician's Statement
3. Medical Certificate from the physician showing:
 doctor's name, dates of consultation,

 Confinement dates, the diagnosis/prognosis
 And treatment/medication give
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Basic Claim Requirements
4. Complete medical records, laboratory and

Diagnostic procedures and biopsy report
history of illness and test results.
5. Current Policy Data Page
6. Policy booklet, If claim results in

termination of policy
15
1.What happens to a Policy with an Accelerated Disability
Benefit of 100% of the Sum Assured in case of a
valid disability claim?
• Any policy debt is deducted from the Accelerated Total and Permanent
Disability Benefit
• The Insured shall receive the disability Benefit together with the
available fund value
• The said policy then terminates
16
2.What is Pru Life UK's Disability Benefit Limitation
in covering seafarers?
• The maximum cover for seafarers is PHP 60,000.00 per life
17
2
WAIVER RIDERS
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“ Heart Facts
• Even at rest, the muscles of the heart work hard–twice
as hard as the leg muscles of a person sprinting
• A Woman's heart beats faster than a man's
• Most heart attacks happen in the hours of
8 and 9am
19
DID YOU KNOW?
Premium Waiver is a benefit that

relieves the Insured/Payor from
premium payment caused by the
condition stated in the covered
benefit of the Policy.
20
Types of Waiver Riders
▰ Waiver of Premium on Total and Permanent Disability

▰ Payor Waiver
▰ Life Care Waiver
Waives premium payments as stated on the conditions

covered by the waiver.
21
1.Waiver of Premium on
22
A rider that waives subsequent premiums if the Life
Insured becomes totally and permanently disabled
due to bodily injury or disease based on the
definition of Total and Permanent Disability.
Pru Life UK shoulders the full premium during the

waived period until the benefit expiration or until
premium term is over, whichever comes first.
23
Rider Limitations
Benefit Who’s
Issue Age
Expiration Covered?
18-59
60 Insured
24
Frequently Asked Questions.
Does the payor need to pay during the

six month waiting period?
Yes, until the premium waiver condition is satisfied

and benefit is granted.
25
What happens if the insured recovers?
Premium payment shall resume.
26
2. Payor Waiver
27
A rider that can be attached to juvenile policies only. It
waives subsequent premiums if the Payor/Policy owner:
• Dies, or
• Becomes totally and permanently disabled, or
• Suffers complete and irrevocable loss of sight of both eyes, or
• Suffers total and permanent loss by removal or disease of:
• Both hands, or
• Both feet, or
• One hand and one foot
28
Rider Limitations
Issue Age Benefit Benefit

Issue Age
(Juvinile Expiration Expiration
(Payor)
insured) (insured) (payor)
18-59
0-17 25 60
29
3. Life Care Waiver
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A rider that waives all future premiums if the
Insured is diagnosed to be suffering from a critical
illness, or has undergone surgery,
in the case of critical illness requiring surgery.
Pru Life UK shoulders the full premium during the waived

Period until the benefit expiration or until premium term is
over, whichever comes first.
31
Rider Limitations
Benefit Who’s
Issue Age
Expiration covered?
18-54
70 Insured
32
1. What if the insured recovers from critical illness?
Premium payments remains to be waived.
33
2. What happens to a Policy's fund value while the

premium is waived?
During the waived premium period, the policy's fund
value shall remain unaffected.
34
3. Can a policy with a waiver rider avail of the benefit

even on premium holiday?
Yes, the benefit may still be availed for as long as the
Insured Satisfies the condition of the benefit.
The fund value shall no longer be subject to any unit
cancellation since the full regular premium shall be paid
by Pru Life UK.
35
3
Accident RIDERS
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Accident Rider
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“ On Accidents…
• 10 to 20 minute naps are ideal for boosting alertness
and energy
• Even the best laid plans can go wrong
• Accidents happen any time, anywhere
38
Accident benefit riders pay lump sum cash benefit
should the Insured suffer bodily injury or death due
to accident. The benefit may extend to cover other
incidental accident expenses.
39
Types of Accident Riders
▰ Accidental Death and Disablement (ADD) rider

▰ Personal Accident (PA) variants:
a. PA Standard c. PA Power
b. PA Executive d. PA Junior
Maximum Accident Benefit Per Life:

Php10,000,000/USD200,000
40
Accidental Death & Disablement Rider
Pays additional cash benefit separate from the Basic Sum Assured in
Case of accidental death, accidental disablement or accidental
Dismemberment following the Table of Losses and Liabilities.
41
Rider Limitations
Waiting Benefit
Issue Age
Period Expiration
5-65
None 73
42
AND TABLES TO COMPARE DATA
Loss Liability
Accidental Death 100 %

Loss of both hands 100 %
Loss of both feet 100 %
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Loss of sight of both eyes 100 %

Loss of one hand and one foot 100 %
Loss of one hand and sight of one eye 100 %
Loss of one foot and sight of one eye 100 %
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Loss of one foot 50 %

Loss of both thumbs 25 %
Loss of hearing in both ears 50 %
Loss of each finger 10 %
45
Personal Accident (PA) Rider
Provides comprehensive accident benefits separate from the

Basic Sum Assured.
46
Components
A. Accidental Death and Disablement (ADD)
A lump sum cash benefit, separate from the benefits of the basic
Policy, is paid due to death or bodily injury caused by an accident.
Cash Benefit is subject to the table of Losses and Liabilities.
47
Components
B. Accidental Total and Permanent Disability
A cash benefit is paid in the event that the accident results in

irreversible injury and the Insured becomes totally and permanently
disabled for a period of six consecutive months and remains to be
so at the end of such period.
48
Components
C. Murder and Assault
A rider that pays 50% of any benefit under the PA rider in the event
of murder and assault.
49
Components
D. Renewal Bonus
A benefit that provides increments of five percent (5%) of the ADD

coverage annually for the next five (5) years to the first Php1M ADD
benefit without additional premium.
50
Components
Accidental Medical Expense Reimbursement
A benefit that reimburses inpatient and outpatient expenses, up to a

specified limit incurred within 30 days from the date of the accident
with respect to medical or surgical treatment by a physician or in
connection with confinement in a registered or government hospital
including:
51
Components
 medications,
 first aid treatment,
 application of dressings,
 examination by x-ray,
 use of operating room and/or ambulance for the administration
of medicines or
 anesthetic as prescribed by a qualified medical practitioner
52
Personal Accident (PA) Rider Special
Benefits
Double Indemnity
A special feature of PA Executive that pays additional 100% cash
benefit of the Accidental Death benefit if the Insured dies while
travelling as a ticketed passenger or officially listed passenger in a
commercial bus, automobile, train, monorail, boat or airplane over
an established land, sea or air route.
Issue ages: 25 to 65
Benefit Expiration: 73 ❤
53
Benefits
Dangerous Sports Coverage

A special feature of PA Power that considers a
25% limited coverage for accidents while engaged
in an amateur extreme sport.
Issue ages: 18 to 24
Benefit Expiration: 26
54
Benefits
Field Trip Coverage (PA Junior)

A special feature of PA Junior that pays additional benefit for death
caused by accidents while in a school-sponsored trip.
Issue ages: 5 to 17
55
1.Can I attach ADD and PA in a Policy at the same
time?
No, only one of the two riders maybe attached.
2.How long after the accident can a claim be valid for filing?
Filing of claims should be made the soonest possible time
When the original documents are ready after the accident.
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4
TERM RIDERS
57
Term Rider
58
“ DID YOU KNOW?
Term Rider temporarily increase the basic
Life insurance coverage of the
Payor/Insured for a limited period.
59
Additional Term Rider
An additional cash benefit to the basic Sum Assured paid to the

stated Beneficiary/ies in case of untimely demise.
Issue age: 0 to 60
Who’s covered? Insured
Maximum sum assured: 100% of basic SA
60
Payor Term Rider
An attachable benefit that covers the untimely demise of the payor.

This rider pays cash benefit to the payor's stated beneficiary/ies
that may or may not be the same as the Insured's.
Issue age: 0 to 60 (PEP), 0 to 70 (PAA)

Who’s covered? Payor
Maximum sum assured: 100% of basic SA
61
5
CRITICAL ILLNESS
RIDERS
62
Critical Illness Rider 63
“ DID YOU KNOW?
 Only about 5 to 10% of All Cancers Are Inherited
 In 2010 , 9 out of 10 Deaths in the Philippines
are caused by Illness.
 A family stricken with critical illness will need
at least Php765,000 to as
much as Php5,000,000 for recovery
64
What are critical illness riders?
Critical illness riders pay lump sum cash

upon diagnosis or surgery of any of the
listed covered critical illness as defined in
the policy.
65
Critical Illness Riders
▰ Crisis Cover Benefit (CCB)

▰ Life Care Benefit (LCB)
▰ Life Care Plus (LC Plus)
▰ Multiple Life Care Plus (MLCP)
▰ Life Care Advance Plus (LCAP)
66
Accelerated Critical Illness Riders
▰ Crisis Cover Benefit (CCB) Covers 15 Critical Illnesses

and accelerates a Policy's Sum Assured (Max. PHP 5M
per life)
▰ Life Care Benefit (LCB) covers 36 critical illnesses and
accelerates the policy’s sum assured (Max. PHP 5M per
life)
Note : The accelerated riders may not be combined in one policy.
It may, instead, be combined together with other non- accelerated
critical illness riders. 67
Non-Accelerated Critical Illness Riders
▰ Life Care Plus

Maximum coverage per policy : 100% of Basic Sum Assured
Maximum coverage per life : PHP 5,000,000 per life
▰ Life Care Advance Plus

68
Non-Accelerated Critical Illness Riders
▰ Multiple Life Care Plus

69
Life Care Advance Plus
Pays up to a maximum of four times of early stage critical illness

provided that succeeding claims are from different early critical illness.
1. Claims for the Early Stage Critical and Advanced Stage Critical
Illness are “coordinated”, or maximum payable to the Insured is up to
100% of the policy.
2. Additional benefits are effective for as long as Early/Advanced

Stages benefits have not been exhausted or terminated.
70
3. The insured must survive at least thirty (30) days from date of diagnosis
for the benefit to be payable.
4. If the Life Insured is diagnosed by a registered doctor having one of the

ten (10) identified early critical illnesses, we pay 25% of the Life Care
Advance Plus benefit.
5. We pay this benefit for early stage critical illnesses up to a maximum of

four (4) times during the term of the policy provided that succeeding
claims are from different Early Stage critical illness/conditions.
71
72
Multiple Life Care Plus
1. Terminal illness may only be covered under the first claim, after
with, this rider terminates.
2. For group 1-cancer, the Life Insured is allowed to make up to 2
critical illness claims provided that the second cancer claim is
made after the expiry of a 5-year cancer-free period.
3. The cancer in the second cancer claim can be a reoccurrence of
the cancer in the first claim.
4. The required gap is one year for each critical illness.
5. The insured must survive at least thirty (30) days from date of
diagnosis for the benefit to be payable. 73
Multiple Life Care Plus
74
Rider Limitations
 Issue Age : 18-60 years old

 Benefit Expiration : Age 70
 Coordination of Critical Illness benefit:
Php8,750,000 per life if with MLCP and LCAP subject to
each CI rider’s sum assured limits
75
Frequently Asked Questions
Does this benefit follow a waiting period?

Yes, 90 days from date of the policy’s effectivity date or last
reinstatement date.
Do we cover pre-existing critical illnesses?
It depends on underwriting evaluation.
What happens to the policy if the benefit accelerates

100% of the Sum Assured?
The policy terminates. 76
6
HOSPITAL
INCOME RIDERS
77
Hospital Income Rider 78
“ DID YOU KNOW?
An average hospital bill is equal to three

times (3x) your monthly income.
79
Hospital Income Benefit Rider
 Hospital Income Benefit

 Long-term Hospitalization
 ICU Benefit
 Surgical Expense Benefit
80
Hospital Income Rider
provides cash benefit for each day of hospital
confinement of the Insured due to injury or
illness.
Rider limitations
Issue Age : 18-54 years old
Benefit Expiration : Age 65
Maximum Accident Benefit per life :
Php5,000 / USD100 81
Benefit Minimum SumAssured Maximum Sum
Assured
Daily Hospital Income PhP1,000 / USD20 PhP5,000 / USD100

Long Term Hospitalization 100% of DHI Benefit
Surgical Expense Benefit 15x of DHI Benefit
ICUBenefit 200% of DHI Benefit
82
Optional Benefits
▰ Long Term Hospitalization

An optional benefit that pays additional daily cash due to continuous confinement in excess
of thirty (30) days until 335 days of confinement
▰ Surgical Expense Benefit

An optional benefit that reimburses the Insured of surgeon’s fees, anesthesiologist’s fees,
operating room and recovery room fees due to in-patient surgery caused by an accident or
an illness up to the specified limit of the benefit
▰ Intensive Care Unit

An optional benefit that pays additional daily cash if confined in an ICU. 83
Will the 365 days daily hospital income benefit be

replenished per year or applied throughout the
lifetime of the insured?
The 365 days daily hospital income benefit per illness

is replenished on a per policy year basis.
84
Are pre-existing conditions covered?
Yes, only if declared.

Pre-existing conditions may only be covered after
twelve (12) months from effectivity date.
85
How do I prevent policy rescission caused by HI

Benefit?
The best way is to ensure the client to duly declare

health history and condition upon application.
86
Is there a waiting period for Hospital Income

Benefit?
Yes, the waiting period for illness only is thirty (30)

days from effectivity or last policy reinstatement.
87
How does this benefit affect PhilHealth, SSS and HMO

benefits?
 Surgical expense benefit requires original official

receipts
 DHI, LCB and ICU will not be affected.
88
What needs to be presented to claim?
• Claimant’s statement
• Attending Physician’s Statement
• Duly certified statement of account of hospitalization
• Admission and discharge summary
• Original official receipts for surgical expense benefit
claims
89
Turn-around Time
Contestable – evaluation process can take a minimum of 2

weeks from the date of completion of requirements
Incontestable – release of claim proceeds 7 working days

from the date of the completion of requirements
90
Denied Claims
Common Reasons:
1. Loss does not fulfill policy provisions
2. Loss falls under Exclusions / within Waiting Period
3. Fraudulent Claims
Delay:
1. Investigation
2. Incomplete Documents
91
THANKS!
Any questions?
92

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RIDERS

Stroke is the leading cause of

▰ Accelerated Total and Permanently Disability

 doctor's name, dates of consultation,

4. Complete medical records, laboratory and

5. Current Policy Data Page

6. Policy booklet, If claim results in

• The maximum cover for seafarers is PHP 60,000.00 per life

Premium Waiver is a benefit that

▰ Waiver of Premium on Total and Permanent Disability

Waives premium payments as stated on the conditions

Pru Life UK shoulders the full premium during the

Does the payor need to pay during the

Yes, until the premium waiver condition is satisfied

What happens if the insured recovers?

Premium payment shall resume.

Issue Age Benefit Benefit

Pru Life UK shoulders the full premium during the waived

1. What if the insured recovers from critical illness?

Premium payments remains to be waived.

2. What happens to a Policy's fund value while the

3. Can a policy with a waiver rider avail of the benefit

▰ Accidental Death and Disablement (ADD) rider

Maximum Accident Benefit Per Life:

Accidental Death 100 %

Loss of sight of both eyes 100 %

Loss of one foot 50 %

Provides comprehensive accident benefits separate from the

A. Accidental Death and Disablement (ADD)

B. Accidental Total and Permanent Disability

A cash benefit is paid in the event that the accident results in

C. Murder and Assault

A benefit that provides increments of five percent (5%) of the ADD

Accidental Medical Expense Reimbursement

A benefit that reimburses inpatient and outpatient expenses, up to a

Dangerous Sports Coverage

Field Trip Coverage (PA Junior)

An additional cash benefit to the basic Sum Assured paid to the

An attachable benefit that covers the untimely demise of the payor.

Issue age: 0 to 60 (PEP), 0 to 70 (PAA)

Critical illness riders pay lump sum cash

▰ Crisis Cover Benefit (CCB)

▰ Crisis Cover Benefit (CCB) Covers 15 Critical Illnesses

▰ Life Care Plus

▰ Life Care Advance Plus

▰ Multiple Life Care Plus

Pays up to a maximum of four times of early stage critical illness

2. Additional benefits are effective for as long as Early/Advanced

4. If the Life Insured is diagnosed by a registered doctor having one of the

5. We pay this benefit for early stage critical illnesses up to a maximum of

 Issue Age : 18-60 years old

Does this benefit follow a waiting period?

What happens to the policy if the benefit accelerates

An average hospital bill is equal to three

 Hospital Income Benefit

Daily Hospital Income PhP1,000 / USD20 PhP5,000 / USD100

▰ Long Term Hospitalization

▰ Surgical Expense Benefit

▰ Intensive Care Unit

Will the 365 days daily hospital income benefit be

The 365 days daily hospital income benefit per illness

Are pre-existing conditions covered?

Yes, only if declared.