Singlife Philippines Medical Insurance Policy

Singlife Philippines Inc.
12F Four/NEO, 30th St. Corner 4th Ave.

Bonifacio Global City, Taguig 1634
singlife.com.ph
Hi GENEST JAN II,
Welcome to Singlife!
Thank you for choosing us as your insurance partner. We recognize how buying insurance can be a
frustrating experience. Here at Singlife, our mission is to make insurance as simple, transparent, and
dynamic as possible to fit the way you live.
This document serves as your Policy Contract for Cash for Medical Costs. It details the benefits and other
important information of your insurance policy. These types of documents can get difficult to read, so we’ve
tried to cut the jargon and make it as simple to understand as possible.
Singlife aims to pay every valid claim on time. To make that happen, please take a few minutes to review the
details of your Policy Contract and understand what you are entitled to so that when the time comes, you’ll
be sure your claim is paid out promptly.
We truly believe that insurance should be offered as flexibly as the way you live. So just in case you change
your mind about buying Cash for Medical Costs, you can cancel your policy until January 15, 2022 by either
contacting us or doing so through the Services Tab in the Product Page on your GCash App. We’ll refund your
payment in full.
If there’s anything you don’t understand in this Policy Contract, or if you have suggestions to make insurance
even simpler, you may reach us via our hotline (02)-8299-3737 or at help@singlife.com.
Rien Hermans
President & CEO
Welcome Letter
Cash for Medical Costs
Form No. GCMheCWcm.21v1

Get in Touch with Us
You can reach us via the following channels:
Email us at:
help@singlife.com
Call us at:
(02)-8299-3737
Message us at:
facebook.com/SinglifePhilippines

12F Four/NEO, 30th St. Corner 4th Ave. Get in Touch with Us
Bonifacio Global City, Taguig 1634 Cash for Medical Costs
singlife.com.ph Page 03 Form No. GCMheCPrS.21v1

Table of Contents
Welcome Letter 02
Get in Touch with Us 03
Policy Details Page 05
Your Policy Contract 06
Definition of Terms We Use 07
01. Your Benefits 11
1.1 Daily Hospital Cash Benefit

1.2 Additional Coverages
1.2.1 Any Critical Condition Diagnosis Benefit
1.2.2 Late Stage Critical Condition Diagnosis Benefit
1.2.3 Medical Cost Reimbursement for Late Stage Critical Condition Benefit
02. List of Covered Critical Conditions 20
03. What We are Not Able to Cover 24
04. Premiums 26
05. Claims 27
06. Your Beneficiaries 29
07. Termination of Your Policy 30
08. Your Rights 32
09. General Provisions 34
Annex A – Description of Covered Critical Conditions
Annex B – Description of Covered Surgeries

12F Four/NEO, 30th St. Corner 4th Ave. Table of Contents

Policy Details Page
as of January 01, 2022 Policy Number: MH-02000017057
Product Name Policy Number Currency

Cash for Medical Costs MH-02000017057 Philippine Peso
Policy Owner’s Information
First Name Middle Name Last Name

GENEST JAN II SEPE RAMIREZ
Primary Insured’s Information

Sex Issue Age

Male 34
Policy Information
Base Insurance Sum Assured Status

Health Insurance (Any Cause) PHP 300,000.00 Active
Benefit Period Effective Date Termination Date

Up to Age 65 January 01, 2022 January 01, 2053
Maximum Years Payable Policy Anniversary Form Number

31 Years Every January 01 GCMheCPDP.21v1
THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID

12F Four/NEO, 30th St. Corner 4th Ave. Policy Details Page
singlife.com.ph Page 5.1.1 Form No. GCMheCPDP.21v1

Policy Details Page
Policy Benefits
Health Insurance (Any Cause)
Benefit Amount
Daily Hospital Cash Benefit PHP 1,000.00 *

*x3 if confined in an ICU
Any Critical Condition Diagnosis Benefit PHP 75,000.00
Late Stage Critical Condition Diagnosis Benefit PHP 300,000.00
Medical Cost Reimbursement for Late Stage Critical Condition PHP 300,000.00
Benefit
* Benefits — Payments or services provided under the circumstances described in your policy.


Policy Details Page
Schedule of Premiums
Product Yearly Monthly
Health Insurance (Any Cause) 8,665.00 867.00
Daily Hospital Cash Benefit 4,138.00 414.00
Any Critical Condition Diagnosis Benefit 948.00 95.00
Late Stage Critical Condition Diagnosis Benefit 1,860.00 186.00
Medical Cost Reimbursement for Late Stage

1,719.00 172.00
Critical Condition Benefit
Total Premium 8,665.00 867.00
Premium Schedule Premium Due Dates Policy Anniversary

Monthly Every 1st of the month Every January 01
* Premiums — The amount of money you pay to be covered under an insurance policy.
Attachments
Issue Date Form Number Attachment
January 01, 2022 GCMheCDpS.21v1 Annex A-Description of

covered Critical Conditions
January 01, 2022 GCMheCDpS.21v1 Annex B-Description of

covered Surgeries
January 01, 2022 GCMheCDpS.21v1 Dependent Coverage

Contract


Policy Details Page


Insured Dependent’s Information

Precious Ledres Ramirez
Sex Issue Age

Not Provided 27
Policy Information



38 Years Every January 01, 2023 GCMheCPDD.21v1

singlife.com.ph Page 5.1.4 Form No. GCMheCPDD.21v1

Policy Details Page
Policy Benefits
Benefit Amount

Benefit


Policy Details Page
Late Stage Critical Condition Diagnosis Benefit 1,125.00 113.00

981.00 99.00

Attachments


covered Surgeries
January 01, 2022 GCMheCDpS.21v1 Dependents Coverage

Contract


Policy Details Page


Insured Dependent’s Information

Shan Kyle Yuan Ledres Ramirez
Sex Issue Age

Not Provided 4
Policy Information



19 Years Every January 01, 2023 GCMheCPDD.21v1


Policy Details Page
Policy Benefits
Benefit Amount

Benefit


Policy Details Page
Late Stage Critical Condition Diagnosis Benefit 480.00 48.00

342.00 35.00

Attachments


covered Surgeries
January 01, 2022 GCMheCDpS.21v1 Dependents Coverage

Contract


Your Policy Contract
This Policy Contract details the insurance you have bought. It consists of the following:
 Your Product Contract contains the benefits of the coverage you have purchased.
This section of the document explains what your insurance does and does not cover.
 Your Policy Details Page(s) describe the summary of benefits unique to each insured individual.
These pages will be updated each time the benefits are updated.
 Your Application Form documents the initial purchase process of your insurance policy through
the GCash App.
The following documents may also form part of this Policy Contract:
 All other forms that will be used in processing your application and servicing your Policy
An example is the Health Statement Form which documents additional questions about your
health that we may ask.
 The Dependents Coverage Contract details the insurance you have bought, if any, for qualified
dependents and contains their benefits. This is created for family plans that allow you to include
dependents in your Policy.
 Endorsements are documents that confirm changes made, if any, to your Policy. For example,
upon our approval of your request to increase your Policy’s coverage, we will issue an
endorsement.
 To provide flexibility to the varying needs of customers, we may offer additional benefits which you
may opt to purchase and add to your Policy. Supplementary Contracts detail additional benefits,
any limitations or conditions that you need to be aware of, and any changes made to the
provisions of your Policy due to the additional benefit.

singlife.com.ph Page 06 Form No. GCMheCPDD.21v1

Definition of Terms We Use
Making insurance as simple and transparent as possible starts with the terms we use. While we have cut the jargon
throughout this document, there are key insurance terms that will help you understand your insurance policy
better.
Policy Roles
Every insurance policy has key policy roles: the Policy Owner, the Primary Insured, and the Beneficiary.
Policy Owner/Primary The person who applies for the Policy. He/she is the person with rights
Insured to the Policy. He/she is also the person covered by the Policy.
Beneficiary The person/s designated to receive the policy benefits if the Insured
passes away. They are primary and revocable in this insurance policy,
which means the Policy Owner has the right to change any of them over
time and perform all his/her policy rights and privileges without the
Beneficiary’s consent.
When we say “you”, we mean both the Policy Owner and the Primary Insured, who is the same individual.
When we say “we”, “us”, and “our”, we mean Singlife Philippines Inc. the issuer of your insurance policy.
Dates & Periods

To ensure your Policy remains active, take note of the following definitions.
Effective Date The day when your insurance coverage becomes active as stated in your
Policy Details Page(s) upon payment of the initial premium.
Age Age refers to the Insured’s age as of his/her last birthday.
Policy Anniversary The date that occurs every year that is the same month and day as your
Effective Date.
Policy Year The twelve (12) month period between Policy Anniversaries.
Renewal Date The date after the end of term of a policy. In this Policy, it falls every
Policy Anniversary from the Effective date.

12F Four/NEO, 30th St. Corner 4th Ave. Definition of Terms We Use

Premium The amount of money you pay to be covered under an insurance policy.
Premium Due Date The day your premium payment becomes payable.
Termination Date The date when your insurance coverage ends.
Waiting Period This is a ninety (90) day duration from the Effective Date or date of last
reinstatement of your Policy that must go by before you can make any
valid claim to your Policy.
The Waiting Period also applies when you make changes to your benefit
coverage, which starts from the effective date of change.
The Waiting Period will apply to hospitalizations, Critical Condition

diagnosis and medical reimbursement due to an illness, where the
diagnosis and/or signs or symptoms are first experienced within the
ninety (90) day Waiting Period.
It will not apply to hospitalizations, Critical Condition diagnosis and

medical reimbursement that are due to Accident.
Free-Look Period This is a fifteen (15) day duration after you have received your Policy
when you may cancel your Policy and get a full refund of the premiums
paid.
Grace Period This is the duration given to you after the Premium Due Date when you
can pay overdue premium without your insurance coverage terminating.
Relating to Your Benefits

Your benefits include certain qualifications that you need to understand, so that your claims are deemed valid.
Critical Conditions This is any of the condition listed on Section 2 ‘List of Covered Critical
Conditions’. The condition must satisfy the descriptions stated in Annex A
‘Description of Critical Conditions Covered’.


Accident or Accidental Any unintentional act or unforeseen, unusual, and unexpected which
directly causes an injury or death, solely and independently from any
other means.
“Injury” means damage to the body caused by external, violent, and

accidental means including accidental drowning, and independent of
any other cause.
Pre-Existing Condition This is any condition, including congenital anomalies and conditions
arising from them, for which the insured may have already had signs or
symptoms, received medical advice, diagnosis, medication, or treatment
prior to the effective date or date of last reinstatement, whichever is later.
Any condition where a physician has certified that the insured has fully
recovered for at least twenty-four (24) months prior to the effective
date or date of last reinstatement (whichever is later) will not be
considered as a Pre-Existing Condition.
Actual Eligible Expense These are reasonable and customary medical costs related to the
diagnosis and procedures/surgeries of Critical Conditions that have been
incurred.
Hospital For this Policy, a hospital is defined as any of the hospitals listed in our
website. This list is kept up to date on a regular basis.
If a hospital is not in the list, it will still qualify if it falls under the
Department of Health (DOH) definition of a hospital:
“A place devoted primarily to the maintenance and operation of health

facilities for the diagnosis, treatment and care of individuals suffering
from illness, disease, injury or deformity or in need of obstetrical or other
surgical, medical and nursing care. It shall also be construed as any
institution, building or place where there are installed beds, cribs or
bassinets for twenty-four (24) hour use or longer by patients in the
treatment of diseases.”
Hospital Days This is the duration that a person stayed in a hospital, from the date of
admission to the date of discharge. This can be found in the Hospital’s
medical statement of account.


Intensive Care Unit This is a facility which meets all of the following requirements:
or ICU  it is a special unit in the hospital;
 it is dedicated to critically or acutely ill patients who need critical
care for severe illness or life-threatening injuries and require
constant monitoring, medication and nursing care; and
 it provides special expertise and technical monitoring facilities on
a twenty-four (24) hour operating basis for full support of vital
functions and uses the skills of medical, nursing and other
personnel highly trained to deliver intensive or critical care.
Reset Period This is a twelve (12) month duration that must pass – starting from the
diagnosis date of the last Late Stage Critical Condition approved under
the Late Stage Critical Condition Diagnosis Benefit – before a new Late
Stage Critical Condition can be payable again under the same diagnosis
benefit. Any diagnosis should be made while your Late Stage Critical
Condition Diagnosis Benefit is active.
Both conditions should be listed in Section 2 ‘List of Covered Critical
Conditions’.
Physician This is a person licensed under the law to practice medicine, excluding
your or the insured's relatives up to the third (3rd) degree of
consanguinity or affinity.
Claim This is a formal request by you, the Policy Owner, the Beneficiary/ies or
any authorized claimant to an insurance company for coverage or
compensation for a covered loss or event. We will validate the claim and,
once approved, issue payment to you or your Beneficiaries.


1. Your Benefits
We will pay the following benefits to you, while your Policy is active and subject to the benefit
amount limits stated in the Policy Details Page(s). If we cannot pay the benefit to you because you
passed away, we will pay it to your Beneficiaries.

Families are often unprepared for the hospitalization costs that an illness or accident may entail.
To cover a portion of your daily hospital room and board, we will pay you the benefit
amount as stated in your Policy Details Page(s) for each hospital day you are confined,
provided that:
 your confinement in a Hospital is because of an Illness or Accident; and
 It is medically necessary as recommended by an attending Physician; and
 You are confined for at least two (2) Hospital Days.
If you are confined in the Intensive Care Unit (ICU), we will pay three times (3x) the Daily
Hospital Cash Benefit for each day of ICU confinement.
Separate hospital confinements that are due to the same cause and happens within thirty
(30) days from date of last discharge to latest confinement, will be considered as one (1)
event of continuous confinement. The total number of Hospital Days that you are confined
within a continuous confinement will be used to determine the minimum Hospital Days
required as described above.
A confinement that starts during the Policy Year and ends in the next Policy Year will be
considered as a confinement for the earlier Policy Year.
Pregnancy-related coverage for Daily Hospital Cash Benefit
Hospital confinement due to Pregnancy is covered under the Daily Hospital Cash Benefit,
provided that:
 the first day of the hospital confinement happens one (1) year after the effective
date or date of last reinstatement of your Policy; provided that the state of being
pregnant must be after one (1) year from the effective date or date of last
reinstatement of your Policy; and
 the confinement is medically necessary as recommended by an attending

physician; and
 you are confined for at least two (2) Hospital Days.

12F Four/NEO, 30th St. Corner 4th Ave. Your Benefits

1. Your Benefits
 your confinement is due to any of the following:
o Any of the following childbirth delivery procedures:
 Natural Spontaneous Delivery / Vaginal Delivery
 Cesarean Section (C-Section)
 Assisted Delivery
o Pregnancy-related complications
o Extended confinement due to childbirth complications.
Things you need to know
 For Daily Hospital Cash, we will only pay up to one hundred (100) Hospital Days of
hospital confinement in a Policy Year. This is inclusive of any confinement in the ICU.
When the total number of Hospital Days claimed under this coverage reaches one
hundred (100) Hospital Days in a Policy Year, you can no longer file a claim under the
Daily Hospital Cash Benefit for that Policy Year. However, you must continue to pay
your premium for your Policy to remain active.
 The one hundred (100) Hospital Days limit under the Daily Hospital Cash Benefit will
reset every Policy Anniversary unless your Policy terminates.
 The ninety (90) day waiting period will not apply for hospital confinements that are
due to an Accident. We will pay the Daily Hospital Cash Benefit if it is due to an
Accident as long as the benefit is active when the incident happens.
 We will not pay for the Daily Hospital Cash Benefit if the hospital confinement is due
to an illness that is present during the ninety (90) day Waiting Period. This includes
any signs or symptoms of the illness that is present during the Waiting Period.
 We will not pay for the Daily Hospital Cash Benefit if the hospital confinement is due
to pregnancy or childbirth within one (1) year from the effective date or date of last
reinstatement, whichever is later, of your Policy.
 A confinement that starts during the Policy Year and ends on the next Policy Year,
will be considered as a confinement for the earlier Policy Year.


1. Your Benefits
The benefits that are specified in the following sections can only be availed if they are
included in the Policy Details Page(s) and the premium for the Additional Coverage is paid
for.

Critical conditions may incur higher than average medical costs that can affect a
family’s financial position.
The Any Critical Condition Diagnosis Benefit can only be availed if it is included in
your Policy Details Page(s) and the premium is paid for.
To help you with the costs for the diagnosis of a Critical Condition, we will pay the
amount as stated in your Policy Details Page(s) in lump sum, provided that:
 You are diagnosed with a Critical Condition as defined in
Section 2 ‘List of Covered Critical Conditions’; and
 The Critical Condition diagnosis happens and/or signs or symptoms are first
experienced after the ninety (90) day Waiting Period, subject to the
conditions set in this Policy.
If you pass away due to a Critical Condition as defined in Section 2 ‘List of Covered
Critical Conditions’, we will pay the benefit amount for Any Critical Condition
Diagnosis Benefit to your beneficiary/ies.
You can claim only once under this benefit, may it be for diagnosis of a Critical
Condition or passing away due to a Critical Condition. Once a claim is approved or
if you passed away (whichever comes first), the Any Critical Condition Diagnosis
Benefit terminates thereafter.
Any Critical Condition
These are conditions that are defined in Section 2 ‘List of Covered Critical
Conditions’. A Critical Condition may be classified as Early Stage, Intermediate
Stage, or Late Stage.


1. Your Benefits
 The ninety (90) day waiting period will not apply for Critical Conditions that are due
to an Accident. We will pay the Any Critical Condition Diagnosis Benefit if it is due to
an Accident as long as the benefit is active when the Accident happens.
 We will not pay the Any Critical Condition Diagnosis Benefit if the Critical Condition
is due to an illness that is already present during the ninety (90) day Waiting Period.
This includes any signs or symptoms of the illness that are present during the
Waiting Period.
 We will not pay the Any Critical Condition Benefit if the claim arises from a
Pre-Existing Condition or from any of the causes listed under Section 3 ‘What we are
not able to Cover’.


1. Your Benefits
For critical conditions that are already in the late stage, medical costs may be much
higher requiring immediate care and/or long-term medical attention.
The Late Stage Critical Condition Diagnosis Benefit can only be availed if it is
included in your Policy Details Page(s) and the premium is paid for.
We will pay the benefit amount for Late Stage Critical Condition Diagnosis Benefit,
as stated in your Policy Details Page(s), provided that:
 You are diagnosed with a Late Stage Critical Condition as defined in
Section 2 ‘List of Covered Critical Conditions’; and
 the Late Stage Critical Condition diagnosis happens and/or signs or

symptoms are first experienced after the ninety (90) day Waiting Period,
subject to the conditions set in this Policy.
If you pass away due to a Late Stage Critical Condition as defined in Section 2 ‘List
of Covered Critical Conditions’, we will pay the benefit amount for Late Stage
Critical Condition Diagnosis Benefit to your beneficiary/ies as long as we have not
approved a claim for that Critical Condition, subject to the conditions set in this
Policy.
Advance Payment of a Critical Condition

If we have approved the Any Critical Condition Diagnosis Benefit, it will be considered
an advance payment of the Late Stage Critical Condition Diagnosis Benefit if:
 the Critical Condition approved under Any Critical Condition Diagnosis
Benefit is an Early or Intermediate Critical Condition as listed in Section 2 ‘List
of Covered Critical Conditions’; and
 the Early or Intermediate Critical Condition is related to the Late Stage Critical
Condition that will be paid under the Late Stage Critical Condition Diagnosis
Benefit.
This means that the Late Stage Critical Condition Diagnosis Benefit we will pay you
will be the benefit amount for Late Stage Critical Condition Diagnosis Benefit as
stated in your Policy Details Page(s) minus the Any Critical Condition Diagnosis
Benefit we have approved thus far, if applicable.


1. Your Benefits
Multi-Claim Feature of Late Stage Critical Condition Diagnosis Benefit
We will pay for the Late Stage Critical Condition Benefit up to three (3) times in
your lifetime, subject to the following conditions:
1. You can only claim for each Late Stage Critical Condition once in your
lifetime, but you can claim up to three (3) unrelated Late Stage Critical
Conditions in your lifetime.
2. In order for a succeeding Late Stage Critical Condition to be paid for the
Late Stage Critical Condition Diagnosis Benefit, the Critical Condition
diagnosis happens and/or signs or symptoms are first experienced after
the twelve (12) month Reset Period. Any claim made during the Reset
Period will not be accepted.
3. If you are diagnosed with more than one (1) Critical Condition on the
same date or if the diagnosis of all conditions and/or their signs or
symptoms are first experienced within twelve (12) months of each other
and claims are filed for all of them, only the earliest valid claim will be
paid the Late Stage Critical Condition Diagnosis Benefit. Additionally, if
they are diagnosed (including signs or symptoms) at exactly the same
time, we will only consider one (1) of the critical condition as part of your
claim.
4. The following conditions can be claimed only if they are not as a result of
other covered critical conditions listed in Section 2 ‘List of Covered Critical
Conditions’:
 Terminal Illness
 Late Stage Loss of Independent Existence
However, if it is due to a covered Critical Condition, the claim will be
payable under that covered Critical Condition.
5. If you already have an approved claim for a Late Stage Critical Condition,
under either Any or Late Stage Critical Condition Diagnosis Benefit, you
can no longer claim for the following Late Stage Critical Conditions:


1. Your Benefits
Reset Period
This is a twelve (12) month duration that must pass - starting from the diagnosis date
of the last Late Stage Critical Condition paid under the Late Stage Critical Condition
Diagnosis Benefit – before a new Late Stage Critical Condition can be payable again
under the same diagnosis benefit. Any new diagnosis should be made while your
Late Stage Critical Condition Diagnosis Benefit is active.
Both conditions should be listed in Section 2 ‘List of Covered Critical Conditions’.
 The ninety (90) day Waiting Period will not apply for Late Stage Critical Conditions
that are due to an Accident. We will pay the Late Stage Critical Condition
Diagnosis Benefit if it is due to an Accident as long as the benefit is active when
the incident happens.
 We will not pay for the Late Stage Critical Condition Diagnosis Benefit if the Late
Stage Critical Condition is due to an illness that is already present during the
ninety (90) day Waiting Period. This includes any signs or symptoms of the illness
that is present during the Waiting Period.
 Any claim for Late Stage Critical Condition Diagnosis Benefit during the Reset
Period is not payable. You will still have to continuously pay for your premiums to
keep your Late Stage Critical Condition Diagnosis Benefit active.
 Once we have approved the third (3rd) Late Stage Critical Condition Diagnosis
Benefit under your Policy, the Late Stage Critical Condition Diagnosis Benefit will
terminate.
 The Critical Conditions are considered related to each other if they belong to the
same Group.
 We will not pay the Late Stage Critical Condition Diagnosis Benefit if the claim
arises from a Pre-Existing Condition or from any causes under Section 3 ‘What We
are Not Able to Cover’.


1. Your Benefits
1.2.3 Medical Cost Reimbursement for Late Stage Critical
Condition Benefit
Costs for serious Critical Conditions can increase especially if it requires immediate
treatment and surgeries.
The Medical Cost Reimbursement for Late Stage Critical Condition Benefit can
only be availed if it is included in your Policy Details Page(s) and the premium is
paid for.
We will pay you for the Actual Eligible Expense up to benefit amount of the
Medical Cost Reimbursement for Late Stage Critical Condition Benefit stated in
your Policy Details Page(s), provided that:
 You are confined to undergo any of the surgeries for the Late Stage Critical
Condition Benefit listed under Annex B ‘Description of Covered Surgeries’; and
 The surgery is for the same Late Stage Critical Condition that was approved
or filed under the Late Stage Critical Condition Diagnosis Benefit; and
 The surgery must happen within 90 days from the date of diagnosis of the
Late Stage Critical Condition.
In case of confinement, treatments or surgeries outside the Philippines, we may -

at our own discretion - re- assess the hospital expenses payable for Medical Cost
Reimbursement for Late Stage Critical Condition to a comparable amount in
Philippine Peso had it been administered in the Philippines. The maximum
amount to be paid will be the benefit amount of the Medical Cost Reimbursement
for Late Stage Critical Condition Benefit stated in your Policy Details Page(s).
Actual Eligible Expense
These are reasonable and customary medical costs related to the diagnosis
and procedures/surgeries of Critical Conditions that have been incurred.


1. Your Benefits
 We will not deduct any payments that have been made by PhilHealth or any
health insurance providers from the benefits we will pay you.
 If we find your claim documents to be invalid or if we have reason to believe

that the cause of confinement, diagnosis, treatment or death is due to
causes listed in Section 3 ‘What We are Not Able to Cover’ or not due to
conditions as defined in Annex A ‘Description of Covered Critical Conditions’
or Annex B ‘Description of Covered Surgeries’ we may request the following
to further assess your claim, where it is not forbidden by law:
o undergo medical examination (at our expense); or
o submit other validation documents; or
o complete other necessary procedures
 Your total benefits under this Policy and your other health insurance
policies/coverages issued by Singlife will be subject to the maximum
allowable amount that we set at the time this Policy was issued. We will
refund to you the total premiums you paid that correspond to any amount
in excess of the maximum allowable amount.


2. List of Covered Critical Conditions
The following are the covered Critical Conditions under your Policy, they are further defined on
Annex A ‘Description of Covered Critical Conditions’:
A Critical Condition may be classified as Early Stage, Intermediate Stage, or Late Stage. The Critical
Conditions are considered related to each other if they belong to the same Group.
Early Stage Intermediate Stage Late Stage

Group
Critical Condition Critical Condition Critical Condition
Cancer Related Conditions
Carcinoma in Situ of Specified

1 Carcinoma in Situ Organs Treated with Radical Major Cancers
Surgery
Heart Related Conditions
Port Access of Keyhole Cardiac Coronary Artery Bypass

2 Transmyocardial Laser Therapy
Surgery Surgery
Pericardiectomy; or Early Cardiomyopathy; or Heart Attack of Specified

3
Cardiac Pacemaker Insertion Cardiac Defibrillator Insertion Severity
Percutaneous Valve
4 Percutaneous Valvuloplasty Heart Valve Surgery
Replacement or Repair
Moderate Coronary Artery Other Serious Coronary Artery

5 Mild Coronary Artery Disease
Disease Disease
Secondary Pulmonary Primary Pulmonary

6 Early Pulmonary Hypertension
Hypertension Hypertension
Large Asymptomatic Aortic Minimally Invasive Surgery to

7 Surgery to Aorta
Aneurysm Aorta
Blood Related Conditions
Myelodysplastic Syndrome or
8 Reversible Aplastic Anemia Aplastic Anemia
Myelofibrosis
Occupationally Acquired HIV; or

9 HIV due to Assault HIV due to Organ Transplant
HIV due to Blood Transfusion

12F Four/NEO, 30th St. Corner 4th Ave. List of Covered Critical Conditions

Group
Neurological Conditions
Diagnosis of Dementia Moderately Severe Alzheimer's Alzheimer's Disease / Severe

10
including Alzheimer's Disease Disease Dementia
11 Akinetic Mutism Locked-in Syndrome Apallic Syndrome
Bacterial Meningitis with

12 Bacterial Meningitis Severe Bacterial Meningitis
Reversible Neurological Deficit
Surgical Removal of Pituitary

13 Tumor by Transsphenoidal/ Benign Brain Tumor
Tumor by Open Craniotomy
Transnasal Hypophysectomy
Coma for 72 Hours; or

14 Coma for 48 Hours Coma for 96 Hours
Severe Epilepsy
Head Trauma Requiring

Reconstructive Surgery; or
Head Trauma Requiring Open
15 Cervical Spinal Cord Injury; or Major Head Trauma
Craniotomy
Surgery for Subdural
Hematoma
16 Peripheral Neuropathy Early Motor Neuron Disease Motor Neuron Disease
17 Early Multiple Sclerosis Mild Multiple Sclerosis Multiple Sclerosis
Spinal Cord Disease or Injury

18 Resulting in Bowel and Bladder Moderate Muscular Dystrophy Muscular Dystrophy
Dysfunction
Loss of Use of One Limb

19 Loss of Use of One Limb Paralysis
Requiring Prosthesis
Moderately Severe Parkinson's

20 Early Parkinson's Disease Parkinson's Disease
Disease
Brain Aneurysm Surgery; or

21 Carotid Artery Surgery Stroke
Cerebral Shunt Insertion
22 Encephalitis with Full Recovery Mild Encephalitis Viral Encephalitis


Group
Organ Related Conditions
Optic Nerve Atrophy with Low

23 Loss of Sight in One Eye Blindness (Loss of Sight)
Vision
Partial Loss of Hearing; or

24 Cavernous Sinus Thrombosis Cochlear Implant Surgery Deafness (Loss of Hearing)
Surgery
25 Liver Surgery Liver Cirrhosis End Stage Liver Failure
Severe Asthma; or
26 Surgical Removal of One Lung End Stage Lung Disease
Insertion of a Vena Cava Filter
Biliary Tract Reconstruction Chronic Primary Sclerosing

27 Fulminant Hepatitis
Surgery Cholangitis
Chronic Kidney Impairment; or

28 Surgical Removal of One Chronic Kidney Disease Kidney Failure
Kidney
Permanent or Temporary Loss of Speech due to Vocal

29 Loss of Speech
Tracheostomy Cord Paralysis
30 Mild Severe Burns Moderately Severe Burns Major Burns
Small Bowel Transplant or Waitlist on a Major Organ/ Major Organ / Bone Marrow
31
Corneal Transplant Bone Marrow Transplantation Transplantation
Others
Early Stage Loss of Intermediate Stage Loss of Late Stage Loss of Independent
32
Independent Existence Independent Existence Existence
Poliomyelitis (Intermediate
33 Peripheral Neuropathy Poliomyelitis
Stage)
Progressive Scleroderma with

34 Early Progressive Scleroderma Progressive Scleroderma
CREST Syndrome
SLE with Lupus Nephritis; or

Mild Systemic Lupus
35 Moderately Severe SLE with
Erythematosus (SLE)
Lupus Nephritis
36 Terminal Illness


The following are Child Related Critical Conditions, which are only payable if the insured is between
thirty (30) days old and seventeen (17) years old at the time of diagnosis (including when signs or
symptoms are first experienced).

Group
Child Related Conditions
Insulin Dependent Diabetes

37
Mellitus
38 Hemophilia A or Hemophilia B
39 Kawasaki Disease
40 Osteogenesis Imperfecta
Rheumatic Fever with Valvular

41
Impairment
42 Severe Asthma
Severe Dengue (Dengue

43
Hemorrhagic Fever)
Systemic Juvenile Idiopathic

44
Arthritis (Still's Disease)
45 Wilson's Disease


3. What We are Not Able to Cover
1. We will not pay for any benefits that are due to an illness that happens within the ninety (90)
day Waiting Period.
2. We will not pay any benefit under your Policy if these are due to any the following:
 a Pre-Existing Condition; or
 suicide or any attempted suicide, while sane or insane; or
 any intentionally self-inflicted injury; or
 any illegal or unlawful act, or any attempt to perform any illegal or unlawful act
(including any act of terrorism) committed by you; or
 while you are in an aircraft or submarine except if as a fare-paying passenger in a
commercial aircraft; or
 voluntary taking, inhaling, or absorbing of poison, gas or fumes; or
 accidents arising from the effects of alcohol or improper use of drugs or narcotics; or
 any nuclear, biological, radioactive, or chemical contamination; or
 engagement in any dangerous sports or hobbies; or
 mental, nervous, or manifested sleep disorders or any other complications arising from
such.
3. We will not pay any benefit under any Daily Hospital Cash Benefit, if the confinement is for the
purpose of any of the following:
 bed rest or rest cures; or
 rehabilitation; or
 hospice care, a special kind of care that focuses on the quality of life for people who are
experiencing an advanced, life-limiting illness; or
 pregnancy related confinements where the state of being pregnant happens within one
(1) year from the effective date or date of last reinstatement of your Policy.
4. We will not pay any benefit under Medical Cost Reimbursement for Late Stage Critical Condition
Benefit and Daily Hospital Cash Benefit, if the expenses or confinement are due to any of the
following procedures or treatments:
 intentional abortion, sterilization of either sex, circumcision, sex transformations, or any
complication thereof; or
 cosmetic or plastic surgery, any dental work, eye or ear examination, except if necessary
for the repair or the alleviation of damage caused solely by an Accident; or
 HIV, AIDS, and AIDS Related Complex, except if stated in Section 2 ‘List of Covered Critical
Conditions’.
5. We will not pay for any medical cost reimbursement that are provided free of charge.

12F Four/NEO, 30th St. Corner 4th Ave. What We are Not Able to Cover

6. We will not pay any benefit if the condition or surgery is not included in either Annex A
‘Description of Covered Critical Conditions’ or Annex B ’Description of Covered Surgeries’.
Waiting Period
This is a ninety (90) day duration from the Effective Date or date of last
reinstatement of your Policy that must go by before you can make any valid claim
to your Policy.
The Waiting Period also applies when you make changes to your benefit coverage,
which starts from the effective date of change.
The Waiting Period will apply to hospitalizations, Critical Condition diagnosis and
medical reimbursement due to an illness, where the diagnosis and/or signs or
symptoms are first experienced within the ninety (90) day Waiting Period.
It will not apply to hospitalizations, Critical Condition diagnosis and medical

reimbursement that are due to an Accident.
Pre-Existing Condition
This is any condition, including congenital anomalies and conditions arising from
them, for which you may have already had signs or symptoms, received medical
advice, diagnosis, medication, or treatment prior to the effective date or date of last
reinstatement, whichever is later.
Any condition where a physician has certified that you have fully recovered for at
least twenty-four (24) months prior to the effective date or date of last reinstatement
(whichever is later) will not be considered as a Pre-existing Condition.
Free of Charge
This is any test, treatment, confinement, and other service that is paid for by the
Philippine government or any of its institutions or by private institutions. It is not
a part of an insurance benefit or any other service that was paid for by
himself/herself or another person/entity prior to getting the service.


4. Premiums
Premiums
The amount of money you pay to be covered under an insurance policy.
Your premiums are due on or before the Premium Due Date stated in your Policy Details Page(s).
The payment of your premiums can be made through the GCash.
Premiums must be continuously paid to keep the benefits active even for the following scenarios:
 For Daily Hospital Cash Benefit — you have already claimed for 100 Hospital Days in a
Policy Year.
 For Late Stage Critical Condition Diagnosis Benefit — during the reset period where no
claim for this benefit is payable.
If the premiums are not paid for all the benefits indicated in the Policy Details Page(s), the policy
will terminate.
You have until the end of the thirty-one (31) day grace period to pay your premiums. If you have
any claim during this grace period, we will deduct any unpaid premium from the benefits payable.
The Premium Rates are only guaranteed on a yearly basis. They may be adjusted on the
renewal date of your Policy depending on the overall actual claims of the product or
other benefit changes made over time. We will notify you forty-five (45) days before the
new Premium Rates become effective.
The new Premium Rates will be subject to prior approval of the Insurance Commission.

12F Four/NEO, 30th St. Corner 4th Ave. Premiums

5. Claims
Claims
A formal request by you, the policy owner, the beneficiary/ies, or any authorized claimant
to an insurance company for coverage or compensation for a covered loss or event. We
will validate the claim and, once approved, we will issue the payment to you or your
beneficiaries.
To file a claim, go to the claims section of your GCash App. Provide the necessary information and
upload electronic copies of the claim documents. We will contact you if we will require any
additional information and/or document(s). You may also call us or check singlife.com.ph to learn
more about other available methods of notifying us and filing a claim. You should notify us within
thirty (30) days from the date of loss or event of the benefit for which you are claiming.
Claim Documents
This refers to, but is not limited to the following:
 Documents to verify the identity of the claimant;
 Proof of Loss;
 Account Information to where the benefits will be paid to
Any notice of claim given to us by a claimant other than you will only be considered valid if we can
verify that you gave your consent to him/her. If we can verify this, we will allow the claimant to
submit the claim documents.
Once you have submitted the completed claims documents and we have approved your claim, we
will pay you the benefits within thirty (30) days from the date of our approval.
However, if we do not reply regarding your claim after sixty (60) days from receiving the claim
documents, your claim is considered approved. We will pay you within thirty (30) days from the day
the claim is considered approved. If we do not pay you within this time, you will be entitled to an
interest.

12F Four/NEO, 30th St. Corner 4th Ave. Claims

5. Claims
The total of all benefits that you claim under this Policy and all other Health Insurance
policies/coverages issued by Singlife will be subject to the maximum combined amount that we set
at the time this Policy was issued. We will refund to you the premiums you paid that correspond to
any amount in excess than the maximum allowable combined limit.
Proof of Loss
This refers to the document/s that may show the following:
1. Complete Medical Records to include but not limited to:

a. Admitting History
b. Discharge Summary
c. Clinical Abstract
d. Medical Certificate
e. Record of Operation (if any)
2. Laboratory results
3. Official accident report
4. Cause of Death
 You need to submit the claim documents within ninety (90) days from the date the
loss occurs. If you do not submit within ninety (90) days and you can show that
proof cannot be provided within the allotted time, we will still accept it. We are not
responsible for the costs for filing forms, acquiring documents or reports, or
incurring losses because of a delay.
 We may also require to see and inspect the original copies of documents you have
submitted. You should keep the original copies of the documents for at least one (1)
year from the day we have decided on your claim.

12F Four/NEO, 30th St. Corner 4th Ave. Claims

6. Your Beneficiaries
When you bought this Policy, Beneficiaries were set to the default and standard order. This means
that if (a) we cannot pay you the benefit because you passed away or (b) you passed away prior to
diagnosis to a covered critical condition as listed in Section 2 ‘List of Critical Condition’, subject to
the conditions in this Policy, we will pay the benefits to your family member/s according to this
sequence:
1. Your surviving legal spouse; or

2. Your surviving legitimate, illegitimate, legitimated, legally adopted, and recognized natural
children, without distinction; or
3. Your surviving parents; or
4. Your surviving siblings.
If none of the family members stated above are alive, the benefits will be paid to your estate.
You may name Beneficiaries after buying this Policy. If you do so, we will pay the benefits to your
named Beneficiaries in case (a) we cannot pay the benefit to you because you passed away or (b)
you passed away prior to diagnosis to a covered critical condition as listed in Section 2 ‘List of
Critical Condition’, subject to the conditions in this Policy. If there are no living named Beneficiaries
upon your passing, we will pay to your family member/s the benefits in the standard order stated
above.
 All Beneficiaries are primary and revocable in your Policy, which means you have the
right to change any of the Beneficiaries over time and you can perform all rights and
privileges under this Policy without your Beneficiary’s consent.
 After we pay any benefit of this Policy to you or your Beneficiaries, we will be discharged
from any liability corresponding to the benefit amount that has been paid.
 The Beneficiaries share the benefits equally, unless specified otherwise. For example, if
you do not have a spouse and have four (4) children, benefits will be distributed equally
among the four (4) of them.
 You may add, remove, or edit information of your Beneficiaries. Any change will only be
applicable after we approve it.

12F Four/NEO, 30th St. Corner 4th Ave. Your Beneficiaries

7. Termination of Your Policy
Termination
Refers to the end of your insurance policy, usually due to the Policy’s term ending or due
to cancellation. Termination date is the date your insurance coverage ends.
7.1 Your Policy and its benefits will terminate on any of the following days, whichever is the
earliest:
 Termination Date stated in your Policy Details Page(s); or
 Effective date of your request for cancellation of your Policy; or
 The day after the end of the thirty-one (31) day grace period, where the premium for
your Policy is due and remains unpaid; or
 Policy anniversary following your sixty-fifth (65th) birthday; or
 The date you pass away.
7.2 Your Any Critical Condition Diagnosis Benefit will terminate on any of the following days,
whichever is the earliest:
 The date the Policy terminates based on 7.1 above; or
 The date we approved your claim for this benefit.
7.3 Your Late Stage Critical Condition Diagnosis Benefit will terminate on any of the following
days, whichever is the earliest:
 The date we have approved the third (3rd) Late Stage Critical Condition Diagnosis claim
under
your Policy.
7.4 Your Medical Cost Reimbursement for Late Stage Critical Condition will terminate on any
of the following days, whichever is the earliest:
 The date we approved the claim for Medical Cost Reimbursement for Late Stage
Critical Condition.
 Ninety (90) days after the termination of your Late Stage Critical Condition Diagnosis
Benefit.

12F Four/NEO, 30th St. Corner 4th Ave. Termination of Your Policy

7. Termination of Your Policy
After the termination of this Policy, we will have no more liability under this Policy except to return
any unused premium to you.
Unused Premium
This is the portion of the premium paid that was not utilized due to the termination of
the Policy.
For example, the policy owner paid for a one (1) year coverage but during the eight (8th)
month of the policy year, the policy is terminated due to one of the reasons listed
above. We will return a portion of the premium corresponding to the remaining four (4)
months of the policy year to the policy owner. However, if the Policy terminates due to
a claim being approved, there will be no unused premium.
 You can still file a claim after your Policy or benefit terminates provided the hospital
confinement, diagnosis, surgery, or death occurred while your Policy and benefit were
active.
 For the schedule of unused premium to be returned to you, refer to the table under
Section 8.5 ‘Right to Cancel’.

12F Four/NEO, 30th St. Corner 4th Ave. Termination of Your Policy

8. Your Rights
8.1 Right of Policy Renewal
Your Policy will automatically renew every policy anniversary if the premiums due are
paid unless we terminated your Policy prior to that date. We will notify you forty-five
(45) days before the renewal date in case we need to terminate your Policy.
8.2 Right of Policy Ownership

While alive, you have all the rights & privileges to this Policy without the need of
consent of any revocable beneficiary.
Rights & Privileges
This may refer to, but is not limited to the following:
 Make changes to the coverages.
 Change your premium payment schedule (ex. from annual to monthly or vice
versa)
 Make changes to Beneficiaries.
 Update your personal information.
8.3 Right to Filing of Legal Action
If you have any issue on our decision regarding your claim, you can only file for legal
action after sixty (60) days from the date you filed the proof of loss. However, if your claim
has been rejected, you can file for legal action anytime. You cannot file for legal action
one (1) year after we have decided on your claim.
Filing of legal action for your Policy can be made anywhere within the legal jurisdiction of
the Philippines.

12F Four/NEO, 30th St. Corner 4th Ave. Your Rights

8. Your Rights
8.4 Right to a Free-Look Period
Free-Look Period
The fifteen (15) day duration after you have received your Policy when you may cancel
your Policy and get a full refund of the premiums paid.
You have fifteen (15) days starting from the date you received this Policy to review it. We
will consider that you have received it once we have sent it electronically to your registered
e-mail. If you cancel your Policy within the free-look period and you have not applied for a
claim under this Policy, we will refund the premiums you paid in full.
8.5 Right to Cancel
We may only cancel your Policy, with prior notice, if it is based on at least one (1) of the
following:
a. Conviction of crime arising out of acts increasing the hazard insured against; or
b. Discovery of fraud or material misrepresentation; or
c. Discovery of willful or reckless acts or omissions increasing the hazard insured
against; or
d. It is determined by the Commissioner of the Insurance Commission that the
continuation of this Policy would violate or would place Us in violation of the
Insurance Code.
We will notify you once your Policy is cancelled due to any of cause above. The notification will
be sent to your registered e-mail and will also state the grounds of cancellation. In the event
of such cancellation, we will refund the paid premiums less the used portion thereof to you.
You may cancel your policy at any time. If you do so, we will refund to you a portion of the
premium you have paid for the policy year based on the table below.


8. Your Rights
Premium Refund (for yearly premium schedule)
% of Yearly Premium
2 Months or below 40% 5 Months 25%
3 Months 35% 6 Months 20%
4 Months 30% Over 6 months 0%
The months above refers to the numbers of months from the Effective Date of your Policy or
the Policy Anniversary, whichever is later.
 The table above applies only to yearly premium schedules.
 For other premium schedules that are not yearly there will be no refund of premium,
but your Policy will be active up to the next premium due date.
8.6 Right to Reactivate (Reinstate)

You can reactivate or reinstate your Policy within three (3) years after it terminated due to
non-payment of premiums by satisfying the following:
 paying the required premiums specified by us; and
 by notifying us through the GCash App; and
 submitting evidence of insurability (such as health declaration, proof of age, etc.) that
is satisfactory to us, if needed.
The reactivation or reinstatement will only be effective upon our approval. Any hospital
confinement, diagnosis, surgery, or death that take places during the time your Policy is
inactive will not be payable.


9. General Provisions
9.1 Applicable Law
This Policy will be interpreted and governed in accordance with the laws of the
Republic of the Philippines.
9.2 Persons Who can Amend the Policy

Only our President and Executives have the power to amend provisions of your policy,
and only in writing.
9.3 Non-Waiver of Policy Provisions

Waiving or modifying any provision of your Policy at any time will not mean that it will
apply to any other time or incident. For example, if we allow you to pay your premium
beyond the grace period and we do not terminate your policy, this does not mean that
succeeding premiums that are due can be paid beyond the grace period.
9.4 Surplus Distribution
Surplus Distribution
The distribution of earnings by a life insurance company to its life insurance Policy Owners.
Your policy does not participate in any of our surplus distribution.
9.5 Accurate Information
If we find that the age, sex, or other info you have declared for yourself are misstated
and affect your benefits, we may return the excess premiums (if any) or collect
additional premium. If you become uninsurable after such adjustment, we will return all
unused premiums. Also, clerical errors in keeping records will not affect your Policy if
the errors are corrected immediately upon discovery.

12F Four/NEO, 30th St. Corner 4th Ave. General Provisions

9. General Provisions
9.6 Payments are not Adjusted for Inflation or Deflation

Article 1250 of the Civil Code of the Philippines (Republic Act No. 386) which reads as
follows is understood and agreed not to apply in determining the extent of any of our
liability in your policy:
“In case an extraordinary inflation or deflation of the currency stipulated should

supervene, the value of the currency at the time of the establishment of the obligation
shall be the basis of payment, unless there is an agreement to the contrary.”
9.7 Contacting the Insurance Commission

The Insurance Commission, with offices in Manila, Cebu and Davao, is the government
office in charge of the enforcement of all laws related to insurance and has supervision
over insurance companies. It is always ready to assist the general public in matters
pertaining to insurance.
For any inquiries or complaints, please contact the Public Assistance and Mediation
Division (PAMD) of the Insurance Commission at 1071 United Nations Avenue, Manila
with telephone number (632) 8-523-8461 to 70 and e-mail address
publicassistance@insurance.gov.ph .
The official website of the Insurance Commission is www.insurance.gov.ph.

12F Four/NEO, 30th St. Corner 4th Ave. General Provisions

Group Early-Stage Critical Condition Intermediate-Stage Critical Condition Late-Stage Critical Condition
1 Carcinoma in Situ Carcinoma in Situ of Specified Organs Major Cancers

Treated with Radical Surgery
‘Carcinoma in situ’ means the focal autonomous A malignant tumor positively diagnosed with
new growth of carcinomatous cells confined to the ‘Carcinoma in situ’ means the focal autonomous histological confirmation and characterized by the
cells in which it originated and has not yet resulted new growth of carcinomatous cells confined to the uncontrolled growth of malignant cells with
in the invasion and/or destruction of surrounding cells in which it originated and has not yet resulted invasion and destruction of normal tissue. The term
tissues. in the invasion and/ or destruction of surrounding malignant tumor includes leukemia, lymphoma,
tissues. and sarcoma.
Carcinoma in situ on the following body parts or
organs are covered:
‘Invasion’ means an infiltration and/or active The diagnosis must be confirmed by a specialist in
 Breast  Penis destruction of normal tissue beyond the basement the relevant field.
 Uterus  Testicle membrane.
 Vulva  Lung We do not cover the following for Major Cancers:
 Vagina  Stomach The diagnosis must be supported by all the
 Cervix uteri  Nasopharynx following:  All tumors which are histologically classified as
 Colon  Bladder. any of the following:
 Histopathological report; and
 Rectum  Fallopian tube (i) Pre-malignant
 It is positively diagnosed upon the basis of a
(ii) Non-invasive
microscopic examination of fixed tissues
“Invasion” means an infiltration and/or active (iii) Carcinoma-in-situ
additionally supported by a biopsy of the
destruction of normal tissue beyond the basement (iv) Having borderline malignancy
removed organ; and
membrane. (v) Having any degree of malignant
 Confirmed by a specialist in the relevant potential
field. (vi) Having suspicious malignancy
Singlife Philippines Inc. Page 01

12F Four/NEO, 30th St. Corner 4th Ave. Annex A – Description of Covered Critical Conditions
singlife.com.ph Form No. GCMheCAnA.21v1

The diagnosis must always be supported by all the The actual undergoing of a Radical Surgery to arrest (vii) Neoplasm of uncertain or unknown
following: the spread of malignancy in that specific organ, behavior
which must be considered as appropriate and (viii) Cervical Dysplasia CIN-1, CIN-2 and
 Histopathological report; and
necessary treatment. CIN-3; or
 It is positively diagnosed upon the basis of a
microscopic examination of the fixed tissue, “Radical Surgery” is the total and complete removal  Any non-melanoma skin carcinoma unless
supported by a biopsy result; and of one (1) of the following organs: there is evidence of metastases to lymph
 Confirmed by a specialist in the relevant field. nodes or beyond; or
 Breast (mastectomy); or
 Malignant melanoma that has not caused
The following are the additional requirements for  Prostate (prostatectomy); or
invasion beyond the epidermis; or
each condition under Carcinoma in situ:  Corpus uteri (hysterectomy); or
 All Prostate cancers histologically described as
 Ovary (oophorectomy); or T1N0M0 (TNM Classification) or below; or
(i) Early Prostate Cancer — Prostate Cancer
 Fallopian tube (salpingectomy); or Prostate cancers of another equivalent or
that is histologically described using the TNM
lesser classification; or
Classification as T1a or T1b or Prostate  Colon (partial colectomy with end to end
cancers described using another equivalent anastomosis); or  All Thyroid cancers histologically classified as
classification. T1N0M0 (TNM Classification) or below; or
 Stomach (partial gastrectomy with end to
(ii) Early Thyroid Cancer — Thyroid Cancer that end anastomosis).  All tumors of the Urinary Bladder
is histologically described using the TNM histologically classified as T1N0M0 (TNM
Classification as T1N0M0 as well as Papillary Classification) or below; or
Early prostate cancer that is histologically described
microcarcinoma of thyroid that is less than using the TNM Classification as T1a or T1b or T1c or  All Gastro-Intestinal Stromal tumors
1cm in diameter. Prostate cancers described using another histologically classified as T1N0M0 (TNM
(iii) Early Bladder Cancer — Papillary equivalent classification is also covered if it has Classification) or below and with mitotic count
microcarcinoma of Bladder been treated with a radical prostatectomy. of less than or equal to 5/50 HPFs; or


(iv) Early Chronic Lymphocytic Leukemia — The actual undergoing of the procedure must be  Chronic Lymphocytic Leukemia less than RAI
Chronic Lymphocytic Leukemia (CLL) RAI confirmed to be necessary by an oncologist. Stage 3; or
Stage 1 or 2.  All tumors in the presence of HIV infection.
(v) Early Melanoma — Invasive melanomas or
less than 1.5mm Breslow thickness, or less We do not cover the following for Carcinoma in
than Clark Level 3. Situ of Specified Organs Treated with Radical
Surgery:
We do not cover the following for Carcinoma in
Situ:  Carcinoma in situ determined through clinical
 Carcinoma in situ determined through clinical diagnosis; or
diagnosis; or  Partial surgical removal such as lumpectomy;
 Cervical Dysplasia, CIN-1, CIN-2 and CIN-3 and or
low grade & high grade squamous epithelial  Partial mastectomy; or
lesions; or
 Prostatic Intraepithelial Neoplasia (PIN); or  Partial prostatectomy; or
 Vulvar Intraepithelial Neoplasia (VIN); or  All grades of cervical intraepithelial neoplasia
 Any lesion or tumor which is histologically (CIN) and prostatic intraepithelial neoplasia
described as benign, dysplasia, premalignant, (PIN).
borderline malignant, or suspicious malignant
potential; or
 All tumors in the presence of HIV infection; or
 Early Chronic Lymphocytic Leukemia — CLL
RAI stage 0 or lower.
 Early Melanoma - Non-invasive melanoma
histologically described as “in-situ”.


2 Transmyocardial Laser Therapy Port Access of Keyhole Cardiac Surgery Coronary Artery Bypass Surgery
The undergoing of transmyocardial laser therapy Coronary Artery Bypass Grafting (CABG) or The actual undergoing of open-chest surgery or
for the treatment of refractory angina. Coronary atherectomy performed by port access Minimally Invasive Direct Coronary Artery Bypass
procedures to correct blockages in the coronary (MIDCAB) surgery to correct the narrowing or
The procedure must be medically necessary must arteries or use Enhanced External Counterpulsation blockage of one or more coronary arteries with
be confirmed by a specialist in the relevant field. Device for intractable angina not responsive to bypass grafts.
medial therapy and not responsive to other surgical
This benefit is not payable in addition to any other
or percutaneous techniques will also be covered The diagnosis must be supported by angiographic
form of cardiac revascularization treatment
under this benefit. evidence of significant coronary artery obstruction
including CABG and coronary angioplasty.
and the procedure must be considered medically
The procedure must be medically necessary must necessary by a cardiologist.
be confirmed by a specialist in the relevant field
and the diagnosis must be supported by We do not cover the following for Coronary Artery
angiographic evidence. Bypass Surgery:
We do not cover the following for Port Access of  Angioplasty; or

Keyhole Cardiac Surgery:
 All other intra-arterial, catheter-based
techniques, ‘keyhole’ or laser procedures.
 All intravascular procedures and Minimally
Invasive Direct Coronary Artery Bypass
(MIDCAB) surgery; or
 All percutaneous intravascular techniques.


3 Cardiac Pacemaker Insertion Early Cardiomyopathy Heart Attack of Specified Severity
Insertion of a permanent cardiac pacemaker that is Cardiomyopathy which has resulted in the Death of heart muscle due to obstruction of blood
required as a result of serious cardiac arrhythmia presence of permanent physical impairments to flow, that is evident by at least three (3) of the
which cannot be treated via other means. Class III or Class IV of the New York Heart following criteria proving the occurrence of a new
Association (NYHA) classification of Cardiac heart attack:
The insertion of the cardiac pacemaker must be Impairment:
confirmed to be necessary by a specialist in the  History of typical chest pain; and
Class I: No limitation of physical activity.
relevant field.
Ordinary physical activity does not  New characteristic electrocardiographic
cause undue fatigue, dyspnea, or changes; with the development of any of the
anginal pain. following: ST elevation or depression,
Pericardiectomy T wave inversion, pathological Q waves or left
Class II: Slight limitation of physical activity. bundle branch block; and
The undergoing of a pericardiectomy or undergoing Ordinary physical activity results in
 Elevation of the cardiac biomarkers, inclusive
of any surgical procedure requiring keyhole cardiac symptoms.
of CKMB above the generally accepted
surgery as a result of pericardial disease.
normal laboratory levels or Cardiac Troponin
Class III: Marked limitation of physical activity.
T or I at 0.5ng/ml and above; and
The surgical procedure must be confirmed to be Comfortable at rest, but less than
necessary by a cardiologist. ordinary activity causes symptoms.  Imaging evidence of new loss of viable
myocardium or new regional wall motion
Class IV: Unable to engage in any physical abnormality. The imaging must be done by a
activity without discomfort. Cardiologist.
Symptoms may be present even at
rest.


The diagnosis must be confirmed by a specialist in The diagnosis must be confirmed by a specialist in
the relevant field. the relevant field.
We do not cover the following for Early We do not cover the following for Heart Attack of
Cardiomyopathy: Specified Severity:
 Cardiomyopathy that is directly related to  Angina; or

alcohol misuse is excluded.
 Heart attack of indeterminate age; or
 A rise in cardiac biomarkers or Troponin T or

I following an intra-arterial cardiac procedure
Cardiac Defibrillator Insertion
including, but not limited to, coronary
angiography and coronary angioplasty.
Insertion of a permanent cardiac defibrillator as a
result of cardiac arrhythmia which cannot be
treated via any other method. Note: 0.5ng/ml = 0.5ug/L = 500pg/ml
The surgical procedure must be confirmed to be

necessary by a specialist in the relevant field.


4 Percutaneous Valvuloplasty Percutaneous Valve Replacement or Repair Heart Valve Surgery
The repair of a heart valve by percutaneous The repair or replacement of a heart valve by the The actual undergoing of open- heart surgery to
intravascular balloon valvuloplasty techniques not deployment of a permanent device or prosthesis by replace or repair heart valve abnormalities. The
involving a thoracotomy. percutaneous intravascular techniques not diagnosis of heart valve abnormality must be
involving a thoracotomy. supported by cardiac catheterization or
The procedure must be confirmed medically echocardiogram.
necessary by a specialist in the relevant field. The procedure must be confirmed medically
necessary by a specialist in the relevant field The procedure must be confirmed medically
We do not cover the following for Percutaneous necessary by a cardiologist.
Valvuloplasty: We do not cover the following for Percutaneous
Valve Replacement or Repair:
 Percutaneous valve replacements.
 Percutaneous balloon valvuloplasty and
other percutaneous repair procedures
where no new valve or any percutaneous
device or prosthesis is deployed are
excluded.


5 Mild Coronary Artery Disease Moderate Coronary Artery Disease Other Serious Coronary Artery Disease
The narrowing of the lumen of two (2) coronary The narrowing of the lumen of three (3) coronary The narrowing of the lumen of at least one
arteries by a minimum of 60%, as proven by arteries by a minimum of 60%, as proven by coronary artery by a minimum of 75% and of two
coronary arteriography or any other appropriate coronary arteriography or any other appropriate others by a minimum of 60%, as proven by
diagnostic test that is available, regardless of diagnostic test that is available, regardless of coronary arteriography, regardless of whether any
whether any form of coronary artery surgery has whether any form of coronary artery surgery has form of coronary artery surgery has been
been recommended or performed. been recommended or performed. performed.
Coronary arteries herein refer to following: Coronary arteries herein refer to following: Coronary arteries herein refer to following:
 Right coronary artery  Right coronary artery  Left main stem

 Left main stem  Left main stem  Left anterior descending
 Left anterior descending  Left anterior descending  Circumflex
 Left circumflex  Left circumflex  Right coronary artery
We do not cover the following for Mild Coronary We do not cover the following for Moderate
Artery Disease: Coronary Artery Disease:
 Any non-invasive method of determining  Any non-invasive method of determining

coronary artery stenosis. coronary artery stenosis.
 Branches of the Coronary arteries referred  Branches of the Coronary arteries referred
to above. to above.


6 Early Pulmonary Hypertension Secondary Pulmonary Hypertension Primary Pulmonary Hypertension
Primary or Secondary pulmonary hypertension Secondary pulmonary hypertension with Primary Pulmonary Hypertension with substantial
with established right ventricular hypertrophy established right ventricular hypertrophy leading right ventricular enlargement confirmed by
leading to the presence of permanent physical to the presence of permanent physical investigations including cardiac catheterization,
impairment of Class III or Class IV of the New York impairment of Class IV of the New York Heart resulting in permanent physical impairment of
Heart Association (NYHA) Classification of Cardiac Association (NYHA) Classification of Cardiac Class IV of the New York Heart Association (NYHA)
Impairment: Impairment: Classification of Cardiac Impairment:
Class I: No limitation of physical activity. Class I: No limitation of physical activity. Class I: No limitation of physical activity.
Ordinary physical activity does not Ordinary physical activity does not Ordinary physical activity does not
cause undue fatigue, dyspnea, or cause undue fatigue, dyspnea, or cause undue fatigue, dyspnea or
anginal pain. anginal pain. anginal pain.
Class II: Slight limitation of physical activity. Class II: Slight limitation of physical activity. Class II: Slight limitation of physical activity.
Ordinary physical activity results in Ordinary physical activity results in Ordinary physical activity results in
symptoms. symptoms. symptoms.
Class III: Marked limitation of physical activity. Class III: Marked limitation of physical activity. Class III: Marked limitation of physical activity.
Comfortable at rest, but less than Comfortable at rest, but less than Comfortable at rest, but less than
ordinary activity causes symptoms. ordinary activity causes symptoms. ordinary activity causes symptoms.
Class IV: Unable to engage in any physical Class IV: Unable to engage in any physical Class IV: Unable to engage in any physical
activity without discomfort. activity without discomfort. Symptoms activity without discomfort. Symptoms
Symptoms may be present even at may be present even at rest. may be present even at rest.
rest.


7 Large Asymptomatic Aortic Aneurysm Minimally Invasive Surgery to Aorta Surgery to Aorta
Large asymptomatic abdominal or thoracic aortic The actual undergoing of percutaneous The actual undergoing of major surgery to repair or
aneurysm or aortic dissection as evidenced by intravascular angioplasty and stenting techniques correct an aneurysm, narrowing, obstruction, or
appropriate imaging technique. The aorta must be to repair or correct an aneurysm, narrowing, dissection of the aorta through surgical opening of
enlarged greater than 55mm in diameter and the obstruction, or dissection of the aorta, as evidenced the chest or abdomen.
diagnosis must be confirmed by a cardiologist. by an echocardiogram or any other appropriate
diagnostic imaging test that is available and The procedure must be confirmed necessary by a
“Aorta” means the thoracic and abdominal aorta confirmed by a cardiologist or vascular surgeon. specialist in the relevant field.
but not its branches.
“Aorta” means the thoracic and abdominal aorta “Aorta” means the thoracic and abdominal aorta
but not its branches. but not its branches.
We do not cover the following for Minimally We do not cover the following for Surgery to
Invasive Surgery to Aorta: Aorta:
 Open repair, resection or grafting of  Surgery performed using only minimally

aneurisms involving laparotomy or invasive or intra-arterial techniques
thoracotomy by laparoscopic (port access)
techniques.

Page 10 Cash for Medical Costs

8 Reversible Aplastic Anemia Myelodysplastic Syndrome or Myelofibrosis Aplastic Anemia
Acute reversible bone marrow failure which results Myelodysplastic syndrome or myelofibrosis Chronic persistent bone marrow failure, which
in anemia, neutropenia and thrombocytopenia requiring regular and permanent transfusion of results in anemia, neutropenia and
requiring treatment with at least one (1) of the blood products for severe recurrent anemia. thrombocytopenia requiring treatment with at least
following: one (1) of the following:
The diagnosis must be confirmed by a hematologist
 Blood product transfusion; or as a result of marrow biopsy.  blood product transfusion; or
 Marrow stimulating agents; or  marrow stimulating agents; or
The condition must be deemed incurable and blood
 Immunosuppressive agents; or transfusion support must be an indefinite  immunosuppressive agents; or
 Bone marrow transplantation. requirement.  bone marrow transplantation.
The diagnosis must be confirmed by a hematologist The diagnosis must be confirmed by a hematologist
as a result of a bone marrow biopsy. as a result of a biopsy.
9 HIV/AIDS due to Assault HIV/AIDS due to Organ Transplant HIV/AIDS Due to Blood Transfusion
Infection with the Human Immunodeficiency Virus Infection with the Human Immunodeficiency Virus Infection with the Human Immunodeficiency Virus
(HIV) or having Acquired Immune Deficiency (HIV) or having Acquired Immune Deficiency (HIV) or having Acquired Immune Deficiency
Syndrome (AIDS) which resulted from a physical or Syndrome (AIDS) through an organ transplant, Syndrome (AIDS) through a blood transfusion,
sexual assault occurring after the effective date of provided that all the following conditions are met: provided that all the following conditions are met:


or date of last reinstatement of your Policy,  The organ transplant was medically  The blood transfusion was medically
whichever is later, provided that all the following necessary or given as part of a medical necessary or given as part of a medical
conditions are met: treatment; and treatment; and
 The incident must be reported to the  The source of the infection is established to  The source of the infection is established to
appropriate authority and that a criminal be from the Institution that provided the be from the Institution that provided the
investigation must be opened; and transplant and the Institution is able to trace blood transfusion and the Institution is able
 Proof that the assault involved a definite the origin of the HIV to the infected to trace the origin of the HIV tainted blood;
source of the HIV infected fluids; and transplanted organ. and
 Proof of seroconversion from HIV negative  The Insured does not suffer from
to HIV positive occurring during the one Thalassemia Major or Hemophilia.
We do not cover the following for HIV due to
hundred and eighty (180) days after the Organ Transplant:
documented assault. This proof must We do not cover the following for HIV/AIDS Due to
include a negative HIV antibody test  If a cure has become available prior to the Blood Transfusion:
conducted within five (5) days of the assault. infection. "Cure" means any treatment that
renders the HIV inactive or noninfectious.  The Insured suffers from Thalassemia Major
or Hemophilia; or
We do not cover the following for HIV due to
assault:  If a cure has become available prior to the
infection. "Cure" means any treatment that
 HIV infection resulting from any other renders the HIV inactive or noninfectious.
means including consensual sexual activity
or the use of intravenous drug.
 If a cure has become available prior to the
renders the HIV inactive or noninfectious.


Occupationally Acquired HIV/AIDS
Infection with the Human Immunodeficiency Virus

(HIV) or having Acquired Immune Deficiency
Syndrome (AIDS) which resulted from an Accident
occurring after the Effective date or date of last
reinstatement of your Policy, whichever is later,
while the Insured was carrying out the normal
professional duties of his or her occupation,
provided that all the following conditions are met:
 proof of the Accident giving rise to the
infection must be reported to us within
thirty (30) days of the Accident taking place;
 proof that the Accident involved a definite
source of the HIV infected fluids;
 proof of seroconversion from HIV negative
to HIV positive occurring during the
hundred and eighty (180) days after the
documented Accident. This proof must
include a negative HIV antibody test
conducted within five (5) days of the
Accident; and
 HIV infection resulting from any other
means including sexual activity and the use
of intravenous drugs is excluded.


The occupations that are accepted for this benefit

to be payable are:
 medical practitioner
 medical student
 state registered nurse
 medical laboratory technician
 dentist (surgeon or nurse)
 paramedical worker
The insured must be registered with the

appropriate regulatory body and working in a
licensed medical center or clinic in the Philippines.
We do not cover the following for Occupationally

Acquired HIV/AIDS:
 HIV infection resulting from any other

means including consensual sexual activity
or the use of intravenous drug.
 If a cure has become available prior to the

renders the HIV inactive or noninfectious.


Neurological Related Conditions
10 Diagnosis of Dementia including Moderately Severe Alzheimer’s Disease Alzheimer's Disease / Severe Dementia
Alzheimer’s Disease
A definite diagnosis of Alzheimer’s disease or Deterioration or loss of intellectual capacity as
Diagnosis of dementia by neurological assessment dementia due to irreversible organic brain confirmed by clinical evaluation and imaging tests,
by a specialist in the relevant field confirming disorders by a neurologist. The Mini-Mental State arising from Alzheimer's disease or irreversible
cognitive impairment characterized by a Examination (MMSE) score must be less than 20 out organic disorders, resulting in significant reduction
Mini-Mental State Examination score of 24 or less of 30 or an equivalent of this score using other in mental and social functioning requiring the
out of 30 or assessed by two (2) neuropsychometric Alzheimer’s tests. There must also be permanent continuous supervision of the Insured.
tests performed six (6) months apart with a battery clinical loss of the ability to do all the following:
of tests which clearly define the severity of the The diagnosis must be confirmed by a specialist in
 Remember; and
impairment. the relevant field.
 Reason; and
The insured must have been placed on disease  Perceive, understand, express and give effect We do not cover the following for Alzheimer's
modifying treatment prescribed by a specialist in to ideas. Disease / Severe Dementia:
the relevant field and must be under the
The diagnosis must be confirmed by a specialist in
continuous care of a specialist in the relevant field.  non-organic diseases such as neurosis and
the relevant field.
psychiatric illnesses; or
We do not cover the following for Diagnosis of  alcohol related brain damage.
We do not cover the following for Moderately
Dementia including Alzheimer’s Disease:
Severe Alzheimer’s Disease:
 If the insured exceeds the age of 85 at the  Non-organic diseases such as neurosis and
time of diagnosis. psychiatric illnesses; or
 Drug or alcohol related brain damage.


Organic brain damage which results in a person Condition in which a person is aware but cannot Universal necrosis of the brain cortex with the
being unable to talk or move despite the fact that move or communicate verbally due to complete brainstem intact.
they appear alert at times. paralysis of all voluntary muscles in the body
except for vertical eye movements and blinking. The diagnosis must be confirmed by a neurologist.
The diagnosis must be supported by evidence There should be evidence of quadriplegia and This condition has to be medically documented for
showing organic brain damage and confirmed by a inability to speak. at least one (1) month.
neurologist. This condition must be medically
documented for a continuous period of at least one The diagnosis must be supported by evidence of
(1) month. infarction of the ventral pons and
electroencephalogram (EEG) indicating that the
person is not unconscious. The diagnosis must be
We do not cover the following for Akinetic confirmed by a neurologist. This condition has to be
Mutism: medically documented for a continuous period of
at least one (1) month.
 Akinetic mutism due to psychological
reasons.


12 Bacterial Meningitis Bacterial Meningitis with Reversible Severe Bacterial Meningitis

Neurological Deficit
Bacterial infection resulting in severe inflammation Bacterial infection resulting in severe inflammation
of the membranes of the brain or spinal cord which The Infection resulting in inflammation of the of the membranes of the brain or spinal cord
requires hospitalization. membranes of the brain or spinal cord resulting in resulting in significant, irreversible and permanent
reversible neurological deficit. neurological deficit. The neurological deficit must
The diagnosis must show the presence of bacterial persist for at least six (6) weeks.
infection in cerebrospinal fluid by lumbar puncture The proof of meningeal infection must be provided
and confirmed by a neurologist. to us by the results of a lumbar puncture and the The diagnosis must show the presence of bacterial
offending organism must be identified and the infection in cerebrospinal fluid by lumbar puncture
diagnosis must be confirmed by a neurologist. and confirmed by a neurologist.
We do not cover the following for Bacterial
Meningitis with Full Recovery:
We do not cover the following for Bacterial We do not cover the following for Severe Bacterial
 Bacterial Meningitis in the presence of HIV Meningitis with Reversible Neurological Deficit: Meningitis:
infection.
 Bacterial Meningitis in the presence of HIV  Bacterial Meningitis in the presence of HIV
infection. infection.


13 Surgical Removal of Pituitary Tumor by Surgical Removal of Pituitary Tumor by Benign Brain Tumor
Transsphenoidal / Transnasal Open Craniotomy
Hypophysectomy Benign brain tumor a non- cancerous tumor
The actual undergoing of total surgical removal of a located in the cranial vault and limited to the brain,
The actual undergoing of surgical removal of a pituitary tumor by open craniotomy is needed as a meninges, or cranial nerves where all the following
pituitary tumor by transsphenoidal/transnasal result of symptoms associated with increased conditions are met and confirmed by a neurologist
hypophysectomy is needed as a result of symptoms intracranial pressure caused by the tumor or where or neurosurgeon:
associated with increased intracranial pressure surgical removal is medically necessary as  it is life threatening; and
caused by the tumor or where surgical removal as confirmed by a specialist in the relevant field.
 it has caused damage to the brain; and
confirmed by a specialist in the relevant field.
The presence of the underlying tumor must be  it has undergone surgical removal or, if
confirmed by imaging studies such as inoperable, has caused a permanent
The presence of the underlying tumor must be
computerized tomography scan or magnetic neurological deficit; and
confirmed by imaging studies such as
computerized tomography scan or magnetic resonance imaging.  its presence is supported by findings on
resonance imaging. Magnetic Resonance Imaging (MRI),
We do not cover the following for Surgical Computerized Tomography, or other reliable
Removal of Pituitary Tumor by Open Craniotomy: imaging techniques
 Surgical removal of the pituitary by We do not cover the following for Benign Brain
transsphenoidal hypophysectomy Tumor:
 cysts; or
 granulomas; or
 vascular malformations; or
 hematomas; or
 tumors of the pituitary gland or spinal cord.


14 Coma for 48 Hours Coma for 72 hours Coma for 96 Hours
Coma that persists for at least forty-eight (48) Coma that persists for at least seventy-two (72) A coma that persists for at least ninety-six (96)
continuous hours. The diagnosis must satisfy all the continuous hours. The diagnosis must satisfy all the hours. The diagnosis must satisfy all the following
following conditions: following conditions: conditions:
 No response to external stimuli for at least  No response to external stimuli for at least  No response to external stimuli for at least
forty-eight (48) hours; and seventy-two (72) hours; and ninety-six (96) hours; and
 life support measures are necessary to  Life support measures are necessary to  Life support measures are necessary to
sustain life; and sustain life; and sustain life; and
 Brain damage resulting in permanent  Brain damage resulting in permanent  Brain damage resulting in permanent
neurological deficit which must be assessed neurological deficit which must be assessed neurological deficit which must be assessed
at least thirty (30) days after the onset of the at least thirty (30) days after the onset of the at least thirty (30) days after the onset of the
coma; and coma; and coma; and
 Diagnosis must be confirmed by a specialist  Diagnosis must be confirmed by a specialist  Diagnosis must be confirmed by a specialist
in the relevant field. in the relevant field. in the relevant field.
We do not cover the following for Coma for We do not cover the following for Coma for We do not cover the following for Coma for
48 Hours: 72 Hours: 96 Hours:
 Medically induced coma; or  Medically induced coma; or  Medically induced coma; or

 Coma caused by alcohol or drug abuse.  Coma caused by alcohol or drug abuse.  Coma caused by alcohol or drug abuse.


Severe Epilepsy
The diagnosis must satisfy all the following

conditions:
 Diagnosis made by a specialist in the
relevant field by the use of
electroencephalography (EEG), magnetic
resonance imaging (MRI), position emission
tomography (PET) or any other appropriate
diagnostic test that is available; and
 Documentation of recurrent unprovoked

tonic-clonic or grand mal seizures of more
than five (5) attacks per week, and be known
to be resistant to optimal therapy as
confirmed through a drug serum-level
testing, and
 The Insured must have been taking at least

two (2) prescribed antiepileptic
(anticonvulsant) medications for at least six
(6) months on the recommendation of a
specialist in the relevant field.
We do not cover the following for Severe Epilepsy:
 Febrile or absence (petit mal) seizures


15 Head Trauma Requiring Reconstructive Head Trauma Requiring Open Craniotomy Major Head Trauma
Surgery
Undergoing of open craniotomy as a result of major Accidental head injury resulting in permanent
The actual undergoing of reconstructive surgery head trauma by an Accident occurring after the neurological deficit with persisting clinical
above the neck (restoration or reconstruction of the Effective date or date of last reinstatement of the symptoms to be assessed within than six (6) weeks
shape of and appearance of facial structures which Policy, whichever is later, for the treatment of from the date of the Accident. The head injury is
are defective, missing or damaged or deformed) depressed skull fractures or major intracranial caused by an Accident occurring after the Effective
performed by a specialist in the relevant field to injury. date or date of last reinstatement of the Policy,
correct disfigurement as a direct result of an whichever is later.
Accident. The procedure must be confirmed to be necessary
by a specialist in the relevant field. The diagnosis must be confirmed by a neurologist
The procedure must be confirmed to be necessary and supported by findings on Magnetic Resonance
by a specialist in the relevant field. Imaging (MRI), Computerized Tomography, or other
We do not cover the following for Head Trauma reliable imaging techniques.
Requiring Open Craniotomy:
We do not cover the following for Head Trauma Permanent neurological deficit with persisting
Requiring Reconstructive Surgery:  Burr hole surgery. clinical symptoms means symptoms of dysfunction
in the nervous system that are present on clinical
 Treatment relating to teeth and/or any other examination and expected to last at least five (5)
dental restoration alone. years from the date of diagnosis.
Symptoms may refer to any of the following:
 Numbness
 Paralysis


Cervical Spinal Cord Injury  Localized weakness

 Dysarthria (difficulty with speech)
Cervical spinal cord injury caused by an Accident
 Aphasia (inability to speak)
occurring after the Effective date or date of last
reinstatement of the Policy, whichever is later,  Dysphagia (difficulty swallowing)
resulting in loss of use of at least one (1) entire  Visual impairment
limb, to be assessed no sooner than six (6) weeks
 Difficulty in walking
from the date of the Accident.
 Lack of coordination
The diagnosis must be confirmed by a specialist in  Tremor
the relevant field and supported by findings on
 Seizures
Magnetic Resonance Imaging (MRI), Computerized
Tomography, or other reliable imaging techniques.  Dementia
 Delirium
 Coma.
Surgery for subdural hematoma
The actual undergoing of Burr Hole surgery to the

head to drain subdural hematoma cause by an We do not cover the following for Major Head
Accident. Trauma:
The procedure must be confirmed to be  Spinal cord injury; or

necessary by a specialist in the relevant field.  Head injury due to any other causes.


Severe peripheral motor neuropathy arising Motor neuron disease characterized by progressive Motor neuron disease characterized by progressive
from anterior horn cells resulting in significant degeneration of corticospinal tracts and anterior degeneration of corticospinal tracts and anterior
motor weakness, fasciculation, and muscle wasting horn cells or bulbar efferent neurons which include horn cells or bulbar efferent neurons which include
that result in a permanent need for the use walking spinal muscular atrophy, progressive bulbar palsy, spinal muscular atrophy, progressive bulbar palsy,
aids or a wheelchair amyotrophic lateral sclerosis and primary lateral amyotrophic lateral sclerosis and primary lateral
sclerosis. sclerosis.
The diagnosis must be confirmed by a neurologist
as a result of nerve conduction studies. The diagnosis must be confirmed by a neurologist The diagnosis must be confirmed by a neurologist
as progressive. as progressive and resulting in permanent
neurological deficit.
We do not cover the following for Peripheral
Neuropathy:
 Diabetic neuropathy; or
 Neuropathy due to alcohol.


The diagnosis of Multiple Sclerosis must be The diagnosis of Multiple Sclerosis must be The diagnosis of Multiple Sclerosis must be
confirmed by a neurologist and supported by all the confirmed by a neurologist and supported by all the confirmed by a neurologist and supported by all the
following: following: following:
 Medical Records; and  Medical Records; and  Medical Records; and

 Well documented history of exacerbations  Any neurological deficit for at least three (3)  multiple neurological deficits which occurred
and remissions of neurological signs. months; and over a continuous period of at least six (6)
 Well documented history of exacerbations months; and
We do not cover the following for Early Multiple and remissions of neurological signs.
Sclerosis:  well documented history of exacerbations
and remissions of said symptoms or
We do not cover the following for Mild Multiple neurological deficits.
 Other causes of neurological damage such
Sclerosis:
as Systemic lupus erythematosus (SLE) and
Human Immunodeficiency Virus (HIV). We do not cover the following for Multiple
 Other causes of neurological damage such
as Systemic lupus erythematosus (SLE) and Sclerosis:
Human Immunodeficiency Virus (HIV).
 Other causes of neurological damage such as
Systemic lupus erythematosus (SLE) and
Human Immunodeficiency Virus (HIV).


18 Spinal Cord Disease or Injury Resulting in Moderate Muscular Dystrophy Muscular Dystrophy
Bowel and Bladder Dysfunction
“Muscular Dystrophy” a group of hereditary “Muscular Dystrophy” a group of hereditary
Spinal cord disease or cauda equina injury resulting degenerative diseases of muscle characterized by degenerative diseases of muscle characterized by
in permanent bowel dysfunction and bladder weakness and atrophy of muscle. weakness and atrophy of muscle.
dysfunction requiring permanent regular self-
catheterization or a permanent urinary conduit The condition must result in the inability to perform The condition must result in the inability of to
which will last for at least six (6) months. (whether aided or unaided) at least two (2) of the perform (whether aided or unaided) at least three
following six (6) “Activities of Daily Living” for a (3) of the six (6) “Activities of Daily Living” for a
The diagnosis must be confirmed by a neurologist. continuous period of at least six (6) months: continuous period of at least six (6) months:
(i) Washing – the ability to wash in the bath (i) Washing – the ability to wash in the bath
or shower (including getting into and out or shower (including getting into and out
of the bath or shower) or wash of the bath or shower) or wash
satisfactorily by other means; or satisfactorily by other means; or
(ii) Dressing – the ability to put on, take off, (ii) Dressing – the ability to put on, take off,
secure and unfasten all garments and, as secure and unfasten all garments and, as
appropriate, any braces, artificial limbs or appropriate, any braces, artificial limbs or
other surgical appliances; or other surgical appliances; or
(iii) Transferring – the ability to move from a (iii) Transferring – the ability to move from a
bed to an upright chair or wheelchair and bed to an upright chair or wheelchair and
vice versa; or vice versa; or
(iv) Mobility – the ability to move indoors (iv) Mobility – the ability to move indoors
from room to room on level surfaces; or from room to room on level surfaces; or


(v) Toileting – the ability to use the lavatory (v) Toileting – the ability to use the lavatory
or otherwise manage bowel and bladder or otherwise manage bowel and bladder
functions so as to maintain a satisfactory functions so as to maintain a satisfactory
level of personal hygiene; or level of personal hygiene; or
(vi) Feeding – the ability to feed oneself once (vi) Feeding – the ability to feed oneself once
food has been prepared and made food has been prepared and made
available. available.
The diagnosis must be confirmed by a neurologist. The diagnosis must be confirmed by a neurologist.
“Aided” shall mean any of the following: “Aided” shall mean any of the following:
 Aid of special equipment. Device and/or  Aid of special equipment. Device and/or
apparatus; or apparatus; or
 Aid from another person.  Aid from another person.


19 Loss of Use of One Limb Loss of Use of One Limb Requiring Paralysis
Prosthesis
Total and irreversible loss of use of one (1) entire Total and irreversible loss of use of at least two (2)
limb due to illness or Accident occurring after the Total and irreversible loss of use of one (1) entire entire limbs due to illness or Accident occurring
Effective date or date of last reinstatement of the limb due to illness or Accident occurring after the after the Effective date or date of last reinstatement
Policy, whichever is later, persisting for a period of Effective date or date of last reinstatement of the of the Policy, whichever is later, persisting for a
at least six (6) weeks. Policy, whichever is later, (above elbow or above period of at least six (6) weeks and with no
knee) which has required the fitting and use of foreseeable possibility of recovery.
This condition must be confirmed by a specialist in prosthesis.
the relevant field. This condition must be confirmed by a specialist in
This condition must be confirmed by a specialist in the relevant field.
We do not cover the following for Loss of Use of the relevant field.
One Limb: We do not cover the following for Paralysis:
We do not cover the following for Loss of Use of
 Self-inflicted injuries One Limb Requiring Prosthesis:  Self-inflicted injuries
 Self-inflicted injuries
20 Early Parkinson’s Disease Moderately Severe Parkinson’s Disease Parkinson’s Disease
The diagnosis of Parkinson’s disease must be The diagnosis of Parkinson’s Disease must be The diagnosis of Parkinson’s Disease must be
confirmed by a specialist in the relevant field and confirmed by a neurologist and must be confirmed by a neurologist and must be
supported by all the following conditions: supported by all the following conditions: supported by all the following conditions:


 The disease cannot be controlled with  The disease cannot be controlled with
 The disease cannot be controlled with
medication; and medication; and
medication; and
 There are signs of progressive neurological  Signs of progressive impairment; and
 Signs of progressive impairment; and
impairment.
 Inability to perform (whether aided or
 Inability to perform (whether aided or
unaided) at least three (3) of the following six
unaided) at least two (2) of the following six
We do not cover the following for Early (6) “Activities of Daily Living” for a continuous
(6) “Activities of Daily Living” for a continuous
Parkinson’s Disease: period of at least six (6) months:
period of at least six (6) months:
 Drug-induced or toxic causes of Parkinson’s (i) Washing — the ability to wash in the
(i) Washing — the ability to wash in the
Disease. bath or shower (including getting into
bath or shower (including getting into
and out of the bath or shower) or
and out of the bath or shower) or
wash satisfactorily by other means; or
wash satisfactorily by other means; or
(ii) Dressing — the ability to put on, take
(ii) Dressing — the ability to put on, take
off, secure and unfasten all garments
off, secure and unfasten all garments
and, as appropriate, any braces,
and, as appropriate, any braces,
artificial limbs or other surgical
artificial limbs or other surgical
appliances; or
appliances; or
(iii) Transferring — the ability to move
(iii) Transferring — the ability to move
from a bed to an upright chair or
from a bed to an upright chair or
wheelchair and vice versa; or
wheelchair and vice versa; or
(iv) Mobility — the ability to move indoors
(iv) Mobility — the ability to move
from room to room on level surfaces;
indoors from room to room on level
or
surfaces; or


(v) Toileting — the ability to use the (v) Toileting — the ability to use the
lavatory or otherwise manage bowel lavatory or otherwise manage bowel
and bladder functions so as to and bladder functions so as to
maintain a satisfactory level of maintain a satisfactory level of
personal hygiene; or personal hygiene; or
(vi) Feeding — the ability to feed oneself (vi) Feeding — the ability to feed oneself
once food has been prepared and once food has been prepared and
made available. made available.
 Aid of special equipment, device and/or  Aid of special equipment, device and/or
We do not cover the following for Moderately We do not cover the following for Parkinson’s
Severe Parkinson’s Disease: Disease:
 Drug-induced or toxic causes of Parkinson’s  Drug-induced or toxic causes of Parkinson’s

Disease. Disease.


21 Brain Aneurysm Surgery Carotid Artery Surgery Stroke
The actual undergoing of surgical repair of an The actual undergoing of Endarterectomy of the A cerebrovascular incident including infarction of
intracranial aneurysm or surgical removal of an carotid artery which has been required as a result brain tissue, cerebral and subarachnoid
arterio-venous malformation via craniotomy or of at least 80% narrowing of the carotid artery as hemorrhage, intracerebral embolism and cerebral
endovascular procedures. diagnosed by an arteriography or any other thrombosis resulting in permanent neurological
appropriate diagnostic test that is available. deficit with persisting clinical symptoms. The
The procedure must be confirmed to be necessary diagnosis must be supported by all the following
by a specialist in the relevant field. The procedure must be confirmed to be necessary conditions:
by a specialist in the relevant field.
We do not cover the following for Brain Aneurysm  Evidence of permanent clinical neurological
Surgery: We do not cover the following for Carotid Artery deficit confirmed by a neurologist at least six
Surgery: (6) weeks after the incident; and
 Endovascular repair or procedures
 findings on Magnetic Resonance Imaging,
 Endarterectomy of blood vessels other than
Computerized Tomography, or other reliable
the carotid artery; or
imaging techniques consistent with the
 Percutaneous carotid angioplasty. diagnosis of a new stroke.
Permanent neurological deficit with persisting

clinical symptoms means symptoms of dysfunction
in the nervous system that are present on clinical
examination and expected to last at least five (5)
years from the date of diagnosis.


Cerebral Shunt Insertion Symptoms may refer to any of the following:

 Numbness; or
The actual undergoing of surgical implantation of a  Paralysis; or
shunt from the ventricles of the brain to relieve
 Localized weakness; or
raised pressure in the cerebrospinal fluid.
 Dysarthria (difficulty with speech); or
The procedure must be confirmed to be necessary  Aphasia (inability to speak); or

by a specialist in the relevant field.  Dysphagia (difficulty swallowing); or
 Visual impairment; or
 Difficulty in walking; or
 Lack of coordination; or
 Tremor; or
 Seizures; or
 Dementia; or
 Delirium; or
 Coma.
We do not cover the following for Stroke:
 Transient Ischemic Attacks; or

 Brain damage due to an Accident, infection,
vasculitis, and inflammatory disease; or
 vascular disease affecting the eye or optic
nerve; or
 Ischemic disorders of the vestibular system.


Severe inflammation of brain substance (cerebral Severe inflammation of brain substance (cerebral Severe inflammation of brain substance (cerebral
hemisphere, brainstem or cerebellum) caused by hemisphere, brainstem or cerebellum) caused by hemisphere, brainstem or cerebellum) caused by
viral infection requiring hospitalization. viral infection resulting in significant but reversible viral infection and resulting in permanent
neurological deficit and there must be evidence of neurological deficit. The permanent neurological
The diagnosis must be confirmed by a neurologist hospitalization for at least two (2) weeks. The deficit must persist for at least six (6) weeks.
and supported by medical records. neurological deficit must persist for at least two (2)
weeks. The diagnosis must be confirmed by a neurologist
and supported by medical records.
We do not cover the following for Encephalitis The diagnosis must be confirmed by a neurologist
with Full Recovery: and supported by medical records.
We do not cover the following for Viral
 Encephalitis caused by HIV infection. Encephalitis:
We do not cover the following for Mild
Encephalitis:  Encephalitis caused by HIV infection.
 Encephalitis caused by HIV infection.


23 Loss of Sight in One Eye Optic Nerve Atrophy with Low Vision Blindness (Permanent Loss of Sight)
Permanent and irreversible loss of sight in one (1) The diagnosis of optic nerve atrophy affecting both Permanent and irreversible loss of sight in both
eye as a result of illness or Accident occurring after eyes leading to a permanent best corrected visual eyes as a result of illness or Accident occurring after
the Effective date or date of last reinstatement of acuity of 3/60 or worse in both eyes using a Snellen the Effective date or date of last reinstatement of
the Policy, whichever is later, to the extent that eye Chart or equivalent test or the vision field of 20 the Policy, whichever is later, to the extent that
even when tested with the use of visual aids, vision degrees or less in both eyes. even when tested with the use of visual aids, vision
is measured at 3/60 or worse in one (1) eye using a is measured at 3/60 or worse in both eyes using a
Snellen eye chart or equivalent test or the vision The optic nerve atrophy and quantum of visual loss Snellen eye chart or equivalent test, or visual field
field of 20 degrees or less in one (1) eye. of sight must be confirmed by an ophthalmologist. of twenty (20) degrees or less in both eyes.
The loss of sight in one (1) eye must be confirmed We do not cover the following for Optic Nerve The blindness must be confirmed by an
by an ophthalmologist. Atrophy with Low Vision: ophthalmologist.
We do not cover the following for Loss of Sight in  Optic Nerve Atrophy with Low Vision caused We do not cover the following for Blindness:
One (1) Eye: by alcohol or drug abuse
 Blindness caused by alcohol or drug abuse
 Loss of Sight caused by alcohol or drug
abuse


24 Partial Loss of Hearing Cochlear Implant Surgery Deafness (Loss of Hearing)
Permanent binaural hearing loss with the loss of at The actual undergoing of a surgical cochlea implant “Total” and irreversible loss of hearing in both ears
least sixty (60) decibels in all frequencies of hearing as a result of permanent damage to the cochlea or as a result of illness or Accident occurring after the
as a result of illness or Accident occurring after the auditory nerve. Effective date or date of last reinstatement of the
Effective date or date of last reinstatement of the Policy, whichever is later. “Total” means “the loss of
Policy, whichever is later. The surgical procedure as well as the insertion of at least eighty (80) decibels in all frequencies of
the implant must be confirmed necessary by a hearing”.
The hearing loss must be established by a specialist specialist in the relevant field.
in the relevant field and supported by a diagnostic The diagnosis must be supported by audiometric
test to indicate the quantum loss of hearing. and sound-threshold tests provided and confirmed
by an Ear, Nose, Throat (ENT) specialist.
Cavernous sinus thrombosis surgery
The actual undergoing of a surgical drainage for

cavernous sinus thrombosis.
The presence of Cavernous Sinus Thrombosis as

well as the requirement for surgical intervention
must be confirmed necessary by a specialist in the
relevant field.


Partial hepatectomy of at least one (1) entire lobe of Cirrhosis of the liver with a HAI-Knodell Scores of End stage liver failure as evidenced by at least two
the liver as a result of illness or Accident occurring six (6) and above as evident by liver biopsy. (2) of the following:
after the Effective date or date of last reinstatement
of the Policy, whichever is later. The diagnosis must be confirmed by a specialist in  permanent jaundice;
the relevant field and based on the histological
 ascites; or
The procedure must be confirmed necessary by a findings of the liver biopsy.
specialist in the relevant field.  hepatic encephalopathy.
We do not cover the following for Liver Cirrhosis:
We do not cover the following for Liver Surgery:
We do not cover the following for End Stage Liver
 Liver disease secondary to alcohol or drug
Failure:
 Liver disease secondary to alcohol or drug abuse.
abuse.
 Liver disease secondary to alcohol or drug
abuse.


26 Severe Asthma Surgical Removal of One Lung End Stage Lung Disease
Evidence of an acute attack of Severe asthma with Complete surgical removal of a lung as a result of End stage lung disease, causing chronic respiratory
persistent status asthmaticus that requires an illness or Accident occurring after the Effective failure. The diagnosis must be supported by
hospitalization and endotracheal intubation and date or date of last reinstatement of the Policy, evidence of all the following:
mechanical ventilation for a continuous period of at whichever is later.
least four (4) hours on the advice of a specialist in  FEV1 test results which are consistently less
the relevant field. The procedure must be confirmed necessary by a than one (1) liter; and
specialist in the relevant field
 Permanent supplementary oxygen therapy
for hypoxemia; and
We do not cover the following for Surgical
Removal of One (1) Lung:  Arterial blood gas analyses with partial
oxygen pressures of 55mmHg or less
Insertion of a Vena Cava Filter  Partial removal of a lung. (PaO2 ≤ 55mmHg); and
 Dyspnea at rest.
The surgical insertion of a vena cava filter after
there has been documented proof of recurrent
pulmonary emboli. The diagnosis must be confirmed by a specialist in
the relevant field.
The insertion of a vena cava filter must be
confirmed to be necessary by a specialist in the
relevant field.


27 Biliary Tract Reconstruction Surgery Chronic Primary Sclerosing Cholangitis Fulminant Hepatitis
Biliary tract reconstruction surgery involving Chronic primary sclerosing cholangitis, where the A submassive to massive necrosis of the liver by the
choledochoenterostomy (choledochojejunostomy diagnosis is supported by evidence of all the Hepatitis virus, leading precipitously to liver failure.
or choledochoduodenostomy) for the treatment of following: The diagnosis must be supported by all the
biliary tract disease, including biliary atresia, that is  Confirmed on a cholangiogram imaging following:
not amenable to other surgical or endoscopic confirming progressive obliteration of the
measures. bile ducts; and  rapid decreasing of liver size as confirmed by
abdominal ultrasound; and
 There is a need immunosuppressive
The procedure must be considered the most
treatment, drug therapy for intractable  necrosis involving entire lobules, leaving only
appropriate treatment by a specialist in
pruritis or if biliary tract obliteration has a collapsed reticular framework; and
hepatobiliary disease.
required balloon dilation or stenting of the
 rapid deterioration of liver function tests; and
bile ducts; and
We do not cover the following for Biliary Tract
 The condition must have progressed to the  deepening jaundice; and
Reconstruction Surgery:
point where there is permanent jaundice and  hepatic encephalopathy
 When the procedure is a consequence of a diagnosed by a gastroenterologist.
gall stone disease or cholangitis.
The diagnosis must be confirmed by a The diagnosis must be confirmed by a specialist in
gastroenterologist. the relevant field.
We do not cover the following for Chronic Primary We do not cover the following for Fulminant
Sclerosing Cholangitis: Hepatitis:
 Biliary tract sclerosis or obstruction as a  Liver failure due to alcohol or drug abuse.
consequence of biliary surgery, gall stone
disease, infection, inflammatory bowel
disease or other secondary precipitants.


Surgical Removal of One (1) Kidney Chronic Kidney Disease Kidney Failure
The complete surgical removal of one (1) kidney Chronic kidney disease with permanently impaired Chronic irreversible failure of both kidneys
due to an illness or Accident occurring after the renal function must be diagnosed by a nephrologist requiring either permanent renal dialysis or kidney
Effective date or date of last reinstatement of the transplantation
Policy, whichever is later. There must be laboratory evidence that shows that
renal function is severely decreased with an The treatment or procedure must be confirmed to
The procedure must be confirmed to be necessary Estimated Glomerular Filtration Rate (eGFR) less be necessary by a specialist in the relevant field.
by a specialist in the relevant field. than 15mL/min/1.73m2 body surface area,
persisting for a period of 6 months or more.
We do not cover the following for Surgical
Removal of One (1) Kidney:
 Kidney donation
Chronic Kidney Impairment
Chronic kidney impairment with advanced stage of

chronic renal insufficiency that must be diagnosed
by a nephrologist
There must be laboratory evidence that shows that

renal function is severely decreased with an
Estimated Glomerular Filtration Rate (eGFR) less


than 30mL/min/1.73m2 body surface area,

persisting for a period of at least ninety (90) days.
29 Permanent or Temporary Tracheostomy Loss of Speech due to Vocal Cord Paralysis Loss of Speech
The performance of tracheostomy for the The complete and irrecoverable paralysis of the Total and irrecoverable loss of the ability to speak
treatment of lung disease or airway disease or as a vocal cords as a result of neurological disease, as a result of disease, illness or Accident occurring
ventilatory support measure following major illness or Accident occurring after the Effective date after the Effective date or date of last reinstatement
trauma or burns. The following conditions should or date of last reinstatement of the Policy, of the Policy, whichever is later, to the vocal cords.
be satisfied: whichever is later. where surgical intervention is
required on the advice of an Ear, Nose, and Throat The inability to speak must be established for a
 The Insured must have been a patient in an (ENT) surgeon to restore the loss of speech. continuous period of twelve (12) months.
Intensive Care Unit (ICU) under the care of a
specialist in the relevant field; and The inability to speak must be established for a The diagnosis must be supported by medical
continuous period of twelve (12) months. evidence furnished by an Ear, Nose, Throat (ENT)
 The tracheostomy is required to remain in
specialist.
place and functional for a period of at least
The diagnosis must be supported by medical
three (3) months.
evidence furnished by an Ear, Nose, Throat (ENT) We do not cover the following for Loss of Speech:
specialist.
 Loss of Speech due to all psychiatric
We do not cover the following for Loss of Speech related causes.
due to Vocal Cord Paralysis:
 Loss of Speech due to all psychiatric related

causes.


Second degree (partial thickness of the skin) burns Third degree (full thickness of the skin) burns Third degree (full thickness of the skin) burns
covering at least 20% of the surface of the Insured’s covering at least 50% of the face of the Insured. covering at least 20% of the surface of the Insured’s
body. body.
The diagnosis must be confirmed a specialist in the the relevant field. The diagnosis must be confirmed a specialist in the
relevant field. relevant field.
The burns must be treated by a specialist in the
The burns must be treated by a specialist in the relevant field. The burns must be treated by a specialist in the
relevant field. relevant field.
31 Small Bowel or Small Intestine Transplant Waitlist on a Major Organ/ Bone Marrow Major Organ / Bone Marrow
Transplantation Transplantation
The receipt of a transplant of at least one (1) meter
of small bowel or small intestine with its own blood Being on an official organ transplant waiting list for
The receipt of a transplant of:
supply via a laparotomy resulting from intestinal the receipt of a transplant of:
failure.
 Human bone marrow using hematopoietic
 Human bone marrow using hematopoietic
stem cells preceded by total bone marrow
stem cells preceded by total bone marrow
ablation; or
ablation; or


Corneal Transplant  One (1) of the following organs that resulted  One (1) of the following organs that resulted
from irreversible end stage failure of the from irreversible end stage failure of the
The receipt of a transplant of a whole cornea due to relevant organ: relevant organ:
irreversible scarring with resulting reduced visual
o Heart o Heart
acuity which cannot be corrected with other
methods. o Lung o Lung
o Liver o Liver
o Kidney o Kidney
o Pancreas o Pancreas
We do not cover the following for Waitlist on a We do not cover the following for Major Organ /
Major Organ/ Bone Marrow Transplant: Bone Marrow Transplantation:
 Other stem cell transplants  Other stem cell transplants


Others
32 Early Stage Loss of Independent Existence Intermediate Stage Loss of Independent Late Stage Loss of Independent Existence
Existence
Total and irreversible physical loss of all fingers and A condition as a result of a disease, illness or
thumbs due to an Accident occurring after the A condition as a result of a disease, illness or Accident occurring after the Effective date or date
Effective date or date of last reinstatement of the Accident occurring after the Effective date or date of last reinstatement of the Policy, whichever is
Policy, whichever is later. of last reinstatement of the Policy, whichever is later, whereby the Insured is unable to perform
later, whereby the Insured is unable to perform (whether aided or unaided) at least three (3) of the
This condition must be confirmed by an attending (whether aided or unaided) at least two (2) of the six (6) "Activities of Daily Living", for a continuous
physician. following (six) 6 "Activities of Daily Living", for a period of six (6) months:
continuous period of six (6) months:
We do not cover the following for Early Stage Loss (i) Washing — the ability to wash in the bath
of Independent Existence: (i) Washing — the ability to wash in the bath or shower (including getting into and out of
or shower (including getting into and out of the bath or shower) or wash satisfactorily
 Loss of fingers due to self-inflicted injuries. the bath or shower) or wash satisfactorily by other means; or
by other means; or
(ii) Dressing — the ability to put on, take off,
(ii) Dressing — the ability to put on, take off, secure and unfasten all garments and, as
secure and unfasten all garments and, as appropriate, any braces, artificial limbs or
appropriate, any braces, artificial limbs or other surgical appliances; or
other surgical appliances; or
(iii) Transferring — the ability to move from a
(iii) Transferring — the ability to move from a
bed to an upright chair or wheelchair and
bed to an upright chair or wheelchair and
vice versa; or
vice versa; or


(iv) Mobility — the ability to move indoors (iv) Mobility — the ability to move indoors from
from room to room on level surfaces; or room to room on level surfaces; or
(v) Toileting — the ability to use the lavatory (v) Toileting — the ability to use the lavatory or
or otherwise manage bowel and bladder otherwise manage bowel and bladder
functions so as to maintain a satisfactory functions so as to maintain a satisfactory
level of personal hygiene; or level of personal hygiene; or
(vi) Feeding – the ability to feed oneself once (vi) Feeding — the ability to feed oneself once
food has been prepared and made food has been prepared and made
available. available
The condition must persist continuously for at least The condition must persist continuously for at least
six (6) months as confirmed by an attending six (6) months as confirmed by an attending
physician or an attending physician confirms that physician or an attending physician confirms that
the insured will not recover from the disability in the insured will not recover from the disability in
the next five (5) years. the next five (5) years.
 Aid of special equipment. Device and/or  Aid of special equipment. Device and/or
We do not cover Intermediate Stage Loss of We do not cover Late Stage Loss of Independent
Independent Existence that is a result of: Existence that is a result of:


 Non-organic diseases such as neurosis and  Non-organic diseases such as neurosis and
psychiatric illnesses. psychiatric illnesses.
33 Peripheral Neuropathy Poliomyelitis (Intermediate Stage) Poliomyelitis
Severe peripheral motor neuropathy arising The occurrence of Poliomyelitis where all the The occurrence of Poliomyelitis where all following
from anterior horn cells resulting in significant following conditions are met: conditions are met:
motor weakness, fasciculation, and muscle wasting
that result in a permanent need for the use walking  Poliovirus is identified as the cause; and  Poliovirus is identified as the cause; and
aids or a wheelchair
 Paralysis of the respiratory muscles  Paralysis of the limb muscles or respiratory
supported by ventilator for a continuous muscles must be present and persist for at
The diagnosis must be confirmed by a neurologist
period of at least 96 hours. least three (3) months.
as a result of nerve conduction studies.
We do not cover the following for Peripheral The diagnosis must be confirmed by a specialist in The diagnosis must be confirmed by a specialist in
Neuropathy: the relevant field. the relevant field.
 Diabetic neuropathy; or
 Neuropathy due to alcohol.


34 Early Progressive Scleroderma Progressive Scleroderma with CREST Progressive Scleroderma

Syndrome
“Progressive Scleroderma” a systemic collagen- “Progressive Scleroderma” a systemic collagen- “Progressive Scleroderma” a systemic collagen-
vascular disease causing progressive diffuse vascular disease causing progressive diffuse vascular disease causing progressive diffuse
fibrosis in the skin, blood vessels and visceral fibrosis in the skin, blood vessels and visceral fibrosis in the skin, blood vessels and visceral
organs. organs. organs.
The diagnosis must be confirmed by a The diagnosis of systemic sclerosis with calcinosis, The diagnosis of progressive scleroderma must be
rheumatologist supported by biopsy and Raynaud phenomenon, esophageal dysmotility, confirmed by a rheumatologist supported by
serological evidence. sclerodactyly, and telangiectasia (CREST) syndrome biopsy and serological evidence and the disorder
must be confirmed by a rheumatologist supported must have reached systemic proportions to involve
We do not cover the following for Early by biopsy and serological evidence. the heart, lungs or kidneys.
Progressive Scleroderma:
The disease must involve the skin with deposits of
We do not cover the following for Progressive
 Localized scleroderma (linear scleroderma calcium (calcinosis), skin thickening of the fingers or
Scleroderma:
or morphea); or toes (sclerodactyly) and also involve the esophagus.
 Eosinophilic fasciitis; There must also be telangiectasia (dilated  Localized scleroderma (linear scleroderma
capillaries) and Raynaud’s Phenomenon causing or morphea); or
artery spasms in the extremities.  Eosinophilic fasciitis; or
Calcinosis, Raynaud phenomenon, esophageal
dysmotility, sclerodactyly, and telangiectasia  Calcinosis, Raynaud phenomenon,
We do not cover the following for Progressive
(CREST) syndrome. esophageal dysmotility, sclerodactyly, and
Scleroderma with CREST Syndrome:
telangiectasia (CREST) syndrome
 Localized scleroderma (linear scleroderma or
morphea); or
 Eosinophilic fasciitis.


35 Mild Systemic Lupus Erythematosus Systemic Lupus Erythematosus with Lupus

Nephritis
A multi-system, multifactorial, autoimmune
disorder characterized by the development of A multi-system, multifactorial, autoimmune
autoantibodies directed against various disorder characterized by the development of
self-antigens. autoantibodies directed against various
self-antigens.
Mild Systemic Lupus Erythematosus will be
restricted to those forms of systematic lupus Systemic Lupus Erythematosus with Lupus
erythematosus that require systemic Nephritis will be restricted to those forms of
immunosuppressive therapy for multiple organ systemic lupus erythematosus which involve the
involvement for at least six (6) months. kidneys (Class III to Class V Lupus Nephritis,
established by renal biopsy, and in accordance with
Evidence must be provided from the treating the WHO Classification).
specialist in the relevant field that there has been
involvement of at least three (3) of the following
The WHO Classification of Lupus Nephritis:
internal organs:
 Kidneys Class I: Minimal Change Lupus

 Brain Glomerulonephritis
 Heart (or pericardium) Class II: Mesangial Lupus Glomerulonephritis
 Lungs (or pleura) Class III: Focal Segmental Proliferative Lupus
 Joints. Joint involvement is defined as the Glomerulonephritis
presence of polyarticular inflammatory
Class IV: Diffuse Proliferative Lupus
arthritis.
Glomerulonephritis


Skin involvement is not considered one (1) of the Class V: Membranous Lupus
specified organs. Glomerulonephritis
The diagnosis must be confirmed by a doctor

specializing in Rheumatology and Immunology.
We do not cover the following for Mild Systemic

Lupus Erythematosus:
Moderately Severe Systemic Lupus
 Other forms, discoid lupus and those forms Erythematosus (S.L.E.) with Lupus Nephritis
with hematological involvement.
A multi-system, multifactorial, autoimmune
disorder characterized by the development of
autoantibodies directed against various self-
antigens.
The diagnosis of S.L.E. with Lupus Nephritis will be

based on all the following conditions:
(i) Clinically there must be at least four (4) out of

the following presentations suggested by The
American College of Rheumatology.
 Malar rash;
 Discoid rash;
 Photosensitivity;
 Oral ulcers;


 Arthritis;
 Serositis;
 Renal Disorder;
 Leukopenia (<4,000/mL), or
Lymphopenia (<1,500/mL), or Hemolytic
anemia, or Thrombocytopenia
(<100,000/mL); or
 Neurological disorder.
(ii) At least two (2) of the following tests being

positive:
 Anti-nuclear Antibodies
 L.E. cells
 Anti-DNA
 Anti-Sm (Smith IgG Autoantibodies)
(iii) There is lupus nephritis causing impaired

renal function with a creatinine clearance rate
of 50 ml per minute or less.



36 Terminal Illness
An illness that is expected to result in the passing

away of the Insured within twelve (12) months from
diagnosis.
The diagnosis must be conclusive and confirmed by

a specialist in the relevant field.
We do not cover the following for Terminal Illness:
 Terminal illness in the presence of HIV

infection.



These conditions are only payable if the insured is between thirty (30) days old and seventeen (17) years old at the time of diagnosis (including when
signs or symptoms are first experienced)
37 Insulin Dependent Diabetes Mellitus
Diabetes mellitus is chronic hyperglycemia, caused

by defective insulin secretion. Insulin Dependent
Diabetes Mellitus is characterized by the
continuous dependence on exogenous insulin for
the preservation of life. The dependency must
persist for at least six (6) months.

the relevant field.
Suffering from severe hemophilia A (VIII deficiency)

or hemophilia B (IX deficiency) with factor VIII or
factor IX activity levels less than one percent (1%).

the relevant field.


39 Kawasaki Disease
This is acute, febrile and multisystem disease of

children, characterized by non-suppurative cervical
lymphadenopathy, skin and mucous membrane
lesions.
There must be echocardiograph evidence or any

other imaging test showing cardiac involvement
manifested by dilatation or aneurysm formation of
at least six (6) millimeters in diameter in the
coronary arteries which persists for at least six (6)
months after the initial acute episode.

the relevant field.
This is a genetic disorder characterized by brittle,

osteoporotic, easily fractured bones.
The diagnosis must be as a type Ill Osteogenesis

lmperfecta and must satisfy all the following


conditions:
 Suffers from growth retardation and hearing

impairment as a result of a physical
examination; and
 Multiple fracture of bones and progressive

kyphoscoliosis as a result of an x-ray; and
 Positive result of skin biopsy.

the relevant field.
41 Rheumatic Fever with Valvular Impairment

conditions:
 Acute rheumatic fever according to the

revised Jones criteria; and
 An involvement of at least one (1) heart

valves and at least mild valve incompetence
attributable to rheumatic fever as confirmed


by quantitative investigations of the valve

function.

the relevant field.
42 Severe Asthma
The diagnosis must satisfy as least four (4) of the

following conditions:
 History of status asthmaticus within the

past two years; or
 Significant and continuous reduction in

exercise tolerance; or
 Chest deformities resulting from chronic

hyperinflation; or
 The need for medically prescribed oxygen

therapy at home; or
 Continuous daily use of oral

corticosteroids (for a minimum period of at
least six (6) months).


43 Severe Dengue

conditions:
 Diagnosed with Dengue; and
 Confined in a hospital for a continuous period
of at least three (3) hospital days; and
 Admission or transfer to Intensive Care Unit
(ICU); and
 Observed with at least two (2) of the following
symptoms/medical actions:
o Platelet count is less than 100,000/μl; or
o With at least one (1) platelet
transfusion; or
o Severe plasma leakage leading to
Dengue Shock Syndrome (DSS) and/or
fluid accumulation with respiratory
distress; or
o Severe bleeding or hemorrhages; or
o Severe organ impairment (hepatic
damage, renal impairment,
cardiomyopathy, encephalopathy, or
encephalitis

the relevant field.


44 Systemic Juvenile Idiopathic Arthritis

(Still's Disease)
The occurrence of Still's Disease, a form of juvenile

chronic arthritis, where there is widespread joint
destruction as a result of the disease necessitating
hip or knee replacement.

the relevant field.
45 Wilson's Disease
A potentially fatal disorder of copper toxicity

characterized by progressive liver disease and/or
neurologic deterioration due to copper deposit. The
diagnosis must satisfy all the following conditions:
 A liver biopsy was performed; and
 The treatment with a chelating agent must

be documented for at least six (6) months

the relevant field.


The following are the surgeries that are payable under Medical Cost Reimbursement for Major Critical
Condition Benefit:
1. Benign Brain Tumor

The surgical excision by craniotomy of a non-cancerous tumor in the brain.
The procedure must be certified to be medically necessary by a neurologist.
We do not cover procedures of the following for Benign Brain Tumor:
 cysts; or
 granulomas; or
 vascular malformations; or
 hematomas; or
 tumors of the pituitary gland or spinal cord.
2. Coronary Artery Bypass Surgery

The actual undergoing of open-chest surgery or Minimally Invasive Direct Coronary Artery Bypass
(MIDCAB) surgery to correct the narrowing or blockage of one or more coronary arteries with
bypass grafts.
The diagnosis must be supported by angiographic evidence of significant coronary artery
obstruction and the procedure must be considered medically necessary by a cardiologist.
We do not cover the following for Coronary Artery Bypass Surgery:
 Angioplasty; or
 All other intra-arterial, catheter-based techniques, ‘keyhole’ or laser procedures.
3. Heart Valve Surgery

The actual undergoing of open-heart surgery to replace or repair heart valve abnormalities.
The diagnosis of heart valve abnormality must be supported by cardiac catheterization or
echocardiogram.
The procedure must be certified to be medically necessary by a cardiologist.

12F Four/NEO, 30th St. Corner 4th Ave. Annex B – Description of Covered Surgeries
singlife.com.ph Page 01 Form No. GCMheCAnB.21v1

4. Major Cancers
The actual undergoing of surgery for the total excision of a cancerous tumor.
The procedure must be certified to be medically necessary by a specialist in the relevant field.
We do not cover procedures of the following for Major Cancers:
 All tumors which are histologically classified as any of the following:

o Pre-malignant
o Non-invasive
o Carcinoma-in-situ
o Having borderline malignancy
o Having any degree of malignant potential
o Having suspicious malignancy
o Neoplasm of uncertain or unknown behavior
o Cervical Dysplasia CIN-1, CIN-2 and CIN-3; or
 Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes
or beyond; or
 Malignant melanoma that has not caused invasion beyond the epidermis; or
 All Prostate cancers histologically described as T1N0M0 (TNM Classification) or below; or
Prostate cancers of another equivalent or lesser classification; or
 All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below; or
 All tumors of the Urinary Bladder histologically classified as T1N0M0 (TNM Classification) or
below; or
 All Gastro-Intestinal Stromal tumors histologically classified as T1N0M0 (TNM Classification)
or below and with mitotic count of less than or equal to 5/50 HPFs; or
 Chronic Lymphocytic Leukemia less than RAI Stage 3; or
 All tumors in the presence of HIV infection.


5. Major Head Trauma
The actual undergoing of decompressive craniotomy caused by Major Head Trauma due to an
Accident, where bleeding and swelling inside of the brain around the area where the head was
struck had resulted in the formation of either subdural or epidural hematoma with significant
intracranial hypertension.
“Decompressive craniotomy” refers to the practice of removing a large bone flap and opening the
underlying dura in order to control brain swelling and raised intracranial pressure.
We do not cover procedures of the following for Major Head Trauma:
 Spinal cord injury; or
 Head injury due to any other causes.
6. Major Organ/Bone Marrow Transplantation

The receipt of a transplant of:
 Human bone marrow using hematopoietic stem cells preceded by total bone marrow
ablation; or
 One (1) of the following organs that resulted from irreversible end stage failure of the
relevant organ:
o Heart
o Lung
o Liver
o Kidney
o Pancreas
We do not cover the following for Major Organ/Bone Marrow Transplantation:
 Other stem cell transplant


7. Stroke
The actual undergoing of surgery by craniotomy in cases of hemorrhagic stroke caused by an
aneurysm or defective blood vessel isolating the aneurysm or defective blood vessel from the
normal bloodstream, and to help relieve increased intracranial pressure.
We do not cover procedures of the following for Stroke:
 Transient Ischemic Attacks; or
 Brain damage due to an accident, infection, vasculitis, and inflammatory disease; or
 vascular disease affecting the eye or optic nerve; or
 Ischemic disorders of the vestibular system.
8. Surgery to Aorta
The actual undergoing of percutaneous intravascular angioplasty and stenting techniques to repair
or correct an aneurysm, narrowing, obstruction, or dissection of the aorta, as evidenced by an
echocardiogram or any other appropriate diagnostic imaging test that is available.
The procedure certified by a cardiologist or vascular surgeon.
We do not cover the following for Surgery to Aorta:
 Open repair, resection or grafting of aneurisms involving laparotomy or thoracotomy by

laparoscopic (port access) techniques.
9. Kidney Transplantation
The actual undergoing of kidney transplantation due to the chronic irreversible failure of both
kidneys.
The procedure must be certified medically necessary by a specialist in the relevant field.


Cash for Medical Costs
Dependents Coverage Contract
This Dependents Coverage Contract will form part of your Policy Contract if it is indicated in your Policy
Details Page(s) as one of the attachments.
This Contract will specify the benefits and provisions that are applicable to the dependents that you have
chosen to insure under Cash for Medical Costs. Each Insured Dependent will be issued his/her own
Policy Details Page(s) and the effective of their coverage will be as stated in his/her own Policy Details
Page.
The provisions of the Product Contract will apply to this Dependent Coverage Contract unless there is a
conflict between this Dependent Coverage Contract and the Product Contract. In which the provisions of
this Dependents Coverage Contract will prevail.
Insured Dependents
These are person/s who rely on you for support and are also covered by the policy.
When we say “his/her, he/she”, in this Dependents Coverage Contract, we mean the
Insured Dependent/s.

12F Four/NEO, 30th St. Corner 4th Ave. Dependents Coverage Contract
singlife.com.ph Page 01 Form No. GCMheCDpS.21v1

1. Qualified Insured Dependents
You can buy insurance coverage under this policy for the following:
a. Your Legal Spouse who is at least eighteen (18) up to fifty-four (54) years old;
b. Your Life Partner who is at least eighteen (18) up to fifty-four (54) years old;
c. Your legitimate, illegitimate, legitimated, legally adopted, and recognized natural children,
who are single and at least thirty (30) days old up to twenty-two (22) years old;
d. Your Legal Spouse or Life Partner’s children, who are single and at least thirty (30) days old
up to twenty-two (22) years old.
Life Partner
 A person who is in a relationship with you and has been living together with you for at
least two (2) years.
 He/she can only be qualified if you both do not have a legal spouse.

12F Four/NEO, 30th St. Corner 4th Ave. Qualified Insured Dependents

2. Ownership of Policy if You Pass Away
If you pass away, the policy shall not terminate as long as any Insured Dependents' coverage is still
active. The new Policy Owner would be the eldest Insured Dependent of legal age (at least 18 years
old). However, if there is no Insured Dependent of legal age, the eldest Insured Dependent becomes
the new Policy Owner. The rights and privileges of the policy may be executed by his/her legal
guardian.
The coverage of the minor Insured Dependent will only extend up to the next premium due date, and
the Policy Contract under which this Dependents Coverage Contract is a part of will terminate.
Once a new Policy Owner is assigned, all Insured Dependents with active coverages will
continue as Insured Dependents of the new Policy Owner.

12F Four/NEO, 30th St. Corner 4th Ave. Ownership of Policy if You Pass Away

3. The Benefits of Your Insured Dependents
We will pay the following benefits, while your Insured Dependent’s coverage is active and subject to
the benefit amount limits stated in his/her Policy Details Page(s) to you, the Policy Owner. If we cannot
pay you the benefit because you passed away, we will pay it to the new Policy Owner, subject to the
condition set in Section 2 ‘Ownership of Policy if you Pass Away’.
If the benefit is because of the Insured Dependent passing away due to a Critical Condition as defined
in Section 4 ‘List of Covered Critical Conditions’ or there are no Policy Owners at the time of the
payment of claim, the benefit will be payable to his/her beneficiaries as named in the application
form. However, if there no living named beneficiaries, we will pay to your family member/s the
benefits in the standard beneficiaries as defined below.
Standard Beneficiaries
These are your Insured Dependent’s family member/s according to this standard order:
1. His/her surviving legitimate, illegitimate, legitimated, legally adopted, and

recognized natural children, without distinction; or
2. His/her surviving parents; or
3. His/her surviving siblings; or
If none of the family members stated above are alive, the benefit will be paid to his/her
estate.
All beneficiaries will share the benefits equally.

Families are often unprepared for the hospitalization costs that an illness or accident may
entail.
To cover a portion of the Insured Dependent’s daily hospital room and board, we will pay
you the benefit amount as stated in his/her Policy Details Page(s) for each hospital day
he/she is confined, provided that:
 The Insured Dependent’s confinement in a Hospital is because of an Illness or
Accident; and
 It is medically necessary as recommended by an attending Physician; and
 The Insured Dependent is confined for at least two (2) Hospital Days.

12F Four/NEO, 30th St. Corner 4th Ave. The Benefits of Your Insured Dependents

If the Insured Dependent is confined in the Intensive Care Unit (ICU), we will pay three
times (3x) the Daily Hospital Cash Benefit for each day of ICU confinement.
Separate hospital confinements that are due to the same cause and happens within 30
days from date of last discharge to latest confinement, will be considered as one (1) event
of continuous confinement. The total number of Hospital Days that the Insured
Dependent is confined within a continuous confinement will be used to determine the
minimum Hospital Days required as described above.
A confinement that starts during the Policy Year and ends in the next Policy Year will be
considered as a confinement for the earlier Policy Year.
Pregnancy-related coverage for Daily Hospital Cash Benefit
Hospital confinement due to Pregnancy is covered under the Daily Hospital Cash Benefit,
provided that:
 the first day of the hospital confinement happens one (1) year after the effective date
or date of last reinstatement of the Insured Dependent’s coverage, provided that the
state of being pregnant must be after one (1) year from the effective date or date of
last reinstatement of the Insured Dependent’s coverage; and
 the Insured Dependent’s confinement is medically necessary as recommended by an

attending physician; and
 the Insured Dependent is confined for at least two (2) Hospital Days.
 the Insured Dependent’s confinement is due to any of the following:

o Any of the following childbirth delivery procedures:
 Natural Spontaneous Delivery / Vaginal Delivery
 Cesarian Section (C-Section)
 Assisted Delivery
o Pregnancy-related complications
o Extended confinement due to childbirth complications.


 For Daily Hospital Cash, we will only pay up to one hundred (100) Hospital Days
of hospital confinement in a Policy Year for each Insured Dependent. This is
inclusive of any confinement in the ICU. When the total number of Hospital
Days claimed under this coverage reaches one hundred (100) Hospital Days in
a Policy Year, you can no longer file a claim under the Daily Hospital Cash
Benefit for that Policy Year. However, you must continue to pay the premiums
for the Insured Dependent’s coverage to remain active.
 The one hundred (100) Hospital Days limit under the Daily Hospital Cash
Benefit will reset every Policy Anniversary unless the Insured Dependent’s
coverage terminates.
 The ninety (90) day waiting period will not apply for hospital confinements that
are due to an Accident. We will pay the Daily Hospital Cash Benefit if it is due to
an Accident as long as the benefit is active when the incident happens.
 We will not pay for the Daily Hospital Cash Benefit if the hospital confinement
is due to an illness that is present during the ninety (90) day waiting period.
This includes any signs or symptoms of the illness that is present during the
Waiting Period.
 We will not pay for the Daily Hospital Cash Benefit if the hospital confinement
is due to pregnancy or childbirth within one (1) year from the effective date or
date of last reinstatement, whichever is later, of the Insured Dependent’s
coverage.
 A confinement that starts during the Policy Year and ends on the next Policy
Year, will be considered as a confinement for the earlier Policy Year.


The benefits that are specified in the following sections can only be availed if they are
included in the Policy Details Page(s) of the Insured Dependent and the premium for the
Additional Coverage is paid for.

Critical conditions may incur higher than average medical costs that can affect a
family’s financial position.
The Any Critical Condition Diagnosis Benefit can only be availed if it is included
in his/her Policy Details Page(s) and the premium is paid for.
To help you with the costs for the diagnosis of a Critical Condition, we will pay
the amount as stated in the Insured Dependent’s Policy Details Page(s) in lump
sum, provided that:
 the Insured Dependent is diagnosed with any Critical Condition as
defined in Section 4 ‘List of Covered Critical Conditions’; and
 the Critical Condition diagnosis happens and/or signs or symptoms are
first experienced after the ninety (90) day Waiting Period, subject to the
If the Insured Dependent passes away due to a Critical Condition as defined in

Section 4 ‘List of Covered Critical Conditions’, we will pay the benefit amount for
Any Critical Condition Diagnosis Benefit.
You can claim only once under this benefit, may it be for diagnosis of a Critical
Condition or passing away due to a Critical Condition. Once a claim is approved
or if the Insured Dependent passes away (whichever comes first), the Any
Critical Condition Diagnosis Benefit terminates thereafter.
Any Critical Condition
These are conditions that are defined in Section 4 ‘List of Covered Critical
Conditions’. A Critical Condition may be classified as Early Stage, Intermediate
Stage, or Late Stage.


 The ninety (90) day waiting period will not apply for Critical Conditions that are due
to an Accident. We will pay the Any Critical Condition Diagnosis Benefit if it is due to
an Accident as long as the benefit is active when the Accident happens.
 We will not pay the Any Critical Condition Diagnosis Benefit if the Critical Condition
is due to an illness that is already present during the ninety (90) day Waiting Period.
This includes any signs or symptoms of the illness that are present during the
Waiting Period.
 We will not pay the Any Critical Condition Benefit if the claim arises from a
Pre-Existing Condition or from any of the causes listed under Section 5 ‘What we are
not able to Cover’.


For critical conditions that are already in the late stage, medical costs may be much
higher requiring immediate care and/or long-term medical attention.
The Late Stage Critical Condition Diagnosis Benefit can only be availed if it is
included in the Insured Dependent’s Policy Details Page(s) and the premium is
paid for.
We will pay the benefit amount for Late Stage Critical Condition Diagnosis
Benefit, as stated in the Insured Dependent’s Policy Details Page(s), provided
that:
 the Insured Dependent is diagnosed with a Late Stage Critical Condition as
defined in Section 4 ‘List of Covered Critical Conditions’; and
 the Late Stage Critical Condition diagnosis happens and/or signs or
symptoms are first experienced after the ninety (90) day Waiting Period,
subject to the conditions set in this Policy.
If the Insured Dependent passes away due to a Late Stage Critical Condition as
defined in Section 4 ‘List of Covered Critical Conditions’, we will pay the benefit
amount for Late Stage Critical Condition Diagnosis Benefit, subject to the
Advance Payment of a Critical Condition

If we have approved the Any Critical Condition Diagnosis Benefit, it will be
considered an advance payment of the Late Stage Critical Condition Diagnosis
Benefit if:
 the Critical Condition approved under Any Critical Condition Diagnosis
Benefit is an Early or Intermediate Critical Condition as listed in Section 4
‘List of Covered Critical Conditions’; and
 the Early or Intermediate Critical Condition is related to the Late Stage

Critical Condition that will be paid under the Late Stage Critical Condition
Diagnosis Benefit.
This means that the Late Stage Critical Condition Diagnosis Benefit we will pay
you will be the benefit amount for Late Stage Critical Condition Diagnosis
Benefit as stated in the Insured Dependent’s Policy Details Page(s) minus the
Any Critical Condition Diagnosis Benefit we have approved thus far, if
applicable.


Multi-Claim Feature of Late Stage Critical Condition Diagnosis Benefit
We will pay for the Late Stage Critical Condition Benefit up to three (3) times in
the Insured Dependent’s lifetime, subject to the following conditions:
1. You can only claim for each Late Stage Critical Condition once in the
Insured Dependent’s lifetime, but you can claim up to three (3)
unrelated Late Stage Critical Conditions in his/her lifetime.
2. In order for a succeeding Late Stage Critical Condition to be paid for

the Late Stage Critical Condition Diagnosis Benefit, the Critical
Condition diagnosis happens and/or signs or symptoms are first
experienced after the twelve (12) month Reset Period. Any claim
made during the Reset Period will not be accepted.
3. If the Insured Dependent is diagnosed with more than one (1) Critical
Condition on the same date or if the diagnosis of all conditions and/or
their signs or symptoms are first experienced within twelve (12)
months of each other and claims are filed for all of them, only the
earliest valid claim will be paid the Late Stage Critical Condition
Diagnosis Benefit. Additionally, if they are diagnosed (including signs
or symptoms) at exactly the same time, we will only consider one (1)
of the critical condition as part of your claim.
4. The following conditions can be claimed only if they are not as a

result of other covered critical conditions listed in Section 4 ‘List of
Covered Critical Conditions’:
However, if it is due to a covered Critical Condition, the claim will be
payable under that covered Critical Condition.
5. If the Insured Dependent already has an approved claim for a Late

Stage Critical Condition, under either Any or Late Stage Critical
Condition Diagnosis Benefit, you can no longer claim for the following
Late Stage Critical Conditions:


Reset Period
This is a twelve (12) month duration that must go by - starting from the diagnosis date
of the last Late Stage Critical Condition paid under the Late Stage Critical Condition
Diagnosis Benefit – before a new Late Stage Critical Condition can be payable again
under the same diagnosis benefit. Any new diagnosis should be made while the
Insured Dependent’s Late Stage Critical Condition Diagnosis Benefit is active.
Both conditions should be listed in Section 4 ‘List of Covered Critical Conditions’.
 The ninety (90) day Waiting Period will not apply for Late Stage Critical Conditions
that are due to an Accident. We will pay the Late Stage Critical Condition Diagnosis
Benefit if it is due to an Accident as long as the benefit is active when the incident
happens.
 We will not pay for the Late Stage Critical Condition Diagnosis Benefit if the Late
Stage Critical Condition is due to an illness that is already present during the ninety
(90) day Waiting Period. This includes any signs or symptoms of the illness that are
present during the Waiting Period.
 Any claim for Late Stage Critical Condition Diagnosis Benefit during the Reset
Period is not payable. You will still have to continuously pay for the premiums to
keep the Late Stage Critical Condition Diagnosis Benefit active.
 Once we have approved the third (3rd) Late Stage Critical Condition Diagnosis
Benefit under the Insured Dependent’s coverage, his/her Late Stage Critical
Condition Diagnosis Benefit will terminate.
 The Critical Conditions are considered related to each other if they belong to the
same Group.
 We will not pay the Late Stage Critical Condition Diagnosis Benefit if the claim arises
from a Pre-Existing Condition or from any causes under Section 5 ‘What We are Not
Able to Cover’.


3.2.3 Medical Cost Reimbursement for Late Stage Critical
Condition Benefit
Costs for serious Critical Conditions can increase especially if it requires immediate
treatment and surgeries.
The Medical Cost Reimbursement for Late Stage Critical Condition Benefit can
only be availed if it is included in the Insured Dependent’s Policy Details Page(s)
and the premium is paid for.
We will pay you for the Actual Eligible Expense up to benefit amount of the
Medical Cost Reimbursement for Late Stage Critical Condition Benefit stated in
the Insured Dependent’s Policy Details Page(s), provided that:
 the Insured Dependent is confined to undergo any of the surgeries for
the Late Stage Critical Condition Benefit listed under Annex B “List of
Covered Surgeries”.
 the procedure is for the same Late Stage Critical Condition that was
approved or filed under the Late Stage Critical Condition Diagnosis
Benefit.; and
 the surgery must occur within 90 days from the date of diagnosis of the
Late Stage Critical Condition.
In case of confinement outside the Philippines, we may - at our own discretion -

re- assess the hospital expenses payable for Medical Cost Reimbursement for Late
Stage Critical Condition to a comparable amount in Philippine Peso had it been
administered in the Philippines. The maximum amount to be paid will be the
benefit amount of the Medical Cost Reimbursement for Late Stage Critical
Condition Benefit stated in the Insured Dependent’s Policy Details Page(s).
Actual Eligible Expense
These are reasonable and customary medical costs related to the diagnosis
and procedures/surgeries of Critical Conditions that have been incurred.


 We will not deduct any payments that have been made by PhilHealth or any
health insurance providers from the benefits we will pay you.
 If we find your claim documents to be invalid or if we have reason to believe

that the cause of confinement, diagnosis, treatment or death is due to
causes listed in Section 5 ‘What We are Not Able to Cover’ or not due to
conditions as defined in Section 4 ‘List of Covered Critical Conditions’ we may
request the following to further assess your claim, where it is not forbidden
by law:
o undergo medical examination (at our expense); or
o submit other validation documents; or
o complete other necessary procedures
 The total benefit amount of the Insured Dependent under his/her coverage
and other health insurance policies/coverages issued by Singlife will be
subject to the maximum allowable amount that we set at the time this policy
was issued. We will refund to you the total premiums you paid that
correspond to any amount in excess of the maximum allowable amount.


The following are the covered Critical Conditions under your Policy, they are further defined on
Annex A ‘Description of Covered Critical Conditions’:
A Critical Condition may be classified as Early Stage, Intermediate Stage, or Late Stage. The Critical
Conditions are considered related to each other if they belong to the same Group.

Group
Carcinoma in Situ of Specified

1 Carcinoma in Situ Organs Treated with Radical Major Cancers
Surgery
Port Access of Keyhole Cardiac Coronary Artery By-pass

2 Transmyocardial Laser Therapy
Surgery Surgery
Pericardiectomy; or Early Cardiomyopathy; or Heart Attack of Specified

3
Cardiac Pacemaker Insertion Cardiac Defibrillator Insertion Severity
Percutaneous Valve
4 Percutaneous Valvuloplasty Heart Valve Surgery
Replacement or Repair
Moderate Coronary Artery Other Serious Coronary Artery

5 Mild Coronary Artery Disease
Disease Disease
Secondary Pulmonary Primary Pulmonary

6 Early Pulmonary Hypertension
Hypertension Hypertension
Large Asymptomatic Aortic Minimally Invasive Surgery to

7 Surgery to Aorta
Aneurysm Aorta
Myelodysplastic Syndrome or
8 Reversible Aplastic Anemia Aplastic Anemia
Myelofibrosis
Occupationally Acquired HIV; or

9 HIV due to Assault HIV due to Organ Transplant
HIV due to Blood Transfusion


Group
Neurological Conditions
Diagnosis of Dementia Moderately Severe Alzheimer's Alzheimer's Disease / Severe

10
including Alzheimer's Disease Disease Dementia
Bacterial Meningitis with

12 Bacterial Meningitis Severe Bacterial Meningitis
Reversible Neurological Deficit

13 Tumor by Transsphenoidal/ Benign Brain Tumor
Tumor by Open Craniotomy
Transnasal Hypophysectomy
Coma for 72 Hours; or

14 Coma for 48 Hours Coma for 96 Hours
Severe Epilepsy
Head Trauma Requiring

Reconstructive Surgery; or
Head Trauma Requiring Open
15 Cervical Spinal Cord Injury; or Major Head Trauma
Craniotomy
Surgery for Subdural
Hematoma
Spinal Cord Disease or Injury

18 Resulting in Bowel and Bladder Moderate Muscular Dystrophy Muscular Dystrophy
Dysfunction
Loss of Use of One Limb

19 Loss of Use of One Limb Paralysis
Requiring Prosthesis
Moderately Severe Parkinson's

20 Early Parkinson's Disease Parkinson's Disease
Disease
Brain Aneurysm Surgery; or

21 Carotid Artery Surgery Stroke
Cerebral Shunt Insertion


Group
Optic Nerve Atrophy with Low

23 Loss of Sight in One Eye Blindness (Loss of Sight)
Vision
Partial Loss of Hearing; or

24 Cavernous Sinus Thrombosis Cochlear Implant Surgery Deafness (Loss of Hearing)
Surgery
Severe Asthma; or
26 Surgical Removal of One Lung End Stage Lung Disease
Insertion of a Vena Cava Filter
Biliary Tract Reconstruction Chronic Primary Sclerosing

27 Fulminant Hepatitis
Surgery Cholangitis
Chronic Kidney Impairment; or

28 Surgical Removal of One Chronic Kidney Disease Kidney Failure
Kidney
Permanent or Temporary Loss of Speech due to Vocal

29 Loss of Speech
Tracheostomy Cord Paralysis
Small Bowel Transplant or Waitlist on a Major Organ/ Major Organ / Bone Marrow
31
Corneal Transplant Bone Marrow Transplantation Transplantation
Others
Early Stage Loss of Intermediate Stage Loss of Late Stage Loss of Independent
32
Independent Existence Independent Existence Existence
Poliomyelitis (Intermediate
33 Peripheral Neuropathy Poliomyelitis
Stage)
Progressive Scleroderma with

34 Early Progressive Scleroderma Progressive Scleroderma
CREST Syndrome
SLE with Lupus Nephritis; or

Mild Systemic Lupus
35 Moderately Severe SLE with
Erythematosus (SLE)
Lupus Nephritis
36 Terminal Illness


The following are child-related Critical Conditions. These Critical Conditions are only payable if the
insured is between thirty (30) days old and seventeen (17) years old at the time of diagnosis.

Group
Insulin Dependent Diabetes

37
Mellitus
39 Kawasaki Disease
Rheumatic Fever with Valvular

41
Impairment
42 Severe Asthma
Severe Dengue (Dengue

43
Hemorrhagic Fever)
Systemic Juvenile Idiopathic

44
Arthritis (Still's Disease)
45 Wilson's Disease


1. We will not pay for any benefits that happen within the ninety (90) day Waiting Period if these
are due to an illness.
2. We will not pay any benefits under your Policy if these are due to any the following:
 a Pre-Existing Condition; or
 suicide or any attempted suicide, while sane or insane; or
 any intentionally self-inflicted injury; or
 any illegal or unlawful act, or any attempt to perform any illegal or unlawful act
(including any act of terrorism) committed by you or the Insured Dependent; or
 while the Insured Dependent is in an aircraft or submarine except if as a fare-paying
passenger in a commercial aircraft; or
 voluntary taking, inhaling, or absorbing of poison, gas or fumes; or
 accidents arising from the effects of alcohol or improper use of drugs or narcotics; or
 any nuclear, biological, radioactive, or chemical contamination; or
 engagement in any dangerous sports or hobbies; or
 mental, nervous, or manifested sleep disorders or any other complications arising from
such.
3. We will not pay any benefit under any Daily Hospital Cash Benefit, if the confinement is for the
purpose of any of the following:
 bed rest or rest cures; or
 rehabilitation; or
 hospice care, a special kind of care that focuses on the quality of life for people who are
experiencing an advanced, life-limiting illness; or
 pregnancy related confinements where the state of being pregnant happens within one
(1) year from the effective date or date of last reinstatement of the Insured Dependent’s
coverage.
4. We will not pay any benefit under Medical Cost Reimbursement for Late Stage Critical Condition
Benefit and Daily Hospital Cash Benefit, if the expenses or confinement are due to any of the
following procedures or treatments:
 intentional abortion, sterilization of either sex, circumcision, sex transformations, or any
complication thereof; or
 cosmetic or plastic surgery, any dental work, eye or ear examination, except if necessary
for the repair or the alleviation of damage caused solely by an Accident; or
 HIV, AIDS, and AIDS Related Complex, except if stated in Section 4 ‘List of Covered Critical
Conditions’.
5. We will not pay for any medical cost reimbursement that are provided free of charge.


6. We will not pay any benefit if the condition or surgery is not included in either Annex A
‘Description of Covered Critical Conditions’ or Annex B ‘List of Covered Surgeries’.
Waiting Period
This is a ninety (90) day duration from the Effective Date or date of last
reinstatement of the Insured Dependent’s coverage that must go by before you
can make any valid claim to your Policy.
The Waiting Period also applies when you make changes to the Insured
Dependent’s benefit coverage, which starts from the effective date of change.
The Waiting Period will apply to hospitalizations, Critical Condition diagnosis and
medical reimbursement due to an illness, where the diagnosis and/or signs or
symptoms are first experienced within the ninety (90) day Waiting Period.
It will not apply to hospitalizations, Critical Condition diagnosis and medical

reimbursement that are due to an Accident.
Pre-Existing Condition
This is any condition, including congenital anomalies and conditions arising from
them, for which the Insured Dependent may have already had signs or symptoms,
received medical advice, diagnosis, medication, or treatment prior to the effective
date or date of last reinstatement of the Insured Dependent’s coverage, whichever is
later.
Any condition where a physician has certified that the Insured Dependent has fully
recovered for at least twenty-four (24) months prior to the effective date or date of
last reinstatement (whichever is later) of the Insured Dependent’s coverage will not
be considered as a Pre-existing Condition.
Free of Charge
This is any test, treatment, confinement, and other service that is paid for by the
Philippine government or any of its institutions or by private institutions. It is not
a part of an insurance benefit or any other service that was paid for by
himself/herself or another person/entity prior to getting the service.


6. Termination of Insured Dependents
Coverage
Termination
Refers to the end of the Insured Dependent’s insurance coverage, usually due to the
coverage’s term ending or due to cancellation. Termination date is the date his/her
insurance coverage ends.
6.1 The Insured Dependent’s coverage and it benefits will terminate on any of the following
days, whichever is the earliest:
 Termination Date stated in his/her Policy Details Page(s); or
 Effective date of your request for cancellation of your Policy; or
 Effective date of your request for cancellation of his/her coverage; or
 The day after the end of the thirty-one (31) day grace period, where the premium for
your Policy is due and remains unpaid; or
 The Policy anniversary following his/her
o Sixty-five (65th) Birthday (for Spouse or Life Partner or Parents)
o Twenty-third (23rd) Birthday (for Children or Siblings)
 The date he/she passes away.
6.2 The Insured Dependent’s Any Critical Condition Diagnosis Benefit will terminate on any of
the following days, whichever is the earliest:
 The date his/her coverage terminates based on 7.1 above; or
 The date we approved your claim for his/her benefit.
6.3 The Insured Dependent’s Late Stage Critical Condition Diagnosis Benefit will terminate on
any of the following days, whichever is the earliest:
 The date we have approved the third (3rd) Late Stage Critical Condition Diagnosis claim
under his/her coverage.

12F Four/NEO, 30th St. Corner 4th Ave. Termination of Insured Dependents Coverage

Coverage
6.4 The Insured Dependent’s Medical Cost Reimbursement for Late Stage Critical Condition
will terminate on any of the following days, whichever is the earliest:
 The date we approved the claim for Medical Cost Reimbursement for Late Stage
Critical Condition.
 Ninety (90) days after the termination of his/her Late Stage Critical Condition Diagnosis
Benefit.
After the termination of Insured Dependent’s coverage, we will have no more liability under the
Insured Dependent’s except to return any unused premium to you.
Unused Premium
This is the portion of the premium paid that was not utilized due to the termination of
the Policy or the Insured Dependent’s coverage.
For example, the policy owner paid for a one (1) year coverage but during the eight (8th)
month of the policy year, the policy is terminated due to one of the reasons listed
above. We will return a portion of the premium corresponding to the remaining four (4)
months of the policy year to the policy owner. However, if the Policy terminates due to
a claim being approved, there will be no unused premium.


Coverage
 You can still file a claim after your Policy or benefit terminates provided the
hospital confinement, diagnosis, surgery, or death occurred while your Policy and
benefit were active.
 Premiums must be continuously paid to keep the benefits active even for the
following scenarios:
o For Daily Hospital Cash Benefit — you have already claimed for one
hundred (100) Hospital Days in a Policy Year limit.
o For Late Stage Critical Condition Diagnosis Benefit — during the reset
period where no claim for this benefit is payable.
If the premiums are not paid during these times, the benefit will terminate.
 If you choose to cancel the Insured Dependent’s coverage by itself without

cancelling the Policy, Section 8.5 ‘Right to Cancel’ of the Product Contract will not
apply. The cancellation of the Insured Dependent’s coverage will be effective on the
next premium due date.
 If we need to return any unused premium to you for your Insured Dependent’s
Coverage, you may refer to the table under Section 8.5 ‘Right to Cancel’ of the
Product Contract for the schedule of unused premium.


Application Form Cash for Medical Costs
Date of Application Application Number Policy Number

January 01, 2022 MH-02000017057 MH-02000017057
Policy Owner & Primary Insured Details

Date of Birth Nationality Sex

January 19, 1987 Filipino Male
Mobile Number Email Address

+639054705915 ayakent@gmail.com
Policy Owner & Primary Insured — The person who applies for the policy. He/she is the only party with rights to the policy. He/she is
also the person who is covered by the policy. .
Insured Dependents
Dependent (1/2)

Precious Ledres Ramirez
Date of Birth Relationship to Policy Owner

January 29, 1994 Spouse/Life Partner

Not supplied Not supplied
Dependent (2/2)

Shan Kyle Yuan Ledres Ramirez
Date of Birth Relationship to Policy Owner

January 28, 2017 Child

Not supplied Not supplied

12F Four/NEO, 30th St. Corner 4th Ave. Application Form
singlife.com.ph Page 01 Form No. GCMheASam.21v1

Page 01
Application Number: MH-02000017057
Beneficiaries
The Primary Insured’s beneficiary/ies will be assigned in the following order:
1. Your surviving Legal Spouse; or 4. Your surviving siblings; or
2. Your surviving legitimate, illegitimate, 5. To your estate.

legitimated, legally adopted & recognized
natural children without distinction; or
3. Your surviving parents: or
Note: The Beneficiary of all insured dependents is the Policy Owner.

Beneficiaries — The persons designated to receive the policy benefits if the insured passes away.
Product Details
Base Insurance Sum Assured Premium Schedule Monthly Premium

Health Insurance PHP 300,000.00 Monthly PHP 1,106.00
(Any Cause)
Initial Premium Payment Initial Payment Method Succeeding Payment Method

PHP 1,106.00 GCash GCash
Note: Succeeding premiums, if applicable, will be based on the Schedule of Premiums and can differ from initial payment.


Additional Information
My Information
Height Weight
162.6 cm 90.0 kg
Mode of Travel for Work

N/A
Description of Current Work
I work in the office/my work desk most of the time.
My work involves manual labor that requires special skills and training. I also usually work in the
_______field.
My work does not seem to fit in the 2 options above.
Insured Spouse/Life Partner Information
Height Weight
157.5 cm 75.0 kg
Mode of Travel for Work

N/A
Description of Current Work
The Insured Spouse/Life Partner works in the office or at his/her work desk most of the time.
The Insured Spouse/Life Partner’s work involves manual labor that requires special skills
______ and training. He/she also usually works in the field.
The Insured Spouse/Life Partner’s work does not seem to fit in the 2 options above.


I confirm the following:
I do not have two (2) or more immediate family members – whether parents, siblings, or
children – who have been diagnosed and/or treated before age fifty (50) due to cancer, heart attack
or stroke.
The Insured Spouse/Life Partner does not have two (2) or more immediate family members –
whether parents, siblings, or children – who have been diagnosed and/or treated before age fifty (50)
due to cancer, heart attack or stroke.
Declarations
I am a Filipino citizen or a Foreigner who is a legal resident in the Philippines, between 18 to 54
years old; and
My Insured Dependent/s are either a Filipino citizen or a Foreigner who is a legal resident in the
Philippines; and
In the past two (2) years, I and my Insured Dependent/s have not been diagnosed and/or treated by
a medical specialist for cancer, heart attack, stroke, or any of the following serious conditions:
 Tumor of any kind  mental or mood disorder

 Diabetes  nervous system disorder
 high blood pressure  endocrine disorder
 cardiovascular disease  disorder of Uro-Genital, blood disorder
 cerebral vascular disease  disease of eye, ear or throat
 liver disease (including hepatitis B or C)  autoimmune disease
 gastro-intestinal disease  sexually transmitted disease, HIV, AIDS or
 respiratory disease AIDS related complex
 musculoskeletal disorder
In the past two (2) years, I and my Insured Dependent/s have not been advised by a medical
specialist or practitioner nor have done any of the following:
 be under medication for more than fourteen (14) consecutive days
 be hospitalized
 undergo a surgery
 undergo any medical treatment (excluding routine medical check-ups and vaccinations)
In the past two (2) years, I and my Insured Dependent/s have not had an application, renewal, or
reinstatement of any insurance policy (life, critical illness, disability, accident, health) that has been
declined, postponed, rated up or issued with any special terms; and


I agree to and have read the Terms & Conditions, Exclusions & Limitations, and
Acknowledgment & Declarations.
Acknowledgement & Declarations
1. I declare that all statements are true. I have not withheld any material information regarding this
application. I will notify Singlife Philippines as soon as possible for any change in information
provided in this application.
2. I declare that I obtained the consent of all the data subjects (Dependents, Beneficiaries, and all
other data subjects in this application) for the purposes listed below.
3. I declare that the premiums for this policy are paid from my household income coming from
salaries and wages or profits earned from business.
4. I acknowledge that Singlife Philippines may collect, use, and store the information provided in this
Application Form to process and service my policies. These information, including those available
during the life of my policies, may further be processed for policy issuance, policy administration,
claims adjudication, data analytics, historical & scientific research, market research, customer
profiling, risk management, product & service enhancements, identity verification, protection
against fraud, and compliance with legal, regulatory, and contractual requirements. I acknowledge
that my and all data subjects’ information may be processed through automated means.
5. I acknowledge that Singlife Philippines reports to its parent company, Singapore Life Pte Ltd. and
may engage partners, affiliates, and third-party service providers who may be located outside the
Philippines. My and all data subjects’ information may be processed, shared, stored, and subjected
to the laws of foreign jurisdictions. Singlife Philippines, its partners, affiliates, and third-party
service providers are required to protect the confidentiality of my and all data subjects’ information
in a manner consistent with data protection principles.
6. I authorize Singlife Philippines to disclose my and all data subjects’ information to Singapore Life
Pte Ltd. and any government or tax authorities to ensure continual compliance with applicable
laws, regulations, and good market practices.
7. I authorize Singlife Philippines to deduct all premiums automatically from my GCash account on
the premium due dates. In case of unsuccessful collection on the due date, I authorize Singlife
Philippines to retry deducting premium from my GCash account within the grace period of the
Policy. I understand and authorize that any outstanding premiums due within the grace period will
be collected by Singlife Philippines.
8. I authorize Singlife Philippines to contact me for additional information needed, to send me policy
information, and to perform other relevant activities to process and service my policies.
9. I understand that I have the right to access my and all data subjects’ personal information at any time;
correct or rectify any information collected or held by Singlife Philippines which are inaccurate, false,
or incomplete; object in case of any unauthorized collection; erase or block information which is
incomplete, outdated, and false; and other such rights as may be available under the Data Privacy Act.


10. During the effectivity of the policy, I understand and agree to provide personal information as may be
requested by Singlife Philippines and submit an updated identification document (ID) prior to its
expiration or not later than three (3) years from the date I last submitted my ID, whichever is earlier
(“Full CDD”). Should I fail to do so, Singlife Philippines may restrict the services available or prohibit any
further transactions until I comply with Full CDD, or exercise its option to terminate my policy and
refund any unused portions of premium or withdrawal value, if any, whichever is applicable.
11. I also understand and agree to abide by obligations set out in relevant United Nations Security Council
Resolutions relating to the prevention and suppression of proliferation of financing of weapons of
mass destruction, including the freezing and unfreezing actions as well as prohibitions from
conducting transactions with designated persons and entities.
12. In accordance with the Insurance Commission's Circular Letter No. 2016-54, my and all data subjects’
medical information will be uploaded to a Medical lnformation Database accessible to life insurance
companies for the purpose of enhancing risk assessment and preventing fraud once uploaded, all life
insurance companies will only have limited access to my and all data subjects’ information in order to
protect my and all data subjects’ right to privacy in accordance with law. A copy of Circular Letter No.
2016-54 may be accessed at the Insurance Commission's website at www.insurance.gov.ph.
Your privacy is important to us. We keep your personal information in strict confidence. You may visit the GCash App
to read more about our Data Privacy Policy and Customer Charter.
You may access your Policy Management Guidelines under Terms & Conditions in your GCash App.
You may call customer support at (02) 8299-3737 should you have concerns.


Singlife Philippines Medical Insurance Policy

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Singlife Philippines Medical Insurance Policy

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Singlife Philippines Inc.

12F Four/NEO, 30th St. Corner 4th Ave.

Hi GENEST JAN II,

Form No. GCMheCWcm.21v1

Singlife Philippines Inc.

singlife.com.ph Page 03 Form No. GCMheCPrS.21v1

Get in Touch with Us 03

Policy Details Page 05

Your Policy Contract 06

Definition of Terms We Use 07

01. Your Benefits 11

1.1 Daily Hospital Cash Benefit

02. List of Covered Critical Conditions 20

03. What We are Not Able to Cover 24

06. Your Beneficiaries 29

07. Termination of Your Policy 30

08. Your Rights 32

09. General Provisions 34

Annex A – Description of Covered Critical Conditions

Annex B – Description of Covered Surgeries

Singlife Philippines Inc.

singlife.com.ph Page 04 Form No. GCMheCPrS.21v1

Product Name Policy Number Currency

Policy Owner’s Information

First Name Middle Name Last Name

Primary Insured’s Information

First Name Middle Name Last Name

Sex Issue Age

Base Insurance Sum Assured Status

Benefit Period Effective Date Termination Date

Maximum Years Payable Policy Anniversary Form Number

THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID

singlife.com.ph Page 5.1.1 Form No. GCMheCPDP.21v1

Health Insurance (Any Cause)

Daily Hospital Cash Benefit PHP 1,000.00 *

Any Critical Condition Diagnosis Benefit PHP 75,000.00

Late Stage Critical Condition Diagnosis Benefit PHP 300,000.00

THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID

singlife.com.ph Page 5.1.2 Form No. GCMheCPDP.21v1

Health Insurance (Any Cause) 8,665.00 867.00

Daily Hospital Cash Benefit 4,138.00 414.00

Any Critical Condition Diagnosis Benefit 948.00 95.00

Late Stage Critical Condition Diagnosis Benefit 1,860.00 186.00

Medical Cost Reimbursement for Late Stage

Total Premium 8,665.00 867.00

Premium Schedule Premium Due Dates Policy Anniversary

January 01, 2022 GCMheCDpS.21v1 Annex A-Description of

January 01, 2022 GCMheCDpS.21v1 Annex B-Description of

January 01, 2022 GCMheCDpS.21v1 Dependent Coverage

THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID

singlife.com.ph Page 5.1.3 Form No. GCMheCPDP.21v1

Product Name Policy Number Currency

Policy Owner’s Information

First Name Middle Name Last Name

Insured Dependent’s Information

First Name Middle Name Last Name

Sex Issue Age

Base Insurance Sum Assured Status

Benefit Period Effective Date Termination Date

Maximum Years Payable Policy Anniversary Form Number

THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID

singlife.com.ph Page 5.1.4 Form No. GCMheCPDD.21v1

Health Insurance (Any Cause)

Daily Hospital Cash Benefit PHP 1,000.00 *