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Le4 Capstone

The document outlines the terms and conditions of a life insurance policy provided by Swift Life Insurance, detailing coverage, benefits, and rights of the policy owner. It includes information on death benefits, critical illness coverage, and the responsibilities of the policy owner regarding premium payments. The policy is designed to be flexible to meet changing needs and offers options for beneficiaries and claims processes.

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lauren c
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0% found this document useful (0 votes)
11 views13 pages

Le4 Capstone

The document outlines the terms and conditions of a life insurance policy provided by Swift Life Insurance, detailing coverage, benefits, and rights of the policy owner. It includes information on death benefits, critical illness coverage, and the responsibilities of the policy owner regarding premium payments. The policy is designed to be flexible to meet changing needs and offers options for beneficiaries and claims processes.

Uploaded by

lauren c
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 13

SWIFT

LIFE INSURANCE

LIFE INSURANCE
CONTRACT
Dear Policy Owner,

This policy provides you with life insurance protection. If an insured person under this policy
dies we pay a death benefit, subject to the terms of the policy.

Your policy is designed to meet your current needs. However, you can change it as your needs
change. You can also choose from several different kinds of coverage.

The details in your policy are explained in the policy specifications that follow. We’ve made
every effort to make these descriptions easy to understand, starting with a summary of your
policy works. Please read this document carefully to become familiar with the features of your
life insurance policy so that you can take full advantage of the benefits it offers.

If you have any questions about your policy, please ask your insurance advisor or contact us
swift_insurance@gmail.com. Thank you again for choosing Swift Life Insurance.

Sincerely,

Taylor Kelce
The Swift Life Insurance Company
Policy Specifications

Insurance Plan: Swift Life Insurance


Policy number: 20240113
Policy date: January 13, 2024
Policy anniversary date: January 13, 2025
Owner: John Doe
Insured person: John Doe
Risk classification: Non-smoker
Beneficiary: Mary Doe
Insurance amount: 320,000
Pavment period: 10 policy years
Date vour policy ends: January 13, 2034

A death benefit is payable when the insured person dies, as described under the heading Death
benefit.
A critical illness benefit is payable to the insured person upon the diagnosis of a covered condition
while this policy is in effect as required under the terms of the policy, provided that the insured
person survives the requisite waiting period and meets all other terms or conditions applicable to
that benefit.
Main Terms of the Policy

Accident or Accidental means a sudden, Contingent owner the person who will own
unexpected, unforeseeable, unavoidable this policy when you die.
external event.
Effective Date means, the date Coverage
Age the age of the insured on their nearest begins as shown on the Policy Summary.
birthday. If it is less than 183 days from their
last birthday, we will treat their age as their Expiry Date means, the date Coverage ends
actual age. If it is 183 days or more from their as shown on the Policy Summary
last birthday, their age will be one year older
Injury means bodily harm resulting directly
than their actual age.
from an Accident and independent of all
Application for Insurance means any other causes including Sickness.
application for or request for change of any
Life Assured shall be deemed to include the
Personal Accident and/or Sickness Coverage
term “Member”
issued by the Company.
Loss the loss referring to hand or foot means
Basic premium the amount you will pay for
complete and permanent severance at or
the basic benefit. You can see this on the
above the wrist or ankle joint; if referring to
policy specifications page.
eyes, ears and speech, means the entire and
Beneficiary/ies the person/s named to irrecoverable loss of sight, hearing and
receive the benefit/s of this policy when the speech; and if referring to finger or toes,
insured dies. means complete severance of at or above the
metacarpo-phalangeal or
metatarsophalangeal joints, respectively.
Death Benefits
We pay a death benefit when the insured person on an insurance coverage dies. The death benefit
is equal to the amount of insurance provided by the insurance coverage plus the account value on
the day the insured person dies.
Your amount of insurance appears in your Policy summary.
If the account value is negative on the day an insured person dies, we reduce the death benefit by
the amount required to increase the account value to zero as of the date of death.
Withdrawals, changes to your planned deposits and investment returns can affect your death
benefit.
Surrender charges do not apply if your policy ends due to the death of the insured person.

When we pay a reduced death benefit


We don't pay the death benefit as described above if the insured person dies by suicide within two
years of the day we issued or last reinstated the insurance coverage, whichever is later. Instead, we
pay the reduced death benefit calculated as described below to the beneficiary or beneficiaries, and
the policy ends.

How we calculate the reduced death benefit


The reduced death benefit is calculated by adding:
• the cost of insurance we charged for the insurance coverage since we issued or last reinstated it,
whichever is later plus
• the account value of the policy

If the account value is negative on the day the insured person dies, we reduce the amount of the
payment by the amount required to increase the account value to zero as of the date of death.

Claiming a death benefit


To claim a death benefit, a person who is entitled to make the claim should call your advisor or
contact us directly at the phone number shown in your most recent policy statement. We will tell
that person which documents we require to allow us to review the claim.

Beneficiaries
Your rights as a policy owner include the right to name and change your beneficiary or
beneficiaries. When a death benefit is payable, we pay that death benefit to each beneficiary
according to your instructions. If you haven't named a beneficiary, we pay the death benefit
described above to you or to your estate.
You can change a beneficiary at any time before an insured person's death, as long as the change
is allowed by law. However, if you have named an irrevocable beneficiary, you can't make a
change without that beneficiary's consent.
Bereavement counseling assistance
When an insured person dies and we pay a death benefit, we provide bereavement counseling
assistance.
We reimburse up to a total of $1,000 of counseling expenses, as described in our administrative
rules.

To qualify for this assistance:


• the people receiving the counseling must be the beneficiaries of the death benefit
• we must receive all receipts within 12 months of the date of death
• the counselor must be professionally accredited or certified

Fraudulent misrepresentation
At any time, we have the right to void your policy or any insurance or rider coverages, or
deny a claim, if you or one of the insured people has fraudulently misrepresented a material fact
by not disclosing it or by stating it incorrectly in any application, or in any medical examination,
or in any other information we have used as evidence of insurability or proof of claim.

Misrepresentation or nondisclosure of a material fact


During the contestability period, we have the right to void your policy or any insurance or
rider coverages, or deny a claim, if you or one of the insured people has misrepresented a material
fact by not disclosing it or by stating it incorrectly in any application, or in any medical
examination, or in any other information we have used as evidence of insurability or proof of
claim.

Incontestability clause
Except for non-payment of premiums or any other grounds recognized by law and
jurisprudence, the Insurer cannot contest the validity of this Policy after it has been in force for
two (2) years from the Policy Effectivity Date or date of approval of last reinstatement, whichever
date is later. Except for non-payment of premiums or any other grounds recognized by law and
jurisprudence, the Insurer cannot contest the validity of insurance on any Member after it has been
in force for two (2) years from the effective date.
Rights of Policy Owner
You own all the rights to this policy. The written approval of all irrevocable beneficiaries
must be obtained to exercise certain rights. In case of your death before the insured, all the rights
will be passed on to any contingent owner or, if there is no contingent owner, to the insured.

Ownership
As long as the Insured is alive, you are the owner of your Insurance Contract, and only you can
ask the Insurer to make changes to it, without the need of the beneficiary consent, irrevocable or
not. If you are a natural person and you are not the insured, your estate will become the owner of
your Insurance Contract if you die, unless you have designated a substitute owner. You can
designate a substitute owner at any time by submitting a written request to us.
Transfer Rights
You can transfer the ownership of your Insurance Contract to another person. If you choose to do
this, you must inform us in writing. We will not under any circumstances be liable for the validity
of this transfer.
Participation Rights
Your Insurance Contract is a non-participating insurance contract. It does not entitle the
Policyholder to receive dividends from the surplus or profit declared by the Insurer.
Conversion
You cannot convert your Insurance Contract into a permanent insurance contract or any other type
of insurance policy.
Cash Value and Advances
Your Insurance Contract has no cash value and does not permit you to receive advances on the
Policy nor obtaining paid-up or extended insurance.
Copy of the Insurance Contract
You may obtain a copy of your insurance policy, including riders attached to it if any, by sending
us a written request. Only the insured may ask us in writing to obtain a complete copy of the
insurance contract.
Policy Charges
You must pay all premiums and any applicable taxes for this policy by the payment due date.

Payments are due monthly on the 13th day of the month, starting on January 13, 2024

Policy premium: ₱ 320,000


2% premium tax: ₱ 2,400
Total annual payment: ₱ 322, 400

This policy premium is guaranteed for 10 policy years while this policy is in effect.
Following the 10th policy year from the date your policy began, we may change your policy
premium every 10 years effective on the policy anniversary. We will give you 30 days written
notice before the change is made.

As the owner, you are responsible for payment of premiums and any applicable taxes. We reserve
the right to apply an administrative fee if a payment is returned.

Filing a Claim
The insured or a person insured or a beneficiary entitled to make a claim, or the agent of any of
them, shall
a) give written notice of claim to the insurer
(i) by delivering it, or sending it by registered mail to the Head Office or the chief
agency of the insurer in the Province, or
(ii) by delivering it to an authorized agent of the insurer in the Province, not later
than 30 days from the date a claim arises under the contract;
b) within 90 days from the date a claim arises under the contract, provide to the
insurer reasonable proof of the happening of the accident or the commencement of the
sickness or disability and the resulting loss, the right of the claimant to receive payment,
the insured's age and the age of the beneficiary, if relevant; and
c) if required by the insurer, provide a satisfactory certificate as to the cause or nature
of the accident, sickness or disability, and the duration of such disability.
Critical Illness Rider
A. PAYMENT OF BENEFITS
1. The coverage under this policy provides that the amount insured shall be paid to the insured
person upon the diagnosis of a covered condition while this policy is in effect as required under
the terms of the policy, provided that the insured person survives the requisite waiting period and
meets all other terms or conditions applicable to that benefit.
2. The coverage applies only to those illnesses, conditions or procedures defined in the policy as
covered conditions. Any illness, condition or procedure not specifically identified as a covered
condition is not covered under this policy and no benefit shall be payable. Each covered condition
has specific requirements which must be satisfied in order for a benefit to be payable. All benefits
are also subject to the limitations, exclusions and reductions of coverage which may appear either
in the description of a benefit or in a separate part dealing with limitations and exclusions of
coverage.

B. COVERED CONDITIONS
The amount insured under this policy shall be paid to the insured person upon the diagnosis of the
first to occur of one of the following covered conditions, provided that the insured person survives
the requisite waiting period and meets all other terms or conditions applicable to that covered
condition:

1. Cancer (Life-Threatening)
A definite diagnosis of a tumor, which must be characterized by the uncontrolled growth and
spread of malignant cells and the invasion of tissue.

Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma.


The diagnosis of Cancer must be made by a specialist.

No benefit will be payable for the following:


• lesions described as benign, pre-malignant, uncertain, borderline, non-invasive, carcinoma in-
situ (Tis), or tumors classified as Ta;
• malignant melanoma skin cancer that is less than or equal to 1.0 mm in thickness, unless it is
ulcerated or is accompanied by lymph node or distant metastasis;
• any non-melanoma skin cancer, without lymph node or distant metastasis;
• prostate cancer classified as T1a or T1b, without lymph node or distant metastasis;
• papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0 cm
in greatest diameter and classified as T1, without lymph node or distant metastasis;
• chronic lymphocytic leukemia classified less than Rai stage 1; or
• malignant gastrointestinal stromal tumors (GIST) and malignant carcinoid tumors, classified less
than AJCC Stage 2.
Moratorium Period Exclusion
No benefit will be payable under this condition if, within the first 90 days following the later of,
the effective date of the policy, or the date of last reinstatement of the policy, the insured person
has any of the following:
• signs, symptoms or investigations, that lead to a diagnosis of Cancer (covered or excluded under
the policy), regardless of when the diagnosis is made; or
• a diagnosis of Cancer (covered or excluded under the policy).

Medical information about the diagnosis and any signs, symptoms or investigations leading to the
diagnosis must be reported to the insurer within 6 months of the date of the diagnosis.If this
information is not provided within this period, the insurer has the right to deny any claim for cancer
or, any critical illness caused by any cancer or its treatment.

2. Heart Attack

A definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a
rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial
infarction, with at least one of the following:
• heart attack symptoms;
• new electrocardiogram (ECG)
• consistent a heart attack; or
• development of new Q waves during or immediately following an intra-arterial cardiac procedure
including, coronary but not limited to, angiography and coronary angioplasty.

Exclusion: No benefit will be payable under this condition for:


• elevated biochemical cardiac markers as a result of an intra-arterial cardiac procedure including,
but _not limited to, coronary angiography and coronary angioplasty, in the absence of new Q
waves; or
• ECG changes suggesting a prior myocardial infarction, which do not meet the heart attack
definition as described above.
The insured person must survive for a period of 30 days following the date the condition is
diagnosed in order for the benefit to be paid.

3. Stroke (Cerebrovascular Accident)


A definite diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis or
hemorrhage, or embolism from an extra-cranial source, with:
• acute onset of new neurological symptoms and
• new objective neurological deficits on clinical examination;
persisting for more than 30 days following the date of diagnosis. These new symptoms and deficits
must be corroborated by diagnostic imaging testing. The diagnosis of stroke must be made by a
Specialist.

Exclusion: No benefit will be payable under this condition for:


• transient ischemic attacks;
• intracerebral vascular events due to trauma; or,
• lacunar infarcts which do not meet the definition of stroke as described above.
The insured person must survive until all of the criteria outlined above have been met in order for
the benefit to be paid.

4. Coronary Artery Bypass Surgery


The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries
with bypass graft(s). The surgery must be determined to be medically necessary by a Specialist.
Exclusion: No benefit will be payable under this condition for angioplasty, intra-arterial
procedures, percutaneous trans-catheter procedures or non-surgical procedures.
The insured person must survive for a period of 30 days following the date of the surgery in order
for the benefit to be paid.

5. Aortic Surgery
The undergoing of surgery for disease of the aorta requiring excision and surgical replacement of
any part of the diseased aorta with a graft. Aorta means the thoracic and abdominal aorta but not
its branches. The surgery must be determined to be medically necessary by a Specialist.

Exclusion: No benefit will be payable under this condition for angioplasty, intra-arterial
procedures, percutaneous trans-catheter procedures or non-surgical procedures.
The insured person must survive for a period of 30 days following the date of the surgery in order
for the benefit to be paid.
Accidental Death Benefit

If an Insured Person dies within 90 days of an Accident, due to an Injury sustained in that Accident,
which occurred while coverage was in effect, the Company will pay the Accidental Death Benefit
specified in the 24 Hour Compensation (P) Benefit Schedule. This benefit will be reduced to
$10,000.00 on the Policy Anniversary Date following the Primary Insured's 70th Birthday.

Total Disability Waiver of Premium Benefit


Total Disability waiver of premium benefit is specially designed to ensure that your protection will
not be affected even if you are unable to meet your premium payments.

The life assured is considered to be totally disabled as a result of injury or illness if he or she is
totally incapable of being engaged in any occupation, business or activity which pays an income
or profit.

The life assured will automatically be considered to be totally disabled if he or she suffers from
the following conditions:
a) total and irrecoverable loss of sight in both eyes; or
b) loss of 2 limbs; or
c) total and irrecoverable loss of sight in 1 eye and loss of 1 limb.

Key Exclusions:
No premium will be waived under this benefit if the life assured’s disability results directly or
indirectly from:
(I) pre-existing physical or mental defect or infirmity; or
(II) war, hostilities (whether war is declared or not), rebellion, insurrection, riot or civil
commotion; or
(III) alcohol, narcotics or drugs unless taken as prescribed by a registered doctor; or
(IV) attempted suicide or self-inflicted injuries while sane or insane; or
(V) participation in any criminal offence; or
(VI) scuba diving or engaging in or taking part in any kind of race other than on foot; or (
VII)traveling or flights in any vehicle or device for aerial navigation other than as a fare-paying
passenger on a scheduled public air service.

How may our credit risk affect your policy?


The guaranteed cash value (if applicable) and insurance benefit of your plan are subject to our
credit risk. If we become insolvent, you may lose the value of your policy and its coverage.
What happens if you do not pay your premiums?
You should only apply for this product if you intend to pay all of its premiums. If you miss any of
your premium payments, we may terminate your policy and you would lose the policy’s coverage.

Why may we adjust your premiums?


We have the right to review and adjust the plan’s premium rates for particular risk classes on each
policy anniversary, but not for any individual customer.

We may adjust premium rates because of several factors, such as our claims and persistency
experience.

Termination of this plan


We will terminate this plan when the first of these happens:
• death of the life assured; or
• you fail to pay your premium within 1 calendar month from its due date; or
• the basic plan to which this plan is attached terminates; or
• the plan reaches its end of benefit term.

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