Hajj & Umrah Takaful Plan. Terms & Conditions

Transcription

1 1 Hajj & Umrah Takaful Plan Terms & Conditions

2 2 Dear Customer We are pleased to provide you with our Hajj & Umrah Plan (Policy), which provides protection against unforeseen events and perils while you are in Kingdom of Saudi Arabia as a pilgrim to perform Hajj/Umrah. Its prime purpose is to indemnify you in the event you sustain any bodily injury by an accident or incur any medical expense as listed in the Schedule of Benefits. In return for your Contribution, you will receive Insurance Cover as stated in the Policy Certificate subject to the terms, conditions, warranties, provisions and exclusions expressed or implied in this policy and Endorsements attached or to be added later. Under a contract, to be made by and between the Company and the Policyholder. Hajj and Umrah shall be covered throughout the period specified in Policy Certificate against the contribution fees payable by the Policyholder. This document shall cover all conditions, provisions and procedures governing the implementation of such contract. When drawing up this Policy, SABB Takaful Company (the Company) has relied on the information and statements, which have been provided by you in the application. The Company agrees to be the Manager of the Policyholders Account and on the basis of terms and conditions contained in this Policy, agrees to provide Insurance Cover to the person protected in this Policy as Participant for risks covered under this Policy to the extent and in the manner stated in the Policy Certificate. Personal Information Collection Statement The information you provide us will enable us to carry on insurance business and; may be used provided information for the purpose of: a) Any insurance or financial related product or service or any alterations, variations, Cancellation or renewal of such product or service; b) Any claim or investigation or analysis of such claim; and c) Exercising any right of subrogation in claims The information you provide to us may be disclosed to: Any related company or any other company dealing with the insurance or reinsurance related business or an intermediary or a claim or investigation or other service provider providing services relevant to insurance business for any of the above or related purposes; Saudi Arabian Monetary Agency (SAMA) or any other government organization that exists or is formed from time to time to carry out regulatory functions of the Saudi Insurance industry Issued by SABB TAKAFUL COMPANY limited liability Head Office P.O. Box 9086, Riyadh 11413, Kingdom of Saudi Arabia Telephone: (9661) Service Help line: (9661) Facsimile: (9661)

3 3 Index Page No Shariah Basis of This Policy 4 Part 1: Definitions 5 Part 2: Period of Insurance Protection 7 Part 3: Coverage 8 Part 4: Exclusions Applicable to all Sections 9 Part 5: General Conditions - Applicable to all Sections 10

4 4 This is the General conditions and the procedures for Hajj and Umrah Takaful Plan. In Consideration of the Policyholder named in the Policy Certificate hereto paying to SABB Takaful Company the Contribution mentioned in policy certificate: The Company agrees subject to the terms exclusions and conditions contained herein or endorsed hereon, to provide Insurance Protection against any bodily injury caused by an accidents or medical emergencies during period of Insurance protection and which may cause death or disablement. The Insurance Protection is valid at any time during the Period of Insurance Protection and during any subsequent period in respect of which the Policyholder shall have paid the Contribution. The Company will pay to the Policyholder the amount of the sum covered in the event of the Accident or medical emergencies provided that the sum covered shall in no event exceed 100% of the benefit in any Period of Protection. Shariah Basis of This Policy In accordance with the cooperative insurance principle: 1. The Company will maintain accounts for insurance operations separate from the shareholders accounts in accordance with the Implementing regulations provisions of the Law on Supervision of Co-operative Insurance Companies. 2. The Company undertakes to invest all funds, whether relating to shareholders or the Policyholders strictly in accordance with the rules of Shariah principles and in consistent with the company Investment policy approved by the Saudi Arabian Monetary Agency. The company will add or subtract the investment return of the Policyholder s invested funds, and subtracting the general expenses related to the Policyholder s portion of the investment activities. 3. The Company, as the insurance administrator, will manage the insurance operations in favor of the Policyholders. In case of net surplus in the insurance operations account, it will be distributed in the following way: a) Ten percent (10%) of the annual net surplus shall be distributed to the Policyholders directly or in the form of reduction in premiums for the next year. b) From the remainder, if any, an amount equal to 15% of the total written premiums shall be carried forward to the shareholders account as a fee against the Company s management of the insurance operations and investment in favor of the Policyholders. This management fee shall not exceed 90% of the net surplus. c) From the remainder, if any, following the distribution referenced (a) and (b) above, company shall carry forward 35% of the net surplus to the shareholders account as performance incentive. d) The Company may maintain the remainder of net surplus, if any, in the Policyholders account or distribute it wholly or partially to the Policyholders following approval by the Saudi Arabian Monetary Agency and the Company s General Assembly. The Company reserves the right to reinsure. We shall endeavor to reinsure on Shariah compliant basis. However, if this is not possible, it is permitted by Shariah Committee to reinsure on a conventional basis until an acceptable Shariah compliant solution is available. The Contributor (Insured) having applied to the Company by a written Proposal (which shall be the basis of this contract and is deemed to be incorporated herein) and having paid or agreed to pay the contribution. Subject to the Terms of the Policy, the Company will indemnify the Insured during the first Period of Insurance as stated in the Policy Certificate and any subsequent period of insurance for which the renewal contribution invited by the Company. Our charges to cover the cost of acquisition and administration will be subject to a maximum charge of 34% of your Contribution. The Company has the right to change any of these charges by an advance notice.

5 5 Part 1: Definitions 1. Accident shall mean an unforeseen and unexpected event of violent, accidental, external and visible nature, which shall independently of any other cause, be the sole and direct cause of bodily injury. 2. Accidental Bodily Injury means bodily injury caused solely and directly by accidental, violent, external and visible means and which shall within 12 calendar months result in death or disablement or necessitate medical or surgical treatment. 3. Accidental Death means death that occurs after the date of the relevant Accident and directly and independently results from Accidental Bodily Injury. 4. Act of Terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public or any section of the public, in fear. 5. Company means SABB Takaful Company 6. Common Carrier means any Bus, coach, taxi, hotel car, ferry, hovercraft, hydrofoil, ship, train, tram or underground train provide and operated by a carrier duly licensed for the regular transportation of fare-paying passengers, and any aircraft provided and operated by an air charter company which is duly licensed for the regular transportation of fare-paying passengers, and any regular scheduled airport limousine operating on fixed routes and schedules. 7. Contribution means the amount stated in the Policy Certificate that you contribute to the Policyholders Account. 8. Endorsement means a written document issued by the Company evidencing any change in or addition to or deletion from the original policy document and which is attached to or endorsed on to the Policy. 9. Hospital means a medical establishment recognized, constituted, and registered as such under the laws of the territory in which that establishment is situated as a Hospital for the care and treatment of sick and injured persons as inpatients, and which (i) has facilities for diagnosis and major surgery, (ii) provides 24 hours a day nursing service supervised by a qualified and registered Physician, and (iii) is not primarily a clinic, a place for alcoholic or drug addicts, a sanatorium, a nature care clinic, a health hydro, a nursing, a convalescent, rehabilitation, extended care facility or rest home. 10. Inpatient means a Participant whose Hospital confinement is as a resident inpatient and whose confinement is necessary for the medical care, diagnosis and treatment of an Accidental Bodily Injury covered by this policy and not merely for any form of nursing, convalescence, rehabilitation, rest or extended care. 11. Insurance Regulations means the Law on Supervision of Co-operative Insurance Companies, promulgated by Royal Decree No. (M/32) dated H corresponding to G and its implementing regulations and any subsequent amendments thereto. 12. Loss of Limb means loss by physical separation at or above the wrist or ankle joint, or total Loss of Use. 13. Loss of Sight means the total and irrecoverable loss of all sight of an eye or eyes rendering the Participant absolutely blind beyond remedy by surgical or other treatment. 14. Loss of Use means total functional disablement. 15. Policyholders Account Manager SABB Takaful Company 16. Medical Practitioner, Physician, Doctor means a practitioner of medicine duly qualified and legally registered as such under the laws of the country in which the claim arises and where the treatment takes place but excluding the Participant himself. 17. Medical Treatment Expenses means the actual expenses paid by the Participant to a Medical Practitioner, Physician, Doctor or Hospital for medical, surgical or nursing treatment including the costs of medical supplies, ambulance hire or professional home-nursing fees, but excluding the cost of dental care and treatment unless such treatment is provided on an emergency basis and caused by accidental injuries to sound natural teeth. 18. Participants means eligible Pilgrims for Insurance Protection and who are persons named in the Policy Certificate. 19. Period of Insurance / Period of Insurance Protection mean the length of time for which the Insurance protection is valid. 20. Permanent Total Disablement means that after 12 calendar months of total continuous disability which has resulted from Accidental Bodily Injury and which has commenced within 30 days after the date of the Accident, the Participant is completely unable to engage in any substantially gainful occupation or employment for the remainder of his/her life. 21. Policyholder/You/Yours means the applicant in whose name the Policy is issued.

6 6 22. SAR stands for Saudi Arabian Riyal 23. Shariah Principles means Islamic law as agreed by the Shariah Committee of the Company. 24. Shariah Committee means a committee of renowned independent Shariah Scholars to supervise the commitment to the Shariah Principle. 25. Sickness means sickness or disease contracted and commencing during the Period of Insurance protection, and excludes any sickness or disease, which was in existence prior to the Policy Certificate date. 26. Insurance Benefits means the amount of Protection for each section as shown in the Policy Certificate. 27. Policy Certificate means our certificate, which provides details of your Insurance Protection. The Policy Certificate is part of this Policy. 28. Policyholders Account means the account allocated for entry of Policyholders contributions collected, returns on investment of Policyholders account, compensation received from reinsurance and any indemnities, fees or other expenses dedicated from it. 29. Insurance / Insurance Protection means Shariah compliant Insurance cover provided under this policy such as Insurance Benefit. 30. We/Us/Ours means the Company.

7 7 Part 2: Period of Insurance Protection Domestic Pilgrim Insurance protection is effective from the time participant (Saudi National or Saudi resident) leaves his/her resident in Kingdom of Saudi Arabia for pilgrimage and continues until the Participant arrives back to his/her residence in Kingdom of Saudi Arabia after performing pilgrimage, or the date of expiry as shown in policy certificate of cover, which is earlier. Pilgrimage from Overseas Insurance Protection is effective from the time Participant arrives at any official entry point in the Kingdom of Saudi Arabia and continues until he/her leaves through official exit point of Kingdom of Saudi Arabia, or the date of expiry as shown in policy certificate of cover, which is earlier. Geographical Limits for coverage Kingdom of Saudi Arabia Age Limits Insurance Protection is subject to the following age limits and the Contribution is based on the Participant being adult or child. Age ranges between 6 months to 65 years. Additional 50% on the contribution would apply over standard rate for age between 65 to 75 years.

8 8 Part 3: Coverage Section 1 - Personal Accident In the event of Accidental Bodily Injury being sustained by a Participant during the Period of Insurance cover, which shall result in death or disablement, the following benefit will be paid as per schedule Adult SAR 1. Accidental Death 100% of Personal Accident (PA) benefit 2. Loss of two eyes, two 100% of PA benefit limbs or one eye and one limb 3. Permanent Total 100% of PA benefit Disablement Conditions for above benefits 1. No benefit will be payable unless death or disablement occurs within twelve months of the date of injury. 2. Insurance Benefits 1-3 are not cumulative and only one benefit is payable not exceeding the maximum amount listed above. 3. Once a claim has been paid, the Company will not pay for any consequential disablement or loss arising out of the same event. 4. If at the time of accident, a Participant has already suffered the amputation or loss of or lost the use of a hand, arm, foot, leg or has lost the sight of one or both eyes, such loss shall not be included in assessing any benefit payable under this policy. Hospital. And this amount is extra to the Sum covered as per the schedule under any other recovery. Medical Expenses will not be payable to the Participant for: a) the treatment obtained outside Kingdom of Saudi Arabia if he /she has come to perform pilgrimage from overseas or in KSA once Participant returns back to his/ her residence in KSA. b) For surgical and medical treatment which in the opinion of the Medical Practitioner treating the Participant can be reasonably delayed until the Participant s return to his/her home country. c) for the additional cost of a single or private room at a Hospital or charges in respect of special or private nursing, cosmetic surgery, eyeglasses and refraction or hearing aids, and prescriptions thereof, except as necessitated by accidental injuries occurring during the Period of Insurance protection; 2. Additional Expenses: Medical Expenses that are payable to the Participant for: Repatriation of remains In the event of Death of a Participant during a Trip, the Company will pay up to SAR 7,500 in respect of reasonable charges, for the transport of body or ashes to place of initial departure. Section 2 Emergencies Medical and Other Expenses 1.Emergencies Medical Expenses a) Emergencies Medical Expense as a result of other than road accident: The Company will pay up to the limit stipulated in the schedule if the Participant suffers Accidental Bodily Injury or Sickness inside the Kingdom of Saudi Arabia during the Period of Insurance Protection requiring urgent treatment. In such circumstances, the Company will indemnify the Participant the Medical Treatment Expenses, additional accommodation and travelling expenses incurred inside the Kingdom of Saudi Arabia within 12 months of the date of incident giving rise to the claim as a direct result of Accidental Bodily Injury sustained by or Sickness of the Participant occurring during the Period of Insurance Protection. b) Medical expense as a result of road accident: The amount of 2,500 Riyal will be paid to the policyholder after presenting the police report about the road accident along with the release letter from the

9 9 Part 4: Exclusions Applicable to all Sections The Insurance Protection under this Policy does not cover the following: 1. Claims arising directly or indirectly as a result of: a) Riot, civil commotion, war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or the act or order of any government or public or local authority. b) Chemical or biological weaponry or ionising or radioactive contamination. c) Suicide or attempted suicide, willfully self-inflicted injury, childbirth, pregnancy, miscarriage, insanity, alcoholism or the use of drugs (other than drugs taken in accordance with treatment prescribed and directed by a registered Medical Practitioner but not for the treatment of drug addiction), self-exposure to needless perils (except in an attempt to save human life), venereal disease, AIDs or AIDs related sickness. d) Aviation, if the Participant is other than a fare-paying passenger in a licensed aircraft operated by a recognised airline or air charter company which is duly licensed by the relevant authorities for the regular transportation of fare-paying passengers. 2. Claims arising from incidents not notified in writing to the Company within 30 days of the end of the Period of Insurance Protection. 3. No benefit or expenses will be paid for any illness, sickness, disease or medical condition, which was in existence prior to the Period of Insurance Protection. 4. This Insurance Protection does not cover claims arising directly or indirectly from, in respect of or due to an Act of Terrorism.

10 10 Part 5: General Conditions - Applicable to all Sections 1. Considered information This Policy is executed with the Participant in consideration of the information provided by the Policyholder and contained in the Policy Certificate and the policyholder paying Contribution to the policyholder s Account when due. 2. Other Insurance Protection/Insurance If the Participant is entitled to payment under any other Insurance Protection or insurance in circumstances where he/she would be entitled to coverage under this policy, the Company will only be liable for amounts not recoverable from such other Insurance Protection, or insurance. This condition however will not apply for benefit under part 3 Section 1 Personal Accident. 3. Payment of claims Payment of any claim under this policy is subject to the Definitions and all other terms and conditions of the policy pertinent to the benefit. 4. Exposure When by reason of an Accident a Participant is exposed to violent and severe or prolonged weather conditions and as a result of such exposure suffers death, such death shall be covered hereunder subject to the Definitions and all other terms and conditions of this policy. 5. Contract: Changes The entire contract between the parties will be constituted by this policy, the application form if any and any endorsements and amendments. No change in the contract will be valid unless evidenced by endorsement or amendments. 6. Reasonable Care The Participant must exercise reasonable care to prevent accidents, injury, illness, loss or damage. 7. Mis-statement or Fraud The Company has the right to repudiate any claim under this policy if they find that the policy has been obtained by providing incorrect information in the proposal form or any claim form under this policy. 8. Mis-statement of Age If the age of any Participant has been misstated, all amounts payable under this policy shall be such as the contribution paid would have purchased at the correct age and age falling within the eligibility criteria, otherwise if the correct age falls outside the eligibility criteria, the policy would become invalid and under such circumstances only 50% of the contribution will be refunded and the rest will be treated as a penalty for his/her misstatement. 9. Hijack This policy shall cover accidents arising from the hijacking of any vessel, vehicle or aircraft upon which the Participant is traveling as a bona fide passenger. 10. Notice of Claim Written notice of claim must be given to the Company immediately upon return and in any event within 30 days of the expiry of the Period of Insurance Protection. Failure to give notice in the time prescribed shall not invalidate a claim if it can be shown to the Company s satisfaction that notice had been provided as soon as was reasonably practicable, and in any event within 60 days from the expiry date of the Period of Insurance. Any notice given to the Company by or on behalf of the claimant must identify the Policyholder in order to be deemed notice. 11. Claim Documents The Company, upon receiving a notice of claim, will acknowledge and ask the claimant to submit required documents in support of the claim. Police report, Medical reports and all proof of loss required by the Company shall be provided at the expense of the claimant and shall be in such form and of such nature as the Company may prescribe. 12. Proof of Claim Written proof in support of a claim must be provided to the Company within 30 days from the receipt of the acknowledgement provided by the Company as above. Failure to provide such proof within such time shall not invalidate any claim if it was not reasonably practicable to give proof within such time, provided such proof is furnished as soon as is reasonably practicable, and in no event later than 180 days from the time such proof is otherwise required. All claims must be submitted with comprehensive supporting information including as follow: a) In the case of Personal Accident (Bodily Injury): Hospital and Physicians reports giving details of the nature of the loss and extent and period of disability, police reports where relevant and in the event of death, a copy of the Accidental Death certificate and the relevant coroner s report. b) In the case of Medical and Other Expenses. All receipts, relevant to the claim and if the claim were in respect of medical treatment, a full Physician s report stipulating: i) the diagnosis of the condition treated ii) the date the disability commenced in the Physician s opinion and iii) the Physician s summary of the course of treatment including medicines prescribed and services rendered. 13. Physical Examination The Company shall have the right and opportunity at its own expense to examine the Participant when and as often as it may reasonably require pending the outcome of a claim under this Policy. In the event of the Accidental Death of the Participant, the Company shall be entitled to have a post-mortem examination carried out at its own expense, except when such examination is prohibited by law.

11 Payment of Benefit Benefit payable under this Policy shall be paid to the Policyholder or as otherwise directed in writing by the Policyholder. In the absence of any such written direction, any benefits unpaid at the time of the Participant s death shall be paid to the estate of the Policyholder. Any receipt which the Policyholder, or any third party to whom the Policyholder has directed that payment be made, may give to the Company for any benefit paid under this Policy shall be deemed a final and complete discharge of all liability of the Company. 15. Subrogation The Policyholder authorises the Company to proceed at its own expense in the name of the Policyholder against third parties who may be responsible for an occurrence, giving rise to a claim under this Policy and the Company shall be entitled to any recovery in connection therewith. 16. Legal Action No action shall be brought to recover on this Policy prior to the expiration of 60 days after written proof of claim has been filed in accordance with this Policy. All rights of recovery under this Policy shall lapse after a period of 180 from the date of occurrence of any event that gives the Participant a right of recovery under this Policy. 17. Governing Law, Jurisdiction, and Arbitration This Policy is subject to the exclusive jurisdiction of the Kingdom of Saudi Arabia and shall be governed in accordance with the laws of the Kingdom of Saudi Arabia including without limitations, the Insurance Regulations, If both parties agrees to resolve the dispute arising under this policy by arbitration, such arbitration shall be carried out in accordance with the laws and regulations of the Kingdom of Saudi Arabia which govern arbitration (not applicable to personal liability) 18. Currency Contribution and benefits payable under this Policy shall be paid in Saudi Riyal. 19. Refund of Contribution No refund of contribution is allowed once the Application Form has been accepted with consecration to clause number 8 from this Part. 20. Gender Unless the context otherwise requires, words and expressions importing the masculine gender also includes the feminine and neuter gender. Further, words and expression in the singular include the plural and vice versa. 21. Governing Language This English translation of the Policy is for reference purposes only. In the event of any inconsistency between the Arabic version and the English version, the Arabic version shall prevail. 22. Termination If the Contribution is not paid, this Policy shall be deemed to have been void from the effective date specified in the Policy Certificate.