AXA Insurance Terms and Conditions

AXA  Insurance Terms and Conditions

Micro, Small and Medium Enterprise Insurance

Benefits and Coverages:

  • One year

  • Cash Assistance benefit for damage to structure/contents due to Typhoon Fire & Lighting, Flooding due to natural causes (i.e. Typhoon, high tide), earthquake

  • Special Extensions: Burglary (10% of Sum Insured); Personal Accident Insurance for 2 named employees (10% of sum insured)

  • Support available at dally.dalisay@axa.com.ph

AXA PROPERTY MICROINSURANCE GUIDE FOR BIXIE

I.  BENEFITS

            A. Description of Benefits

            B. Amount of Benefits

            C. Maximum Benefits

II. EFFECTIVITY AND TERMINATION OF COVER

III. CLAIMS – Important!

IV. INQUIRIES



I.  BENEFITS

             A. Description of Benefits

                   1.  Cash Assistance for Property Damage

                         The cash assistance for property damage shall cover protection against Fire & Lightning plus Allied Perils (building improvement, furniture & fixtures and fittings, equipment & stocks). The structure your business is maintained in and its contents are also protected from earthquake, flood caused by natural causes and typhoon.


This cash assistance does not cover any loss or damage:

· Caused to residential structures and the contents therein unless the same is used in a commercial enterprise

· Claims due to Arson

· Flooding caused by man-made or mechanical events

· Fraudulent claims or those involving any false declaration

· Loss, destruction, damage, or legal liability, directly or indirectly caused by or contributed to by or arising from nuclear weapons material

· Establishments that are less than 50 meters away from a body of water

· Establishments that are not made of Class A materials defined as being made of concrete walls and iron/steel/concrete roof

· Establishments in public markets with no sprinkler systems


2.  Personal Accident (PA)

·  Covers death, disablement or bodily injury to the insured caused by violent, accidental or external and visible causes/forces.  The injury should not be caused by anything other than the accident.

·  PA coverage shall remain in force even if the cash assistance benefit has been exhausted.

·  The maximum benefit in one policy year should not exceed the maximum sum insured.  In case of another disablement or accidental death after a portion of the disablement benefits have been paid, death benefits to be paid out will be based on the remaining balance.



Table of Permanent Disablement Benefits

Description of Loss

Percentage of Accident Benefit

Loss of both hands or both feet

100%

Loss of any two limbs

100%

Total loss of sight of both eyes

100%

Loss of hearing in both ears

50%

Loss of one hand/feet/ limb or sight of one eye

50%


The PA benefit will not be paid in case of accidental death or disablement caused by :

·  Suicide or self-inflicted injuries

·  Active war, active terrorism or riots

·  Illegal or criminal acts committed by the insured punishable under the Revised Penal Code, as amended, (Act No. 3815) or special penal laws.

PA cover terminates when the insured turns 66 years old.


3.  Burglary & Robbery

Coverage for Burglary and Robbery is terminated once the cash assistance for property damage has been exhausted.   Cash/Monies/Money losses are not covered by this benefit.

3.1 In case of robbery, the insured shall be entitled to the actual amount of loss, up to the maximum amount of benefit, provided that the loss or damage must be within the insured property. Further, loss must be a direct result of robbery which is defined as an actual theft or an attempt with:

3.1.1) actual forcible and violent entry into or exit from the insured property; or

3.1.2) an assault or violence to any person or threat thereof.

3.2 In case of burglary, the insured shall likewise be entitled to the actual amount of loss, up to the maximum amount of benefit provided the loss or damage must be within the insured property.


4.  24/7 Emergency Assistance in key cities nationwide

Provides access to a hotline for the following services:

·  Ground and Air Ambulance assistance

·  Roadside assistance – towing, crane, and minor onsite repair services (change of flat tires, battery boosting, emergency fuel delivery).

·  Fire assistance – coordination with the nearest fire department

·  Police assistance – coordination with the nearest police station

All assistance services availed thru the hotline shall be paid by the insured member. For ambulance and roadside assistance, rates will vary depending on the specific service requested and your location.


Emergency assistance benefits can be downloaded from:

B.  Amount of Benefits

Benefit

Benefit Amount

Remarks

Cash Assistance for Property Damage

Plan 10,000

· If damage incurred is 70% or less of property insured, insured will receive 50% of Benefit Amount

· If damage incurred is more than 70% or less of property insured, insured will receive 100% of Benefit Amount

Fire & Lightning cover

Php 10,000

Earthquake cover

Php 10,000

Flood cover

Php 10,000

Typhoon cover

Php 10,000

Accidental Death & Disablement

Php 1,000

Subject to the Table of Permanent Disablement Benefits

Burglary & Robbery

Php 1,000

Actual amount of loss, up to the maximum Benefit Amount

Emergency Assistance

Included

Access only.  Actual service availed will be paid by the Insured


The amount of insurance shall be reduced automatically by the amount of any claim paid.

C. Maximum Benefits. Only one policy shall be in force and payable at any point in time.  Should a Member secure another cover for the same establishment/structure, only one benefit will be paid upon the claim.  Premiums in excess of the coverage will be refunded.


II. EFFECTIVITY AND TERMINATION OF COVER

A.  Period of insurance coverage: To be stated in the communications received by insured Members

B.  Grace Period. Members have a maximum grace period of forty-five (45) calendar days from due date of premiums payments.  Your policy is in force during this time unless You notify us in writing of your intention to terminate the policy.  In which case, You shall be liable to Us for payment of a pro-rata premium for the time the policy shall have been in force during the grace period.

C.  Termination of Insurance.  Insurance will terminate on the earliest of the following dates:

         1.  The date of termination of the Bixie Group Policy;

         2.  The date at the end of the grace period if any premium due for the Member’s insurance remains unpaid;

         3.  The date the Member ceases to be eligible for Insurance:

               i.  For Personal accident, when the Member attains age 65, or

               ii.  when the Member ceases to be a member of Bixie

         4.  The date of death of the Member.

Any unused premiums due to Member termination shall be refunded to the Member based on the proportion of premiums shared.

D.  Short Period Rate Cancellation Table. It is hereby agreed that, in the event of this Policy being surrendered by the Member for cancellation, AXA shall retain a premium in accordance with the following scale for the time the policy has been in force.

No of Months

1

2

3

More than 4

Percentage

60%

80%

90%

100%


III.  CLAIMS

A. Notice of Claim Filing. In respect to any claim to be made, claimants must provide written notice to AXA within the prescribed number days stated below.  Failure to provide written notice of claim within the stated period shall entitle Us to deny the claim:

                 ·  For Personal Accident claims: 30 calendar days from the date of the accident

                 ·  For Cash Assistance or Burglary/Robbery claims: 60 calendar days from the date of the burglary, robbery or the incident resulting in the damage to the insured property.

B. Settlement of claim clause.  Claims will be paid within ten (10) working days from receipt of complete claim requirements by AXA.

C. Claim Requirements


PROPERTY CLAIM

Property Damage – Structure and Contents

1. Barangay Certificate stating that insured property is an official operating business, validate location

2. Incident Report (Claimant’s report)

3. Photograph of property – before and after damage

4. Inventory with cost (optional)

5. Valid gov’t ID of claimant

6. Micro property claim form


Robbery and Burglary

1. Formal claim letter/advice

2. Affidavit of loss

3. Police Investigation Report - reporting item lost & estimated amount

4. Photo/s showing forcible entry or exit

5. Valid gov’t ID of claimant


PA CLAIM

Accidental Death Claim

1. PA Claim form

2. Attending Physician Statement or Medical Certificate (original or CTC)

3. Police Investigation Report and Statement of Witnesses (original or CTC)

4. Death Certificate of Insured.   PSA certified or stamped certified copy of Local civil registrar

5. For Beneficiaries

a. If Spouse - Marriage Contract (original or NSO certified). LCR copy acceptable

b. If Parent – Birth certificate of Insured.


LCR copy acceptable.

c. If Child – Birth certificate of Child. LCR copy acceptable

6. Valid gov’t ID of claimant

7. Proof of Bank account e.g. copy of deposit slip or passbook showing name of and account number of Claimant


Permanent Disability Claim

1. PA Claim form (see PA claim form under Accidental Death requirement)

2. Attending Physician Statement or Medical Certificate (original or CTC)

3. Police Investigation Report/Incident report/Barangay narrative if not reported to police authorities and Statement of Witnesses (original or CTC)

4. Hospital Records – for amputation. This is optional if medical certificate states amputation already

5. Picture of amputated affected body parts of the victim.

a.  Whole body shot

b.  Close body shot of affected body parts

6. Valid gov’t ID of claimant

D.  In Case of Fraud or Misrepresentation. Should there be proof that the insured or any party representing him committed fraud or concealed material information that would otherwise make the claim or policy invalid, We have the right to deny such a claim.


E.  Sending of Claim requirements

1.  Complete claim requirements should be sent to : property.claims@axa.com.ph

(Suggested) Subject : Bixie property microinsurance claim – Name of insured or policy number

2.  AXA will revert with any additional claim requirements within three (3) WD

3.  If premiums for the claiming member have not yet been received by AXA, Bixie should  provide proof of payment for AXA to proceed with claims payout.

4.  If claim is approved, settlement forms e.g. quit claim documents, will be sent by AXA to the claimant which have to be signed before claims are paid out to the claiamant’s bank account.

Gcash and Paymaya are not yet set up to for claims payouts.


IV.  INQUIRIES

For inquiries, please send a message to Dally DALISAY  at dally.dalisay@axa.com.ph.

For Claims: Complete claim requirements should be sent to : property.claims@axa.com.ph