I.ALL-MED INSURANCE ASSURANCE - TERMS AND CONDITIONSEligibility: This insurance is available for all NATCOM Subscribers aged 18 to 60 and self-declared in good health. ALL-MED INSURANCE will not be liable for any claim on account of illness, injury, or death caused by conditions pre-existing the registration and known by the subscriber.
Subscription: Subscription to this insurance required subscriber to send a confirmation SMS. By sending this confirmation SMS, subscriber acknowledge that he have read and understood the terms and conditions of this policy.
Commencement: This insurance cover starts from the first day of the month following the customer’s first payment.
Payment of premiums: By subscribing to this insurance, subscriber authorizes NATCOM to make 20 daily deductions each month from his prepaid account, using the NATCOM Payment Service.
Group policy: subscriber will be covered under the Master policy for NATCOM subscribers. This cover summary tells subscriber the key things that subscriber need to know, but should be read in conjunction with the full policy wording, which is available at www.NATCOM.com.ht
Sum insured: Life insurance which pays the full cover amount to his named beneficiaries if subscriber die from accident or sickness.
Claim payment: if the insured subscriber dies, the benefit is paid to the registered beneficiary chosen by the subscriber. To make a valid claim, subscriber or his beneficiary must contact the ALL-MED INSURANCE at 509 3333-3274. ALL-MED INSURANCE will assess claim within 3 Business Days. The benefit will be paid by check.
Exclusions: It is important to know that this policy does not cover claims arising from Intentional Violation of Laws and Regulations, Terrorism, War, Suicide, Drugs & Alcohol, Gang fighting or violence/wars/disputes or a medical condition that subscriber already suffer from.
II.CUSTOMER POLICYThis life policy insurance (“Policy” or “Life Policy”) is issued by ALL-MED INSURANCE S.A., a company registered under the laws of Haiti, Port-au-Prince, Haiti.
- IMPORTANT ACKNOWLEDGMENTS
b) NATCOM is the Insurer’s agent, is not an insurance company and is not liable for any benefits payable in respect of Family Plan of Subscriber
c) Subscriber authorizes NATCOM to pay the Monthly Premiums to the Insurer on behalf of subscriber. NATCOM will do so by making 20 daily deductions each month from prepaid account of subscriber one monthly deduction from the postpaid account (NATCOM Payment Service). The NATCOM Payment Terms (published at www.NATCOM.com.ht as revised from time to time) apply to use of the NATCOM Payment Service.
d) ALL-MED INSURANCE is liable for assessing or meeting any claims arising in connection with the Family Life Plan of subscriber
e) This Policy and the NATCOM Payment Terms are available at www.NATCOM.com.ht\insurance (or such other website as we may notify from time to time).
- ELIGIBILITY AND REGISTRATION
The Subscriber is eligible to apply for a Family Life Plan under the Policy if subscriber meet all the criteria set out below:
- Subscriber is a NATCOM Client;
- Subscriber is a natural person;
- Subscriber is at least 18 and below 60 years of age, as at the Registration Date and the Commencement Date; and
- Subscriber is in good health
- Registration is affected using his mobile phone.
- The Insurer or its agents will contact subscriber and explain the Family Life Plans available to subscriber and to explain to subscriber that:
- i. By paying the Premiums, the Insured assumes all actions taken with his/her phone and waives any objection as to the authenticity of messages or actions originating from the Insured's telephone and assumes the responsibility for actions taken therewith;
- ii. Subscriber. will immediately notify a call center by phone in the event that subscriber loses his phone or believe that his phone may have been compromised;
- iii. Unless NATCOM or the Insurer is advised as to a compromise of his phone, subscriber understands that all actions taken with his phone is his own and that subscriber will not make a claim otherwise;
- iv. Subscriber agrees that she will not be covered in the event of Intentional Violation of Laws and Regulations, Earthquake, Terrorism, War, Suicide, Drugs & Alcohol, Gang fighting or violence/wars/disputes or a medical condition that subscriber already suffer from at the time that subscriber registers; and
- v. All claims under the policy need to be made via call center to NATCOM.
- If Subscriber wish to apply for and subscribe to a Family Life Plan under the Policy, He will be required during the Registration Process to
- vi. Acknowledge that Subscriber has read and understood the terms of the Policy and the NATCOM Payment Terms;
- vii. Confirm that the relevant NATCOM phone account is his;
- viii. Confirm that subscriber meets the eligibility criteria set out in clause 2.1 of this Policy (including without limitation that subscriber is in good health, his age is between 18 and 60, he is not a police officer nor a security agent);
- ix. Confirm the Family Life Plan that subscriber wish to apply for;
- x. Authorize NATCOM to make 20 daily deductions each month from his prepaid or postpaid account using the NATCOM Payment Service; and
- xi. Acknowledge that:
b) NATCOM is not his insurance provider and subscriber will not make any claim otherwise;
c) Policy benefits are the sole liability of the Insurer;
d) the benefits payable are subject to his confirmation in clause 2.2(c)(iii) being true and correct; and
e) if his confirmation is untrue or incorrect, no benefits will be payable and the Premiums subscriber paid will not be refunded.
If his application for Policy is approved, subscriber will receive an SMS asking subscriber to confirm the Family Life Plan subscriber select. Subscriber must reply to the SMS confirming his selection and authorizing NATCOM to make daily deductions from his NATCOM prepaid or postpaid account (in accordance with clause 5 of this Policy).
- NOMINATION OF BENEFICIARY(IES)
- COMMENCEMENT AND COVER
Unless subscriber pays a full month’s worth of Premium (Monthly Premium), the amount of benefit under his cover is reduced in proportion to the amount of Premium subscriber pays; and
Subscriber must pay at least the 20% of the Monthly Premium (Threshold) applicable to his Family Life Plan for his Family Life Plan cover to commence. If the Premium subscriber pays is less than the Threshold:
- i. His Family Life Plan cover will be suspended the following month; and
- ii. The amount collected will be carried forward to the following month and counted as part of the Premium for that month.
- PREMIUM PAYMENT
- Once subscriber becomes an Insured Member, Subscriber authorizes NATCOM to pay the Monthly Premiums to the Insurer on behalf of subscriber
- NATCOM will do so by making a total of 20 deductions each month from NATCOM prepaid account of subscriber, each on consecutive or non-consecutive days of the month in question or once a month from postpaid account of subscriber (NATCOM Payment Service).
- The NATCOM Payment Terms apply to use of the NATCOM Payment Service of Subscriber.
- To cease daily deductions, subscriber must deregister his Life Policy by contacting Us or our agent. Otherwise, NATCOM will continue making daily deductions for so long as prepaid or postpaid account of subscriber has a positive credit balance.
- If subscriber has insufficient credit balance in his prepaid or postpaid account, subscriber may fail to pay the Monthly Premium in full, in which case clause 4(a) or clause 4(b) applies.
- i. His death; or; we may require provision of satisfactory proof, as determined by ALL-MED INSURANCE, of:
- ii. His membership status; and
- iii. His age on the Registration Date, on the Commencement Date and/or as at the date of the Event.
- CLAIM NOTIFICATION
- Notice of any claim and any supporting documentation required for a claim under this Policy shall be given to Us or to Our agent as soon as practicable, but not later than two (2) months from the occurrence of an Event causing his death. Otherwise we may decline the claim due to late notification. Notice can be made by contacting our call center at + 509 3333-3274. The supporting documentation required for completing a claim includes presentation of birth certificate and death certificate of subscriber which must be done no later than two (2) months from the occurrence of the Event causing the death otherwise we may decline the claim due to lack of valid documentation.
- This Policy is free from all restrictions as to occupation, foreign travel or residence, except as may be specially provided herein to the contrary, and is indisputable unless there be non-disclosure or misrepresentation of a material fact.
- No benefits under this Policy shall be subject to interest charges and we shall not be affected by any trust, charge, lien, assignment or any other unauthorized dealing related to this Policy.
- The Identification card(s) (ID) and the receipt of a form of discharge from the beneficiary(ies) or from any other person or persons duly authorized by them by notice in writing to Us shall be an absolute discharge in respect of the payment by Us of any Sum Insured under this Policy.
- GENERAL CONDITIONS OF INSURANCE
- We reserve the right to vary from time to time any of the terms of this Policy and of any endorsement attaching to it upon giving to the Insured three months’ notice of our intention to do so. Any such variation, other than a variation of the Premium, shall apply only to the Sums Insured or increases in Sums Insured becoming effective on or after the expiry of such notice. Any such change will be alerted to subscribers through his phone. Subscriber has the option of terminating this policy after such change.
- We reserve the right upon giving written notice to subscriber to terminate this Policy upon any infringement of these general conditions and payment of any benefit shall be conditional upon subscriber complying with the terms of this Policy.
- If subscriber was under or over the eligible age at the Registration Date or at the Commencement Date:
ii. The Insurer (ALL-MED INSURANCE) and NATCOM shall return to subscriber all Premiums paid by or on behalf of subscriber under the Policy; and
iii. No benefit under the Policy shall be paid and if any benefit has already been paid, the Insurer shall inform subscriber of any action intended to be taken to enforce its rights at law.
Subscriber acknowledges and agrees that NATCOM is not responsible for the return of any Premium to subscriber
Any fraud, concealment, or deliberate misstatement by or known to subscriber shall render the whole Policy null and void and all claims hereunder shall be forfeited.
This Policy does not acquire a surrender value.
III.SUM INSUREDLife of subscriber shall, as from the Commencement Date, be insured for the Sum Insured, subject to the terms and conditions set out in this Policy, the NATCOM Payment Terms and the Registration Data.
Each Insured Member may only subscribe for one (1) Family Life Plan under this Policy. In the event that subscriber, as an Insured Member, subscribe to more than one (1) Family Life Plan under this Policy (including through different NATCOM mobile accounts):
i.His maximum benefit upon death shall be 150,000 Gourdes across all Family Life Plans;
ii. Our maximum liability to subscriber or his beneficiary shall be 150,000 Gourdes.
The Family Life Plans (with the applicable Premium and Sum Insured) available to each Eligible Applicant is given below, but may be subject to change during the period of the Policy.
|Family Life Plan 1||Family Life Plan 2||Family Life Plan 3|
|Sum Insured (Gourdes)||50,000||100,000||150,000|
|Monthly Premium (Gourdes)||50||100||150|
|Daily deductions (Gourdes)||2.5||5||7.5|
If subscriber doesn’t not have sufficient balance available to meet the relevant deductions above, his proportional cover will be reduced by reference to the actual Premium deducted for the most recent month based on the following successful partial deductions per month:
|HTG 50,000 policy|
|Actual Premium deducted||Revised Sum Insured|
|HTG 100,000 policy|
|Actual Premium deducted||Revised Sum Insured|
|HTG 150,000 policy|
|Actual Premium deducted||Revised Sum Insured|
Subscriber must pay at least the 20% of the Monthly Premium (Threshold) applicable to his Family Life Plan for his cover to commence. If the amount subscriber pays is less than the Threshold, the amount collected will be carried forward to the following month and counted as part of the Premium for that month.
In the month N-1 if subscriber pays at least the 20% of the Monthly Amount that subscriber can receive the insurance packet of the month N+1
1.1 Automatic termination
The coverage of Life Policy of subscriber will automatically terminate upon the earlier of:
Subscriber reaching 60 years of age;
Payment of death benefits under this Policy; and
Settlement of a claim made by subscriber’s Beneficiary(ies) under this Policy.
1.2 Termination due to default
We may terminate subscriber Life Policy of subscriber by giving subscriber 5 days notice if:
Subscriber ceases to be a NATCOM Client, for any reason; or
Subscriber fails to pay the Monthly Premium due under his Family Life Plan in full,
(each a “default”) in which case subscriber Life Policy cover of subscriber ends at the expiry of the 5 days notice unless subscriber remedies the default before the notice period expires.
1.3 Effect of termination
If subscriber Life Policy of subscriber terminates for any reason, we may require subscriber to make a fresh declaration of good health before we reinstate subscriber Life Policy of subscriber.
2. POLICY EXCLUSIONS
2.1 Intentional Violation of Laws and Regulations
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for death of subscriber arising out of or in connection with: (a) his participation in an activity that constitutes a crime or an intentional offence.
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for death of subscriber arising out of or in connection with Terrorism of any kind including (without limitation) nuclear, chemical or biological Terrorism.
Terrorism means, when the Insured is taking no active part in such hostilities, a situation of armed conflict, when the death is caused by any act which by its nature or context, is to intimidate the population or to compel a government or an international organization to do or abstain from doing any act.
Nuclear, Chemical, Biological Terrorism means, during an act of Terrorism, the use of any nuclear weapon or device or the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous Chemical agent and/or Biological agent during the period of this Policy by any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s.
Chemical agent means, any compound which, when suitably disseminated, produces incapacitating, damaging or lethal effects on people, animals, plants or material property.
Biological agent means, any pathogenic (disease-producing) micro-organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically synthesized toxins) which cause illness and/or death in humans, animals or plants.
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for the death of subscriber arising out of or in connection with war of any kind.
For the purposes of this exclusion, war means any war, invasion, acts of foreign enemies, hostilities (whether war is declared or not), civil war, rebellion, revolution, insurrection, military or usurped power.
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for the death of subscriber arising out of or in connection with his conduct that involves:
suicide or attempted suicide; or
Exposure to exceptional danger (except in the attempt to save human life).
2.5 Drugs and alcohol
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for the death of subscriber arising out of, or in connection with or resulting from subscriber being under the influence of:
alcohol; or drugs (except as prescribed by a registered qualified medical practitioner).
12.6 Gang fighting or violence/wars/disputes
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for the death of subscriber arising out of or in connection with the participation of the Insured Member in gang fighting, gang violence, gang wars or gang related disputes.
12.7 Pre existing condition
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for, the death of subscriber arising out of or in connection with a Pre-existing Condition affecting subscriber (where subscriber is in his first 90 days of contributing membership).
The Insurer will not be liable to pay any amount under this Policy in respect of a claim for, the death of subscriber arising out of or in connection with a Earthquake.
13. GENERAL PROVISIONS
13.1 Governing law
The domestic laws of the Republic of Haiti shall govern this Policy and the Courts of Haiti shall have jurisdiction in any dispute arising hereunder.
If any provision of this clause is found by any court or administrative body of competent jurisdiction to be invalid or unenforceable, such invalidity or unenforceability will not affect the other provisions of this clause which will remain in full force and effect.
This Policy has been especially created to provide protection for those NATCOM Clients who successfully apply for that protection and who pay the appropriate Premium. Accordingly, notices to subscriber may be provided by:
SMS to his prepaid or postpaid mobile service (from which daily deductions are made);
Notification placed on www.NATCOM.com.ht/insurance or on the Insurer’s website at http://www.ALL-MED INSURANCE procare.org; or by publication in a major newspaper in Haiti.
If a notice is made by SMS, the notice is deemed to be received on the day the SMS is sent and “accepted” or “declined” by subscriber.
Accident means an event that is not expected or intended by the Insured Member and that directly causes the Insured Member’s death or directly causes the Insured Member’s Total and Permanent Disability.
Applicant means the individual who applies for a Family Life Plan under this Policy.
Business Day means a day other than a Saturday or Sunday or a day that is partly or wholly observed as a public holiday in Haiti.
Commencement Date means the effective date of cover of an Insured Member under this Policy.
Criminal Act means the intentional commission of an act usually deemed socially harmful or dangerous and specifically defined, prohibited, and punishable under criminal law.
NATCOM Client means the holder of NATCOM prepaid or postpaid mobile service.
NATCOM Payment Terms means NATCOM’s payment terms published at www.NATCOM.com.ht/insurance. as revised from time to time.
Eligible Applicant means an Applicant who meets the eligibility criteria set forth in this Policy.
Epidemic means as declared by the World Health Organization.
Event means an occurrence. The definition of Event is subject to the following qualifications. If there are multiple occurrences, and it is not possible to allocate losses suffered to one of the occurrences, Insurer will allocate the losses to the occurrence Insurer considers to have resulted in the losses.
If there is uncertainty over scientific issues, the Parties agree to seek expert advice from a neutral and recognized organization.
Family Life Plan means one of the life insurance covers under this Policy.
Injury means bodily injury or mental harm suffered by an Insured Member as a consequence of an Accident which occurs whilst an Insured Member is covered under this Policy.
Insured Member means a person who meets the eligibility criteria set out in clause 2.1, whose application for subscription to a Family Life Plan under this Policy has been approved by Us and who pays Premiums as required under this Policy.
Life Policy or Policy means this life insurance cover.
Party means a party to this Policy and Parties means the parties to this Policy.
Pre-Existing Condition means:
a) Any physical injury, mental harm, sickness, disease or other medical condition suffered by the Insured Member for which treatment, medication or advice (including investigation) has been received or prescribed by a medical advisor prior to commencement of this Policy; or
b) Any chronic or ongoing physical injury, mental harm, sickness, disease or other medical condition documented prior to commencement of this Policy.
Premium means the premium payable by an Insured Member to Insurer in relation to this Policy.
Registration Date means the date that an Eligible Applicant’s application to subscribe for the Family Life Plan under this Policy is approved (being the date that the confirmatory SMS is sent to the Eligible Applicant).
Sickness means a sickness or disease that is contracted by, and causes harm to, an Insured Member as a consequence of an Accident which occurs whilst the Insured Member is covered under this Policy.
Sum Insured means the amount payable under this Policy upon: The death of an Insured Member
Subscribermeans an Applicant or an Insured Member as the context require.
We, Our, Us or Insurer means ALL-MED INSURANCE.