Act of God
An event arising out of natural causes with no human intervention or could not have been prevented by reasonable care or foresight. Examples are floods, lightning, and earthquakes.
Activities of daily living (ADL)
1. Transfer : Getting in & out of a chair without requiring physical assistance.
2. Mobility : The ability to move from room to room without requiring any physical assistance.
3. Continence : The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
4. Dressing : Putting on and taking off all necessary items of clothing without requiring assistance of another person.
5. Bathing/Washing : The ability to wash in the bath or shower(including getting in or out of the bath or shower) or wash by any other means.
6. Eating : All tasks of getting food into the body once it has been prepared.
A person who carries on the business of investigating the cause and circumstances of a loss and ascertaining the quantum of loss.
One who solicits, negotiates or effects contracts of insurance on behalf of an insurance company.
Deterioration or loss of intellectual capacity or abnormal behavior as evidenced by the clinical state and accepted standardized questionnaires or tests arising from Alzheimer`s Disease or irreversible organic degenerative brain disorders resulting in significant reduction in mental and social functioning (such that continuous supervision is required). The diagnosis must be clinically confirmed by a neurologist. The following are excluded:
– Non organic brain disorders such as neurosis and psychiatric illnesses and
– Drug or alcohol related brain damage.
Angioplasty and other invasive treatments for major coronary artery disease
Means the actual undergoing for the first time of Coronary Artery Balloon Angioplasty, artherectomy, laser treatment or the insertion of a stent to re-vascularise a narrowing or blockage of one or more coronary arteries as shown by angiographic evidence. Intra-arterial investigative procedures are not included. Payment under this clause is limited to 10% of the Critical Illness coverage under this policy subject to a maximum of RM 25,000. This benefit is payable once only and shall be deducted from the amount of this Contract, thereby reducing the amount of the Lump Sum Payment which may be payable herein.
A contract that provides for a stream of periodic income for a term dependent upon human life.
The transfer of ownership rights of a life insurance policy to another party.
Automatic premium loan
A loan granted by a life insurance company to a policyholder using the cash value of the life policy to pay any premiums due at the end of the grace period of the same policy. The loan is automatic as allowed under one of the provisions in the life policy.
Stipulates that an insurance company is only liable for such proportion of the loss as the sum insured bears to total value at risk. This clause is applicable to the insurance of a property.
The procedure for making the effective date of a policy earlier than the application date. Backdating is often used to make the age at issue lower than it actually was in order to get a lower premium.
Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit lasting for a minimum period of 30 days and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living .
The diagnosis is to be confirmed by:
– an appropriate specialist
– the presence of bacterial infection in the cerebrospinal fluid by lumbar puncture
Benign brain tumor
A life-threatening, non-cancerous tumor in the brain or meninges within the cranium, giving rise to characteristic signs of increased intra-cranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The presence of the underlying tumor must be confirmed by imaging studies such as CT Scan or MRI. The following are excluded:
c) Malformations in or of the arteries or veins of the brain
e) Tumors in the pituitary gland, or spine
f) Tumors of the acoustic nerve
A situation where the condition of an insured item has become better following a repair or replacement.
Blindness /total loss of sight
Total and irreversible loss of sight in both eyes as a result of illness or accident. The blindness must be confirmed by an ophthalmologist.
Bodily injury liability
Legal liability for causing physical injury or death to another.
This is the extra money paid with the final benefit for participating policies. However bonuses are not guaranteed and depend on the performance of the insurance fund.
The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed. The following are excluded:
1.Burr hole procedures, transphenoidal procedures and other minimally invasive procedures
2.Brain surgery as a result of an accident
One who represents an insured in the solicitation, negotiation or procurement of contracts of insurance, and who may render services incidental to those functions.
Any malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma. For the above definition, the following are not covered:
1. All cancers which are histologically classified as pre-malignant, non-invasive; carcinoma in situ; having either borderline malignancy; or having low malignant potential
2. All tumours of the prostate, thyroid and urinary bladder histologically classified as T1N0M0 (TNM classification)
3. Chronic Lymphocytic Leukemia less than RAI Stage 3
4. All cancers in the presence of HIV
5. Any skin cancer other than malignant melanoma
Chronic aplastic anemia
Irreversible persistent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring treatment with at least 2 of the following:
1. Regular blood product transfusion;
2. Marrow stimulating agents;
3. Immunosuppressive agents; or
4. Bone marrow transplantation.
The diagnosis must be confirmed by a bone marrow biopsy.
Notification to an insurance company that payment of an amount is due under the terms of the policy.
A provision in a medical and health policy which requires the policyholder to bear the difference in room charges as well as other eligible benefits (usually 10% – 20%) described in the policy contract if the rate charged by the hospital is higher than the policyholder’s eligibility.
A state of unconsciousness with no reaction or response to external stimuli or internal needs, persisting continuously for at least 96 hours, requiring the use of life support systems and resulting in a permanent neurological deficit, lasting more than 30 days. Confirmation by a neurologist must be present. Coma resulting directly from self-inflicted injury, alcohol or drug abuse is excluded.
Remuneration paid to an agent by an insurance company for his services.
A certain amount of money given as payment as determined accordingly in response to a claim made by the policyholder.
The monetary consideration payable once or periodically by a participant to a takaful operator for his participation in the takaful scheme.
Coronary artery by-pass surgery
Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by way of Coronary Artery By-Pass Grafting. Angioplasty and all other intra-arterial, catheter based techniques, keyhole or laser procedures are excluded.
Deafness/ total loss of hearing
Total and irreversible loss of hearing in both ears as a result of illness or accident. Total means “the loss of at least 80 decibels in all frequencies of hearing”. Medical evidence in the form of an audiometry and sound-threshold tests must be provided and certified by an Ear, Nose, and Throat (ENT) specialist.
The portion of an insured loss to be borne by the policyholder before he is entitled to recover from the insurance company. Also known as excess.
A condition that affects to some degree a person’s ability to carry on his normal pursuits. A disability may be partial or total, and temporary or permanent.
The benefit payable upon the disablement of the life insured under a disability income policy or a provision of some other policy such as life insurance or takaful family plan.
Money made available to policyholders based on an insurance company’s earnings and monetary surplus.
Duty of disclosure
E.g. ‘Full Disclosure of Material Fact’, refers to revealing all your relevant details in your insurance application to the insurance company. Failure to do so may render your policy invalid.
Defined as severe inflammation of brain substance, resulting in permanent neurological deficit lasting for a minimum period of 30 days and certified by a neurologist. The permanent neurological deficit must result in an inability to perform at least three (3) of the Activities of Daily Living. Encephalitis in the presence of HIV infection is specifically excluded.
End stage kidney failure
End stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis is initiated or renal transplantation carried out.
End stage liver failure
End stage liver failure as evidenced by all of the following:
– Permanent jaundice;
– Ascites; and
– Hepatic encephalopathy.
Liver failure secondary to alcohol or drug abuse is excluded.
End stage lung disease
End stage lung disease causing chronic respiratory failure. All of the following criteria must be met:
1. Requiring permanent oxygen therapy as a result of a consistent FEV1 test value of less than one liter. (Forced Expiratory Volume during the first second of a forced exhalation)
2. Baseline Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less
3. Dyspnea at rest
A combination of protection and savings whereby the money will be paid at the end of a specific period upon your demise or if you suffer total and permanent disability.
A contractual provision that denies coverage for certain perils, persons, property, or locations.
The termination of a term life Insurance policy at the end of its period of coverage.
A period of time (usually 15 days) during which a policyholder may examine a newly issued individual life or health insurance, and surrender it in exchange for a full refund of premium less expenses incurred for the medical examination of the life policyholder, if not satisfied for any reason.
Full blown AIDS
The clinical manifestation of AIDS (Acquired Immuno-deficiency Syndrome) must be supported by the results of a positive HIV (Human Immuno-deficiency Virus) antibody test and a confirmatory Western Blot test. In addition, the life Insured must have a CD4 cell count of less than two hundred (200) and one or more of the following criteria are met:
1. Weight loss of more than 10% of body weight over a period of six (6) months or less (wasting syndrome);
2. Kaposi Sarcoma;
3. Pneumocystis Carinii Pneumonia;
4. Progressive multifocal leukoencephalopathy;
5. Active Tuberculosis;
6. Less than one-thousand (1000) Lymphocytes
7. Malignant Lymphoma.
Fulminant viral hepatitis
This is defined as a sub massive to massive necrosis of the liver caused by any virus leading precipitously to liver failure. The diagnostic criteria to be met are:
1. A rapidly decreasing liver size as confirmed by abdominal ultrasound;
2. Necrosis involving entire lobes, leaving only a collapsed reticular
3. Rapidly deteriorating liver functions tests; and
4. Deepening jaundice.
Hepatitis B infection or carrier status alone does not meet the diagnostic criteria
A prescribed period, usually 30 days from the premium due date, during which an insurance contract is kept in force despite non-payment of premium. If premium is not paid within the grace period, the policy may lapse or be subject to reduced paid-up or automatic premium loan.
Group life insurance
Life insurance covering a group of people under a master policy. The policy is issued usually without the requirements of medical examination on the lives assured. It is typically issued to an employer for the benefit of employees, or to members of an association.
The death of a portion of the heart muscle (myocardium) as a result of inadequate blood supply and being evidenced by all of the following criteria:
1. A history of typical prolonged chest pain,
2. New electrocardiographic changes resulting from this occurrence,
3. Elevation of the cardiac enzyme, CPK-MB above the generally accepted laboratory levels of normal or troponins recorded at the following levels or higher: -Troponin T > 1.0 ng/ml or equivalent threshold with other Troponin I methods Angina is specifically excluded.
Heart valve surgery
The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities. Repair via intra-arterial procedure, key-hole surgery or similar techniques are specifically excluded.
HIV due to blood transfusion
Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the following conditions are met :-
1. The blood transfusion was medically necessary or given as part of a medical treatment;
2. The blood transfusion was received in Malaysia or Singapore after the commencement of the policy;
3. The source of the infection is established to be from the Institution that provided the blood transfusion and the Institution is able to trace the origin of the HIV tainted blood;
4. The insured does not suffer from Hemophilia; and
5. The insured is not a member of any high risk groups such as but not limited to intravenous drug users
A clause in a life insurance policy providing that after a policy has been in effect for a given length of time (one or two years), the life insurance company shall not be able to contest the statements contained in the application unless fraud can be proven.
Restoration of the claimant to the same financial position immediately before a loss by payment, repair or replacement.
A basic principle of insurance that requires the person purchasing insurance to have an interest in the insured item or life insured in that the loss or damage to the item or life insured would result in a financial loss to the person.
A company licensed under the Insurance Act 1996 to carry on life or general insurance business or both life and general insurance business.
The person whose life or health is covered by a specific policy.
A life insurance policy where the policy value at any time varies according to the value of the underlying assets at the time.
Also known as “Effective Date”. The date that an insurance policy is approved.
Termination of a policy because of failure to pay the premium. This generally happens because the policy has yet to develop any cash value.
An agreement that guarantees the payment of a stated amount of monetary benefits upon the death of the insured, or under other circumstances specified in the contract, such as total disability.
Loss of independent existence
Confirmation by an appropriate specialist of the loss of independent existence lasting for a minimum consecutive period of 6 months and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living .
Loss of speech
Total and irrecoverable loss of the ability to speak for a continuous period of 12 months. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be supplied by an Ear, Nose, and Throat specialist. All psychiatric related causes are excluded.
Third degree (i.e. full thickness) skin burns covering at least twenty percent (20%) of the total body surface area.
Major head trauma
Physical head injury causing permanent functional impairment lasting for a minimum period of three (3) months from the date of the trauma or injury. The resultant permanent functional impairment is to be verified by a neurologist and must result in an inability to perform at least three (3) of the Activities of Daily Living.
Major organ / bone marrow transplant
The receipt of a transplant of:
– Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or
– One of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end stage failure of the relevant organ.
Other stem cell transplants are excluded.
The date at which a life insurance policy has completed its full term and the face amount becomes payable usually with the condition that the life insured survives to that date.
The amount payable to a living insured at the end of an endowment period or to the owner of a whole life policy if he lives past a certain age.
Medical and health insurance
Insurance which provides specified benefits to cover medical expenses incurred against risks of persons becoming totally or partially incapacitated or hospitalised as a result of sickness or infirmity.
Medullary cystic disease
A progressive hereditary disease of the kidneys characterized by the presence of cysts in the medulla, tubular atrophy and interstitial fibrosis with the clinical manifestations of anemia, polyuria and renal loss of sodium, progressing to chronic renal failure. Diagnosis should be supported by a renal biopsy.
Mortgage reducing term assurance
A policy that covers the repayment of the outstanding loan in the event of untimely death, disability or critical illness of the borrower.
Motor neuron disease
Refers to a progressive degeneration of the corticospinal tracts and anterior horn cells or bulbar efferent neurons. These include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis. The diagnosis must be confirmed by a neurologist as progressive and resulting in permanent neurological deficit.
Coverage from two or more policies which duplicate coverage of certain risks.
Unequivocal diagnosis by a consulting neurologist confirming the following combination, which has persisted for at least a continuous period of six (6) months:
1. Symptoms referable to tracts (white matter) involving the optic nerves, brain stem and spinal cord, producing well-defined neurological deficits;
2. A multiplicity of discrete lesions; and
3. A well-documented history of exacerbation and remissions of said symptoms/neurological deficits.
The diagnosis of muscular dystrophy shall require a confirmation by a neurologist of the combination of 3 out of 4 of the following conditions:
1. Family history of other affected individuals
2. Clinical presentation including absence of sensory disturbance, normal cerebro-spinal fluid and mild tendon reflex reduction
3. Characteristic electromyogram
4. Clinical suspicion confirmed by muscle biopsy
No benefit will be payable under this Covered Event before the Life Assured has reached the age of 12 years next birthday.
A reward scheme for the policyholder if no claim was made against the policy during the preceding 12 months of policy. Different NCD rates are applicable for different classes of vehicles. For a private car, the scale of NCD ranges from 25% to 55% as provided in the policy.
The act of naming someone as the nominee of a life or personal accident policy.
A person or persons named in a life or personal accident policy to receive the benefits under the policy.
A type of life insurance policy or annuity for which the policyholder does not receive dividends or bonus.
Occupationally acquired human immunodeficiency virus ( HIV) infection
Infection with the Human Immunodeficiency Virus (only if the life assured is a Medical Staff as defined below), where it was acquired as a result of an accident occurring during the course of carrying out normal occupational duties with sero-conversion to HIV infection occurring within six (6) months of the accident. Any accident giving rise to a potential claim must be reported to the Company within thirty (30) days of the accident taking place supported by a negative HIV test taken within seven (7) days of the accident. “Medical Staff” is defined as Doctors (General Physicians and Specialists), nurses, laboratory technicians, dentists (surgeons and nurses), ambulance workers who are working in the medical centre or hospital or dental clinics/polyclinics in Malaysia. Infection in any other manner including as a result of sexual activity, blood transfusions or recreational intravenous drug use is specifically excluded.
Other serious coronary artery disease
The narrowing of the lumen of at least three major coronary arteries (not inclusive of their branches) by a minimum of 60 percent or more as proven by coronary arteriography (non-invasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery(LAD) and Left Main Stem ( a narrowing of 60% or more of the Left Main Stem will be considered as a narrowing of two major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed.
A term used to describe the condition that exists when a policyholder has purchased coverage for more than the actual cash value or replacement cost of a subject of insurance.
A policy which does not require any future premium payments but which is not yet terminated by either death or maturity.
The complete and permanent loss of use of both arms or both legs, or of one arm and one leg, through paralysis caused by illness or injury persisting for at least six (6) months from the date of trauma or illness.
Unequivocal diagnosis of Parkinson`s Disease by a neurologist where the condition:
1. Cannot be controlled with medication
2. Shows signs of progressive impairment
Activities of daily living assessment confirm the inability of the life insured to perform without assistance three (3) or more of the Activities of Daily Living.
Only idiopathic Parkinson’s Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded.
A policy which shares in the distributable surplus of a life insurance company by acquiring bonuses or dividends.
A rider or provision often found in juvenile policies under which premiums are waived if the person paying the premium, usually one of the parents, becomes disabled or dies while the child is still a minor.
A loan made by an insurance company to a policy owner of a part or all of the cash value of the policy assigned as security for the loan.
A coverage limitation included in many medical and health policies which states that conditions or illnesses that exist before the effective date of a medical and health policy, for which the insured is still receiving treatment or shown symptoms will not be covered under the policy. It doesn’t matter whether or not the insured is aware of this condition.
The monetary consideration payable once or periodically by a policy owner to an insurance company in return for the insurance coverage provided.
Primary pulmonary arterial hypertension
Means Primary Pulmonary Arterial Hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of cardiac impairment. Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:-
1. Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms.
2. Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
Pro Rata Rate
A rate charged for a period of coverage shorter than the normal period. An example, if an insured had coverage for only one quarter of a year, his premium would be only one quarter of the annual premium.
Most medical and health policies contain a waiting period for illness and disease, which means that eligibility for benefits under the policy will only start, says 30 days as the waiting period after the effective date of the policy.
A paid-up policy with a lower value of sum assured compared with the initial sum assured purchased. A policyholder with a policy that has acquired a cash value can opt to stop paying future premiums and convert his/her policy to a reduced paid-up policy.
Revival of a policy that has lapsed within a period of time under certain conditions.
An attachment to a policy that modifies its conditions by expanding benefits.
Scale of benefits
The scale of benefits refers to the amount of compensation payable by an insurance company in the event of injury to or loss of limb, sight or hearing. It determines the proportion of compensation vis-à-vis the loss suffered.
An impaired function of the heart muscle, unequivocally diagnosed as Cardiomyopathy by a cardiologist, and resulting in permanent physical impairment of at least Class III of the New York Heart Association`s classification of cardiac impairment. The diagnosis has to be supported by echocardiographic findings of compromised ventricular performance. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:-
1. Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms.
2. Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
Cardiomyopathy directly related to alcohol or drug abuse is excluded.
Properties such as apartments, condominiums, flats etc.
Defined as a cerebrovascular accident or incident producing neurological sequelae of a permanent nature, having lasted not less than three months. Infarction of brain tissue, hemorrhage and embolization from an extra-cranial source are included. The diagnosis must be based on changes seen in a CT scan or MRI and certified by a neurologist. Specifically excluded are cerebral symptoms due to transient ischemic attacks, any reversible ischemic neurological deficit, vertebrobasilar ischemia, cerebral symptoms due to migraine, cerebral injury resulting from trauma or hypoxia and vascular disease affecting the eye or optic nerve or vestibular functions.
Surgery to aorta
The actual undergoing of surgery via a thoracotomy or laparotomy to repair or correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. Angioplasty and all other intra-arterial, catheter based techniques, keyhole or laser procedures are excluded.
To give up a life policy. The insurance company pays the insured the cash value, if any, which the policy has built up if it is surrendered.
The amount available in cash upon voluntary termination of a policy before it becomes payable on death or maturity. Also called cash value.
Systemic lupus erythematosus with lupus nephritis
Refers to a multi-system, autoimmune disorder characterized by the development of auto-antibodies, directed against various self-antigens. Within the context of this policy, SLE is restricted to only those forms of systemic lupus Erythematosus, which involve the kidneys (Type 111 to Type V Lupus Nephritis, established by renal biopsy). Other forms such as discoid lupus and those forms with only hematological and joint involvement are specifically excluded. WHO Lupus Classification:
– Class I: Minimal change glomerulonephritis
– Class II: Mesangial glomerulonephritis
– Class III:Focal Segmental glomerulonephritis
– Class IV:Diffuse glomerulonephritis
– Class V: Membranous glomerulonephritis
A rate established by a rating organisation, which comes from the tables, schedules and rules found in the tariff. For tariff rates products, all policyholders pay the same standard premium if no loadings are involved.
Insurance payable only on death within a specified period.
The conclusive diagnosis of a condition that is expected to result in death of the Life Insured within 12 months. The insured must no longer be receiving active treatment other than that for pain relief. The diagnosis must be supported by written confirmation from the appropriate specialist and confirmed by the Company’s appointed doctor.
A loss of sufficient size so that it can be said there is nothing left of value.
Total and Permanent Disability
‘Total and Permanent Disability’ (hereinafter referred to as ‘TPD’) shall mean disability caused by an accidental bodily injury, illness or disease which wholly prevents the participant from engaging in any work, business, occupation or profession for wages, compensation or profit, provided however, that such disability must last for a continuous period of not less than six (6) months in duration…..
TPD is defined as totally unable to perform independently at least three (3) of the ‘Activities of Daily Living’ as herein after defined.
‘Activities of Daily Living’ shall mean
(i) Transfer of mobility…., (ii) Continence…., (iii) Dressing…., (iv) Toileting…., (v) Eating….
The occurrence of any of the following shall also be considered as Total and Permanent Disability:
i. total and irrecoverable loss of sight of both eyes; or
ii. loss by severance of two limbs at above wrist or ankle; or
iii. total and irrecoverable loss of the sight of one eye and loss by severance of one limb at above wrist or ankle.”
The act of, or attempt threat, which induces a policyholder, to drop an existing policy and take another. A policyholder is usually worse off when his/her policy is twisted.
A condition in which not enough insurance is purchased to cover the insurable value.
Utmost good faith
One of the basic principles of insurance that essentially requires the policyholder to disclose all the material facts to the insurance company when proposing for a policy. This is in view that the insurance company normally takes on the risk by relying on the information given by the policy owner in the proposal form.
A rider waiving (excluding) liability for a stated cause of injury or sickness or a provision or rider agreeing to waive premium payments during a period of disability of the insured.
Whole life insurance
Life-long protection and premiums are paid throughout your life and the money including any bonuses will be paid when you pass away or suffer total and permanent disability.