SECTION I: COVERAGES 

1. DEFINITIONS

ACCIDENT/ACCIDENTAL refers sudden, unintended and unforeseen mishap caused by external, violent and visible means.

APPOINTED ASSISTANCE COMPANY refers to a company appointed by Myanma Insurance to provide the Insured with travel assistance and medical emergency services.

DEDUCTIBLE refers to the amount of any claim which Insured must pay themselves.

EFFECTIVE DATE refers to the Policy Commencement Date or Date of the Insured’s first enrollment into the Policy, whichever is later.

ILLNESS refers to Covid-19 disease, manifesting itself during the period of insurance, and excluding any pre-existing conditions.

INSURED refers to natural person or legal entity that purchases an Insurance Policy, and in some cases an insured can be a policy owner as well as an insured person.

MEDICAL EXPENSE refers to the services fee that the Hospital or Medical Center charges Insured that are considered Normal and Customary while he/she is their Inpatient.

MEDICAL PRACTITIONER refers to a person who has a medical degree, is licensed or registered in the country which they operate and is accredited by a medical board or equivalent organization to render medical services, except of Family Members.

LOSS OF SIGHT refers to a physical condition where the Insured is completely blind and cannot be cured.

PERIOD OF INSURANCE refers to the period of cover shown in the Policy Schedule for which the appropriate premium has been paid.

ISOLATION refers to Hotel quarantine and facility centers due to the infection of covid-19.

HOSPITAL refers to only an establishment duly constituted and registered as a hospital or clinic for the care and treatment of sick and injured persons as bed-paying patients, and which:

1. 1. 1. has facilities for diagnosis and major surgery,
      2. provides twenty-four (24) hours a day nursing services by registered and graduate nurses,
      3. is under the supervision of a medical practitioner.

DEDUCTIBLE means the accumulative total amount of medical expenses incurred by an insured person during any one policy year in excess of which the policy will indemnify or compensate the insured person for medical expenses covered by the policy.

INJURY means bodily injury sustained by you during the period of insurance caused solely and directly by an accident.

IN-PATIENT refers to someone who is continuously confined to a hospital and under the care of a physician for more than twenty-four (24) consecutive hours, such confinement being certified as medically necessary by the attending physician.

LOSS OF A LIMB means loss by physical severance or total and permanent loss of use of a hand at or above the wrist or of a foot at or above the ankle.

PRE-EXISTING CONDITIONS means any disabilities for which you have reasonable knowledge of in the twelve (12) months prior to the commencement of this policy. You are considered to have reasonable knowledge of pre-existing conditions where the condition is one for which:

1. 1. 1. you have been diagnosed; or
      2. symptoms existed that would cause an ordinary prudent person to seek diagnosis, care or treatment; or
      3. medical advice, diagnosis, care or treatment that has been recommended by medical practitioner, irrespective of whether such treatment was actually received prior to the commencement date of this policy; or
      4. you have received or are receiving treatment.

PERMANENT TOTAL DISABLEMENT refers to Injury which:

1. 1. 1. falls into one of the categories listed in the Scale of Permanent Disablement Benefits Table.
      2. Commencing within twelve (12) months from the date of bodily injury, you are totally, continuously and permanently disabled for twelve (12) continuous months and are prevented from performing three (3) or more activities of daily living as herein defined which would normally be carried out by your daily life had such disablement not occur and for which there is no hope of recovery and entirely prevents the insured from engaging in gainful employment of any and every kind.

Treatment is medically necessary if it:

• • • Consistent with the diagnosis and customary medical treatment for a covered illness or injury;
    • In accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits;
    • Not for the convenience of the insured person or the physician, and unable to be reasonably rendered out of hospital (if admitted as an inpatient)
    • Not of an observational, experimental, investigational, research, check-up, preventative or screening nature, cosmetic, elective procedures; and
    • For which the charges are fair, reasonable and customary in relation to the illness or injury.

Activities of daily living means

1. 1. 1. Transfer: Getting in and out of a chair without requiring any 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 the food has been prepared.

PREMIUM refers to amount paid by an insured to an insurer under an Insurance Policy as consideration for the obligations assumed by the insurer.

REASONABLE AND CUSTOMARY CHARGES refer to charges or fees which are generally prevailing and of normal standard for the medical condition concerned in the country and city where the insured is treated.

THE COMPANY refers to Myanma Insurance.

TRAVELING ROUTE refers to the journey between the Republic of the Union of Myanmar and the designated country that is in line with the itinerary, as the passenger of a commercial airline including scheduled transit for refueling and flight connection.

TRIP refers to the period between the Commencement of Cover and Expiry of Cover.

COVID-19 Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

2. SCOPE OF COVER

All Benefits in this policy are subject to:

1. 1. 1. The total maximum limits of your chosen plan as stated in the schedule of benefits;
      2. The event giving rise to a claim having occurred within the period of insurance; and
      3. All the terms, conditions and general and respective/specific exclusions set out in this policy 

• • PERSONAL ACCIDENT BENEFITS 

• • • ACCIDENTAL DEATH

The Company will pay the sum insured as stated in the Schedule of Benefit, if the Insured sustained Accident during the Trip, which results in Death within 90 days from the day the incident occurred.

• • • PERMANENT DISABLEMENT

The Company will pay the sum insured as stated in the Schedule of Benefit, if the Insured sustained Accident during the Trip which results in Permanent Disablement. The disablement must be certified by a Medical Practitioner.

Benefit Schedule

 

• • MEDICAL AND EVACUATION BENEFITS 

• • • OVERSEAS EMERGENCY MEDICAL EXPENSES

The Company will reimburse to the Insured all medically necessary treatment and services provided by or on the order of a Physician to the insured Person when admitted as a registered in-patient to a Hospital up to the limit specified in the Table of Benefits and medical expense sub-limit section which is reasonably and customary charges incurred whilst during the trip as    a direct, sole and independent result of Accident or illness suffered by the insured. or authorized hospital/medical center up to the limit specified in the schedule of benefit and medical expense sub-limit section which is reasonably and customary charges incurred whilst overseas as a direct, sole and independent result of Accident or Illness suffered by the Insured.

Cover includes ordinary board and room, nursing charges and other medical charge such as the diagnostic, laboratory or other medically necessary facilities and services, physician’s / surgeon’s fee / anaesthetist’s fee or physiotherapist’s fees, operating theatre charges, surgery implants and all drugs, dressings or medications prescribed by the treating physician for in-hospital; intensive care unit charges, hospital general expenses and in-hospital surgeon visit up to the limit specified in the Table of Benefits.

The company do not pay for the costs of non-medically necessary goods or services including such items as telephone, television and newspapers; personal items such as bed sheet, urine pot, medical appliances are not covered as well.

DEDUCTIBLE: USD 100 for SI USD 10,000, USD 300 for SI 30,000 and USD 500 for SI 50,000 in each claim.

• • • OVERSEAS EMERGENCY MEDICAL EXPENSES DUE TO COVID-19

The company will reimburse to the insured all medically necessary treatment and services provided by or on the order of a physician to the insured person when admitted as a registered in-patient to a hospital up to the limit specified in the Table of Benefits and medical expense sub-limit section which is reasonably and customary charges incurred whilst during the Trip as a direct, sole and independent result of Covid-19 infection suffered by the insured.

Cover includes ordinary board and room, nursing charges and other medical charge such as the diagnostic, laboratory or other medically necessary facilities and services, physician’s/ surgeon’s fee/ anaesthetist’s fee or physiotherapist’s fees, operating theatre charges, surgery implants and all drugs, dressings or medications prescribed by the treating physician for in-hospital; intensive care unit charges, hospital general expenses and in-hospital surgeon visit up to the limit specified in the table of benefits.

The company do not pay for the costs of non-medically necessary goods or services including such items as telephone, television and newspapers; personal items such as bed sheet, urine pot, medical appliances are not covered as well.

DEDUCTIBLE: USD 100 for SI USD 10,000, USD 300 for SI 30,000 and USD 500 for SI 50,000 in each claim.

• • • EMERGENCY MEDICAL EVACUATION

In the event of an accident or sudden illness, the Company will not bear the costs of transferring or repatriating the Insured to a properly equipped health center or to his/her usual country of residence.

• • • FOLLOW UP TREATMENT IN REPUBLIC OF THE UNION OF MYANMAR

We will reimburse You, up to the limit specified in the schedule of benefit for Medical Expenses necessarily as a registered in-patient to a hospital incurred as follow-up medical treatment in Republic of the Union of Myanmar for injury which You had sustained whilst Overseas. The time limit for seeking such medical treatment is as follows:

1. 1. 1. 1. if prior medical treatment has not been sought Overseas, You must seek medical treatment
         2. as a registered in-patient to a hospital in Republic of the Union of Myanmar within 48 hours upon Your arrival in Republic of the Union of Myanmar. From the date of the first medical treatment in Republic of the Union of Myanmar, You have up to a maximum of 30 days to continue medical treatment in Republic of the Union of Myanmar up to the limit specified in the table of benefits.
            DEDUCTIBLE: USD 100 for SI USD 10,000, USD 300 for SI USD 30,000 and USD 500 for SI USD 50,000 in each claim.
         3. if medical treatment had already been sought Overseas, you have up to a maximum of 30 days (inclusive of the period of follow-up medical treatment) upon Your arrival in the Republic of the Union of Myanmar to continue medical treatment as a registered in-patient to a hospital in the Republic of the Union of Myanmar up to the limit specified in the schedule of For covid-19 disease sustained while overseas, we will reimburse you, up to the limit specified in the table of benefits, the Medical Expenses as a registered in-patient to a hospital necessarily incurred in the Republic of the Union of Myanmar for follow-up medical treatment for covid-19 disease.
            DEDUCTIBLE: USD 100 for SI USD 10,000, USD 300 for SI USD 30,000, and USD 500 for SI USD 50,000 in each claim.

SECTION II: GENERAL CONDITIONS AND PROVISIONS

1. DUTY OF DISCLOSURE

The accuracy of the information provided over any means of electronic communications or in the Insured’s proposal form will form the basis of and be part of the contract. Before Insured enter into the Insurance contract and during the Period of Insurance, Insured must declare to The Company everything Insured know or could reasonably be expected to know which will affect The Company’s decision on the coverage and the terms of the insurance. If Insured are uncertain about whether a fact is relevant or not, Insured must declare to The Company about it. The Company will acknowledge receipt of acceptance of material information by stating these on the Policy Schedule. If Insured do not provide this information to The Company, The Company may:

1. 1. 1. reduce the amount payable for the claim under this Policy; or
      2. refuse to pay the claim that may arise; or
      3. cancel Insured’s Insurance Policy from

2. ELIGIBILITY

Persons eligible for cover under this Policy are:

1. 1. 1. An Individual aged above one year.

3. AMENDMENT OF THE INSURANCE POLICY

The Amendment of the Insurance Policy will be valid when The Company accepts such agreement and it is legally binding after a formal written statement is attached to the Policy or is issued as an endorsement by The Company’s authorized representative.

4. CHANGE OF INSURANCE AGREEMENT

Insured shall give the Company immediate written notice of any changes in the Country of Residence, occupation, pursuits or health of any Insured, which is likely to result in a material increase in hazard to The Company and shall pay any additional premiums that may be required by The Company. Failure to do so shall entitle The Company, in the event of a claim, to repudiate such a claim or at The Company’s discretion, adjust the benefits payable.

The Company reserves the rights to amend the terms and provisions of this Policy on any Policy Anniversary date by giving Insured thirty (30) days’ written notice of such change. Notice can be delivered via electronic means or sent by ordinary mail to Insured’s last known correspondence address in The Company’s records. No alteration to this Policy shall be valid unless approved in writing by The Company’s authorized representative and reflected in an endorsement. No broker, agent or advisor has the authority to amend or waive any of the terms and conditions of this Policy.

5. MISSTATEMENT

• • • Misstatement of Age

If the date of birth of any Insured has been incorrectly stated on the proposal form, then the annual premium shall be adjusted based on the correct age. Any excess premium that may have been paid as a result of any misstatement of age shall be refunded without interest. If at the correct age Insured would not have been eligible for cover under this Policy, no benefit shall be payable. Proof of age of each Insured must be submitted to The Company before any claims can be made under the Policy.

• • • Misstatement or fraud

The Company shall have no liability to pay any benefit under this Policy if Insured or any Insured:

• • • • fail to fully and truthfully disclose to The Company all material information known (or which could reasonably be expected to be known) before inception of this policy and upon each renewal;
      • fail to properly fulfil the terms and conditions of this policy;
      • make any untruth statement;
      • omit, suppress or incorrectly state any material information affecting the risk;
      • make any claim that is fraudulent or exaggerated or make any false declaration or statement in support of a claim.

6. GOVERNING LAW AND JURISDICTION

The Policy shall be governed by and interpreted in accordance with the Law of Republic of the Union of Myanmar. The jurisdiction is the competent court in Republic of the Union of Myanmar.

7.  CURRENCY

The currency of the premium and any coverage amounts (benefits) will be in US Dollar. This Provision remains applicable unless there is a regulation to control the use of currency.

8. CONFIDENTIALITY

The Company shall keep all information to which Insured provided confidential either through filling the application form or via electronic communication.

9. DISAPPEARANCE

If during the period of cover and whilst on the insured Trip, an Insured disappears following the disappearance, sinking or wrecking of a conveyance in which they were traveling and their body has not been found within twelve (12) months after the date of disappearance, they will be deemed to have died as a result of an Accident at the time of disappearance, sinking or wrecking of the conveyance. If benefit under PERSONAL ACCIDENT BENEFITS is payable because of disappearance, the Company will only pay provided the Insured’s beneficiary gives the Company a signed undertaking that the amounts will be repaid to the Company if the Insured is subsequently found to be alive.

 

SECTION III: EXCLUSIONS

Out-patient services

All forms of outpatient treatment including doctor consultation, purchasing medication via external pharmacy, outpatient diagnosis and lab test.

Dental Treatment

Dental conditions including dental treatment, restorative procedure (including but not limited to crowning, bridging and root canal treatment) or oral surgery. 

ADDICTION/ INTOXICATION

Those claims are derived from illnesses or pathological states caused by the voluntary consumption of alcohol, drugs, toxic substances, narcotics or medicines acquired without medical prescription, as well as any kind of mental illness or mental imbalance.

AERIAL ACTIVITIES

This Policy does not pay claims arising from flying or other aerial activity except as a fare-paying passenger in a fully licensed aircraft operated by a licensed commercial air carrier or recognized charter company.

BACTERIAL & VIRAL INFECTION

The Company will not pay for claims arising from bacterial or viral infections even if contacted by accident except for bacterial infection that is the direct result of an accidental cut or wound.

CARELESSNESS

Those claims are caused directly or indirectly by the bad faith of the Insured, by his/her participation in criminal acts, or as a result of his/her fraudulent, seriously negligent, or reckless actions. The consequences of the actions of the Insured in a state of derangement or under psychiatric treatment are not covered either.

COSMETIC/ PLASTIC SURGERY

Any Plastic, Elective, Reconstructive Surgery including treatments for skin, blemishes, aging spots, freckles, dandruff, hair loss, weight control, or elective surgery to improve physical appearance, except where such Surgery is necessary for the repair of damage caused solely by bodily injuries as a result of an accident.

HAZARDOUS ACTIVITIES & SPORTS

Any treatment or accident arising from participating in:

• animal hunting (game hunting), car/ boat/ horse racing, Boxing
• all Skiing for recreation or competition including Jet Skiing, Skating, and Parachuting (unless to save Insured’s life)
• while getting in, getting out or taxing in Balloons or Gliders
• Bungee Jumping, Mountain Climbing with or without Mountain Climbing Equipment, and Diving using Oxygen Cylinders and other Breathing Apparatus
• traveling in an aircraft not operated by a commercial airline which is taxiing, taking off, or landing.
• This extends to driving a car or motorcycle without a driver’s license.
• Participation in competitions or tournaments organized by sporting federations or similar organizations.

FELONY / MISDEMEANOR / BRAWLING

• The Company will not indemnify the Insured in respect of any Liability or Injury arising out of criminal offenses alleged.
• The Company will not pay claims for any accident occurring when the Insured is encouraging or taking part or participating in a brawling fight.

FIT TO TRAVEL

Where the Insured is not fit to undertake the Trip as confirmed by his/her medical practitioner when booking the Trip or purchasing this policy.

PSYCHIATRY

Any diagnosis, medical investigation, symptom, diseases or treatment relating to emotional, stress, psychiatric or psychological disorders, Insanity, Behavioral or Characteristic Disorders. This extends to Concentration Problems, Autism, Depression, Eating Disorders or Anxiety.

PRE-EXISTING CONDITION

Any Pre-existing condition which the Insured received medical treatment, diagnosis consultation or prescribed drugs for which medical advice or treatment as recommended by physician preceding the Effective Date of the contract.

PREGNANCY

Any treatment arising from Pregnancy, Child Delivery, Abortion, Miscarriage (except accidental miscarriage), Infertility (includes Infertility Investigation and Treatment), Vasectomy or Contraception.

RADIOACTIVITY

Nuclear Weapons, Radiation, Radioactivity from Nuclear-Fuel or Nuclear Waste or Nuclear Radiation caused by combustion of fuel and Nuclear Fission which self-ignites. Explosion by Radioactivity Nuclear material or dangerous objects are used in a Nuclear Explosion.

SEXUALLY TRANSMITTED DISEASES (STDs)

Any investigation, test or treatment arising directly or indirectly from Sexually Transmitted Diseases, including Venereal Diseases, Immune Deficiency Syndrome (AIDs), any AIDs-related condition or infection by Human Immune Deficiency Virus (HIV).

SONIC BANGS

Loss, destruction, or damage directly occasioned by pressure waves caused by aircraft and other aerial devices traveling at sonic or supersonic speeds.

SUICIDE

This Insurance does not cover suicide or attempting to commit suicide, self-inflicted accidents, attempting to cause accidents to him/herself, or arranging for any third party to undertake such an act.

TOUR OPERATOR & AIRLINE FAILURE

Any claim that results from the tour operator, airline, or any other company, firm, or person not being able or not being willing to carry out any part of their obligation to the Insured.

TRAVELLING AGAINST WHO ADVICE

The Insured travel to a country, specific area, or event when the World Health Organization (WHO) or regulatory authority in a country to/from which you are traveling has advised against all, or all but essential travel.

WAR/ TERRORISM

Any accidents or treatment arising from the war (whether it is announced or not), invasion or execution by a foreign enemy, Civil War, Revolution, Rebellions, Demonstrations against the government, Riot, Strike, Calamity, or any political unrest having to announce martial law to control the situation, including Terrorism.

NATURAL PHENOMENA

Extraordinary natural phenomena such as floods, earthquakes, landslides, volcanic eruptions, atypical cyclonic storms, falling objects from space and aerolites, and in general any extraordinary atmospheric, meteorological, seismic or geological phenomenon.

 

SECTION IV: CLAIM PROCEDURE

1. CLAIM

In the event of any occurrence which may give rise to a claim for indemnity under this Policy, the Insured (or the Insured’s Beneficiary in case of death) shall:

1. give notice to the Company in writing with full details within 30 consecutive days after the completion of the Trip or 24 consecutive hours from the date of Accident in the case of death or disablement if practicable,
2. give the Company at his/her own expense all medical evidence, certificates, reports, original receipts, proof of ownership, documentation, and any other evidence.
3. The reimbursement for the Treatment of eligible injury or illness will be made either up to the amount as stated in the Table of Benefit or the amount insured person have incurred for medical treatment- whichever is the lower amount.
4. Claim reimbursement will be paid in the local currency unless we have previously agreed otherwise in writing. Claims incurred in any other currency will be converted using the exchange rates on the date of treatment or date of discharge for inpatient treatment. We shall not be liable for any bank charges, credit charges or losses due to currency fluctuation.
5. In the event of an Emergency, Serious Accident, or Illness, please call the Company’s helpline number shown on the Certificate of Insurance, the Company’s Website, or Claim form. The Insured shall provide his/her name, policy number and details of his/her Accident or Illness, contact details of his/her attending doctor, his/her present location and how he/she can be contacted.

2. LEGAL PROCEEDINGS

No action at law or in equity shall be brought under this Policy against the Company prior to the expiration of 60 days after the proof of claim has been filed in accordance with the requirements of this Policy nor shall such action be brought at all unless it is brought within 2 years from the expiration of the period within which proof of claim is required under this Policy. If the Company shall disclaim liability for any claim under this Policy and no action has within five (5) calendar months from the date of such disclaimer been commenced against the Company, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable.

3. DISPUTE RESOLUTION

• The Parties may agree to take part in the dispute resolution or mediation in good faith and undertake to honor the terms of any settlement reached.
• Or If any dispute is not reached any settlement through dispute resolution and mediation methods, the dispute may be submitted to Insurance Business Regulatory Board (IBRB) in Republic of the Union of Myanmar and an arbitral award shall be final and in force to the Parties of the dispute.

 

SECTION V: BENEFITS 

  

 

 

 SECTION VI: Additional general conditions

1. In the case of a foreign language document, You shall at Your expense provide Us with an English translation of such document if We require.
2. We may refuse to pay any claims for which You cannot provide receipts, bills or other supporting documents that We may require.
3. You or your legal representative must pay for any certificates, information and evidence, which We may need. When there is a claim for injury or illness, We may ask for, and will pay for, any insured person to be medically examined on Our behalf.
4. All claims will be paid in USD. For claims incurred in a foreign currency, We will convert the foreign currency amount into USD at a foreign currency exchange rate to be determined by Us.
5. We shall have full discretion in the conduct of any proceeding or the settlement of any claim.
6. Any person who is seeking indemnity under this policy shall give Us all the information, documents and assistance We require to enable any claim to be validated for Us to achieve a settlement.
7. You must pay Us back any amount which We have paid which You are not covered for.
8. Access to and Your Doctor

If You make a medical or dental claim, You may be asked to supply Your Doctor’s name to enable Us to access Your medical records. This will help the treating Doctors, and Us, to provide You with the most appropriate treatment and assess whether the cover applies. If You do not agree to provide this We may not deal with Your claim.

9. Fraud

If You, or anyone acting for You, make a claim under this policy knowing the claim to be dishonest or intentionally exaggerated or fraudulent in any way, or if You give any false declaration or statement to support the claim, We will not pay the claim and all cover under the policy will end. We reserve the right to lodge a report with the Local Police about any dishonest claim.

10. Your duty to take precautions

You must at all times take reasonable precautions to prevent and avoid losses, damages, Accident,  Accidental injuries and minimise claims under the policy.

11. Your duty to comply with policy conditions

Our provision of insurance under this policy is conditional upon You observing and fulfilling the terms, provisions, conditions and clauses of this policy.

12. Burden of proof

The burden of proving the validity of any claim is upon You. If We deny any claim by reason of any exclusion, the burden of proving that We are legally responsible for the claim is also upon You.

13. Rights of recovery

In the event authorisation for payment and/or payment is made by Us or an authorized service provider appointed by Us for any medical or non-medical claim for which policy liability is not engaged, We reserve the right to recover against You for the full sum.