TERMS & CONDITIONS

 

These Terms and Conditions (“Terms”) govern your access to and use of MILVIK (BIMA) Insurance Agency Inc.’s, (“BIMA Philippines”) website, products, and services (“Products”).  Please read these Terms carefully prior to availing of any of the Products provided by BIMA Philippines.

 

By using our website, you confirm that you have read and agreed to be bound by these Terms and our Privacy Policy (www.bima.ph/bimapp). These Terms set forth your rights and obligations with respect to your availment of any of the Products of BIMA Philippines. If you do not agree to all of the terms as set forth below and privacy policy, you should not avail of the Products of BIMA Philippines.

 

BIMA Philippines reserves the right to make changes to these Terms from time to time and you shall be informed to the changes made. Customers are expected to review the terms and conditions regularly.

Eligibility:

 

Any Filipino citizen who is over 18 years old but below 65 years old. He/she must be able to do any of following daily activities without any assistance and support aide: washing, toileting, feeding, dressing, and transferring.

 

However, persons engaged in the following occupation are not eligible to avail of our Products: detectives, secret service personnel, miners, underground workers, fireworks and explosive makers, and members of the military, air or naval service.

 

By availing of our Products, you represent, undertake and warrant that you have the right, authority and capacity to enter into this agreement and comply with all of the Terms.

 

Enrollment:

 

These terms and conditions apply to the following Products which you may avail yourself of:

 

Inclusion for BIMA Life:

Personal Accident Insurance: The policy pays a lump sum in the event of death or disability of the Insured individual due to an accident. The amount of cover payable depends on the extent of disability as outlined in table below. The premium must be paid continuously. 

 

There is no waiting period for accidental causes of death or disability.

 

Insurance Event

Percentage of Amount of Insurance

Death

100%

Dismemberment of both hands or both feet or disablement of sight of both eyes

100%

Dismemberment of one hand and one foot or either hand or foot and disablement of sight of one eye

100%

Dismemberment of one hand or one foot or disablement of sight of one eye

50%

 

Life Insurance: The policy pays a lump sum in the event of death of the Insured Individual due to natural and non-natural causes. This includes death as a result of medical surgery-related complications and suicide (10% cash benefit if it happens within the 12 months of enrollment). There is a waiting period of 6 months for deaths due to pre-existing conditions. The premium must be paid continuously. 

 

 

BIMA LIFE

  •         BIMA Silver – with monthly premium of PHP 120 – for Personal Accident plus Life Insurance with coverage of up to PHP 210,000 for accidental death and disability, and PHP 60,000 for life insurance with a cover period of one month from the date of receipt of first premium;

  •         BIMA Gold – with monthly premium of PHP 165 – for Personal Accident plus Life Insurance with coverage of up to PHP 210,000 for accidental death and disability, and PHP 90,000 for life insurance with a cover period of one month from the date of receipt of first premium;

  •         BIMA Platinum – with monthly premium of PHP 300 – for Personal Accident plus Life Insurance with coverage of up to PHP 360,000 for accidental death and disability, and PHP 180,000 for life insurance with a cover period of one month from the date of receipt of first premium;

 

The Insurance cover shall be automatically renewed each month, unless otherwise deregistered as set forth below.

 

Inclusion for BIMA Health:

 

Hospital Cash Insurance: The policy covers confinement within a hospital as an inpatient under the care of a physician due to sickness and injuries caused by accidental and non-accidental causes, beginning on the first day of such confinement but not to exceed the maximum period of 10 days per month. A waiting period of ninety (90) days shall be imposed on the occurrence of Confinement due to Sickness at the commencement of insurance coverage. No payment shall be made to the Insured Individual during the said waiting period. Full benefits shall be available to the Insured Individual after the lapse of this waiting period and continuous renewal of insurance coverage thereafter. The waiting period does not apply for Confinement caused by Injuries sustained from an Accident. The premium must be paid continuously. 

BIMA Health with monthly premium of PHP 125 – for Hospital Cash Insurance with coverage of PHP 500 for Daily hospital cash benefit. Cover period will start one month from the date of receipt of first premium;

 

The Insurance Policy availed shall be automatically renewed each month, unless otherwise deregistered as set forth below.

 

 

BIMA LIFE and Health

  •         BIMA 220 – with monthly premium of PHP 220 – for Personal Accident plus Life Insurance with coverage of up to PHP 210,000 for accidental death and disability, and PHP 60,000 for life insurance with a cover period of one month from the date of receipt of first premium; for Hospital Cash Insurance with coverage of PHP 500 for Daily hospital cash benefit, maximum of 10-days cover per month

  •         BIMA 265 – with monthly premium of PHP 265 – for Personal Accident plus Life Insurance with coverage of up to PHP 210,000 for accidental death and disability, and PHP 90,000 for life insurance with a cover period of one month from the date of receipt of first premium; for Hospital Cash Insurance with coverage of PHP 500 for Daily hospital cash benefit, maximum of 10-days cover per month

  •         BIMA 400 – with monthly premium of PHP 400 – for Personal Accident plus Life Insurance with coverage of up to PHP 360,000 for accidental death and disability, and PHP 180,000 for life insurance with a cover period of one month from the date of receipt of first premium; for Hospital Cash Insurance with coverage of PHP 500 for Daily hospital cash benefit, maximum of 10-days cover per month

 

 

Payment: 

 

Your subscription to the insurance policy, when paid through your post-paid mobile account, shall automatically be renewed and premiums shall automatically be billed every month and will be reflected in every billing statement. We encourage you to make sure you maintain sufficient funds/credit limit to pay the premium every month.

 

You can opt-out of auto-renewal at any time. If you have not opted out, then, the subscription will be automatically renewed for the next period. You can cancel auto-renewal by deregistering as set forth below.

 

 

Exclusion:

 

BIMA Life

 

The policy does not cover loss, cost, or expense of whatever nature, directly or indirectly caused by or resulting from any of the following instances:

 

  •         Intentionally self-inflicted injuries, suicide or any attempt thereat, while sane or insane. The insurer will be liable for 10% of the amount of the insurance if the Insured commits suicide within the first year and in full after the first year. The policy also covers suicide committed in a state of insanity regardless of the date of commission.   
  •         Murder, assault or any attempt thereat, except as specifically provided under the Murder and Assault Provision.
  •         Losses incurred while performing duties as a member of the Armed Forces, including those of escort and security services rendered in whatever capacity or form;
  •         War, invasion, an act of a foreign enemy, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, rebellion, revolution, insurrection, military or usurped power, civil commotion assuming the proportion of or amounting to a popular specifically refer to it in whole or in part;
  •         Poison, gas or fumes voluntarily taken, or any nuclear reaction, nuclear radiation or radioactive contamination, and chemical or biological contamination, or for the effects of nuclear and/or chemical and/or biological substances which cause illness and/or disablement and/or death;
  •         Accident occurring while the insured individual is operating or learning to operate or serving as a crew member of an aircraft or Sea Craft;
  •         Accident occurring while the insured individual is engaged in any dangerous sports or hobbies such as racing on wheels, glider flying, sailing or other hobbies which are comparably dangerous and risky unless sports premium is paid to cover such risk;
  •         The accident caused by the effect of alcohol or any unprescribed drug on the insured individual.
  •         Death caused by pregnancy is excluded from life insurance coverage.
  •         Death caused by illness in a pre-existing condition has a contestability period of 6 months for life insurance. The premium must be paid continuously. 

 

Murder and Assault Provision:

The policy shall cover losses caused by the risks of murder, assault, or any such attempted provided that such risks:

  1.     Shall not have been provoked by the Insured Individual; and
  2.     Shall not have happened while the Insured Individual is a) engaging in political activities, or b) performing investigative, security or political function, or c) holding any elective governmental position.

 

 

Exclusion:

 

BIMA Hospital Cash

 

This Group Policy does not cover Loss, cost, or expense of whatever nature, directly or indirectly caused by or resulting from any one of the following:

 

  •         Any pre-existing condition(s);
  •         Any medical treatment or test that the Insured Individual has planned or expected to undergo;
  •         Any treatment or surgical procedure for Congenital Anomalies;
  •         Any treatment and complications related to Sexually Transmitted Diseases (STD’s), Human Immunodeficiency Virus (HIV), and HIV-related diseases or Acquired Immune Deficiency Syndrome (AIDS);
  •         Any claim caused directly or indirectly by the use of alcohol or prohibited drugs, and any drug or medicine not prescribed by a Physician;
  •         Any intentionally self-inflicted injuries, suicide or any attempt of such, while sane or insane;
  •         Any treatment of mental and nervous disorders, including but not limited to insanity;
  •         Long-term rehabilitation and psychiatric care;
  •         Any treatment for obesity, weight reduction or weight improvement;
  •         Any experimental procedures or procedures that are not accepted as standard medical procedures including but not limited to chiropractic, acupuncture, herbal medicine, alternative medicine and other similar procedure or treatment;
  •         Cosmetic or plastic surgery, any dental work, treatment or surgery, eye or ear examination, except to the extent that any of them is necessary for the repair or alleviation of damage to the Insured Individual caused solely by Accident;
  •         Any claim relating to:
  1. a)     Auto racing and any form of racing other than on foot;
  2. b)     Bungee jumping, contact sports, motorcycling, parasailing, polo playing, skydiving, hang gliding, parachuting, paragliding or gliding, flying other than as a fare-paying passenger on a duly licensed commercial aircraft, rock or mountain climbing, non-recreational diving or sport diving, scuba diving, or any other hazardous activity;
  3. c)     Participation in any professional dangerous sports, competition and preparatory or training;
  4. d)     Participation in competition or tournaments organized by sporting federations or similar organizations;
  5. e)     Damage caused by engaging in dangerous sports including but not limited to mountaineering, underwater activities or shooting;
  •         Any violation or attempted violation of the law or resistance to arrest by the Insured Individual;
  •         Murder, assault, brawl or any attempt thereat, unless these are not have been provoked by the Insured Individual and not have happened while the Insured Individual is a) engaging in political activities, or b) performing investigative, security or political function, or c) holding any elective governmental position;
  •         Losses incurred while performing his duties as a member of the Armed Forces, including those of escort and security services rendered in whatever capacity or form;
  •         Poison, gas or fumes voluntarily taken, or any nuclear reaction, nuclear radiation or radioactive contamination, and chemical or biological contamination. For the purposes of this exclusion, “contamination” means the contamination or poisoning of people by nuclear and/or chemical and/or biological substances which cause illness and/or disablement and/or death; War, invasion, act of foreign enemy, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, rebellion, revolution, insurrection, military or usurped power, civil commotion assuming the proportion of or amounting to a popular uprising. This exclusion shall not be affected by any endorsement which does not specifically refer to it in whole or in part; and
  •         Any Act of Terrorism or any action taken in controlling, preventing, suppressing, or in any way relating to, any act of terrorism. For the purpose of this exclusion, an “Act of Terrorism” means an act, including but not limited to, the use of force or violence, atomic/ biological/ chemical weapons, weapons of mass destruction, disruption or subversion of communication and information systems infrastructure and/or the contents thereof, sabotage or any other means to cause or intended to cause harm of whatever nature and/or the threat of any of the aforementioned acts, of any person or group(s), whether acting alone or in 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.
  •         Maternity and maternity-related complications. Maternity includes childbirth whether normal or caesarian, abortion, miscarriage or any complications incident to pregnancy.

 

 

Claims:  

 

This Insurance Policy is issued by Pioneer Life Inc. as Principal Insurer.

 

All claims filed with us shall be governed by the Group Insurance Policy issued by our Principal Insurers. All claims shall subject to the approval of our Principal Insurers. BIMA Philippines and our Principal Insurers have the right to check the authenticity of all requirements that have been sent for claims. BIMA Philippines and the Principal Insurers have also the right to request documents that will support claim application.

 

Benefit for death of the Insured Individual is payable to the surviving beneficiary designated as such and filed with the Insurer. If more than one beneficiary is designated and no specification is made as to the respective interests of the beneficiaries, the beneficiaries shall share the proceeds equally. If no beneficiary is filed, then the beneficiary shall be the first surviving class of the following classes of beneficiaries in successive preference: the Insured Individual’s (1) widow or widower, (2) children, (3) parents, (4) brothers and sisters; otherwise, (5) the Insured Individual’s estate. All other payments under this Group Policy are payable to the Principal Insured.

 

 

Claim Documentation:  

In presenting your claim, the following documents are required:

 

  1. Completed Claim Form (for all product)
  2. Government-issued ID (for all product)
  3. Police Report (for Personal Accident)
  4. Medical and/or Death Certificate (for BIMALife)
  5. Proof of Relationship to Beneficiary (for BIMALife ex. Marriage Contract, Birth Certificate, or other relevant document where the Beneficiary and the Insured are not related)
  6.     Medical Certificate/proof of confinement (for BIMA Health i.e. a certificate of admission to a hospital for a continuous number of hours for which the Hospital has charged a full daily room and board fee)
  7. Other related document that the underwriter may request

For any questions regarding the Group Insurance Policy or your copy of your Certificate of Cover, you may contact our customer service hotline at Smart 09186633248 /Globe 09175061523, M-F, 9-6, or contact your Policyholder or Insurers directly through the following contact numbers:

 

Pioneer Customer Engagement Center

Contact Number:    +632 7 750 5433

                                 +632 8 812 2832

 

Notice and Proof of Claim:  

Notice of any Claim under this Policy shall be given within;

  •         Thirty (30) days from the date of death, or
  •         One hundred eighty (180) days from the date of disability of the Insured Life.

 

The Insurer, upon receipt of a Notice of Claim, must then provide the claimant with the necessary forms for filing Proof of Claim. All Proofs of Claim must be submitted to the Insurer within ninety (90) days after the date that the forms are provided.

 

In case complete supporting documentation has not been provided within the timelines specified as above, the Claim shall be deemed to not have been submitted.

 

Payment of Claim:  

All claims shall be paid within ten (10) days upon complete submission of documents by the Insured Individual or nominated beneficiary (in the event of death of the Insured Individual).

 

 

Cessation of Cover:

Cover for an Insured Individual shall cease due to any of the following reasons:

  •         Deregistration from the policy by the Insured Individual;
  •         Date of his/her death;
  •         The date on which the Insured Individual attains age of 65 years;
  •         Non-payment of premiums within the Grace Period;
  •         Misrepresentation or fraud;
  •         The date the Insured Individual enters the military, air, or naval service;
  •         The date a claim of the Insured Individual for Total and Permanent Disability is approved, if applicable;
  •         the date the Principal Insured ceases to be an active and bonafide member of the Policyholder; or
  •         Cancellation of the BIMA group policy.

Subscription:

 

Kindly download the BIMA app from Play Store. Complete the registration by providing the personal information of the insured. Confirm your subscription by simply choosing your Globe post-paid account in the in-app as your payment channel or through a payment link sent via SMS.

 

 

Deregistration:  

 

Just simply access your account through the BIMA App to unsubscribe. For assistance, you may contact our customer service hotline at Smart 09186633248 / Globe 09175061523, M-F, 9-6 

 

BIMA Philippines may require you to send documents to validate your identity.

 

Miscellaneous

 

To learn more about our product, you may contact our customer service hotline through email at customerservice@bima.ph or call us at Smart 09186633248 /Globe 09175061523, M-F,9-6 

 

 

Definitions

 

“Accident” means any unintentional act or unforeseen, unusual, and unexpected event which directly causes an Injury or death.

 

“Insured Individual” means the Principal Insured and Dependent Insured, if included, who are insured under this Group Policy. Any pronoun used in this Group Policy shall apply to either gender and the singular form shall include the plural unless the context clearly indicates a different meaning. The term “Individual Insurance” shall mean an Insured Individual’s insurance under this Group Policy with respect to himself.

 

“Disablement” or “Disability” shall mean permanent total and irrecoverable loss of use or entire physical loss caused by dismemberment.

 

“Loss of Use” means the complete and permanent inability of the Insured Individual to move or perform an action for which his limbs, fingers, toes or metacarpals are normally fitted or used, or for which they normally exist. It includes paralysis, which means complete and permanent inability to move as a result of neurological damage.”

 

“Dismemberment” shall mean complete and permanent severance of any of the following: (a) hand – at the wrist; (b) foot – at the ankle joint.

 

“Confinement” means admission of the Insured Individual in a Hospital or Birthing Home for a continuous number of hours for which the Hospital or Birthing Home has charged a full daily room and board fee.

 

“Birthing Home” means a legally constituted establishment which meets all of the following requirements:

  1. a) holds a license as a birthing home;
  2. b) operates primarily for maternity service on pre-natal and post-natal care, normal and spontaneous delivery, and care of newborn babies;
  3. c) provides twenty-four (24)-hour a day nursing service by registered nurses;
  4. d) has a staff of one or more licensed physicians and/or midwives available at all times; and
  5. e) is not primarily a clinic, nursing home or convalescent home or similar establishment nor, other than incidentally, a place for alcoholics or drug addicts.

 

“Hospital” means a legally constituted establishment which meets all of the following requirements:

  1. a) holds a license as a hospital;
  2. b) operates primarily for the reception, care and treatment of sick, ailing or injured persons as in-patients;
  3. c) provides twenty-four (24)-hour a day nursing service by registered nurses;
  4. d) has a staff of one or more licensed physicians available at all times;
  5. e) provides organized facilities for diagnosis and surgical facilities; and
  6. f)   is not primarily a clinic, nursing home or convalescent home or similar establishment nor, other than incidentally, a place for alcoholics or drug addicts.

 

“Injuries” mean bodily injuries that

  1. a) are sustained while this Group Policy is in force;
  2. b) are caused solely by external, violent, and accidental means and independent of any other cause; and
  3. c) produce a visible contusion or wound on the exterior of the body except in the case of drowning or of internal injury revealed by an autopsy.

 

“Inpatient” means a person admitted to a Hospital or Birthing Home as a resident or bed-patient who is provided at least one day’s room and board by the Hospital or Birthing Home.

 

“Insured Individual” means the Principal Insured and Dependent Insured, if included, who are insured under this Group Policy. Any pronoun used in this Group Policy shall apply to either gender and the singular form shall include the plural unless the context clearly indicates a different meaning. The term “Individual Insurance” shall mean an Insured Individual’s insurance under this Group Policy with respect to himself.

 

“Pre-Existing Condition” shall mean any acute, chronic or ongoing injury, sickness, disease or other physical, mental, medical or nervous condition suffered by the Insured Individual for which treatment, medication or advice (including investigation), has been received or prescribed by a medical advisor or documented prior to commencement of this Policy

 

“Policyholder” shall refer to entity named as such under this Group Policy.