Life Insurance Plans: Terms & Conditions

Benefits

The Insurance Company hereby agrees, subject to the terms and conditions provided under this Policy to pay the following benefits:

 A. Accidental Death &

B. Permanent Total Disability (accident)

Eligibility

• An insured person must be a customer of FRiENDi mobile (with the minimum vintage of 2 calendar days) who subscribes for inclusion in the Policy and holds a valid Oman residence visa on the date of subscription to the Policy.

• An insured person must be of age between 18 years to 55 years as on last birthday.

Definitions

• Accidental Death: Death that results solely, directly and independently of all other causes from bodily injury affected through external, violent, visible and accidental means or from a surgical operation necessarily consequent thereto, within 90 days of such accident
• Permanent Total Disability (due to accident): Being totally and permanently disabled as a result of an accident, to the extent of being unable ever again to follow his own occupation or any other occupation for which he is reasonably fitted by reason of training, education or experience. The disability results solely, directly and independently of all other causes from bodily injury affected through external, violent, visible and accidental means or from a surgical operation necessarily consequent thereto, within 90 days of such accident

Conditions

• It is warranted that the benefits payable hereunder are not to accumulate with any benefit payable under any other policy
• Maximum coverage per insured person is limited to RO 4000 irrespective of multiple subscriptions or change of subscriptions
• Coverage under the Policy for each insured person will run for a period of thirty (30) days from the date of first inclusion of each insured person and is automatically renewed thereafter for subsequent periods of thirty (30) days subject to the insured person having sufficient funds for the auto-renewal and unless terminated earlier by a insured person in accordance with section on termination mentioned below.

No payment shall be made under this policy on the accidental death of the insured person if such Accident occurs as a result of:

• Free Climb Mountaineering or Mountaineering and rock climbing using ropes or guides, bungee jumping, scuba diving or free diving and High Diving (other than from a purpose built diving board over a man-made swimming pool).
• The following activities are excluded if conducted on a professional basis: 
• Big Game Hunting, Jousting, Martial Arts, Micro-lighting, Motor Rallies or Competitions, Show Jumping (during horse riding), Water Ski Jumping, Wrestling or any variations thereof.
• Engaging in or taking part in any naval, military or air force operation
• Losses sustained or contracted in consequence of a named insured being intoxicated or under the influence of any narcotic or drug unless administered on the advice of a physician.
• Suicide.
• Participation in, or training for, any hazardous sport of competition or riding or driving in any form of race or competition except in the case for leisure/pleasure.

Exclusions:  Applicable to Permanent Total Disability (Accident) Benefit: (Addition to above)

• Attempted suicide or self-inflicted injury whilst sane or insane.
• Any breach of the law by the insured person of any assault provoked by him
• Accidents caused by the use of intoxicating liquor or drugs, other than drugs taken in accordance with treatment prescribed and directed by a qualified medical practitioner, but not for the treatment of drug addiction.
• Aviation, gliding of any other forms of flight other than as a fare paying passenger of a recognized airline or charter service.
• Involvement in any professional underwater activity.
• Injury caused by nuclear fusion, nuclear fission or radioactive contamination.
• Serving in any capacity for any military forces (navy, army or air force).

Other exclusions to accidental death and Permanent Total Disability (Accident)

Active participation in a war or in warlike operations.

Cover is excluded if an insured person is an Active Participant and/or directly or indirectly involved in a war (whether declared or not) or warlike operations.

 “Active Participant” in Warlike Operations means an active member of a military force e.g. army, navy, air force, territorial army or police or any other special forces activated by the government of a country or other public authorities to defend law and order in case of a warlike operation, or any other person who takes up arms in an active or defensive role.

“Warlike Operations” means terrorism, hostilities, mutiny, riot, civil commotion, civil war, rebellion, revolution, insurrection, conspiracy, military or usurped power and martial law or state of siege.

The above exclusion shall not apply if an insured person is non-participant and is an innocent bystander.  However, above exclusion shall apply for  Insurance coverage including Passive War Cover in a) Iraq, Afghanistan, Libya, Palestine, Israel, Syria, Iran, Sudan, Yemen and any other country where war or warlike operation takes place; b) Where an insured person remains in a country for more than 28 days following an outbreak of war in that country; and c) Where an insured person is travelling to or visiting a country after war has been declared in that country or after it has been recognized as a war zone by any one of the competent International  Agencies namely be United Nations or the USA or the EU or  UK or any other competent International Agencies or if foreign offices advice against all travel in that country or where there are war likes operations.

Destructive Agents Exclusion

This policy does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly or indirectly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event contributing concurrently or in any other sequence thereto.  This exclusion shall apply to non-participant & innocent bystander too.

Terrorism Exclusion

This policy does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly or indirectly from an act or multiple or related acts of Terrorism as defined below regardless of any other cause or event contributing concurrently or in any other sequence thereto. The term “Terrorism” as used herein, shall mean an activity that satisfies both of items 1 and 2 below:

1. Involves a violent act or an act dangerous to human life, tangible or intangible property or infrastructure, causing damage to property or injury to persons, or a threat thereof;

2. Appears to be intended to:

• Intimidate, coerce or incite a civilian population: or
• Inflict economic loss or disrupts any segment of a local, national or global economy; or Influence, protest, intimidate or coerce against the policy or conduct of a government by any means, including mass destruction, murder, kidnapping, hijacking, hostage-taking.

This exclusion shall not apply if the insured person is a non-participant and is an innocent bystander to an act of terrorism.   However, above terrorism exclusion shall strictly apply to claims arising a) as a result of Nuclear Weapons or Devices, Chemical or Biological Agents and b) occurring in Travel restricted zones/Warzones as mentioned above.

Termination of individual insured person's insurance

The insurance coverage of an insured person under the Policy shall automatically terminate as of the date on which:

• an insured person ceases to subscribe to the services of the Policyholder;
• an insured person terminates the Policy by online cancellation, SMS, or USSD;
• the Premium payments for this Policy are discontinued in accordance with section 7; or
• an insured person reaches the age of 55. 

Terms and conditions of beneficiary nominations

• Please clearly indicate above who should receive your life insurance pay out in the event of death
• This form supersedes any previous beneficiary nominations you have made
• Making a beneficiary nomination is a serious undertaking
• The form should be witnessed by a person who is a major and not your parent, spouse, child or immediate blood relative.
• A minor cannot be nominated as a beneficiary. A minor is defined as an individual that is less than 18 years of age
• Beneficiary nominations should be reviewed regularly for circumstances change (e.g. marriage, marriage breakdown, birth of a child, or my benefit being affected by a payment split) that may require a change in nomination to ensure that your beneficiary is always up to date. If you need to add or change your beneficiary, please inform Orient Insurance on their customer service number
• Group Life Insurance nominations are not related to end of service benefits payout.

Claim notification

A claimant shall:

• within the first thirty (30) days of coverage from the Normal Inclusion Date of the relevant insured person notify the Insurance Company of any incident giving rise to a claim within fifteen (15) days of the date of occurrence of the incident; and
• thereafter notify the Insurance Company of any incident giving rise to a claim within six (6) months of the date of occurrence of the incident. 

The Insurance Company shall administer, investigate, and if verified make payments of any and all claims arising under this Policy by a Claimant in a timely manner pursuant to professional industry standards, and in any case no later than fifteen (15) days of receiving a claim by a Claimant.

The Insurance Company shall ensure good faith and fair dealing in administering and investigation of any and all claims raised by Claimants under the Policy. 

In the event a Claimant notifies the Policyholder of any claim arising under the Policy, the Policyholder shall redirect the Claimant to the Insurance Company for the administration of the claim. 

In the event a Claimant raises a claim directly with the Insurance Company, the Insurance Company shall send to the Policyholder a written notice of such claim, along with all necessary supporting information within three (3) calendar days of receipt of the claim. The Policyholder shall within three (3) calendar days of receipt of such notice provide to the Insurance Company written confirmation of the relevant insured person’s status as an active customer of the Policyholder at the time the claim arose.