Life Insurance Benefit
If a Member dies by suicide within one (1) year from the effective date or latest reinstatement date, whichever is later, of such Member’s individual insurance coverage, the Company’s liability shall be limited to a return of premiums paid for such Member’s coverage. However, suicide committed in a state of insanity shall be compensable regardless of the date of commission.
Accidental Death, Dismemberment and Disability Benefit Exclusions
No payment under this benefit shall be made for any loss caused directly or indirectly, wholly or partly:
(a) by intentionally self-inflicted injury, suicide or any attempt thereat, while sane or insane;
(b) by war, invasion, act of foreign enemy, acts of terrorism, hostilities or warlike operations (whether war be declared or not), mutiny, riot, civil commotion, strike, civil war, rebellion, revolution, insurrections, conspiracy, military or usurped power, martial law or state of siege, or any of the events or causes which determine the proclamation or maintenance of martial law or state of siege, seizure, quarantine, or under the order of any government or public or local authority;
(c) by any weapon or instrument employing atomic fission, thermonuclear fusion or any form of radiation, whether in time of peace or war;
(d) by homicide or assault, or any attempt thereof, or physical injuries, occasioned by the provocation of the Member;
(e) by congenital anomalies and conditions arising therefrom;
(f) by pregnancy and resulting childbirth, miscarriage or abortion;
(g) by cosmetic or plastic surgery, except as a result of Injury;
(h) while the Member is in active service in the Armed Forces of any country or any international authority;
(i) while in any attempted commission of, or willful participation by the Member in any crime punishable under any prevailing law or ordinance of the Philippines or of any country in which the crime was attempted;
(j) while resisting lawful arrest;
(k) while entering, leaving, operating, servicing, or being in, on, or about any aerial or submarine device or conveyance, except while as a passenger (not as an operator or crew member), boarding or alighting from a certified passenger aircraft provided by a commercial airline on any regular, scheduled or non-scheduled, special or chartered flight, and operated by a properly certified pilot flying between duly established and maintained airports over an established passenger route;
(l) by dental care or surgery except to natural teeth as occasioned by Injury;
(m) while under the influence of alcohol or unprescribed drugs;
(n) by alcoholism or drug addiction;
(o) by disease, bacterial infection or out of or consequent upon or contributed to by Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC);
(p) by hernia, ptomaines, or other bacterial infections which are not pyogenic infections occurring at the same time with or because of any accidental cut or wound;
(q) by circumcision, sterilization, artificial insemination, sex transformation, diagnosis and treatment of infertility, congenital deformities and defects;
(r) by mental or nervous disorders;
(s) by poison, gas or fumes voluntarily or involuntarily taken;
(t) by automobile and motorcycle racing, judo, karate and similar martial arts, scuba diving, hang gliding and sky-diving;
(u) by routine health checks, any investigation(s) not directly related to admission diagnosis, illness or injury, or any treatment or investigation which is not medically necessary, or convalescence, custodial or rest care
Hospital Income Benefit Exclusions
No payment shall be made under this benefit for Illness, Injury, Hospitalization or any charges caused directly, wholly or partly:
(a) by intentionally self-inflicted injury, suicide or any attempt thereat, while sane or insane;
(b) by war, invasion, act of foreign enemy, acts of terrorism, hostilities or warlike operations (whether war be declared or not), mutiny, riot, civil commotion, strike, civil war, rebellion, revolution, insurrections, conspiracy, military or usurped power, martial law or state of siege, or any of the events or causes which determine the proclamation or maintenance of martial law or state of siege, seizure, quarantine, or nationalization by or under the order of any government or public or local authority;
(c) by any weapon or instrument employing atomic fission, thermonuclear fusion or any form of radiation, whether in time of peace or war;
(d) by murder, frustrated murder or any attempt thereof;
(e) by homicide, frustrated homicide or any attempt thereof, or physical injuries, occasioned by the provocation of the Member;
(f) by congenital anomalies and conditions arising therefrom;
(g) by pregnancy and resulting childbirth, miscarriage or abortion;
(h) by cosmetic or plastic surgery, except as a result of Injury;
(i) while the Member is in active service in the Armed Forces of any country or any international authority and in such an event, we, upon written notification by the Assured, shall return the pro-rata premium for any such period of service;
(j) while in any attempted commission of, or willful participation by the Member in, any crime punishable under any prevailing law or ordinance of the Philippines or of any country in which the crime was attempted;
(k) while resisting lawful arrest;
(l) while entering, leaving, operating, servicing, or being in, on, or about any aerial or submarine device or conveyance except as specifically provided herein;
(m) by dental care or surgery except to natural teeth as occasioned by Injury;
(n) routine health checks, any investigation(s) not directly related to admission diagnosis, illness or injury, or any treatment or investigation which is not medically necessary, or convalescence, custodial or rest care;
(o) while under the influence of alcohol or unprescribed drugs;
(p) by alcoholism or drug addiction;
(q) by disease, bacterial infection or out of or consequent upon or contributed to by Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC);
(r) by hernia, ptomaines, or other bacterial infections which are not pyogenic infections occurring at the same time with or because of any accidental cut or wound;
(s) by circumcision, sterilization, artificial insemination, sex transformation, diagnosis and treatment of infertility, congenital deformities and defects;
(t) by psychosis, mental or nervous disorders, sleep disturbance disorders;
(u) by automobile and motorcycle racing, judo, karate and similar martial arts, scuba diving, hang-gliding and sky-diving;
(v) by poison, gas or fumes voluntarily or involuntarily taken.
