Hospital Income Benefit
Product and Services
HOSPITAL INCOME BENEFIT (HIB)
This Rider shall become effective on the effective date of the Policy unless a different date is indicated above.
The insurance premium pertaining to this Rider shall be as specified in the Policy.
DAILY HOSPITAL INCOME BENEFIT
Subject to the limitations provided herein, the Hospital Income Benefit specified in the Policy shall be paid to the Insured for each day of hospital confinement, if any, for a maximum of 30 days.
DEFINITION OF TERMS
Hospital means a duly licensed institution having full diagnostic, surgical and therapeutic facilities under the supervision of a staff of licensed physicians and with full time nursing care and services rendered by registered nurses. This shall not apply to any establishment primarily operated as a convalescent or nursing home, home for the aged, rest treatment and care of persons suffering from alcoholism or drug addiction, or from nervous or mental disorder.
Sickness means a specific illness, disease, or disorder of the human body commencing while this Rider is in force.
Injury means accidental bodily injury resulting independently of any other causes sustained while this Rider is in force and producing a visible contusion or wound on the exterior of the body except in cases of drowning and internal injury revealed by medical examination or autopsy.
Physician means a person legally licensed to practice medicine and/or surgery other than the Insured or a member of the Insured’s immediate family within the third (3rd) civil degree, whether by affinity or by consanguinity.
Hospital Confinement means confinement in a hospital for at least eighteen (18) hours as a resident patient for necessary treatment of injury or sickness. Hospital confinement to be compensable must be recommended by a qualified physician.
Repeated Hospital Confinement means successive hospital confinements which arise from the same or closely interrelated cause or causes and which shall be considered one period of hospital confinement if such confinements are not separated by a period of at least three (3) months or one (1) month of continuous active work, whichever is sooner.
The total number of days for such repeated hospital confinements shall be subject to the designated maximum number of days per confinement as stated in this Rider Any subsequent hospital confinements separated by an interval of at least three (3) months from a prior confinement or one (1) month of continuous active work, whichever is sooner, shall be considered as an entirely new confinement and the designated maximum number of days per confinement shall apply separately to such subsequent confinement.
This Rider shall not cover any Pre-existing illness or condition as herein defined. An illness or condition shall be considered Pre-existing if, during the period prior to the Effective Date of this Rider, any of the following conditions are present: a) any professional advice or treatment was given for such illness or condition; b) such illness or condition was in any way evident to the Insured; or c) the pathogenesis of such illness or condition has started whether or not an Insured is aware of such illness or condition.
For purposes of this provision, it is hereby understood and agreed that the following conditions and their complications, but not limited to, when occurring during the first year of coverage after the Effective Date shall be considered Pre-existing: (a) endometriosis; (b) hemorrhoids; (c) diseased tonsils requiring surgery; (d) pathological abnormalities of nasal septum and turbinates; (e) hyperthyroidism / goiter; (f) cataracts; (g) sinus condition requiring surgery; (h) epilepsy; (i) asthma; (j) cirrhosis of the liver; (k) tuberculosis; (l) anal fistulae; (m) cholecystitis / cholelithiasis; (n) calculi of the urinary system; (o) gastric or duodenal ulcer; (p) hallux valgus; (q) tumors, whether benign or malignant, of all organs and organ systems, including malignancies of the blood and bone marrow; (r) diabetes mellitus; (s) hypertension; (t) collagen disease; (u) cardiovascular diseases; (v) hernia; (w) HIV/AIDS and (x) chronic skin conditions.
The Pre-existing Condition Provision shall no longer be applicable after an Insured has been covered for twelve (12) consecutive months and this Rider is renewed. This is on the condition that there is no failure to disclose or there is no misrepresentation and concealment, whether intentional or unintentional, of material information in the original application.
The following cases are excluded from the coverage of this Rider:
- hospital confinements not recommended, approved, and performed by a legally qualified physician or surgeon;
- hospital confinements due to declared or undeclared war, riots, illegal demonstrations, or criminal acts;
- hospital confinements due to fortuitous events;
- hospital confinements outside the Philippines;
- confinements prior to the effective date of coverage of the Policy;
- confinements primarily for diagnosis, routine physical examination, check-up, rest and recuperation, speech therapy, physical therapy, radiotherapy, chemotherapy, and renal dialysis;
- confinements because of intentionally self-inflicted injury, or attempted suicide whether the insured individual is sane or insane;
- confinements caused by fertility or infertility, pregnancy, childbirth, miscarriage, abortion, or complications of any of these
- confinements caused by venereal diseases, nervous or mental diseases or disorders;
- confinements involving all bodily injury or sickness contracted while the insured is in the military, naval or air service;
- confinements as a result of murder and provoked assault;
- AIDS or AIDS-related confinements;
- confinements by reason of cosmetic surgery, dental surgery, or plastic surgery, except to the extent that any of them are necessary for the repair or alleviation of damage to the insured person caused solely by accidental bodily injuries covered by this Rider;
- confinements involving congenital deformities;
- confinement due to alcoholism or drug addiction or any reaction to drug, unless such drug was prescribed by a licensed medical practitioner;
- confinements due to medical or surgical procedures which are experimental in nature or not generally accepted by the medical profession;
- confinements due to ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel; and confinements in which a proximate cause was the Insured’s attempted commission of or willful participation in a crime punishable under the Revised Penal Code of the Philippines except crimes of reckless imprudence as defined in Article 365, or under similar laws of any country in which the crime was attempted, or resistance to lawful arrest.
The Association, at its own expense, reserves the right, through its designated examiners, to medically examine the Insured for any injury or sickness resulting to any claim under this Rider.
This Rider shall automatically terminate if premiums due for this Rider remain unpaid beyond the grace period as stated in the Grace Period Provision of the Policy.
The individual insurance under this Rider shall automatically terminate on the earliest of the following:
- termination of this Rider or the Policy; or
- attainment of the Insured of the termination age for this Rider as stated in the Policy; or
- termination of the Insured’s individual insurance under the Policy.
Termination of this Rider or the individual insurance shall be without prejudice to any claim arising prior to the date of termination.