CL Health Care is an Individual Personal Accident Insurance specifically designed for Cebuana Lhuillier clients. It covers Accidental Deat h and Disability (AD&D), Double Indemnity, 24/7 Call a doc, OP ER One Time use and Dail y Hospital Income Benefit.

CL Health Care is underwritten by Generali Life Assurance Philippines, Inc.

Packages

Period of Coverage

The Policy is Effective for one (1) year from the date of issuance or after payment of claim, whichever comes first.

General Provisions

1. Target Market are clients of Cebuana Lhuillier branches, corporations, institutions, and organization outside Cebuana network.
2. With free Php 5,000.00 GPA coverage.
3. Age eligibility is 18 years old to 65 years old, in good health and are actively at work. Non Tran sferrable.
4. For medical plans, coverage will take effect 48 hours from purchase while after 24 hours for all other plans.
5. Suicide is not covered in the first 6 months of insurance. It wi ll only be covered if insurance is continuous, which means there is n o time gap in the coverage. In this case, death by suicide committed after the first 6 months will be payable.
6. No benefit shall be paid if the insured dies due to a pre existi ng condition within the first 3 months of continuous insurance.
7. A maximum of 5 units per individual with an effectivity date fro m the date of purchase (5 units should be purchase at the same date)
8. Products are available for all markets except: mining, construction, manufacturi ng of Tobacco, Petroleum, Coal Products , Rubber, Plastics and Leather.
9. All health related cases are covered under 24/7 Call a Doc, including COVID 19, except for those indicated in the General Exclusions such as but not limited to self inf licted injury, beautification, any communicable disease in epidemic or pand emic proportion asdeclared by the Government by the Government
10. Covered if insured member dies as a result of an injury or accident.Covered if insured member dies as a result of an injury or accident.
11. Double Indemnity is covered for certain cauDouble Indemnity is covered for certain causes (please refer below for the ses (please refer below for the details under details under IV. Definition of Coverage, Part C IV. Definition of Coverage, Part C –– Double IndemniDouble Indemnity)ty)

1. Murder or provoked assault; or,
2. Suicide while sane or insane, or intentionally self-inflicted injuries; or,
3. Willful exposure to needless peril other than in an attempt to save human life; or,
4. Bodily or mental infirmity or disease of any kind or infection other than infection occurring simultaneously with and in consequence of an accidental cut or wound; or,
5. Committing or attempting to commit an assault, felony or other illegal act or resistance to lawful arrest; or,
6. Pregnancy, childbirth, miscarriage or any complications thereof; or,
7. Injury sustained from any aviation or marine activities, other than riding as a fare-paying passenger on an aircraft or ship operating on a scheduled service in an established passenger route; or,
8. Sports activity such as hunting, steeple chasing, racing of any kind (other than on foot), football, polo, mountaineering in the course of which it is necessary to use guides or ropes, winter sports, underwater pastimes, water-skiing, or potholing, professional sports, except and insofar as the Company has by endorsement agreed to extend this insurance; or,
9. War, whether declared or not, rebellion or insurrection; or,
10. Drug or intoxicant overdose (unless under proper medical supervision); or,
11. Any poison, gas or fumes, voluntarily or otherwise taken, administered, absorbed or inhaled other than or as a result of an accident arising from a hazard incident to the member’s occupation; or,
12. Contamination or pollution of soil, air or water; or,
13. Any nuclear reaction; or,
14. Being under the influence of alcohol; or,
15. Any injury received in a brawl, assembly or demonstration, civil commotion, riots, strikes, military or popular uprising.
16. Non emer gency cases that can be treated thru Call a doc.
17. Those for services and supplies deemed not medically necessary, as determined by the company for the diagnosis, care, or treatment of the disease, illness or injury involve.
18. Medical treatment for learning di fficulties, hyperactivity, attention deficit disorder, speech impediments, behavioral problems or other development issues.
19. All charges for the diagnosis or treatment of any mental health, behavioral, psychiatric or psycho social illnesses, alcoholism, dru g and substance abuse/dependency including any medical condition and/or bodily injury directly or indirectly arising therefrom.
20. Costs for any drugs or medications that are not prescribed and not provided as part of a hospital admission.
21. Any charges incurre d resulting from venereal disease, sexually transmitted diseases, gender reassignment or any other form of sexual related condition, and any related condition.
22. Any charges incurred resulting to contraception, sterilization of either sex or its reversal and infertility
23. Circumcision, unless deemed medically necessary
24. Claims resulting from intentional, fraudulent, illegal, criminal, deliberately careless or reckless acts on the Insured Individual's part and their consequences.
25. Any treatment which is purely for physical therapy or for recuperative purposes
26. Vaccinations or immunizations of any kind and general health check ups
27. Plastic surgery unless it is medically requiedas a direct result of accident.
28. Any claim arising when the Insured Individual is performing military service or police duty.
29. The cost associated with an organ donor
30. Charges for dental treatment or surgery except dental operation resulting from an injury sustained by the Insured Individual in an accident.
31. Any treatment or surgical operations for c ongenital deformities or defects, such as harelip, clubfoot, hernia, heart defect, birthmark, abnormal bone or muscular growth, cerebral palsy and others.
32. Any treatment for tuberculosis, except surgical operations for removal of diseased portions of organs afflicted with tuberculosis, e.g. caecum, kidney, spine.
33. Any communicable disease in epidemic or pandemic proportion as declared by the government.

Definition of Coverage

Emergency medical expenses incurred by the insured person for the treatment of an eligible emergency condition. The insured person is an Out Patient in the Emergency Room Department of a Hospital.

Accidental Death and Disability (AD&D)

Part A - Accidental Death Benefit
Generali will pay the benefit amount, less any amount paid or pay able under Part B of this provision, if an insured employee dies as a result of an injury within one hundred eighty (180) days from the date of accident.

Part B - Accidental Disability Benefit
Generali will pay the percentage of the benefit amount indicat ed in the schedule of indemnities if an insured employee suffers any of the covered losses as a result of an injury within one hundred eighty (180) days from the date of accident.

Part C Double Indemnity
Generali will double any benefit payable if an in sured employee suffered the Injury:
1. While riding as a fare paying passenger of a licensed motori zed public utility vehicle over an established land route; or
2. While riding an elevator car (except those in mines and construction sites); or
3. In consequence of the burning of any theater, hotel, mall, churc h, hospital, market, restaurant or other public building in which the insured employee shall be at the commencement of the fire and in which the presence of the insured employee is only coincidental

24/7 Call a Doc ( T elemedicine)
The insured employee will have access to Call a Doc, our spe cial service that provides 24x7 consultation, management and treatment of non emergency / non life threatening cases by duly licensed physicians over the phone, video conferen ce and the internet (if necessary) for a minimal fee.

Call a Doc gives the following benefits to the insured employee:

• Provides convenient and immediate access to professional medical care from the comfort of home, office or any location outside a medical facility
• Minimizes the risk of exposure to hospital acquired infe ctions by not having to go to a medical facility to seek treatment
• Reduces overall costs by preventing unnecessary diagnostic tests usually required by emergency rooms and diagnostic clinics
• Provides electronic prescriptions via e mail that is generally accepted by pharmacies
• Delivers medicines to the residence of the borrower at a minimal cost

Emergency Care

Covers expenses, up to Php 5 000.00, incurred in case of emergency, suc h as consult ation/s, prescribed laboratory and diagnos tic tests and needed medicines.

Considered emergency situations are cases that need immediate attention such as life threatening illnesses, accidental injuries and the like. Examples are, but not limited to, dif ficulty in breathing, vomiting with the danger of dehydration, loss of consciousness, open wounds that need suturing.

Go to any Generali accredited hospital provider nationwide and present the SMS confirmation of coverage.

Coverage begins 48 h ours fro m the time of purchase.

Daily Hospital Income Benefit (DHIB)


If the insured is hospitalized and receives medical treatment as a result of illness or disease commenced, or accidental injury sustained, Generali will pay the Daily Hospital Income Benefit f or each day o n hospital confinement up to a maximum of thirty one (31) days and continuous confinement for the same injury or illness.

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Terms and Conditions

*Services available within the Philippines