Does the customer need to fill up any form for availing insurance coverage?
No, it is not necessary to fill up any form by the customer for Accidental insurance.
However, for Critical illness coverage, a separate form needs to be filled at the time of account opening and for Medical insurance claim, customer needs to fill the form at the time of claim.
Who are included in family members for the purpose of insurance coverage?
Family denotes account holder, his/her spouse and two children below the age of 21 as declared by the account holder at the time of account opening. However, insurance does not cover account holder's parents.
I. In which case customer can claim for medical insurance?
Customer can claim medical insurance for hospitalization case only.
II. What is the process for Medical claim?
The customer needs to submit their medical insurance claim along with the following documents: -
a. Duly completed Claim form signed by the Medical Practitioner,
b. Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner,
c. Original bills from chemists supported by proper prescription,
d. Original investigation test reports and payment receipts,
e. Indoor case papers,
f. Medical Practitioner’s referral letter advising Hospitalization in non-Accident cases,
g. Any other document as required by the Company or Health Service Provider to investigate the Claim or the Company’s obligation to make payment for it.
III. Does insurance company pay the bill of regular routine checkup?
No, insurance company will not pay the bill of regular routine checkup.
IV. Does insurance company pay the bill of dental treatment other than treatment caused due to accident?
No, insurance company will not pay the bill of dental treatment other than treatment caused due to accident.
V. In how many days Insurance company will pay the medical claim?
Except for exceptional cases, claim payment shall be complete within 7 days of receipt of all required claim-related documents.
VI. Is homeopathic hospital treatment included in medical insurance?
No, only allopathic hospital treatment is included in medical insurance.
VII. Does insurance company pay foreign hospitals treatment bills?
No, Insurance company will pay the bill for treatment done only in Hospitals of Nepal.
VIII. What is the maximum age limit for claimant of medical insurance?
Customer up to age of 65 years can claim for medical insurance.
Accidental Death Insurance
I. What are the risks covered under Personal Accident Insurance Benefits?
The risks covered under Personal Accidental Death Insurance are as follows:
b. Permanent Total Disablement
c. Loss of sight of both eyes or hands or legs.
d. Loss of sight of one eye or one hand or one leg.
II. How will customer claim for Accidental Death Insurance?
Legal heir of the customer shall notify the Branch with written application and required documents on case to case basis as defined below:
a) In case of accidental death (spot death)
· Police report (Sarjiwani muchulka)
· Death certificate
· Relationship certificate
· Postmortem report
· Citizenship certificate copy of accountholder and legal heir
· Recommendation for payment from CDO to legal heir
· Branch shall further, issue letter mentioning accidental death of accountholder with account number, average monthly deposit and legal heir name to insurance company in our letter head.
· Additional documents if any asked by Insurance company.
b) In case of accidental death (after hospitalization) additional document required is as below apart from documents mentioned in (a):
· Discharge summary/death certificate
c) In case of permanent total disablement:
· Letter from bank notifying the medical claim with account number, accountholder’s name and average monthly deposit.
· Prescription/ Verification from hospital of permanent disablement
· Original Medical Bills
· Lab reports
· Discharge paper
Ø Photographs of customer verifying the permanent disablement (if available)
III. Is death abroad covered by the accidental insurance coverage?
Yes, it covers the account holder and her/his family member's death abroad as well.
Critical Illness Coverage
I. How many diseases are covered in Critical Illness?
Total 25 diseases are covered in critical illness.
II. What are the diseases covered under Critical Illness Insurance?
The diseases covered under critical insurance are as follows:
i. Cancer of Specified Severity
ii. Coronary Artety Disease Requiring Surgery
iii. Other Serious Coronary Artery Disease
iv. First Heart Attack of Specified Severity
v. Cerebro Vascular Resulting Permanent Neurological Sequeale
vi. Kidney Failure Requiring Regular Dialysis
vii. Major Organ Transplant
viii. Stroke Resulting in Permanent Sysmptoms
ix. Permanent Paralysis
x. Open Heart Replacement
xi. End Stage Liver Disease
xii. Loss of Speech
xiii. Major Burns
xiv. Coma of Specified Severity
xv. Alzheimer’s Disease Before the Age of 50 Years
xvi. Parkinson’s Disease Before the Age of 50 Years
xviii. Multiple Sclerosis with Persisting Symptoms
xix. Benign Brain Tumor
xxi. Bone Marrow Transplant
xxii. Fulminant Viral Hepatitis
xxiii. Repair of Heart Valves
xxiv. Acute Myocardial Infraction
xxv. Paralysis of Limbs
III. What is waiting period for Critical Illness?
The critical illness coverage for eligible saving accountholders commences only after the 30 days from such account opening date or scheme transfer date i.e. during such period there should not be any symptom of critical illness to the account holder.
IV. What is the age limit for claimant of Critical illness insurance?
Age limit for claimant of critical illness insurance is 18 to 60 years.
V. In how many days Insurance company will pay the claim?
Except for exceptional cases, claim payment shall be complete within 7 days of receipt of all required claim related documents.
VI. When can customer claim the critical illness insurance coverage?
The customer after submitting the diagnosis report of having critical illness shall get the assured amount of critical illness as per the customer category.