1. In which product insurance benefits are available?
Insurance benefits are available in;
Product Name | Variant |
New Premium Super Chamatkarik Bachat Khata | Diamond |
New Premium Super Chamatkarik Nari Bachat Khata | Diamond |
New Premium Super Chamatkarik Jestha Nagarik Bachat Khata | Diamond |
New Premium Super Chamatkarik Talab Bachat Khata | Prime |
2. What are the Insurance benefits available under New Premium Super Chamatkarik Deposit Products?
Following insurance benefits are available under New Premium Super Chamatkarik Deposit Products;
- Medical Insurance (including OPD coverage)
- Critical Illness
- Accidental Death/Permanent Disability
3. What will be the insurance benefits in case of Joint Account?
In case of joint account, insurance claim shall be provided to the joint applicant in proportionate basis.
4. What will be the insurance benefits, in case of a single person who has maintained multiple joint account with different person?
The person (i.e common applicant) will be provided cumulative insurance benefits on proportionate basis under all insurance category.
5. What is the validity of Insurance benefits under the New Premium Super Chamatkarik Deposit Products?
The validity of Insurance is one year from the date of Account Opening/scheme transfer into the New Premium Super Chamatkarik Deposit Products.
A. Medical Insurance
6. What is the scope and coverage amount of Medical Insurance?
It has the coverage of Rs. 1 Lakhs for Accountholder (OPD up to Rs. 20,000 and Hospitalization treatment up to Rs. 80,000) to the accountholder.
7. Does Medical Insurance coverage start immediately after Account Opening?
Under medical insurance, Hospitalization coverage starts immediately after account opening and OPD insurance coverage starts after 30 days from the date of account opening/scheme transfer. It means that there is a 30 days waiting period for OPD coverage.
8. Who can avail the benefit of Medical Insurance facility?
Account holder of New Premium Super Chamatkarik Bachat/ Jestha Nagarik /Nari Bachat Khata under Diamond category and New Premium Super Chamatkarik Talab Bachat Khata- Prime can avail the medical insurance facility.
9. What refers to hospitalization treatment under medical insurance? Hospitalization refers as treatment done by staying at hospital for minimum 24 hours by the account holder. However, in case of surgery, being hospitalized for minimum 24 hours is not necessary.
10. What are the exclusions under medical insurance?
Major exclusions under medical insurance are;
- Pre-existing diseases
- Beauty related treatment
- Eye
- Pregnancy and maternity
- Dental
11. Is homeopathic hospital treatment included in medical insurance?
No, only Allopathic Hospital treatment is included in medical insurance.
12. Does insurance company pay foreign hospitals treatment bills?
No, only Allopathic Hospitals of Nepal and India are covered.
13. What is the maximum age limit for claimant of medical insurance?
Account holder up to the age of 65 years can claim for medical insurance.
14. Is Medical Insurance coverage extended to account holders’ family?
No, it has been restricted to account holder only under New Premium Super Chamatkarik Bachat Khata product series.
15. What is the process for Medical claim?
The customer needs to submit the following documents;
For OPD:
- Completely filled claim form
- Original bills,
- Doctor prescriptions
- Original bills from chemists supported by proper prescription
- 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.
For Hospitalization:
- Completely filled claim form
- Original bills, receipts and discharge certificate/card from the Hospital/Medical
Practitioner,
- Original bills from chemists supported by proper prescription,
- Doctor prescriptions,
- 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.
16. Does insurance company pay the bill of regular routine checkup?
No, insurance company will not pay the bill of regular routine checkup.
17. Is hospitalization due to pre-existing disease covered?
No, pre-existing diseases are not covered.
18. Does insurance company pay the bill of dental treatment?
No, insurance company will not pay the bill of dental treatment. However, the dental treatment cases due to accident are covered.
19. Within how many days Insurance claim should be made?
Claim should be made within 15 days from the date of discharge from the hospital to the Bank.
20. In how many days Insurance company will pay the medical claim?
Except for exceptional cases, claim payment shall be completed within 7 days of receipt of all required claim related documents
B. Accidental Death/Permanent Disability Insurance
21. Does Accidental Death/Permanent Disability Insurance coverage start immediately after Account Opening?
Yes. Accidental Death/Permanent Disability Insurance coverage starts immediately after account opening. There is no waiting period.
22. Is Accidental Death/Permanent Disability Insurance coverage extended to customers’ family?
No, insurance benefit is restricted to account holder only.
23. What is the age limit for claimant of Accidental Death/Permanent total disability insurance?
No age limit.
24. Does customer need to visit branch physically for submitting the insurance claim in case of permanent disability?
No. Customers need not to visit physically in case of permanent disability.
25. Within how many days' claim should be made?
Claim should be made within 15 days from accident.
26. What is the process of Accidental Death/Permanent Disability Insurance claim?
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)
- Claim Form
- Police report (Sarjiwani Muchulka)
- Death certificate
- Relationship certificate
- Postmortem report
- Citizenship certificate copy of deceased and legal heir
- Ghatanasthal Laas Jach Muchulka
- Account Statement
- Recommendation for payment from CDO to legal heir
- Branch shall further, issue letter mentioning accidental death of account holder 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), the following additional document, apart from documents mentioned in (a), is required.
- Discharge summary/death certificate
c. In case of permanent total disablement:
- Letter from bank notifying the medical claim with account number, account holder’s name and average monthly deposit.
- Prescription/ Verification from hospital of permanent disablement
- Original Medical Bills
- Lab reports
- Discharge paper
- Photographs of customer verifying the permanent disablement (if available)
27. In how many days Insurance company will pay the claim?
Claim payment shall be complete within 7 days of receipt of all required claim related documents by the insurance company.
28. What are the risks covered under Personal Accident Insurance Benefits?
The risks covered under Personal Accidental Death Insurance are as follows:
a. Death
- Permanent Total Disablement
- Loss of sight of both eyes or hands or legs.
- Loss of sight of one eye or hand or one leg
C. Critical Illness Coverage
29. Does Critical Illness Insurance coverage start immediately after Account Opening?
No, there is a waiting period of 30 days from the date of Account Opening or Scheme transfer.
30. Is pre-existing disease covered in the Critical Illness Coverage?
No, pre-existing diseases are not covered.
31. Is Critical Illness Insurance coverage extended to customers’ family?
No, benefit is only restricted to account holder.
32. What is the age limit for claimant of Critical illness insurance?
Age limit for claimant of critical illness insurance is up to age of 60 years.
33. Whether actual medical bills are required?
No, only diagnosis report of critical illness is required as the customer will get full amount as per the customer category rather than actual reimbursement.
34. Within how many days, the claim should be lodged?
Claim should be lodged within 15 days from the date of diagnosis.
35. In how many days Insurance company will pay the claim?
Claim payment shall be completed within 7 days of receipt of all required claim related documents by the insurance company.
36. How many diseases are covered in Critical Illness?
Total 18 diseases are covered in critical illness.
37. What are the diseases covered under Critical Illness Insurance?
The diseases covered under critical insurance are as follows:
First time diagnosis of the below-mentioned disease:
- Cancer
- End Stage Renal Failure
- Multiple sclerosis
- Benign Brain Tumor
- Parkinson’s Disease
- End Stage Liver Disease
Undergoing for the first time of the following surgical procedures:
- Major Organ/Bone marrow Transplant
- Heart Valve Replacement or Repair
- Coronary Artery Bypass Graft
- Surgery of Aorta
Occurrence for the first time of the following medical events more specifically described below:
- Stroke resulting in Permanent Symptom
- Paralysis
- Myocardial Infarction or Heart Attack
- Coma of specified severity
- Major burns (at least 50% of body surface area)
- Total and irreversible loss of hearing in both ears
- Total and irreversible loss of speech