why
health insurance?
This
policy has been designed to reimburse medical expenses incurred
by the insured person
in Government or Private
hospitals as an inpatient. The policy can be extended to cover reimbursement
of outdoor expenses.
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Group/Family Hospitalization
This
scheme is introduce on the occasion of its 10th anniversary in view
of the increasing need of Health insurance with wide coverage at economical
premium rate. The range of covers and arrangements are:
1. Salient Features
In the event of any claim becoming admissible under Hospitalization
Insurance, the company will pay to the insured person(s) 85% of
the amount of such expenses which are actually and necessarily incurred
in respect thereof anywhere in Nepal or on behalf of such insurd
person(s) but not exceeding in any one period of insurance amounts
mentioned under the category in the Table of Benefits.
2.
Scope of Cover
Hospitalization expenses for such illness/disease/injury which is
in the normal course could require care and treatment at hospital/nursing
home only.
3.
Age Limit
This insurance is available to persons between the age of 6 and
60 years an cover may be taken for spouse and dependent children
(2 nos. only) and/or dependant parents.
4.
Sum Insured
The limit of sum insured amount per year per person/group is ranging
from Rs. 25,000 to Rs. 1,00,000 only.
5.
Premium Rates
Premium rate per annum will be 1.5% of Sum to be insured.
Coverages
a.
Room,
Boarding Expenses as provided by the hospital/nursing home.
b.
Nursing
Expenses.
c.
Surgeon, Anesthetist Medical Practitioner, Consultants, Specialists
Fees.
d.
Anesthesia,
Blood, Oxygen, Operation Theatre Charges, Surgical Appliances,
Medicines & Drugs, Diagnostic, Materials and x-ray, Dialysis,
Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs
& Cost of Organs and similar expenses.
Table
of Benefits
In
the event of any claims becoming admissible under this scheme, the
Company will pay to the Insured person the amount of such expenses
as would fall under different heads mentioned below and as are reasonably
and necessarily incurred thereof by or on behalf of such Insured
Person, but not exceeding in the Sum Insured in aggregate mentioned
in the table given below for each category.
Room
Charge and Cosultant Fee (Doctor's Visit/Nursing Charge)
7,500
15,000
22,500
30,000
5.
Anesthetist,
Operation Theatre Charge, Surgeon's Charge for Opereation, Blood,
Oxygen
7,500
15,000
22,500
30,000
Total
25,000
50,000
75,000
100,000
Premium
Rate @1.5%
375
750
1,125
1,500
Exclusions
1.
The
Company shall not be liable to make any payment under this policy
in respect of any expenses whatsoever incurred by any Insured
Person in connection with or in respect of:
2.
Such
disease which have been in existence at the time of proposing
this insurance. Pre-existing condition means any injury which
existed prior to the effective date of this insurance. Pre-existing
condition also means any sickness or its symptoms which existed
prior to the effective date of this insurance. Complications
arising from pre-esisting disease will be considered part of
that pre-existing condition.
3.
Any
expenses on hospitalization incurred in the first 30 days from
the commencement date of insurance cover except in case of injury
arising out of accident.
4.
During
the first year of the operation of insurance cover, the expense
on treatment of disease such as Cataract, Benign Prostatic Hypertrophy
Hysterctomy for Menorrhagia of Fibromyoma, Herina, Hydrocle,
Congenital internal diseases, Fistula in anus, piles, Sinusits
and related disorders are not payable.
5.
Injury or Disease directly or indirectly caused by or arising
from or attributable to War, Invasion, Act of Foreign Enemy,
War like operations (whether war be declared or not).
6.
Circumcision
unless necessary for treatment of a disease not excluded hereunder
or as may be necessitated dut to an accident, vaccination or
inoculation or change of life or cosmetic or aesthetic treatment
of any description, Plastic surgery other than as may be necessitated
due to an accident or as a part of any illness.
7.
Cost of spectacles and contact lenses, hearing aids.
8.
Dental
treatment or surgery of any kind unless requiring hospitalization.
9.
Convalescence,
general debility, "Run-down" condition or rest cure,
congenital external disease or defects or anomalies, sterlity,
general disease, intentional self-injury and use of intoxicating
drugs/alcohol.
10.
All expenses arising out of any condition directly or indirectly
caused to or associated with Human T-Cell Lymphadinopathy Virus
type III (HTLD-III) or Lymphadinopathy Associated Virus (LAV)
or the Mutants Derivative or Variations Deficiency Syndrome
or any Syndrome or condition if a similar kind commonly referred
to as AIDS.
11.
Charge incurred at Hospital or Nursing Home primarily for diagnostic,
X-ray or laboratory examination not consistent with or incidental
to the diagnosis and treatment of the positive existence of
presence of any ailment, sickness or injury, for which confinement
is required at a Hospital/Nursing Home.
12.
Expenses
on vitamins and tonics unless forming part of treatment for
injury or disease as certified by the attending Physician.
13.
Injury or disease directly caused by or contributed to by nuclear
weapons/materials.
14.
Treatment
arising from or traceable to pregnancy, child birth including
caesarean section.
15.
Voluntary medical termination of pregnancy during the first
12 weeks from the date of conception.
16.
Naturopathy treatment.
car
safe policies
Covers
the vehicle
comprehensively against all types of losses and damages including
liability to third parties in respect of bodily injury, death or
property damage.
house
protection
Under
this insurance
the Company will indemnify the Insured against loss or damage to
the House & Household contents.
group/family
hospitalization policy
This
scheme is introduce on
the occasion of its 10th anniversary in view of the increasing need
of Health insurance with wide coverage at economical premium rate..
