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HEALTH INSURANCE – WHS PLUS

PRODUCT DETAILS

WEBDOC in collaboration with the underwriters brings In Patient Coverage ( IPD , ICU/CCU)  often known as Hospitalization and Major Medical Care Health INSURANCE coverage for the families including parents which  is quite unique. Customers will pay Rs. 2000 per annum to avail the following cover.

NOTE: All the policies come with TELE DOCTORS SERVICES and Insurance is in addition.

Customers will receive the Tele-Doc number to dial at the time of Sales for the period of insurance.

Rs.2000 per annum cover up to  Rs. 100,000 max. 10,000/day

Waiting period 15 days

15 days free lookup period apply

5+2 family Members can be covered under the policy which needs to be registered before the claim.

 

NOTE:  THE DAILY MAXIMUM LIMIT APPLY. MAXIMUM 50% LIMITS FOR PARENTS APPLY.

              Age coverage between 5 years – 65 years – Including parents

EXCLUSIONS

Payment of claims is subject to exclusions, as outlined below. Health Insurance Cover shall not cover

  • Any Pre-existing conditions. Pre-existing is defined here as any diagnostics previously found before the date of the policy including waiting period.
  • Any Dental procedures
  • OPD all sorts- Any admission less than 24 hours and no overnight stay  is considered as OPD and day care.
  • Day care surgeries
  • Cosmetic or any surgical procedures
  • Regular medications such as Insulin etc
  • Any Special Investigations which are not due to the admission.
  • War, strikes, riots, civil commotion and any natural or man-made perils (including chemical, nuclear, biological, and radiological) that results in the declaration of a state of emergency on a local or national level

Nomination of Policy owner

At time of Policy- The main policy holder can Nominate at time of policy that this is for his / her spouse , children or parents. The process of which will be by notifying WEBDOC through WhatsApp, Call center or at time of purchase of policy

Eligibility & Enrollment

Applicants are eligible to apply for a Health Insurance Plan under the Policy if Applicants meet ALL the criteria set out below:

(1)   All Eligible Applicants shall be natural persons. Corporations, partnerships and businesses Employees who have been registered are not eligible for coverage under the Policy.

(2)   All Eligible Applicants shall be a minimum of five (5) years of age and a maximum of Sixty Five (65) years of age at the time of registration.

(3)   If the Applicant wishes to apply for and subscribe to a Plan under this Insurance Policy, the Applicant will be required during the registration process to:

  1. Acknowledge that the Applicant has read and understood the terms of the Policy
  2. Confirm that the Applicant meets the eligibility criteria
  3. The Insurance Benefits payable are subject to the Applicant’s confirmations being true and correct
  4. If the Applicant’s confirmation is untrue or incorrect, no Insurance Benefits will be payable and the End User Price the Subscriber paid will not be refunded.

Mistake In Age

  • The Company shall only pay Insurance Benefits based on the disclosed age of the Insured. With the onus on the customer for incorrect disclosure the Company shall not be liable to pay any benefit under this Policy in that particular case.

Intentional False Statements Of The Insured

  • In the event of any concealment or misrepresentation the Policy shall become null and void with respect to the relevant Insured.

Notice Of Claims

The Company shall be notified of the occurrence of Insured Claim as soon as possible, but not later than 30 (Thirty days ) from the date of discharge from hospital, which it shall be treated as time‑barred and the Company shall not be bound to pay the Claim.

(2)   For each Claim reported, the Company shall obtain:

From the Claimant:

  • Admission Slip of Hospital
  • Discharge Slip of Hospital
  • Lab reports, if any
  • Any Bills to be claimed.
  • CNIC of service holder (Both Sides)
  • B-Form/CNIC of Claimant (Both Sides)
  • Service Number

(3)   If there is a dispute, suspected fraudulent activity on the claim or a unique situation which requires further clarification, the payment period can be extended but shall not exceed ten (10) working days, or as long as the dispute takes to resolve in the legal system.

Termination of Individual Insurance

The insurance of an Insured shall automatically terminate at the earliest time below:

  • Upon payment of the claim 
  • Upon cancellation or withdrawal of subscription
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