Disclaimer: Webdoc in partnership with our underwriter East West insurance company is providing the product. This is a recurring payment model.
EXCLUSIONS
Payment of claims is subject to exclusions, as outlined below. Health Insurance Cover shall not cover
- Any preexisting conditions.
- HIV/Aids related disease are not covered
- Intentional and due to quarrel injuries are not covered
- OPD of all sorts Any admission less than 24 hours and no overnight stay is considered as OPD, and day care will not be covered
- Surgical procedures e. cosmetic surgeries, joint replacement, dental procedures are not covered
- Regular medications such as Insulin
- Any Special Investigations which are not due to the admission pre post are not covered
- War, strikes, riots, civil commotion and any natural or manmade perils (including chemical, nuclear, biological, and radiological) that results in the declaration of a state of emergency on a local or national level
- Miscarriage purposely isn’t covered in insurance.
TERMS AND CONDITIONS
- Claim will be calculated according to normal charges of the hospital around claimant’s city
- Maximum limit of Surgeon Fee is Rs. 10,000/- in case of surgical procedures and other charges e. anesthesia, operation room charges will be calculated at standard rates
- Nursing charges are not payable
- Medicines on discharges are not covered
- Food charges are excluded
- 7 Days waiting period applied
NOTICE OF CLAIMS
The Company shall be notified of the occurrence of Insured Claim as soon as possible, but not later than 15 (Fifteen 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.
For each Claim reported, the Company shall obtain:
From the Claimant:
- Admission Slip of Hospital
- Discharge Slip of Hospital
- Doctor Prescription/Note for admission or Medical History
- Medical Reports, if any
- Any Bills to be
- CNIC Both Sides
- In case of income loss compensation customer must submit proof of income loss e salary slip etc.
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 fifteen (15) working days, or as long as the dispute takes to resolve in the legal system.