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 Personal Accident and BIMA SEHAT Policy shall become null and void with respect to the relevant Insured.
Notice of Claims
The Company shall be notified of the hospitalization and occurrence of Death of the Insured or the Permanent Disablement of the Insured or in case of hospitalization as soon as possible, but not later than 270 (two hundred & seventy days) days from the date of incident or from the first night of hospitalization after which it shall be treated as time barred and the Company shall not be bound to pay the Claim.
(1)For each Claim reported, the Company shall obtain:
From the Claimant:
In case of Hospitalization
CNIC; final hospital invoice or discharge report which states date of admission and discharge.
Insurer may require any other document if reasonably deems necessary before approving a claim under the Policy.
In case of Accidental Death:
A notice of death, which could be a legal death certificate, a certificate of attending physician, containing his registration number and mentioning actual cause of death, and proof of the personal identity of the Insured, which could be the official personal identity data.
In case of Permanent Disablement:
Medical report containing the degree of Disablement certified by the surgeon.
In case of Permanent Disablement, unnatural or unusual death, Insurer may require any other document it reasonably deems necessary before approving a claim under the Policy.
(3) The Company” shall process and pay genuine and approved claims on receipt of required documents from the Claimant within three (3) working days.
(4) 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 on Death or
- Upon settlement of the Insured of the amount of insurance, including in the event of early termination of such relationship; or
- Upon cancellation or withdrawal of subscription by Jazz of the contract/relationship with the Insured, whatever the reason may be, or
- In case of non-payment of the individual End User Price for the Insurance Policy.
- In case of non-payment of End User Price by the Funder for the Insurance Policy., Policy of Funder and Recipient will be terminated
Interested customers shall participate through an electronic enrolment process, assisted by a call center agent, or by submitting information electronically via their handset, in two phases:
Name of the Customer:
Age or CNIC Number:
Name of the Beneficiary:
Relationship to Customer:
Insurance Benefits selected by Customer:
Once the customer has answered the questions in the 1st Phase, the customer shall receive an SMS on for or on behalf of the Company and shall be asked to dial a short code, or send an SMS to a particular number to confirm registration. Alternatively, the Customer may offer his verbal consent over an official recorded channel managed by MILVIK to a MILVIK agent. This confirmation serves as digital signature for the BIMA SEHAT/Personal Accidental Insurance Cover. After receiving positive response, the customer shall be enrolled under the BIMA SEHAT/Personal Policy.
All differences arising out of this policy shall be referred to the decision of an arbitrator to be appointed in writing by the parties in difference or if they cannot agree upon a single arbitrator to the decision of two arbitrators one to be appointed in writing by each of the parties within one calendar month after having been required in writing so to do by either of parties or incase the arbitrators do not agree of an umpire appointed in writing by the arbitrators before entering upon the reference. The umpire shall sit with the arbitrators and preside at their meetings and the making of an award shall be a condition precedent to any right of action against the Company. If the Company shall disclaim liability to the Insured Person for any claim hereunder and such claim shall not within twelve calendar months from the date of such disclaimer have been referred to arbitrator under the provisions herein contained then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder. Notwithstanding stated above, dispute resolution forums given under the Insurance Ordinance, 2000, such as the Insurance Ombudsman, Small Disputes Resolution Committee and the Insurance Tribunals, shall prevail in the order of precedence, and over the seat of Arbitration.
Compliance with Policy Provisions
Failure to comply with any of the provisions contained in the policy shall invalidate all claims hereunder.
The Company hereby agrees to pay the following benefit subject to the terms and conditions provided under the Personal Accident/BIMA SEHAT Policy as defined hereunder.
If an Insured dies or is permanently disabled due to an Accident hospitalized due to any reason(with the exception of exclusions), on a twenty four (24)-hour worldwide basis, the Company will, upon receipt of due proof in writing of the Hospitalization/ Death or Permanent Disablement of the insured, pay the Insured or Beneficiary as the case may be the sum assured, according to their Insurance Cover level as described in this Insurance Benefits Section of the Policy Wording
The amount of benefit received by the Insured or the Beneficiary in the event of the Hospitalization from the first night of hospitalization or accidental Death or Total and Permanent Disablement of the Insured will be according to the amount of premium paid and subject to the terms and conditions of the product.
Terms and conditions of this cover are as follows:
- One (1) Personal Accidental and One (1) BIMA Sehat policy per applicant (individual applicant, Funder or customer)
- A Claim must be intimated to the Company within two hundred & seventy (270) days from the date of first night of hospitalization or from the date of occurrence of Death or Permanent Disablement
- Payment of claims is subject to exclusions, as outlined in the Exclusions section of this contract
In the event of partial pay-out following Permanent Disablement due to Accident, the Company shall permit renewal of the insurance offer on a case-by case basis, and inform the registered subscriber accordingly.
The following actions shall be taken depending on the decision of renewal or non-renewal:
- On non-renewal: The insurance policy shall be terminated, and all airtime deduction or billing shall be discontinued; any amount deducted or billed after the cancellation of the service is nonrefundable.
- On renewal: the insurance policy shall continue on auto-renewal, and all airtime deduction or billing will continue to apply in subsequent calendar month
Each Applicant can select the level of maximum insurance benefit at the point of Enrolment.
The Subscriber has the option to choose between four (4) cover levels, at four (4) corresponding End User Price points, as given below.