The Insurance is underwritten by Alfalah Insurance and delivered by BIMA.
BIMA Mobile Pakistan is the global leader in mobile micro insurance and it protects the future of 30 million families worldwide. It has operations in 15 markets across Asia, Africa, Latin America, and the Caribbean. BIMA is proud to have paid over $ 8 million in claims.
Bima is proudly underwritten by Alfalah Insurance. Alfalah Insurance offers first class security and service to the insuring public at an international standard.
Jazz Telecom, is facilitating this offering but shall not be responsible for any grievance of the Jazz Customer relating to the Insurance Services and Alfalah Insurance’s or BIMA’s performance of its obligations.
BIMA Sehat POLICY
Whereas the Insured Person by a proposal which shall be the basis of the contract and be held as incorporated herein has applied to the Company for the insurance hereinafter contained and has paid or agreed to pay the first premium as consideration for such insurance.
Now this policy witnesses that subject to the terms conditions and exceptions contained herein or endorsed hereon, if at any time during the period of insurance, if the Insured Person shall be hospitalized due to any reason (with the exception of the exclusions) the Company will pay to the Insured Person or his beneficiary
- BIMA SEHAT SERVICE means monthly hospitalization insurance policy with Health Services
- ALFALAH refers to the COMPANY, the INSURER, or Alfalah Insurance Company Limited.
- APPLICANTmeans the individual who applies for BIMA Sehat Plan under this Policy.
- BENEFICIARY is defined as Beneficiary in the application or the person substituted as such.
- INSURANCE BENEFIT(S) are amounts payable in the event of an idemnifiable claim and as detailed in the Schedule of Insurance Benefits attached hereinafter.
- BIMA refers to BIMA Mobile Pakistan.
- The COMPANY is stated as Alfalah Insurance Company Limited.
- ELIGIBLE APPLICANT means an Applicant who meets the eligibility criteria set forth in this Policy.
- END USER PRICE means the amount to be charged to the Subscriber for getting the Insurance Policy and it shall include the Premium, Jazz’s Consideration and any applicable taxes on the telco services involved in the provision of Insurance Services.
- HOSPITALis defined as “Any institution in Pakistan that has been registered as a hospital with the local authorities and is under the supervision of a registered and qualified medical doctor.”
- HOSPITALISATION: staying minimum of one night in a facility recognized as hospital.
- INSURANCE COVER means the amount which shall be paid by Alfalah to the Beneficiary or the Insured as per the terms and conditions of the Insurance Policy.
- INSURANCE POLICY means this insurance policy setting out the terms and conditions on which insurance coverage is granted to a Subscriber.
- INSURANCE SERVICES shall mean the insurance services to be provided to Jazz Customers.
- The INSURED or INSURED PERSON means any Jazz Telecom subscriber who opt to purchase policy
- The INSURER is stated as Alfalah Insurance Company Limited.
- MSISDN shall mean Mobile Subscriber Integrated Services Digital Network Number.
- PREMIUM means the premium payable by an Insured Member to Insurer in relation to the Insurance Policy.
- SUBSCRIBER means those Jazz Customers who subscribe for the Insurance Services to get this Insurance Policy.
- JAZZ refers to Pakistan Mobile Communications Limited, a company duly incorporated and registered under the Companies Ordinance 1984 of Pakistan, and having its registered office at 1-A, IBC Building, F-8 Markaz, Islamabad, Pakistan.
- JAZZ CUSTOMERSshall mean the customers of Jazz using Jazz’s System.
- JAZZ SYSTEMS means Jazz’s GSM mobile cellular system.
- JAZZ PAYMENT TERMS means Jazz’s payment terms published at jazz.com.pk, as revised from time to time.
The BIMA Sehat Cover shall not cover any hospitalization claim which is caused by, or resulting, directly or indirectly, wholly or partly, from any of the following factors:
- intentional self-inflicted injury, suicide attempt, or arising out of non-adherence to medical advice;
- elective treatment, such as cosmetic surgery; and
- pregnancy and any complications arising from pregnancy during the first nine (9) months from the Subscription.
- Eligibility & Enrolment
Applicants are eligible to apply for BIMA Sehat insurance plan under the Policy if Applicants meet ALL the criteria set out below:
(1) Eligible Applicants shall include individual pre-paid and post-paid Jazz Customers. It is understood and agreed between the Parties that only one (1) person shall be insured per pre-paid or post-paid telecommunication connection.
(2) All Eligible Applicants shall be natural persons. Corporations, partnerships and businesses shall not be eligible for coverage under the BIMA Sehat Policy.
(3) All Eligible Applicants shall be a minimum of eighteen (18) years of age and a maximum of sixty four (64) years of age at the time of registration.
(4) If the Applicant wishes to apply for and subscribe to the BIMA Sehat Plan under this Insurance Policy, the Applicant will be required during the registration process to:
i. acknowledge that the Applicant has read and understood the terms of the Policy and the Jazz Payment Terms;
ii. confirm that the Applicant meets the eligibility criteria set out in General Provision 1 of the policy;
iii. confirm the BIMA Sehat Plan that the Applicant wishes to apply for;
iv. authorize Jazz to make 30 daily deductions each month from the prepaid account and
a. the Insurance Benefits payable are subject to the Applicant’s confirmations being true and correct; and
b. 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 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 of the Insured as soon as possible, but not later than 270 (two hundred & seventy days) days from the 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.
(2) For each Claim reported, the Company shall obtain:
From the Claimant:
CNIC; final hospital invoice or discharge report which states date of admission and discharge.
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 Death of Policy Holder 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.
- Participation Requirement/Process
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 BIMA to a BIMA agent. This confirmation serves as digital signature for the BIMA Sehat Insurance Cover. After receiving positive response, the customer shall be enrolled under the BIMA Sehat 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.
- Insurance Benefits
The Company hereby agrees to pay the following benefit subject to the terms and conditions provided under the BIMA Sehat Policy as defined hereunder.
If an Insured is 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 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 from the first night of hospitalization 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:
- Only One (1) policy per applicant
- A Claim must be intimated to the Company within two hundred & seventy (270) days from the date of first night of hospitalization
- Payment of claims is subject to exclusions, as outlined in the Exclusions section of this contract
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
The BIMA Sehat service is extended to one (1) person per Jazz subscriber who is a successful Applicant for the BIMA Sehat Insurance Cover. Each Applicant is allowed to 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. Unlimited M‑health is included for all four (4) cover levels.
|Monthly End User Price
||Maximum sum assured per night (max 30 nights per year)
If a Subscriber has not paid the full monthly End User Price due in a calendar month, a proportional cover is given, based on the successful partial payment per the relevant month. This proportional cover is specified in the partial deduction tables below.
Cover: lump sum pay out based on number of overnight stays in hospital, maximum thirty (30) nights per year.
In addition to the Hospitalization cover BIMA Sehat service includes:
Access to one health program, chosen by the Subscriber from a menu of health programs provided by BIMA. Health programs include periodic delivery of program-specific content through different communication channels. The health program is only available for the Subscriber.
Unlimited access to tele-consultations with BIMA doctors to address acute minor ailments and to receive medical advice on general health topics, however, these may not be used for urgent conditions. The teleconsultations are available for the Subscriber and Subscriber’s immediate family members, limited to the Subscriber’s parents, spouse, children and siblings.
- Services Provided:
BIMA provides connects individuals with participating licensed physicians (the “Providers”) in real time via telephone for the purpose of participating in a health care consultation. BIMA also provides other types of administrative services and information (“Services”). BIMA does not provide medical care or practice medicine or any other licensed profession, and BIMA does not interfere with the practice of medicine or other licensed profession by Providers. The Services do not include the provision of medical care by BIMA. Rather, the BIMA enables access to Providers who have agreed to provide patient care to Customers using BIMA’s Services. The Providers reserve the right to deny care for actual or potential misuse of the Services.
- Use of BIMA Mobile health Services is NOT FOR EMERGENCIES:
BIMA’s Services are NOT for use for medical EMERGENCIES or urgent situations. If you are in an emergency, you should visit your nearest emergency room/doctor. You must not delay your visit to the emergency room in anticipation of obtaining medical advice from a Provider through BIMA.
- Relationship with your Primary Care Physician:
Your interaction with the Providers through the Service is not intended to replace your relationship with your existing primary care physician or be your permanent medical access point. You should seek emergency help or follow-up care when recommended by a Provider or when otherwise needed, and continue to consult with your primary care physician and other health care professionals as recommended.
- Prescription Policy:
Providers may prescribe medications when medically indicated in their sole professional judgment, however they cannot guarantee the availability of the medicine in your city/area. In the event that a Provider does prescribe a medication, he/she will comply with all applicable federal and provincial laws and will only prescribe a medication as determined appropriate in his/her sole discretion and professional judgment. BIMA does not guarantee that a provider will issue a prescription.
- You agree that any prescriptions that you acquire from a Provider shall be solely for your personal use. You agree to fully and carefully read all provided product information and labels and to contact a physician or pharmacist if you have any questions regarding the prescription
- Informed Consent
Telemedicine is the delivery of health care services using interactive audio and/or video technology, where the patient and Provider are not in the same physical location. During your telemedicine consultation with a Provider details of your medical or health history and personal health information may be discussed through the use of interactive audio, video, and/or other telecommunications technology, and the Provider may perform a physical exam through these technologies. Depending on your medical or health history and/or specific complaint, you may be asked to provide information through other electronic means, and verify your identity with a national identity card or other legal document.
- Limitations of Tele-Medicine:
Among the benefits of BIMA’s Service is improved access to health care professionals and convenience. However, there are potentials risks associated with the use of telemedicine. These risks include, but may not be limited to:
- In some instances, the information transmitted may be of insufficient quality to allow for appropriate medical or health care decision making by the Provider (i.e., poor call quality, poor resolution of images, etc.)
- Delays in evaluation or treatment could occur due to failure of the electronic equipment;
- In some instances, a lack of access to all of your medical records and incomplete disclosure by the patient may result in adverse drug reactions or allergic reactions or other judgment errors;
- Although the electronic systems we use will incorporate networks and software security protocols to protect the privacy and security of health information, in some instances, security protocols may fail and cause a breach of privacy and/or personal health information.
- You understand that you may expect the anticipated benefits from the use of telemedicine in your care, but that no results can be guaranteed or assured;
- You understand that you are fully responsible to visit an emergency room if you feel your situation is urgent.
- You understand your Provider, in his or her sole discretion and professional judgment, may determine that telemedicine services are not appropriate for some or all of your treatment needs and, accordingly, may elect not to provide telemedicine services to you through BIMA.