FAQs on insurance claim

A.  General
1.    What are the insurance coverage available under Chamatkarik Deposit Products?
Accidental Death/Total Permanent Disablement, Critical Illness and Medical Insurance are covered under Chamatkarik Deposit Products.

2.    Does the customer need to fill up any Form for availing insurance coverage?
It is not necessary to fill up any form by the customer for Accidental insurance. Medical insurance claimant customer needs to fill the form at the time of claimant only.
However, for Critical illness coverage a separate form need to be filled at the time of account opening.

3.    Who will pay the premium for Insurance Coverage?
The premium for Insurance Coverage under Chamatkarik Deposit Products shall be borne by the Bank.

4.    Will my family be covered under my insurance coverage under my Chamatkarik Deposit Account?
No, the family members are not covered. The insurance coverage applies only to the account holder. To cover the insurance coverage of family member you need to open separate account in the name of your family member.

5.    Who is eligible for benefit related to various insurance in case of joint account?
Insurance benefit is provided to joint accountholders on proportionate basis.
Joint account can be opened by maximum 2 person under Chamatkarik deposit products. The joint accountholder of Chamatkarik Deposit Products shall get proportionate coverage of 50% of sum insured.

6.    Where do I have to submit the documents related to my claim?
You have to submit the required claim related documents to the nearest branch of the Bank. The Bank shall initiate the claim processing with the Insurance Partner after receiving complete documents.

7.    Which cases are not covered in Insurance Coverage?
Following cases are permanent excluded from insurance coverage:
i.    Congenital diseases/ disorders are permanently excluded
ii.    All substances that are considered as food stuff.
iii.    Sight and Dental benefits unless mentioned in the schedule of benefits.
iv.    Any in hospital treatment or the diagnostic tests and any medical tests that can be performed outside the hospital without endangering the health of the assured.
v.    General epidemics and contagious diseases, Sars, and all diseases covered by the state.
vi.    Placement of artificial limbs and implementation of any instrument in the human body and the medical assistance instruments such as artificial knee, heart stimulator, etc and all other instruments.
vii.    Medical and psychological disorders (Mental and Psychiatric disorders) sedatives and mental medicines, epilepsy, congenital and genetic disease and astigmatism.
viii.    Dentistry and oral surgery, bridgework denture, crowns and all related work, unless it was the result of an accident which took place while the insurance is in effect.
ix.    Cases of hearing and sight correction, instruments of hearing and sight unless due to accident covered by the insurance policy.
x.    Quarantine, venereal diseases, sterility telemedicine and everything related to fertility.
xi.    Acne, freckles, loss of hair.
xii.    Plastic surgeries and cosmetic treatments unless, it was the result of a covered accident that took place while the insurance cover were in effect.
xiii.    Paraplegia, , AIDS and related treatment, hemiplegia, Alzheimer, and mental disorders, STD.
xiv.    All undeclared pre-existing cases (For non PED policies/ waiting period for PED policies)
xv.    Nuclear fission or fusion, automatic radioactive pollution, and chemical and biological toxicants.
xvi.    All cases to addiction of alcohol or drugs and all products that cause hallucination.
xvii.    Dangerous sports such as motor racing, climbing, or motor cycle racing of any kind etc.
xviii.    War, invasion, acts of foreign hostility, aggression (whether the war is declared or not), rebellion, armed revolt, acts of terrorism and also due to civil commotions.
xix.    Committing or trying to commit criminal activity or participate in any unrest or brawl (All forms of judicial cases).
xx.    Suicide, attempted suicide or self-inflicted injury.

B.    Medical Insurance:

1.    In which case customer can claim for medical insurance?
Customer can claim medical insurance for hospitalization case only. Claim is valid for hospitalization as an inpatient for even less than 1 night in hospital on the written advice of a medical practitioner.

2.    What is waiting period for medical insurance?
There is no waiting period for medical insurance.

3.    What is the process for Medical claim?
The customer need to submit their medical insurance claim along with the following documents;
a.    Duly completed Claim form signed by the Medical Practitioner,
b.    Original bills, receipts and discharge certificate/card from the Hospital/Medical     Practitioner,
c.    Original bills from chemists supported by proper prescription,
d.    Original investigation test reports and payment receipts,
e.    Indoor case papers,
f.    Medical Practitioner’s referral letter advising Hospitalization in non-Accident cases,
g.    Any other document as required by the Company or Health Service Provider to investigate the Claim or the Company’s obligation to make payment for it.

4.    Within how many days’ customer have to claim for the medical claim?
Customer have to process for medical claim soon after the date of discharged from hospital not exceeding 15 days.

5.    Does insurance company pay the bill of regular routine checkup?
No, insurance company will not pay the bill of regular routine checkup.

6.    Does insurance company pay the bill of dental treatment other than treatment cause due to accident?
No, insurance company will not pay the bill of dental treatment other than treatment cause due to accident.

7.    In how many days Insurance company will pay the medical claim?
Except for exceptional cases, claim payment shall be complete within 7 working days of receipt of all required claim related documents.

8.    Is homeopathic hospital treatment included in medical insurance?
No, only allopathic hospital treatment is included in medical insurance.

9.    Does insurance company pay foreign hospitals treatment bills on Medical Insurance?
Medical Insurance coverage shall be provided for hospitalization expenses of hospital in Nepal and renowned hospital of India only.

10.    What is the maximum age limit for claimant of medical insurance?
Customer up to age of 65 years can claim for medical insurance.

C.    Accidental Death/Total Permanent Disablement Insurance
1.    What are the risks covered under accident death/total permanent disablement Insurance Benefits?
The risks covered under Personal Accidental Death Insurance are as follows:
a.    Death
b.    Total Permanent Disablement
c.    Loss of sight of both eyes or hands or legs.
d.    Loss of sight of one eye or hand or one leg.

2.    Is normal death is covered under Accidental death insurance coverage?
No, only accidental death is covered.

3.    What is the maximum age limit for claimant of accidental death/permanent disablement insurance?
Customer of any age can claim for accidental death/permanent disability insurance.

4.    What is waiting period for accidental death/permanent disablement insurance?
There is no waiting period for accidental death/permanent disablement insurance.

5.    How will customer claim for Accidental Death Insurance?
Legal heir of the customer shall notify the Branch with written application and required documents on case to case basis as defined below:
a)    In case of accidental death (spot death)
•    Police report (Sarjiwani muchulka)
•    Death certificate
•    Relationship certificate
•    Postmortem report
•    Citizenship certificate copy of accountholder and legal heir
•    Recommendation for payment from CDO to legal heir
•    Branch shall further, issue letter mentioning accidental death of accountholder with account number, average monthly deposit and legal heir name to insurance company in our letter head.
•    Additional documents if any asked by Insurance company.

b)    In case of accidental death (after hospitalization) additional document required is as below apart from documents mentioned in (a):
•    Discharge summary/death certificate

c)    In case of permanent total disablement:
•    Letter from bank notifying the medical claim with account number, accountholder’s name and average monthly deposit.
•    Prescription/ Verification from hospital of permanent disablement
•    Original Medical Bills
•    Lab reports
•    Discharge paper
•    Photographs of customer verifying the permanent disablement (if available)

D.    Critical Illness Coverage
1.    How many diseases are covered in Critical Illness?
Total 18 diseases are covered in critical illness.

2.    What are the diseases covered under Critical Illness Insurance?
The diseases covered under critical insurance are as follows:
First time diagnosis of the below-mentioned disease:
a.    Cancer
b.    End Stage Renal Failure
c.    Multiple sclerosis
d.    Benign Brain Tumour
e.    Parkinson’s Disease
f.    End Stage Liver Disease

Undergoing for the first time of the following surgical procedures:
a.    Major Organ/Bone marrow Transplant
b.    Heart Valve Replacement or Repair
c.    Coronary Artery Bypass Graft
d.    Surgery of Aorta

Occurrence for the first time of the following medical events more specifically described below:
a.    Stroke resulting in Permanent Symptom
b.    Paralysis
c.    Myocardial Infarction or Heart Attack
d.    Coma of specified severity
e.    Major burns (at least 50% of body surface area)
f.    Total and irreversible loss of hearing in both ears
g.    Total and irreversible loss of speech

3.    What is waiting period for Critical Illness?
The critical illness coverage for accountholders commences only after the 30 days from such account opening date or scheme transfer date i.e. during such period there should not be any symptom of critical illness to the account holder.

4.    What is the age limit for claimant of Critical illness insurance?
Age limit for claimant of critical illness insurance is 18 to 60 years.

5.    In how many days Insurance company will pay the claim?
Except for exceptional cases, claim payment shall be complete within 7 working days of receipt of all required claim related documents.

6.    When can customer claim the critical illness insurance coverage?
The customer after submitting the diagnosis report of having critical illness shall get the assured sum amount of critical illness as per the customer category and insurance policy.

7.    While undergoing treatment of critical illness, insured accountholder dies before critical illness claim is made to bank. Can beneficiary apply now for claim amount?
Yes, if all the criteria are fulfilled, then Critical Illness Claim shall be paid if the illness is diagnosed before his/her death.

8.    Will any customer be insured if she/he is already a patient of any above mentioned 18 disease of critical illness?
Customer shall declare regarding any pre-existing critical illness in the insurance proposal form. Apart from the declared illness of pre-existing illness, customers are insured for other critical illnesses.

9.    How many times or for how many Critical Illness, a claimant gets insurance payment?
Critical Illness coverage is for only one time per year for first time diagnosis of any critical illness.
From next year onward till offer is valid, customer is eligible for diagnosis of remaining undiagnosed critical diseases