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Pravasi Bhartiya Bima Yojana

New India Assurance

The New India Assurance Company

 

Regd. & Head Office : The New India Assurance Building, 87, M.G. Road, Fort, Mumbai-400 001

 

PROSPECTUS

OF

PRAVASI BHARTIYA BIMA YOJANA POLICY

 

1.0                    This insurance scheme is available to all Indians Citizens between the age group of 18-60 years whilst stay abroad having valid visa for the purpose of employment only, for the period of cover as stated in the schedule to the policy.

 

2.0                    SECTION – I : PERSONAL ACCIDENT BENEFITS 

 

3.0                    COVERAGE : Accidental death or permanent total disablement during currency of the policy - Capital Sum Insured Rs.2.00 lakhs.

4.0                    SALIENT FEATURES :

 

4.1                    Accidental bodily injury caused by external violent and visible means has occurred during insured’s stay abroad.

 

4.2                    Such injury within twelve calendar months of its occurrence is the sole and direct cause of death or permanent total disability of the insured.

 

4.3                    In case of death, the person assigned in the policy legal heirs would be entitled to Rs.2.00 lacs, i.e. the Capital Sum Insured under the policy, and in case of permanent total disability -

 

a)               Sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the Capital Sum Insured of Rs.2 lacs.

b)              Use of two hands or two feet, or of one hand or one foot, or of such loss of sight of one eye and such loss of use of one hand or one foot, the Capital Sum insured of Rs.2 lacs.

 

4.4                    Maximum liability in respect of one or more claims during the policy period is the Capital Sum Insured under the policy

 

5.0                   SPECIAL ADD ON BENEFIT

 5.1                   FAMILY COVER

 The family of the insured in India consisting of spouse and two dependent children upto 21 years of age shall be entitled to hospitalization benefit cover for an amount not exceeding Rs. 10,000/- in all, in the event of death or permanent disability of the insured. Maternity benefit shall however not be available under this extended cover to the insured’s spouse.

 6.0                   EXCLUSIONS

 The Company is not liable to pay any compensation in respect of death or disablement of the insured person resulting from –

a)               Intentional self-injury, suicide or attempted suicide.

b)              Whilst under the influence of intoxicating liquor or drugs.

c)              Whilst engaging in Aviation or Ballooning except as passenger in an aircraft.

d)              Directly or indirectly caused by venereal diseases, Aids or insanity.

e)               Arising or resulting from the insured person committing any breach of law with criminal intent. 

f)                War, invasion, civil war, insurrection etc.

g)              Caused by or arising from ionizing radiations or contamination by radioactivity from any nuclear fuel, nuclear weapon material, etc.

h)              Directly or indirectly caused by contributed to or aggravated or prolonged by childbirth or from pregnancy or in consequence thereof.

 

7.0                  SECTION – II (A):

RE-IMBURSEMENT OF REPATRIATION / TRANSPORT EXPENSES ON ACCOUNT OF DEATH / PERMANENT TOTAL DISABILITY / TERMINATION OF CONTRACT ON ACCOUNT OF CONTRACTING MAJOR AILMENTS

7.1                   SCOPE OF COVER :

In the event of accidental death of the insured person whilst abroad actual expenses incurred for repatriation of the dead body or transportation charges to India if the contract of employment is terminated due to insured person contracting major ailment(s) as defined hereunder or due to permanent total disability of the insured person following an accident whilst abroad including cost incurred on economy class return air fare of one attendant shall be reimbursed.

7.2                   DEFINITION OF MAJOR AILMENTS :

 

a)     liver Nephritis of any Aetiology plus Bacterial renal failure requiring Kidney Transplantation & Dialysis.

 

b)    Cerebral or Vascular Strokes.

 

c)     Open and Close Heart Surgery (inclusive of C.A.B.G.).

 

d)    Malignancy disease which are confirmed on Histopathological report.

 

e)     Encephalitis (Viral).

 

f)      Neuro Surgery.

 

g)     Total Replacement of joints.

 

h)     Liver disorder (Hepatitis B & C) associated with complications like Cirrhosis of.

 

a)     Grievous injury including multiple fracture of long bones, head-injury leading to unconsciousness, burns of more than 40%, injury requiring artificial ventilatory support plus Vertebral Column Injury.

 

7.3                   OTHER CONDITIONS

 

a)               The repatriation charges / transportation expenses due to termination of service contract on account of major ailments will be considered only when a specialist has diagnosed such disease and treatment is recommended in India.

 

b)              The repatriation charges / transportation expenses on account of permanent total disability will be allowed only for travel of the insured / accompanying person, as the case may be, to India from the country of employment.

 

c)              Cost of airfare of attendant will be considered only if the insured is declared in writing by a competent medical practitioner to be medically and physically unfit to travel alone.

 

d)              The expenses for airfare of the insured /attendant as the case may be, will be reimbursed only in economy class, one way for the insured, and return fare for the attendant (if found necessary by the Company at its sole discretion) to any airport in India nearest to the place of residence of the insured person as mentioned in the proposal form by the shortest route

 

e)               The claim for reimbursement for the insured and the attendant shall be filed within 90 days of completion of journey.

 

8.0                   SECTION II (B):

 

REIMBURSEMENT OF REPATRIATION / TRANSPORT

EXPENSES DUE TO TERMINATION OF CONTRACT OF    

EMPLOYMENT IN  CERTAIN OTHER CASES

 

On arrival of the insured person at his work place or destination abroad, if he/she is not received by the employer or if there is any substantive change in the job/Employment Contract/agreement to the disadvantage of the Insured person, or if the employment is prematurely terminated

 

 

within three months for no fault of the insured person, the Company shall re-imburse one-way Economy Class airfare provided the grounds for repatriation are certified by the concerned Indian Mission/Post and the Air-tickets are submitted in original.

 

8.1                   EXCLUSIONS

 

The Company shall not be liable to make any payment under this sub-section of the Policy - 

 

a)               if the repatriation of the insured person is on account of violation of any law, fraud, or any breach of employment conditions,

b)              such repatriation becomes necessary due to any amendment or change in the existing laws of the country of employment, or proclamation by Government Order that all workers of foreign origin are being deported,

 

c)              the employment is obtained through fake or forged documents, work permit or improper entry visa, or

 

d)              the entry into the country has been made without completing legal   

                     formalities for whatsoever reason.

 

e)       no attempt being made by the insured person to contact his employer on arrival if the insured person is not received at such time,

 

          f)       the entry into the country has been refused on medical grounds,

 

g)       short term contracts i.e. contracts for the period of less than 3 months.

 

 

9.0                   SECTION – III :        HOSPITLISATION COVER

 

9.1                   SCOPE OF COVER

 

If at any time during currency of this policy, the insured person whilst stay abroad shall contract any disease or suffer from any illness or sustain any bodily injury through accident and if such disease or injury shall require any such insured person, upon the advice of a duly qualified medical practitioner or duly qualified surgeon to incur hospitalization expenses for medical / surgical treatment at any nursing home / hospital in India as an inpatient, the Company will pay to the insured person / his nominee / legal representatives as the case may be, the amount of such expenses as are reasonably and necessarily incurred in India in respect thereof by or on behalf of such person maximum upto Rs.50,000/- in Indian currency only.

 

10.0              DEFINITIONS :

 

10.1               HOSPITAL / NURSING HOME means any Institution in India established for indoor care and treatment of sickness and injuries and which

 

Either

 

a)      has been registered either as a Hospital or Nursing Home with the  

        local authorities and is under the supervision of a registered and   

        qualified Medical Practitioner.

 

OR

 

b)      Should comply with minimum criteria as under :-

 

(i)                It should have atleast 15 in-patient Beds.  In Class ‘C’ towns condition of maximum number of beds would be 10.

 

(ii)              Fully equipped operation theatre of its own wherever surgical operations are carried out.

 

(iii)            Fully qualified Nursing Staff under its employment round the clock.

 

(iv)            Fully qualified Doctor(s) should be incharge round the clock.

 

 

 

10.2               The term “HOSPITAL / NURSING HOME” shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place for alcoholics, a hotel or a similar place.

 

10.3               Expenses on Hospitalization for minimum period of 24 hours are admissible.  However, this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy D&C taken in the Hospital / Nursing Home and the insured is discharged on the same day, the treatment will be considered to be taken under Hospitalization Benefit. Further this condition will also not apply in case of stay in hospital of less than 24 hours under any of the following circumstances.

 

a)      The treatment is such that it necessitates hospitalization and the   

        procedure involves specialized infrastructural facilities available in   

        hospitals.

 

b)    Due to technological advances hospitalization is required for less  

       than 24 hours only.

 

c)   Surgical procedure is involved.

 

 

10.4              EXCLUSIONS :

 

The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any insured person in connection with or in respect of :-

 

a)               During the first year of the operation of insurance cover, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in anus, Piles, Sinusitis and related disorders are not payable.ysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in anus, Piles, Sinusitis and related disorders are not payable.

 

b)              Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not).

 

c)              Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, Vaccination or inoculation or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.

 

d)              Cost of spectacles and contact lenses, hearing aids.

 

e)               External Medical Equipment of any kind used at home as post hospitalization care including cost of instrument used in treatment

of sleep appnea syndrome (C.P.A.P.) and continuous Peritoneal Ambulatory dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial asthmatic condition.

 

f)                Any dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from disease or injury and which requires hospitalization for treatment.

 

g)              Convalescence, general debility, Run-down condition or rest cure, congenital external disease or defects of anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol.

 

h)              All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus type III (IITLB-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency syndrome or any Syndrome or any condition of a similar kind commonly referred to as AIDS.

 

i)                 Charges incurred at Hospital or Nursing Home primarily for diagnostic, x-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital / Nursing Home.

 

j)                 Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.

 

k)              Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons / materials.

 

l)                 Voluntary medical termination of pregnancy.

 

m)            Naturopathy Treatment.

 

 

11.0              OTHER EXTENSION

 

11.1              MATERNITY BENEFIT

 

The policy is extended to cover actual maternity benefit expenses for the insured upto a maximum limit  of Rs.20,000/- provided treatment is taken by the insured in a Hospital / Nursing Home as in-patient in India only.

11.2               MATERNITY EXPENSES BENEFIT means treatment taken in Hospital / Nursing Home arising from or traceable to pregnancy, childbirth including normal Caesarean Section.

 

11.3              SPECIAL CONDITIONS APPLICABLE TO MATERNITY EXPENSES BENEFIT EXTENSION :

 

a)               These Benefits are admissible if the expenses are incurred in Hospital / Nursing Home as in-patients in India only.

 

b)              A waiting period of 9 months is applicable for payment of any claim relating to normal delivery or caesarean section or abdominal operation for extra uterine pregnancy.  The waiting period may be relaxed only in case of delivery, miscarriage or abortion induced by accident or other medical emergency.

 

c)              Claim in respect of delivery for only first two children and / or operations associated therewith will be considered in respect of any one insured person covered under the Policy or any renewal

 

thereof.  Those insured persons who are already having two or more living children will not be eligible for this benefit.

 

d)              Pre-natal and post-natal expenses are not covered unless admitted in Hospital / Nursing Home and treatment is taken there.

 

12.0              CLAIMS PROCEDURE

 

12.1               Upon the happening of any event which may give rise to a claim,  under any Section of the Policy, the insured / nominee or authorized / legal representative / s as the case may be, is required to give notice thereof to the Policy Issuing Office in writing.

 

12.2               The insured/ nominee is required, within one month of occurrence of the event, to submit claim form to the Policy Issuing Office  and thereafter to give all assistance / cooperation and to furnish information/ documents as required by the company.

 

12.3               Compensation under the policy will be paid in India in Indian currency and will not carry any interest.

 

13.0              PREMIUM

 

a)               Rs.500/- per person for policy period of six months.

b)              Rs.800/- per person for policy period of one year.

c)              Rs.1,500/- per person for policy period of two years.

 

Service Tax as applicable will be extra.

 

14.0              CANCELLATION CLAUSE :

 

14.1               The company may allow cancellation of the policy only in case when the journey is not undertaken subject to production of the original passport as a proof.  The Company will retain Rs. 101/- as cancellation charges.

 

 

 

15.0               This prospectus shall form part of your proposal form, hence please sign as you have noted the contents of this prospectus.

 

Signature:                                           Name & Address:

 

Place:                                                 Date:        

 

16.0              SPECIAL NOTE

 

The prospectus only sets out salient features of the Pravasi Bhartiya Bima Yojana Policy, while the terms and conditions of the policy are set out in detail in a separate document attached to the policy schedule.

THE NEW INDIA ASSURANCE COMPANY LIMITED

REGD. & HEAD OFFICE: 87, M.G. ROAD, FORT, MUMBAI

 

 

      PRAVASI BHARTIYA BIMA YOJANA POLICY

 

1.0     THE NEW INDIA ASSURANCE COMPANY LIMITED having its registered office at 87 Mahatma Gandhi Road, Fort, Mumbai, 400 001 do hereby agree to pay to the insured person as described in the schedule hereto, or his nominee / legal representative/s as the case may be, in consideration of the premium paid by the insured person as stated in the schedule, in respect of any of the perils insured against during the period of the policy as stated therein, and subject to the terms conditions and exclusions of the PRAVASI BHARTIYA BIMA YOJANA POLICY with respect to various sections of the policy as specified in the schedule and  terms conditions and exclusions under individual Sections of the policy as contained herein, such amount as payable hereunder.                      

 

 

2.0     GENERAL CONDITIONS    

 

2.1           Upon the happening of any event which may give rise to a claim under this Policy, the insured / assignee or authorized / legal representative(s) as the case may be, shall forthwith give notice thereof to the Company in writing, in the manner given below :

 

 

a)               Personal accident claims under Section I of the policy and re-imbursement of repatriation/ transport expenses under Section II of the policy shall be lodged with the Policy issuing office of the company mentioned in the policy schedule.

 

 

b)      Hospitalization claims under Section III of the policy shall be lodged with the policy issuing office, the address of which is mentioned in the policy schedule.

 

The insured / nominee shall thereafter within one month of the occurrence of the event, submit the claim form duly filled in all respects, signed and supported by documents relevant to the claim, to the Policy issuing office as stated below :

 

 

          a)   In case of death due to accident:

 

                   (i)Police Report confirming accidental death.

 

                   (ii)Post Mortem Report.

 

                   (iii)Certificate / Report from concerned Indian Embassy.

 

                   (iv)Duly attested copy of passport (all pages).

 

          b)  Permanent Total Disability -              

 

                   (i)Medical records pertaining to treatment following the accident.

 

          (ii)Disability certificate issued by the competent medical

               authority.

 

In case of permanent total disability, the insured person shall, if the Company so desires, also present himself / herself for examination

 

 

 

 

before a medical practitioner to be deputed by the Company to assess the extent of disability suffered by the insured.

 

2.2     The insured / nominee or authorized / legal representative as the case may be, shall thereafter give all assistance and cooperation and furnish such information    and   documents depending on the nature of claim  as    may   be   sought  by  the Company,  inter alia  –

 

a)            Original insurance certificate / policy.

 

          b)  Application form for compensation duly filled in all respects and

                    signed by the claimant.

 

          c)  Copy of passport (all pages) duly attested, if death occurs outside

               India.

 

d)  In case of permanent disability:

(i)  Medical records pertaining to treatment following the accident.

         (ii)  Disability certificate issued by the competent medical

                authority.

 

e)  In case of death due to accident:

(i)  Police Report confirming accidental death.

(ii) Post Mortem Report.

(iii) Certificate / Report from concerned Indian Embassy.

 

f)  In case of permanent total disability, the insured person shall, if the    

     Company so desires, also present himself / herself for examination    

     before a medical practitioner to be deputed by the Company to assess   

     the extent of disability suffered by the insured.

 

2.3     Any compensation under this Policy will be paid in India in Indian currency only.  No sum under this Policy shall carry interest.

 

2.4   If any dispute or difference shall arise as to the quantum to be paid under     this policy (liability being otherwise admitted) such difference shall independently of all other questions be referred to the decision of a sole arbitrator to be appointed in writing by the parties to or if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.

 

It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as hereinbefore provided, if the Company has disputed or not accepted liability under or in respect of this policy.

 

It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy that the award by such arbitrator/ arbitrators of the amount of the loss or damage shall be first obtained.

 

2.5     If the Company shall disclaim liability to the insured for any claim hereunder and if the insured shall not within 12 calendar months from the date of receipt of the notice of such disclaimer notify the Company in writing that he does not accept such disclaimer and intends to recover his claim from the Company then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.

 

 

2.6     The Company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner fraudulent or supported by any fraudulent means or device whether by the insured person or by any other person acting on his behalf. Non co-operation by the insured will nullify the cover under the policy issued.

 

2.7     The company may allow cancellation of the policy only in case where a journey is not undertaken subject to production of the original passport as a proof.  The company will retain Rs. 101/- as cancellation charges.

 

2.8 Policy disputes Clause : Any  dispute  concerning  the interpretation  of  the  terms conditions limitations and/or exclusions contained herein is understood and agreed to by both the Insured and Company  to be

 

 

subject to India Law.  Each party agree to submit to the jurisdiction of any Court of competent jurisdiction within India and to comply with all requirements necessary to give such Court of jurisdiction.  All matters arising hereunder shall be determined in accordance with the law and practice of such Court.

 

3.0     SECTION – I : PERSONAL ACCIDENT BENEFITS

 

If at any time during currency of this policy, as stated in the schedule hereto, and whilst stay abroad, the insured person shall sustain any bodily injury resulting solely and directly from accident caused by external, violent and visible means, then the Company shall pay to the

 

 

 

insured, insured’s nominee or insured’s legal representative(s), as the case may be, the sum or sums hereinafter set forth, that is to say :

 

a)     If such injury shall within twelve calendar months of its occurrence  

     be the sole and direct cause of the death of the insured, the Capital   

     Sum Insured (CSI) of Rs.2 lacs.

b)    If such injury shall within twelve calendar months of its occurrence 

     be the sole and direct cause of the total and irrecoverable loss of :

(i) Sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the Capital Sum Insured of Rs.2 lacs.

 

(ii) Use of two hands or two feet, or of one hand or one foot, or of such loss of sight of one eye and such loss of use of one hand or one foot, the Capital Sum insured of Rs.2 lacs.

 

(iii) If such injury shall, as a direct consequence thereof, immediately, permanently, totally and absolutely, disable the insured person from engaging in any employment or occupation of any description whatsoever, then a lump sum equal to 100% of the Capital Sum Insured.

NOTE :  For the purpose of Cause (b) above, physical separation of a hand means separation at or above the wrist and of the foot at or above the ankle.

 

4.0        SPECIAL ADD ON BENEFIT

 

4.1        FAMILY COVER

 

    The family of the insured in India consisting of spouse and two   

dependent children upto 21 years of age shall be entitled to hospitalization benefit cover for an amount not exceeding Rs. 10,000/- in all, in the event of death or permanent disability of the insured.  Maternity benefit shall however not be available under this extended cover to the insured’s spouse.

 

1.0                   EXCEPTIONS

 

 

             5.1 PROVIDED ALWAYS THAT :

 

             The Company shall not be liable under this Policy for :

 

   a)  Any payment in case of more than one claim under the Policy        

        during any one period of insurance by which the maximum liability

        of the Company in that period would exceed the capital sum insured

        under the Policy.

 

             b) Payment of compensation in respect of death or disablement of the insured person (a) from intentional self-injury, suicide or attempted suicide, (b) whilst under the influence of intoxicating liquor or drugs, (c) whilst engaging in Aviation or Ballooning whilst mounting into, dismounting from or traveling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world, (d) directly or indirectly caused by venereal diseases, Aids or insanity, (e) arising or resulting from the insured person committing any breach of law with criminal intent.

      Standard type of Aircraft means any aircraft duly licensed to carry   

      passengers (for hire or otherwise) by appropriate authority  

      irrespective of whether such an aircraft is privately owned OR  

      chartered OR operated by a regular airline OR whether such an 

      aircraft has a single engine or multi engines.

 

c)      Payment of compensation in respect of Death, Injury or Disablement   

      of the insured person due to or arising out of or traceable to : War,   

      Invasion, Act of foreign enemy, Hostilities (whether war be declared

      or not), threat of war or civil strife in the country of employment and/

      or in the neighbouring country / region, Civil War, Rebellion,

      Revolution, Insurrection, Mutiny, Military or Usurped Power

      Seizure, Capture, Arrests, Restraints and Detainments by kings,

      princes and people of whatever nation, condition or nature.

 

d)    Payment of Compensation in respect of death of, or bodily injury or

     any disease or illness to the insured person :

               (i) directly or indirectly caused by or contributed to by or arising from

                    ionizing radiations or contamination by radioactivity from any  

 

 

                    nuclear fuel or from any nuclear waste from the combustion of

                    nuclear fuel.  For the purpose of this exception, combustion shall

                    include any self-sustaining process of nuclear fission.

 

               (ii)directly or indirectly caused by or contributed to by or arising

                    from nuclear weapon material.

 

              (iii)The total and irrecoverable loss of:

 

                   (A)The sight of one eye, or of the actual loss by physical

                           separation of one entire hand or one entire foot.

                     (B)Total and irrecoverable loss of use of a hand or a foot without

                          physical separation.

 

 

 

PROVIDED also that due observance and fulfillment of the terms and conditions of this Policy (which conditions and all endorsements thereon are to be read as part of this Policy) shall so far as they relate to any thing to be done or not to be done by the

 

 

insured be a condition precedent to any liability of the company under this Policy.

 

e)     Pregnancy Exclusion Clause :  The insurance under this Policy shall

    not extend or cover death or disablement resulting directly or

    indirectly caused by contributed to or aggravated or prolonged by

    childbirth or from pregnancy or in consequence thereof.

 

6.0     SECTION – II :     

 

6.1     (A) RE-IMBURSEMENT OF REPATRIATION / TRANSPORT EXPENSES ON ACCOUNT OF DEATH / PERMANENT TOTAL DISABILITY / TERMINATION OF CONTRACT ON ACCOUNT OF CONTRACTING MAJOR AILMENTS

 

6.2     SCOPE OF COVER :

 

In the event of accidental death of the insured person whilst abroad actual expenses incurred for repatriation of the dead body or transportation charges to India if the contract of employment is

 

 

terminated due to insured person contracting major ailment(s) as defined hereunder or due to permanent total disability of the insured person following an accident whilst abroad including cost incurred on economy class return air fare of one attendant shall be reimbursed.

 

6.3     DEFINITION OF MAJOR AILMENTS :

 

a) Nephritis of any Aetiology plus Bacterial renal failure requiring Kidney Transplantation & Dialysis.

 

b)  Cerebral or Vascular Strokes.

 

c)  Open and Close Heart Surgery (inclusive of C.A.B.G.).

 

d)  Malignancy disease which are confirmed on Histopathological report.

 

 

e)  Encephalitis (Viral).

 

 

f)  Neuro Surgery.

 

g) Total Replacement of joints.

 

h)     Liver disorder (Hepatitis B & C) associated with complications like   

     Cirrhosis of liver.

 

i)        Grievous injury including multiple fracture of long bones, head-injury   

     leading to unconsciousness, burns of more than 40%, injury requiring 

     artificial ventilatory support plus Vertebral Column Injury.

 

6.4     OTHER CONDITIONS

 

a) The repatriation charges / transportation expenses due to termination of  

     service contract on account of major ailments will be considered only   

     when a specialist has diagnosed such disease and treatment is  

     recommended in India.

 

b)  The repatriation charges / transportation expenses on account of 

     permanent total disability will be allowed only for travel of the insured

     / attendant, as the case may be, to India from the country of

 

 

    employment.

 

c)  Cost of airfare of attendant will be considered only if the insured is  

     declared in writing by a competent medical practitioner to be 

     medically and physically unfit to travel alone.

 

d) The expenses for airfare of the insured /attendant as the case may be,

      will be reimbursed only in economy class, one way for the insured,

      and return fare for the attendant (if found necessary by the Company 

     in its sole discretion) to any airport in India nearest to the place of 

     residence of the insured person as mentioned in the proposal form by

     the shortest route.

 

e) The claim for reimbursement for the insured and the attendant shall be

     filed within 90 days of completion of journey.

 

 

 

 

 

 

6.5     B.  REIMBURSEMENT OF REPATRIATION / TRANSPORT

          EXPENSES DUE TO TERMINATION OF CONTRACT OF    

          EMPLOYMENT IN  CERTAIN OTHER CASES

 

On arrival of the insured person at his work place or destination abroad, if he/she is not received by the employer or if there is any substantive change in the job/Employment Contract/agreement to the disadvantage of the Insured person, or if the employment is prematurely terminated within three months for no fault of the insured person, the Company shall re-imburse one-way Economy Class airfare provided the grounds for repatriation are certified by the concerned Indian Mission/Post and the Air-tickets are submitted in original.

 

6.6                   EXCLUSIONS

 

The Company shall not be liable to make any payment under this sub-section of the Policy if the repatriation of the insured person is on account of –

 

 

 

a)  violation of any law, fraud, or any breach of employment conditions.

 

b)     such repatriation becomes necessary due to any amendment or change

     in the existing laws of the country of employment, or proclamation by   

     Government Order that all workers of foreign origin are being   

    deported,

 

c)     the employment is obtained through fake or forged documents, work

     permit or improper entry visa.

 

d)     the entry into the country has been made without completing legal

     formalities for whatsoever reason.

 

e)      no attempt being made by the insured person to contact his employer on arrival if the insured person is not received at such time,

 

 

 

 

          f)       the entry into the country has been refused on medical grounds,

 

g)       short term contracts i.e. contracts for the period of less than 3 months.

 

 

6.7                   GENERAL EXCEPTIONS

 

PROVIDED ALWAYS THAT :

 

The Company shall not be liable under this Policy for :

 

a)     Any repatriation charges / deportation expenses necessitated by

     termination of contract of the insured if such expenses are to be borne

 

 

     by the employer as per employment contract.

 

b)    Any repatriation charges / transportation expenses necessitated by

               termination of contract of the insured and consequent deportation on

               account of misconduct, commission of any criminal offence, etc.

 

c)     Clauses (a) to (e) of the exceptions under Section I shall apply mutatis 

 

 

     mutandis to this Section to the extent applicable.

 

 

7.0     SECTION – III    :     HOSPITLISATION COVER

 

7.1    SCOPE OF COVER

 

If at any time during currency of this policy, the insured person whilst stay abroad shall contract any disease or suffer from any illness or sustain any bodily injury through accident and if such disease or injury shall require any such insured person, upon the advice of a duly qualified medical practitioner or duly qualified surgeon to incur hospitalization expenses for medical / surgical treatment at any nursing home / hospital in India as an inpatient, the Company will pay to the insured person / his nominee / legal representatives as the case may be, the amount of such

 

 

 

expenses as are reasonably and necessarily incurred in India in respect thereof by or on behalf of such person maximum upto Rs.50,000/- in Indian currency only.

 

7.2     DEFINITIONS :

 

7.3     HOSPITAL / NURSING HOME means any Institution in India established for indoor care and treatment of sickness and injuries and which

 

Either

 

a)     has been registered either as a Hospital or Nursing Home with the

     local  authorities and is under the supervision of a registered and  

     qualified Medical  Practitioner.

 

          OR

 

      

 

          b)  Should comply with minimum criteria as under :-

 

     (i)It should have atleast 15 in-patient BedsIn Class ‘C’ towns  

   condition of minimum number of beds would be 10.

 

 

 

              (ii)Fully equipped operation theatre of its own wherever surgical

         operations are carried out.

 

             (iii)Fully qualified Nursing Staff under its employment round the

          clock.

 

            (iv)Fully qualified Doctor(s) should be incharge round the clock.

 

The term “HOSPITAL / NURSING HOME” shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place for alcoholics, a hotel or a similar place.

 

 

 

7.4     Expenses on Hospitalization for minimum period of 24 hours are admissible.  However, this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy D&C taken in the Hospital / Nursing Home and the insured is discharged on the same day, the treatment will be considered to be taken under Hospitalisation Benefit.  Further this condition will also not apply in case of stay in hospital of less than 24 hours under any of the following circumstances.

 

a)     The treatment is such that it necessitates hospitalization and the  

      procedure involves specialized infrastructural facilities available in

      hospitals.

b)    Due to technological advances hospitalization is required for less than   

     24 hours only.

 

          c)  Surgical procedure is involved.

 

7.5     EXCLUSIONS :

 

The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any insured person in connection with or in respect of :-

 

 

a)     During the first year of the operation of insurance cover, the expenses

     on treatment of diseases such as Cataract, Benign Prostatic

     Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia,

 

 

     Hydrocele, Congenital Internal Disease, Fistula in anus, Piles,

     Sinusitis and related disorders are not payable.

 

b)    Injury or disease directly or indirectly caused by or arising from or 

     attributable to War, Invasion, Act of Foreign Enemy, War like   

     operations (whether war be declared or not).

 

c)     Circumcision unless necessary for treatment of a disease not excluded

     hereunder or as may be necessitated due to an accident, Vaccination   

     or inoculation or cosmetic or aesthetic treatment of any description,

 

 

     plastic surgery other than as may be necessitated due to an accident or

     as a part of any illness.

 

d) Cost of spectacles and contact lenses, hearing aids.

 

f)       External Medical Equipment of any kind used at home as post

     hospitalization care including cost of instrument used in treatment of

     sleep appnea syndrome (C.P.A.P.) and continuous Peritoneal

     Ambulatory dialysis (C.P.A.D.) and Oxygen Concentrator for

     Bronchial asthmatic condition.

 

g)     Any dental treatment or surgery which is a corrective, cosmetic or

     aesthetic procedure, including wear and tear, unless arising from

     disease or injury and which requires hospitalization for treatment.

 

h)     Convalescence, general debility, Run-down condition or rest cure,

     congenital external disease or defects of anomalies, sterility, venereal

    disease, intentional self-injury and use of intoxicating drugs / alcohol.

 

f)      All expenses arising out of any condition directly or indirectly caused

     to or associated with Human T-Cell Lymphotropic Virus type III

     (IITLB-III) or Lymphadinopathy Associated Virus (LAV) or the

     Mutants Derivative or Variations Deficiency syndrome or any

     Syndrome or any condition of a similar kind commonly referred to as

     AIDS.

 

g)     Charges incurred at Hospital or Nursing Home primarily for

     diagnostic, x-ray or laboratory examinations not consistent with or

     incidental to the diagnosis and treatment of the positive existence or

     presence of any ailment, sickness or injury, for which confinement is

 

 

     required at a Hospital / Nursing Home.

 

j)        Expenses on vitamins and tonics unless forming part of treatment for    

     injury or disease as certified by the attending physician.

 

k)     Injury or Disease directly or indirectly caused by or contributed to by

     nuclear weapons / materials.

 

 

 

l)   Voluntary medical termination of pregnancy.

 

        m)   Naturopathy Treatment.

 

8.0     OTHER EXTENSION:

 

8.1     MATERNITY BENEFIT

 

The policy is extended to cover actual maternity benefit for the insured upto a maximum limit of Rs.20,000/- provided treatment is taken by the insured in a Hospital / Nursing Home as in-patient in India only.

 

8.2       MATERNITY EXPENSES BENEFIT means treatment taken in   

          Hospital / Nursing Home arising from or traceable to pregnancy,   

          childbirth including normal Caesarean Section.

 

8.3     SPECIAL CONDITIONS APPLICABLE TO MATERNITY EXPENSES BENEFIT EXTENSION:

 

a) These Benefits are admissible if the expenses are incurred in Hospital /

     Nursing Home as in-patients in India only.

 

b)    A waiting period of 9 months is applicable for payment of any claim

     relating to normal delivery or caesarean section or abdominal   

    operation for extra uterine pregnancy.  The waiting period may be

     relaxed only in case of delivery, miscarriage or abortion induced by

     accident or other medical emergency.

 

c)     Claim in respect of delivery for only first two children and / or 

     operations associated therewith will be considered in respect of any

     one insured person covered under the Policy or any renewal thereof. 

     Those insured persons who are already having two or more living

 

 

     children will not be eligible for this benefit.

 

d)    Pre-natal and post-natal expenses are not covered unless admitted in

     Hospital / Nursing Home and treatment is taken there.

 

 

 

 

 

 

9.0     NOTICE OF CLAIM

 

 

9.1     Preliminary notice of claim with particulars relating to policy numbers, name of insured person in respect of whom claim is made, nature of illness/injury and Name and Address of the attending medical practitioner/Hospital/Nursing Home should be given to the Policy issuing Office within 7 days from the date of hospitalization.

 

9.2     Final claim alongwith hospital receipted original Bills/Cash memos, claim form and list of documents as listed in the claim form etc. should be submitted to the Policy issuing Office not later than 30 days of discharge from the hospital.  Also give the Company such additional information and assistance as the company may require in dealing with the claim.

 

10.0   PAYMENT OF CLAIM

 

All admissible claims should be payable in Indian Currency only.

THE NEW INDIA ASURANCE COMPANY LIMITED

Regd. & Head Office : New India Assurance Bldg., 87, M.G. Road, Fort, Mumbai–400 001

 

     Proposal Form for Pravasi Bhartiya Bima Yojana Policy

 

 

ELIGIBILITY :

 

This Insurance is specially designed for Indian citizens between the age group of 18 years to 60 years and going abroad for the purpose of employment for the period of their stay abroad on valid visa.

IMPORTANT NOTICE :

 

This Proposal Form must be completed and signed to the best of the proposer’s knowledge and belief and all material facts* must he disclosed. 

·        A material fact is one of that is likely to influence the acceptance or assessment of the Proposal.

·        Non-disclosure of facts material to the assessment of the risk, providing misleading information, fraud or non-cooperation by the insured will nullify the cover under the policy issued.

1.0       PERSONAL DETAILS :

1.1       Name(Mr/Mrs/Miss): ___________________________________________________

            (BLOCK LETTERS)

1.2       Father/Spouse’s Name : _________________________________________________

1.3       Sex : Male / Female : _______________

1.4       Date of Birth : _____ / _____ / ________        Age_____________________________

                                    DD       MM       YYYY                     

1.5       Height : ______ ft. _______ inch (________cms.)       Weight : ______lbs _____(Kgs.)

1.6       Passport No. : _________________________________________________________

1.7       a) Date of Issue : ____/____/_____   b) Place of Issue : ________________________

                                       DD     MM  YYYY             

1.8       Type of Visa Held:_____________________________________________________

1.9       Address of the proposer in India : _________________________________________

Pin Code : _____________________                     Tel. No. : ____________________

1.10     a) Details of Spouse and / or children of the Proposer (maximum two) :

           

Name

Age / Date of Birth

Relationship

Spouse

     

1st  Child

     

2nd Child

     

b)     Address : ______________________________________________________________

          ______________________________________________ Tel. No. : _______________

2.0       Country of Employment:_________________________________________________

2.1              Address in Country of Employment ________________________________________

_____________________________________________________________________

            __________________________________ Tel. No. : __________________________

2.2       Name & Address of work place the proposer is attending : ___________________    Tel. No. ___________________

3.0       a) Brief details of employment to be undertaken: ____________________________

             ____________________________________________________________________

             ______________________ Tel. No. :  _____________________________________

b) Period of Contract From _______________________  to __________________________

(note:  please attach attested copy of the appointment letter of overseas employer)

3.1 Name & Address of Overseas Employer / Sponsor : ______________________________

___________________________________________________________________________

Relationship : ____________________________

4.0       Period of Insurance Required : ____________________________________________

4.1       Commencement Date : _________ / __________ / ______________

                                                     DD                MM                 YYYY

5.0   PROPOSER’S MEDICAL HISTORY :

       ANSWERS TO THE FOLLOWING QUESTIONS ARE TO BE GIVEN AS YES OR   NO (A DASH IS NOT SUFFICIENT)

5.1  Is the proposer in good health and free from physical defect or infirmity ? ___________________

5.2    Does the proposer ordinarily enjoy good health ?

       ________________________________

5.3       Are there any additional facts affecting the proposed insurance which should be disclosed to insurers ? ________________________________________________________

6.0  Please attach a copy of the Medical Report of the Proposer, if any, which was required for Entry Visa.

7.0       DECLARATION :

I hereby declare that the above answers are true to the best of my knowledge and belief that I have disclosed all particulars affecting the assessment of the risk.  I agree that this PROPOSAL and DECLARATION shall be the basis of the contract between me and the Company.

Date : _____ / _____ / ________

             DD      MM     YYYY                        Signature of Proposer____________________

Place : _____________

8.0       ASSIGNMENT :

I, ______________________________________________ do hereby assign the moneys payable by The New India Assurance Company Limited, in the event of my death to Mr./Mrs. (Name) _____________________________________________ (relation to the

insured) ________________________________ and I further declare that in the event of death of the Assignee named herein all benefits shall become payable to the children named in the Policy and I further declare that his / her / their receipt shall be sufficient discharge to the Company.

Date : _____ / _____ / ________

             DD      MM     YYYY                        Signature of Proposer____________________

Place : _____________

UNDERTAKING

I, Mr/ Mrs/ Miss______________________________________ do hereby solemnly declare and state that all information given above are true and correct to the best of my knowledge.  In case any such information is found at any time in future to be false or misleading or it is found by the insurer that I have not disclosed any fact which is material to the assessment of the risk, the insurance cover granted to me shall be deemed to be null and void and I shall not be entitled to any benefit thereunder.

Date : ____ / _____ / _______                        Signature of Proposer_____________________

           DD        MM     YYYY

Place : __________________

PROHIBITION OF REBATES

 

Section 41 of the Insurance Act, 1938 :

(1)        No person shall allow, or offer to allow, either directly or indirectly as an inducement of any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on this policy, nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.

(2)        Any person making default in complying with the provisions of this section shall be punishable with fine which may extend upto five hundred rupees.

THE NEW INDIA ASURANCE COMPANY LIMITED

Regd. & Head Office : New India Assurance Bldg., 87, M.G. Road, Fort, Mumbai–400 001

Claim form for Pravasi Bhartiya Bima Yojana

 

Name of Claimant:   Mr. / Mrs._______________________________________________

Home address and

Telephone No. in India        __________________________________________________

                                                ________________________________________________

PERSONAL DETAILS OF INSURED PERSON:

Name Mr. / Mrs.______________________________________________Age__________

Insurance I.D. No.__________________________Valid from __________ to __________

Occupation____________________________Country of Eomployment_______________

POLICY SECTION RELATING TO CLAIM (Tick Boxes)

Section  -  I     (Personal Accident Benefits)                                                     


Section  -  II    (Re-imb. of  Repatriation/Transportation Exp.)              


Section  -  III   (Hospitalization Benefits)                                                          


Section  -  IV   (Re-Imbursement of One Way Air-fare)                                   


Section  -  V    (Family Floater Hospitalization Cover)

Date of Injury / Illness______________________________________________________

Nature of Injury / Illness____________________________________________________

Place of Injury / Illness______________________________________________________

Details of Expenses Claimed_________________________________________________

________________________________________________________________________

________________________________________________________________________

PLEASE COMPLETE APPROPRIATE SECTION OF CLAIM FORM AND READ CAREFULLY THE INSTRUCTIONS RELATING TO SUPPORTING DOCUMENTS REQUIRED.  WHEN COMPLETED PLEASE SIGN DECLARATION:

I declare that to the best of my knowledge all particulars contained in this form are true.  I also authorize _______________________ Third Party  Administrator to obtain my medical records or information necessary to process the claim.

Date ______________________  Place________________   (Signature) ________________

         

DOCUMENTS REQUIRED:

The following documents must be enclosed with your completed claim form:

1.      Copy of Insurance I.D. Card                                              ) Applicable for all type

2.      Attested copy of Pass Port (All pages)                                ) of claims

3.      Death Certificate issued by the Competent Authority           )

4.      Post Mortem Report                                                           )Applicable for Accidental

5.      Certificate/Report of the concerned Indian Embassy            )Death cases only

Confirming the accidental death                                           )

6.   Police Report                                                                     )

7.   Disability Certificate issued by the Competent Medical         )Applicable for Permanent

Authority alongwith other relevant medical documents         )Total Disability claim

8.   Air-lines tickets alongwith medical advices for the               )

      accompanying person, if applicable                                     )

9.      Certificate from the Competent Medical Authorities            )Applicable for claims lodged

Confirming that the insured person contracted the                )under Sections II & IV only

Major Ailment(s) during the period of employment             )

Contract, if applicable.                                                       )

10.  Documentary proof confirming that service contract            )

Of the insured person is terminated on account of the           )

Insured perils only                                                               )

11.  Hospital discharge summary alongwith Bill(s)/Cash              )

Memo, Prescription, Investigation Report(s) etc. in              )Applicable if treatment not

Original if during the period of work contract,                      )taken in the Networking

If applicable.                                                                       )Hospital

The required documents must be supplied with the Claim Form duly completed in all respects by the Claimant at his / her expense. The claimant shall also provide such further documents and information as may be sought by the Company from time to time. Failure to do so will delay the processing of your claim and could result in it being declined.

 

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