Critical Illness Coverage

• Age: Above 16 to below 60 years
• Monthly Minimum Balance: 
          • Special Salary Account: NPR 25,000.00
          • All other Savings Account: NPR 100,000.00
• All the existing account holders has to enroll, to get this benefit

• Who is eligible for this Insurance plan?

  This Insurance plan covers all new & existing saving accountholders who are natural person with good health and age 16 years completed and not reached 60 years, who maintain minimum required balance in whole month and who signs “Health Declaration”.The critical illness coverage for eligible saving accountholders commences only after the Waiting Period of 30 days from the date of enrollment into individual coverage.  

  All eligible new & existing saving deposit account holders - after the Policy is in effect – will be enrolled into this insurance plan commencing the coverage from the first day of the following month (Bikram Sambat) of account opening or subject to meeting above criteria or requirements. 

  Please contact or visit our branch offices for detail of this scheme.

• What is waiting period of 30 days?

  Critical Illness coverage shall not be effective or does not cover the insured for the first 30 days from the date of enrollment into individual coverage.

• 3. What is the insurance coverageand exclusions under this plan?

  i. This covered Critical Illnesses under this plan are Major Cancers, Stroke, First Heart Attack, Serious Coronary Artery Disease, Heart Valve Surgery,Primary Pulmonary Hypertension. (Coverage amount equal to Rs. 300,000) The covered Critical Illnesses under this plan are listed and defined in the Policy under “Definition of Critical Illness."

  ii. Term Life (Coverage amount equal to Rs. 25,000) Pre-existing medical conditions related to critical illnesses are excluded in addition to other exclusions stated in the policy. For detail of the insurance coverage and exclusions, please refer to “Summary of Insurance Coverage"

• Who is your Insurance Partner of this Plan?

  Our Insurance Partner of this Plan is American Life Insurance Company, MetLife Nepal.

• Is coverage effective at work, at home or during vacation and travelling in & out of country?

  Yes. The coverage under this plan provides 24 hours a day and 365 days a year worldwide protection.

• Should the accountholders submit the Critical Illness treatment bills for reimbursement of medical expenses?

  
  No. Bills are not required. Only diagnosis documents and physician statement are required for claim. It’s simple. 

• Should the account holders pay for enrollment under this Insurance Coverage plan?

  No. Eligible Accountholder should not pay any cost.  The Bank itself will pay the premium for insurance coverage on behalf of eligible accountholders. 

• I have already purchased Life and Critical Illness policies. Am I still eligible for the coverage under this plan?

  Yes. You are eligible for the Insurance coverage. 

• Will my family be covered under my Insurance coverage from my account?

  No. Family members are not eligible. The family members who are eligible as mentioned above (1) can participate under this plan opening separate new saving account on their names.  

• Are accountholders who have been already suffering or receiving treatment from Cancer, HIV / AIDS, Kidney, Liver or Lungs Disorder, Brain Diseases, Heart or Blood Diseases or other covered Critical Illness of which any signs or symptoms already occurred eligible for this coverage under this plan?

   
  No. Such accountholders are not eligible to signthe Health Declaration Form and not eligible for enrollment under this plan. In such pre-existing conditions, no insurance benefit or claim shall be payable.

• Will my insurance coverage continue if my saving account balance falls below the required minimum balance in any single day of month or in case of account closure?

  No. The coverage discontinues on both cases.

   

• How many times a claimant will be eligible for Critical Illness claim?

  Critical Illness claim is payable only one time in insured’s life.

• Does Critical Illness and Term Life coverage on Insured continue after the payment of Critical Illness Claim amount?

  
  Critical Illness coverage on Insured shall be terminated after the payment of Critical Illness benefit to the insured and such insured shall not be eligible for Critical Illness coverage thereafter. However, Term Life coverage on such insured can be continued as long as the Group Master Policy is in force and his or her enrollment is active. 

• Who will get the claim amount in case of death of insured accountholder?

  In case of death of insured accountholder, the insured amount under Term Life shall be paid in lump-sum to insured’s legal heir.

• The insured is out of country for treatment of Critical Illness for long time. Can she or he claim for insurance coverage under this plan anytime?

  The valid claims per the Critical Illness definition mentioned in Policy “Definition of Critical Illness” shall be paid if the claimant provides all documents with proof of diagnosis to the Insurance Company within one (1) year from the date of diagnosis of Critical Illness or loss of life. 

• If insured accountholder dies during treatment of Critical illness before Critical Illness claim is filed to the Insurance Company, can beneficiary or legal heir claim for Critical Illness and Term Life?

  Critical Illness claim is paid if the Insured accountholder is diagnosed to be suffering from a critical illness listed and defined in Policy “Definition of Critical Illness” while insured is still living at the time of diagnosis subject to applicable waiting period and Pre-existing conditions. In case of death of such insured after the diagnosis, the insured amount under Term Life shall also be paid in lump-sum to insured’s beneficiary or legal heir.

   

   

• How do I make a claim?

  Claim process and required claims are mentioned in “Claim Requirements”  , Claim Form Death , Claim Form CI Disability, Physician Statement CI Disability  . Please contact our branch office for assistance.

• What are the documents required for claim filing?

  The claim process and list of required documents for claim is mentioned in “Claim Requirement”. Please contact our branch office for assistance.

• How long will it take to receive claim amount?

  Claim payment in normal course, except exceptions will be 10 - 15 working days for valid claims from the date of complete claim documents receipt from the claimant.

   

• Does any tax apply to claim amount?

  Tax does not apply to the Death claim amount, however as per the Nepal Income Tax Act, the TDS tax 5% is applicable on Critical illness claim amount currently and such tax rate is subject to change as per amendments on such act by Nepal Government.