Docstoc

Regd

Document Sample
Regd Powered By Docstoc
					              The New India Assurance Company Limited
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.




                                                                                              1
.
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.



                                                                               2
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.




                                                                           3
      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.

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



                                                                               4
           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




                                                                                  5
       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.




                                                                                 6
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.




                                                                                 7
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




                                                                        8
            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.




                                                                               9
       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.




                                                                            10
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)




                                                                                 11
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




                                                                           12
      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




                                                                                 13
        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.

2.8Policy 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




                                                                                14
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.




                                                                                 15
          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.

5.0   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




                                                                                16
   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




                                                                           17
            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).




                                                                              18
      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.




                                                                                  19
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,




                                                                                20
      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




                                                                                21
      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 Beds. In 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.




                                                                              22
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,




                                                                                 23
   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.




                                                                            24
       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.




                                                                                 25
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.




                                                                           26
        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:_____________________________________________________




                                                                                                27
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 : ____________________________________________




                                                                                      28
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 : _____________




                                                                                               29
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.




                                                                                                30
     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_________________________________________________

________________________________________________________________________
________________________________________________________________________




                                                                                             31
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) ________________




                                                                                          32
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.




                                                                                            33

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:1/31/2012
language:
pages:33