Biz 200 plan

Dear customer,
Welcome to Himalayan Everest Insurance.

This document provides all details of the hospitalisation benefits you have subscribed to, and how you can avail them if needed. Stay safe!

Benefits

1. You are eligible for hospitalisation benefits of NPR 1000 per night of hospitalisation, upto a maximum of 10,000 rupees per 15 days and subject to the terms mentioned in this document
2. The eligibility starts when your data with insurance benefit pack is activated.
3. To claim hospitalisation, the hospitalisation needs to be for a minimum of one night during the eligible period
4. You are eligible for a claim if the hospitalisation happens within 15 days of activation of the data pack
5. In case the hospitalisation starts within this 15 day validity but extends beyond it, you will be covered only for the number of days falling within this validity period
6. The claim amounts is a per diem amount and is regardless of the actual medical bill that the customer is paying
7. To claim, you need to be between 18-60 years of age

Terms & Conditions

1. This policy only covers hospitalisation in hospitals registered under Nepal Government, and which offer 24 hours nursing facility.
2. Routine eye tests dental treatment or other examination and/or tests not incidental to treatment or diagnosis of an insured injury sickness or disease are not covered
3. Pregnancy complications of pregnancy miscarriage abortion birth control sterilisation or infertility treatment are not covered
4. Mental or nervous breakdown congenital or hereditary defects or conditions HIV/AIDS or any sexually transmitted disease, alcoholism or substance abuse self-inflicted injury suicide or any attempt thereat organ transplants elective surgery or any pre-existing condition (a pre-existing condition shall mean any condition which manifested itself, or for which treatment was rendered during the 12-month period preceding the effective date of an Insured persons coverage) are not covered
5. Prostheses cosmetic plastic or reconstructive surgery unless as a result of an insured accidental injury are not covered
6. Hospitalisation directly or indirectly occasioned by or through or in consequence of riot strike civil commotion.
7. Hospitalisation directly or indirectly occasioned by war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection by military, or usurped power are not covered
8. Hospitalisation expenses incurred outside of Nepal are not covered
9. Hospitalisation expenses incurred where the Insured Person has been resident outside of Nepal for more than 90 consecutive days in any one period of insurance are not covered
10. Hospitalisation expenses incurred for any person over the age of sixty (60) or below eighteen(18) are not covered
11. Expenses incurred where the Insured Person has been in violation of the laws of Nepal are not covered
12. Covid-19 / Coronavirus claims will carry an exclusion period of 15 days and will be paid in accordance with the terms mentioned above
13. Customer should not be hospitalised on the day of data pack activation
14. Hospitalisation should not be planned

Claim Process

1. Please call up 9801575858 (toll free) or 9801969214/9801969215/9801969216 with your basic details ready. Calls will be answered between 10am and 5pm. All calls outside these times will be responded to within 24 hours.
2. You will be asked for
   1. Dates of hospitalisation
   1. Personal details (citizenship number, address, email etc)
   1. Banking details for claim processing
3. You will need to submit digital copies of all relevant documents such as
   1. Claim form signed by the claimant
   1. Hospital discharge summary
   1. Nagarikta patra
   1. Scanned copy of cash bills (Tax invoice) incurred for the treatment
4. These details can be sent to HEI through email, Viber or Whatsapp
5. Once a claim is registered, you will be given a reference number (also sent to you via SMS)
6. After the claim is processed, you will get a call from Himalayan Everest Insurance with the decision and details on how to receive the claim amount.

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