eSewa Life Care:
Terms & Conditions:
• The Customer is eligible for a Critical Illness claim only after 90 days of the policy issued and s/he can inform the CI after 30 days of diagnosis of the Illness.
• Accidental Claims can be requested only after 24 hours of the purchase.
• Accidental Claims must be notified within 35 days after paying the bills.
• Every hospital, that are legally registered under Nepal Government will be counted for the claim.
•The customer has to carry eSewa Care or eSewa Life Care’s payment proof for the redemption of benefits.
• Customers must provide the necessary documents asked for by Insurance Companies to claim for the Insurance Services.
• Can be purchased from Age 18 years to 45 years only.
• Original documents are required for the claim process.
Illness covered in Critical Illness (CI) through eSewa Life Care are as follows:
- Cancer (क्यान्सर)
- Kidney Failure (मृगौलाफेल हुनु)
- Primary Pulmonary Arterial Hypertension (प्राइमरीपल्मनरी आर्टरीयल हाइपरटेन्सन)
- Heart Valve Surgery (मुटुकोभल्भ सर्जरी)
- Multiple Sclerosis (मल्टिपलस्क्लेरोसिस)
- Coronary Artery Bypass Graft (कोरोनरीआर्टरीयल बाइपास ग्राफ्ट)
- Aorta Graft Surgery (आओर्टाग्राफ्ट सर्जरी)
- Stroke (स्ट्रोक)
- Myocardial Infarction or First Heart Attack (पहिलोहृदयघात वा म्योकार्डियल इन्फ्राक्शन)
- Coma (कोमा)
- Total Blindness (पूर्णअन्धोपन)
- Paralysis (प्यारालाइसीस)
- Bening Brain Tumor (बेनाइनब्रेन ट्यूमर)
- Mental illness due to accident (दुर्घटनाकोकारण भएको मानसिक रोग)
- Major Organ Transplant (महत्वपूर्णअंग प्रत्यारोपण)
The insured Nominee should intimate the claim process immediately once the event has occurred
- Insured Policy Paper
- Insured and Nominee National Identity cards like citizenship, Passport, national ID
- Application by Nominee
- Nominee relationship certificate
In the case of Death by Illness
- Medical reports
In the case of Death by Accident
- Police Report and Ground Report
- Hospital Report
In case of Natural Death
- Death certificate by local government
Required Document
- Insured Policy Paper: provided in an email by Sun Nepal Life Insurance
- Insured and Nominee National Identity cards like citizenship, Passport, national ID
- Application by Insured/Nominee
- In case of the claim intimated by the Nominee, the Nominee relationship certificate
- Medical reports and hospital certificate regarding CI
- Cancelled cheque
eSewa Care:
Terms & Conditions:
- Only treatment carried out in hospitals will be eligible for claims.
- Claim can be requested only after 24 hours of the purchase.
- Notify within 35 days after paying the bills.
- Can be purchased from Age 2 years to 60 years only.
- Every hospital, that are legally registered under Nepal Government will be counted for the claim.
- Original documents are required for the claim process.
Claim segregation:
- Accidental Treatment: Up to Rs. 100,000/-
- Hospital Bed Charge: Up to Rs. 10,000/- (per day Rs. 1,000/- for 10 days)
- Accidental Death: Rs. 100,000/-
- Funeral Expenses: Rs. 10,000/-
- Funeral Transportation: Rs. 10,000/-
Required Documents:
- Claim Form: will be provided after contacting eSewa/Himalayan Everest Insurance
- Accidental Treatment:
- Doctor’s prescription
- Hospital Card
- Payment bills
- Police report (in case of Road Accident)
- Hospital Bed Charge:
- Hospital admission document
- Discharge summary
- Payment bills
- Accidental Death, Funeral Expenses & Funeral Transportation:
- Death certificate
- Police report (in case of Road Accident)
- Payment bills
Wallet Insurance Terms & Conditions:
Wallet Insurance makes sure you get:
.Maximum coverage per event of Rs. 20,000.
.You can claim up to 2 times per year.
.Premium: 50 Rs per year.
Claim Settlement Process
Here’s how to file a claim in case of a fraudulent incident:
.Claim Intimation: Request and submit a claim notification to eSewa/Himalayan Everest Insurance (HEI) within 48 hours of the event occurrence.
.Police Report: File a complaint with the police station regarding the incident.
.eSewa will review your claim details and share them with HEI.
.HEI Assessment: HEI will assess your claim and request additional documents (from eSewa/police) if needed.
.Client Consultation: HEI may consult you for further details about the incident.
.Claim Payment: Upon confirmation, HEI will issue a discharge voucher for the claim amount. This amount will be credited directly to your eSewa wallet.
EXCLUSIONS AND LIMITATIONS:
Here are the major exclusions:
.Fraudulent activities related to the purchase of goods and services are not covered.
.Fraud resulting from the hacking of social media accounts, whether it’s your own account or someone else’s, is excluded from coverage.
.Further Limitations Include:
1. Subsequent loss that arises out of the theft of Card, or captured information by any means from the Mobile;
2. Loss caused by an officer or employee of the bank or financial institution;
3. Any incident giving rise to a loss or potential loss involving the Insured Person ‘s family members as perpetrators of the Robbery (for purposes of this exclusion, family members include relatives as far removed as first cousins);
4. Any costs, charges or expenses incurred by the Insured Person or by any financial institution in establishing the existence of loss or potential loss provided under the Policy or as a party to any legal proceeding, whether such legal proceeding exposes the Insured Person to loss covered by this Policy;
5. Mobile Phone left unattended;
6. Any loss resulting from use of a Mobile Phone for any reason other than the loss of funds from a mobile phone that is stolen;
7. Loss resulting from the voluntary giving or surrendering of funds in any exchange or purchase;
8. Any loss resulting from the use of a Mobile Phone by anyone other than the Insured Person;
9. Damages of any type for which the Insured Person is legally liable, except
compensatory damages, but not multiples thereof, arising directly from a
loss covered under this Policy;
10. Indirect or consequential loss of any nature;
12. Subsequent loss that arises out of the theft of any Mobile Phone;
Benefits
The stolen amount withdrawn via the Insured Person’s personal mobile telephone will be payable provided the Robbery is reported to the police and the Insured Person’s bank after 1 week of its occurrence, and the following documentation is produced upon submission of a claim:
1. A copy of the police report and a self-declaration of the police complaint
2. The IMEI Number of the phone;
3. A fully completed claim form dated and signed by the Insured Person;
4. A copy of the bank receipt to the bank statement showing the amount withdrawn,
Time and date; and
5. Confirmation from the financial institution records that the Transaction occurred at the time, date and stated location; or
6. In the case of a personal mobile phone Robbery, confirmation from the
financial institution records that the transaction occurred at the time, date and
stated location.