GoodHope Family Life-Circle Package

GoodHope Family Life-Circle Package

Benefit Schedule of Family Circle Package

*** Period: 1 Year & Covered Persons: Prime Member, Spouse, 1/2 Kids.

Product Features

• Eligibility

  • Any Bangladeshi national having sound physical & mental health

  • Age limit for adult members is 18 to 60 years and child age limit is 1 to 18 years

  • Life coverage is entitled to Primary Insured only

• Waiting Period

  • 15 days waiting period after purchasing the pack will be applicable for claiming any medical benefits under Medical Insurance

  • 24 hours hospital confinement will be applied for claiming under Hospitalization coverage

Terms & Conditions

• Death Coverage

  • Death due to any reason except HIV Aids and Suicide

  • Accidental death while involving in any unlawful activity will be excluded.

  • Death due to any pre-existing disease or conditions

  Note: pre-existing condition refers to any type of disease or disability, both physical and mental, of an insured which was diagnosed and/or treated before purchasing GoodHope Family Circle Package.

• Hospital Cash Back

  • Maximum 3 days of hospitalization will be covered in a single confinement (3 days of hospitalization at a stretch will be covered)

  • Maximum 30 days of hospitalization will be covered in the coverage period

  • Maximum hospital cash back per year shall not exceed maximum limit of Hospitalization Plan

  • One (01) hospitalization coverage will be allowed per month

• OPD Cash Back

  • Consultation fees cash back will be allowed for Specialist Doctors (FCPS, MD, FRCS) only

  • Consultation fees cash back will be BDT 500 for package A, BDT 1,000 for Package B & BDT 1,000 for Package C per visit

  • Maximum (02) two consultation fee cash back will allowed within the coverage period

  • Cash back for medical investigation/ diagnosis will be BDT 500 for package A, BDT 1000 for Package B & BDT 2000 for Package C per investigation

  • 02 (Two) investigation/diagnostic tests cash back will be allowed within the coverage period

  • Maximum cash back for per OPD claim will not exceed 50% of maximum package limit (1 consultation fee and 1 investigation bill)

  • One (01) OPD coverage will be allowed per month.

• Critical Illness

  In case of occurring any of the following Critical illness(s)/ Major Disease(s), CLICL will pay lump sum amount as per Sum Assured to the insured at a time. This claim shall be paid upon the result of the diagnostic test(s) of the Insured. Waiting period for CI is 90 days from the date of inception.

  • Myocardial Infarction (Heart Attack):The death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis for this will be evidenced by all the following criteria:
    
    i. Recent history of typical chest pain
    ii. New ECG changes
    iii. Elevation of cardiac enzymes, Troponins or other biochemical markers

  • Stroke: Cerebrovascular Disease due to an illness or accidental traumatic to the brain producing neurological deficit lasting more than 24 hours. Diagnosis has to be confirmed by typical clinical symptoms and by CCT scan or MRI of the brain. Evidence of neurological deficit for at least 3 months has to be produced.

  • Cancer: Clinical condition manifested the presence of malignant disease characterized by uncontrolled growth and spread of malignant cell and invasion of tissues. The term ‘cancer’ shall also include breast cancer, leukemia and malignant disease of the lymphatic system such as Hodgkin’s disease.

  • Kidney Failure: Renal end stage due to chronic irreversible failure of both the kidneys to function which must be evidenced by regular renal dialysis or have undergone renal transplant.

  • Major Organ Transplantation: Irreversible failure of the organ to function normally resulting in an end-stage phase. It will include kidney, heart, liver, lung, pancreas and bone marrow transplant.

  • Multiple Sclerosis: Unequivocal diagnosis of Multiple Sclerosis by a consultant neurologist holding such an appointment at an approved hospital. This must be evidenced by the typical clinical symptoms of demyelization and impairment of motor and sensory functions as well as by typical MRI findings.

  For proving the diagnosis, the Policyholder must either exhibit neurological abnormalities that have existed for a continuous period of at least 6 months or must have had at least two clinically documented episodes at least one month apart or must have had at least one clinically documented episode together with characteristic findings in the cerebrospinal fluid as well as specific cerebral MRI lesions.

  • Paralysis: Total and irreversible loss of use of two or more limbs through paralysis due to sickness of the spinal cord. These conditions have to be medically documented for at least 3 months.

  • Coronary Artery (Bypass) Surgery: The actual undergoing of open chest surgery for the correction of two or more coronary arteries, which are narrowed or blocked, by coronary artery bypass graft (CABG). The surgery must have been proven to be necessary by means of coronary angiography and realization of the surgery has to be confirmed by a specialist.

• Accidental Indemnity Cash Back

  • Only applicable for hospitalization due to accident

  • Benefits are applicable as per the following AI chart

• Accidental Indemnity (AI) Coverage

  Types of Accidental Hospitalization	Description of Disabilities due to Accident	Amount of Coverage (BDT)
  Head Injuries	Severe collision impacts can cause a closed head injury. In that situation, the fluid and tissue inside the skull are damaged because of the sudden movement or impact of the head. Less severe closed head injuries often result in concussions, while the most severe impacts can cause brain damage.	Up to 100% of Sum - assured
  2nd & 3rd Degree Burn	Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful. Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.	Up to 70% of Sum- assured
  Chest Injuries	These injuries can be more severe such as broken ribs or internal injuries. Drivers often experience chest injuries because of their position which allows very little freedom of movement	Up to 40% of Sum- assured
  Fractures & Dislocation	Depending on the nature of the collision, injuries might be mere bruises or scrapes, but even breaks can occur.	Up to 20% of Sum- assured
  *For Accidental Indemnity an insured will be entitled to receive only one claim - AI/Hospitalization (which is higher) one time for a particular incident.

Exclusions

General Exclusions:

• All pre-existing disease related to all types of coverage of the policy (any disease that already diagnosed or under treatment is completely excluded from the coverage)

• Any treatment related Maternity

• Death caused by self-inflicted injury or the commission of or attempted commission of an assault or any unlawful act, or being engaged in any illegal activity or felony

• By participating in any types of illegal activities

• Suicide while sane or insane

• The condition of Acquired Immune Deficiency Syndrome (AIDS), or any AIDS related illness or HIV virus

• Any congenital infirmity (any inborn disease/disability)

• Any minor surgery, daycare treatment

• Circumcision, prophylactic and immunization procedures

• Mental, emotional or psychiatric disorders, alcoholism or any other narcotic addiction

• Obesity i.e., treatment for, or required as a result of obesity, any cosmetic or plastic treatment/surgery, unless required as reconstructive surgery as a consequence of an injury due to accidents, burns

• Any procedures which is experimental or not generally accepted by the medical profession viz. acupuncture, herbal/ ayurvedic/ homeopathy treatment and any Alternative Medical Care (AMC) etc

• Treatment or advice by a person or professional not registered under BMDC (Bangladesh Medical & Dental Council)

• Rest, convalescence or rejuvenation cures, thermal baths, physiotherapy or confinem ent for the purposes of slimming or beautification

• Fracture and trauma due to physical assault, injury arising due to accident while participating in any unlawful activities (e.g., driving a car without a license), attempted suicide, violation or attempted violation of the law, injuries willfully or intentionally self-inflicted or due to insanity or under the influence of a drug

• Assembly of artificial limbs & necessary treatment of the said artificial limbs (unless required due to accident)

• Routine examination of eye and ear, fitting or replacement of eyeglasses (including Intra -ocular lens or contact lenses) or hearing aids, health screening including routine physical examinations (health check-ups), malignant cancer, radiotherapy, chemotherapy, dialysis and any dental treatment unless require hospitalization for re-constructive surgery as a consequence of an accident

• Non-surgical care for tuberculosis, hepatitis B & C and any other vaccinations, epidemic/ pandemic, all expenses incurred in connection with the donor for any treatment, AIDS and HIV diseases, lupus and other connective tissue and autoimmune disorders and costs of prostheses, corrective devices

• Sleep disorders i.e., treatment for insomnia, sleep apnea, snoring, or any other sleep related breathing problem

• IgE test, vitamin tests

• Participating in competitions, races, contest, matches, on land, air or sea; pot -holing, paragliding, bungee jumping, parachuting and/or scuba diving

• Treatment of family planning purposes including termination of pregnancy, sterility or treatment related to assisted reproduction, cost of contraception, cost of female hygiene product like sanitary pads, etc.

• Mental, emotional or psychiatric disorders, alcoholism or any other narcotic addiction

• Injury arising due to accident while participating in any unlawful activities (e.g., driving a car without a license), attempted suicide, violation or attempted violation of the law, injuries willfully or intentionally self-inflicted or due to insanity or under the influence of a drug

Claim Process

Documents Submission:

• To avail any cash claim, claim documents have to submit digitally via GoodHope web portal/call center

• Required documents have to attach during claim submission

• Death claim have to submit by the nominee

• Claims have to submit within 30 days of occurrence of the assured event (OPD/ Hospitalization/ Accidental indemnity/ Death)

Claim Documents

• Death Claim

  • Death Registration Certificate from local Councilor/Chairman

  • Death Certificate from hospital in case of death during hospitalization

  • Copy of NID of Nominee & policy holder

  • Hospital Discharge Certificate (If applicable)

  • Doctor’s prescriptions (If applicable)

  • Copies of diagnosis reports and (If applicable)

  • Copies of Hospital Bills (If applicable)

  • FIR for accidental death (If applicable)

  • Nominee Bank Account details

  • GD/FIR in case of Police Case.

• Hospitalization/ AI/ CI Claim

  • Doctor’s prescriptions/advice for hospitalization

  • Hospital Discharge Certificate

  • All investigation/diagnostic test reports

  • Hospital treatment sheet

  • Hospital Bills

  • GD/FIR in case of Police Case

• OPD Claim

  • Doctor’s prescriptions

  • Consultation fees Bills

  • All investigation report

  • All investigation Bills

  • GD/FIR in case of Police Case

• Claim Settlement

  All claims will be processed and settled within ten (10) working days subject to receive all required documents related to submitted claim.

• Claim Payment

  A/C payee cheque will be issued to the claimant (nominee/beneficiary) or payment will be transferred directly to beneficiary’s mobile wallet (bKash/ Rocket/ Nagad). If the Nominee is a minor then the cheque or payment will be transferred to the legal guardian of nominee subject to receive all documents required to verify the legality of the guardian of nominee.