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Alpha Islami Life Insurance Limited
Supplementary Health Insurance (HI) Member Hospitalization Plan:
“Health is Wealth"- while it is important for you to adopt a healthy style, it is also important to have a health insurance plan which will take care of some of the major medical expenses that you may incur
In today's fast paced and stressful life you are striving hard to give best of everything to your family. Yet you never know when you or your family may have to face any medical emergencies. If such situation arises, it puts pressure on your immediate cash flows. In the absence of adequate health insurance protection there may be a need to liquidate assets or borrow money to pay medical expenses.
Alpha Islami Life Insurance Ltd (hereinafter referred to as “Alpha Life”)
strives to get those bills out of your way with our simple plans that take care of your expenses. Your only concern should be getting back your health and happiness.
Alpha Health Insurance is Simple, Comprehensive, Rewarding and Flexible to your needs more than your expectation
Highlights:
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Accommodation (Room & Bed) ICU/ CCU/ NICU /HDU care investigation, Surgeries, Anesthesia, consultation fee charge Medicines etc.
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Country wide preferred Hospital/Diagnostic/Clinic optional family Coverage & Emergency Ambulance Service Benefits
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In case of cashless or Credit facilities Hospital worldwide Treatment Coverage, Long term Renewability
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- Health Insurance (HI) Rider- Hospitalization or In-Patient scheme only
The Hospitalization Insurance scheme will cover the hospitalization treatment expenses for eligible Sickness or Accidental Injury of an Insured while policy is in force. Out-Patient (OPD) treatment expenses are excluded from this scheme. Maternity Benefits coverage may be included under Hl Rider by paying additional premium for this coverage.
This benefit is a Rider which can be attached to any individual life policy under following terms and conditions
(01)
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- Group Insurance Policy Terms & Condition:
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Entry Age
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Policy holder and Spouse: 18 years to 59 years dependent children: 1 years to 24 years old unmarried/ unemployed. However, partial inclusion of eligible children is not allowed.
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Over Age
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Coverage of the member benefit shall case as and when policy holder and spouse rich the age 65 years dependent Children: 25 years
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Face Value of basic Life Policy & Hospital Policy Term
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2 lac BDT or more face value or sum assured of basic policy is eligible to get hospital insured coverage. Maximum hospital insured coverage including dependent family members will be limited to maximum 50% of basic life policy sum assured. Policy term remain same as basic policy term.
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Premium Rate
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Age dependent yearly premium rate applicable. For details. Please contact our Group Health Insurance Department or Head office.
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Premium
Payment Mode
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Payable Yearly in Advance
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Underwriting Requirement
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No medical examination is required only “Health insurance application” to be filled in by the proposer describing his and his dependent family members to be covered under the scheme. However, the company reserves the right to call for certain medical tests report before accepted of Policy based on once health conditions.
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Waiting Period
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30 days waiting period is applicable for any illness except accidental injury. Two years waiting period is applicable as described in Annexure- A
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- Benefit: Any eligible disease or medical emergency injury are experienced by the insured (while the policy is in force) which requires hospitalization by the advice of a Registered physician, following expenses shall be covered as per terms and conditions of the policy,
(02)
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1.1 Hospitalization Schedule Per Confinement
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S. N
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Scope of Benefit
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Maximum Limit per Confinement
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A
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Hospital Stay per confinement
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21 days from the day of admission (including 14 days ICU/ CCU/ NICU/ HDU)
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B
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Total Accommodation Room & Bed Charge
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Actual but not exceeding 40% of annual Benefit Limit.
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(b1)
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Room & Board Daily Limit (Actual or Maximum)
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Actual but not exceeding 2% of annual Benefit Limit.
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(b2)
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ICU/CCU/NICU/HDU) Limit per Insurer (at Actual up to)
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14 days However. Maximum limit under S.N no- B-1 & B-2 of this schedule shall be limit to (B) 40% of the annual benefit limit.
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C
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Others Hospitalization Expenses: Total limit per year includes Surgeries, Investigation, Medicine, Anesthesia, Doctor Visit during the Hospitalization. Not allowed ICU/CCU /NICU/ HDU.
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Actual but not exceeding 60% of annual Benefit Limit.
However, daily consultation fee would be actual or maximum BDT: 1,000 during the Hospitalization period.
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D
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Daily Allowances (Applicable only for Govt. Hospital)
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BDT: 500 per day in Govt. hospital where room/bed rent is free of cost.
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E
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Ambulance Charges (Applicable -only for emergency condition)
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1% of annual benefit Limit or BDT: 5,000 Whichever is less and applicable only for one way from home/office to hospital.
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(03)
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Hospitalization Policy Terms & Conditions:
- Worldwide Treatment Coverage: ln-patient treatment facilities for eligible conditions from outside of Bangladesh are also covered but reimbursement shall be made in Bangladeshi currency within the annual benefit limit as per benefit schedule and Standard Cost of such treatment in Bangladesh where applicable.
- 100% Cashless” Hospitalization services from Alpha Life's affiliated Hospital /Clinic is preferred, except in case of any emergency condition, or where network hospital is not available, and/or required treatment is not available in network Hospital. However, re-imbursement claim settlement is subject the logical explanation for not to use the Cashless Services.
- COVID-19 Coverage Applicable” if require emergency Hospitalization directly to the ICU only. However, maximum 75% annual benefit limit shall be eligible to use per confinement by following terms and conditions of the Benefit Schedule.
Definitions:
- Accident" shall mean sudden and unforeseen event resulting in bodily injury of any kind whatsoever requiring Hospitalization while this Policy is in force.
- Annual Benefit Limit" shall mean the maximum benefits payable for the Hospitalization/ In-Patient Treatment to an insured per year.
- Hospitalization" shall mean an admission to a hospital for the treatment of Eligible condition or Injury.
- Confinement" shall mean a Hospitalization for a period of at least 24 (twenty-four) consecutive hours. However, hospital stay less than 24 hours due to technological advances for surgical interventions like Cholecystectomy, Tonsillectomy, Fracture dislocation bone & joints, Lithotripsy etc. shall be considered as Confinement subject to the merits of sickness. However, successive period of hospital Confinement within 90 days due to the same or different disability/sickness shall be considered as a single Confinement. But in no event shall the total benefit exceed the limit set forth in the Schedule of Benefits of this Plan.
(04)
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- 3. Coverage Option:
Self- Couple (Husband & Wife), Family (Couple & Kids)
Premium Rate:
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Maximum Premium: Hospitalization (IPD) Per Member Yearly Coverage
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Option
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Plan-A
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Plan-B
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Plan-C
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Plan-D
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Plan-E
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Coverage
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3,00,000
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2,00,000
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1,50,000
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1,00,000
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50,000
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Age Limit
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Premium
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Premium
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Premium
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Premium
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Premium
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Up to 35
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6,000
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5,100
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4,200
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2,900
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1,500
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36 - 40
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6,300
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5,300
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4,400
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2,950
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1,550
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41 - 45
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6,500
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5,400
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4,500
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3,000
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1,600
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46 – 50
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6,700
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5,500
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4,600
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3,100
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1,650
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51 - 55
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6,850
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5,600
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4,700
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3,200
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1,700
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56 - 60
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6,950
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5,700
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4,800
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3,300
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1,750
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61 - 65
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9,600
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6,600
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5,100
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3,500
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1,800
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- Maternity Coverage (Optional):
It is a special type of hospital coverage which provide the benefit for any condition related to pregnancy or child birth and any complication there from during the period from the date of conception to till final delivery, maternity coverage is provided separately in addition to the usual hospitalization benefits but maternity claim will be settled by following Maternity benefits Table.
Maternity benefits coverage may be included under HI member by paying additional premium for this coverage. Maturity benefit may be included from the inception date of the insurer or any anniversary thereof. The maternity treatment benefit of the newborn. Total cost of maternity benefit shall not exceed the limit as stared in the following maternity Table.
(05)
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Maternity Hospitalization Benefit Table:
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Event
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Standard Plan (BDT)
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Superior Plan (BDT)
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Caesarian delivery (Maximum Per Yearly)
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30,000
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40,000
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Normal delivery (Maximum Per Yearly)
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15,000
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20,000
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Legal Abortion or Miscarriage (Maximum Per Yearly)
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7,500
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10,000
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Premium Rate Per Member Per Year BDT.
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7,500
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9,500
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Terms & Conditions Hospitalization Maternity Benefit:
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Age Limit
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Standard child bearing age (18-45) years applicable for legal married female are insured or spouse of male.
However, Standard maternity coverage not applicable.
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Maximum Coverage
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Up to 2 chilled births
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Waiting Period
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First Claim: 2 years from the date of commencement of Maternity member. Second Claim: 2 years from the date first claim. (Except Legal abortion or miscarriage maximum, benefit payable once in a policy year
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Cashless Service
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Not applicable
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Maternity OPD Treatment Exp.
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Not covered by this Scheme
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Claim Submission
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All maternity related expenses should be claimed at the end of final delivery/ LN/ MC (No piece meal claim is allowed)
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(06)
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- Exclusions:
Treatment expenses or losses resulting from or incurred in connection with or in consequence of the followings are not covered by the Policy. Definition or clarification of Exclusion items are illustrated in your policy Documents-
- Pre-existing Conditions
- Non-Allopathic and Experimental Treatment
- Breach of Law
- Conflicts and Disasters
- Newborn child up to the age of 1(one) year.
- Aviation
- Hazardous Activities
- Self- infected injuries or attempted suicide
- Substance Misuse and De-addiction
- Rehabilitation and Convalescence
- Cosmetic & Beautification treatments
- Sleep disorder and obesity
- Hormone Replacement Therapy
- Dental treatment sunless necessitated due to an Accident.
- Routine Eye(s) and (Ear) aliments
- HV/AIDS & Cancer related dieses
- Sexually transmitted Disease and other Sexual problems
- Circumcision
- Birth Control and Assisted Reproduction /Infertility /Subfertility
- Pregnancy: This exclusion does not apply in case of ectopic pregnancy and emergency arising from rupture ovarian cyst, pregnancy eligible for payment under 'Maternity Benefit as described in this policy.
- Pre and post hospitalization expenses
- Psychological disorders
- Congenital Conditions/ Congenital infirmity
- Preliminary diagnostics materials and Examination
- Expenses of Life Insured as Donor or cost of Donor
- Failure to take Reasonable Medical Care
- Expenses Other than Reasonable and Customary Medically Necessary
- Immunization & Nutritional treatment
- Nuclear Reaction
(07)
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Convenient Claim Process:
You or any of the lives insured in your family have the option to avail cashless Hospitalization services or claim the medical expenses insured as reimbursement.
Cashless Hospitalization Services:
Cashless Hospitalization Treatment Facilities- shall mean the facilities that the Alpha Life may authorize upon the request of the insured member for the direct settlement of the admissible treatment expenses as per agreed charge between affiliated Hospitals and the Alpha Life. In such cases, the Alpha Life will directly settle the eligible expenses with affiliated Hospitals and the insured member may not have to pay any bills after the end of the treatment at the Hospital up to the Annual benefit Limit stated under the Scheme.
- Please visit our official website www.alphalife.com.bd to know latest Hospital List affiliated by Alpha Life.
- Information to the Alpha Life
- For planned admission, inform to Alpha Life 24 Hours before the admission send document as advised by company.
- For emergency admission (cardiac condition or accident resulting in admission to an ICU or emergency ward), get admitted in the hospital first. Then inform to Alpha Life within 24 hours of admission Alpha Life will advise you about mode of claim payment based on nature of Hospital.
- If cashless hospitalization is applicable, Alpha Life will issue a Guarantee of Payment Letter (GOP) by mentioning details of claim limit and terms and conditions.
- Do not forget Issues-
- To produce the Health Insurance Card at the time of admission.
- If you are availing cashless services- on discharge, you are expenses to verify the hospital bills for its accuracy and sign it. Please pay any extra amount beyond coverage. Hospital shall ask you to pay such amount as advised by Alpha Life.
(08)
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- Any non-eligible expenses that is paid the Policyholder by the company or any eligible expenses that is unpaid by the policyholder at the time of discharge from hospital due to clerical/printing/ technological error, shall be re adjustable or recoverable by the both parties.
- If the cashless Claim Services is denied for any unforeseen reason or re imbursement services is eligible as per your policy, you may submit your claim for Reimbursement within 0 days after you have discharge from hospital.
- Reimbursement Claims (Non-Cashless Hospitalization): you have to submit following claim documents to Alpha Life.
- Duly filled and signed Claim from (available in official website alphalife.com.bd)
- Prescription containing details about the condition and advice for hospitalization.
- Investigating reports and original money receipt
- Original itemized hospital bills and money Receipts
- Discharge Card/ Certificate
- Original Money Receipt of all itemized Medicine, medical and Surgical items or any relevant item.
Alpha Life is committed to settle the Claim within 7 working days after submission of supporting documents. The company reserve rights to call any documents/ evidence/ clarification before final settlement of your claims.
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Alpha Islami Life Isnurance Limited
Corporate Office: A J. Tower: Level (3, 4, 8-12) Plot # 4, Sonargaon Link Road, Kawran Bazar, Dhaka-1215. Phone: 02 550133004-5
Group Health Insurance : 01778 546140, 01325 436075
IP Phone No : 09666400200 Ext. 207
Email : sazed.group@alphalife.com.bd
: sazed.alphalife@gmail.com
Website : www.alphalife.com.bd
(09)
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Alpha Islami Life Insurance Limited
Bridging the Gap of Life
Hospitalization Plan:
Group Insurance Department
ALPHA ISLAMI LIFE INSURANCE LTD.
Corporate Head Office: A J. Tower: Level (3, 4, 8-12) Plot # 4, Sonargaon Link Road, Kawran Bazar, Dhaka-1215, Bangladesh. Phone No: 02 55133004,
Email: info@alphalife.com.bd Website: www.alphalife.com.bd,
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