1. Who can avail UPaisa Healthy Aap?

Customers of UPaisa who are Pakistani nationals and aged minimum eighteen (18) years and under sixty-five (65) years can avail UPaisa Healthy Aap upon payment of applicable premium. The registration under UPaisa Healthy Aap will expire when an insured person reaches the age of sixty-five (65) years. In case of availability of only year of birth information, January 1 shall be considered the month and day of birth respectively.

2. When will cover start and what will be the term of the cover?

3. How can I claim under UPaisa Healthy Aap?

In case of any insured loss, you or any of your family members can notify us through one of these methods: 1- Call at Waada’s UPaisa Healthy Aap helpline 021-3319297 2- Upaisa Customers - Ufone Subscribers: 7777 , Other Mobile Operator: 042-111-786-365, Franchise/Retailers:8265 3- Send an email at helpdesk.pakistan@waada.com Please note that you or your family members must notify a claim within fifteen (15) days of occurrence of the insured loss. Failure to do so can affect claim approval.

4. What documents will be required to claim under UPaisa Healthy Aap?

Following documents must be provided within fifteen (15) days of the date of occurrence of insured loss through the process explained below: 1. Claimant Statement signed by the customer 2. Hospitalization and treatment record giving dates of admission and discharge, diagnosis and treatment given and confirming temporary total disability and out-of-pocket expenses incurred 3. Physician’s Statement 4. Copy of CNIC of the Insured person 5. Heir-Ship Certificate to establish claimant title in case of death of the Insured person 6. Police FIR and Medico-Legal report in case of hospitalization as result of accident, violence, attempted self-destruction All documents can be submitted in scanned form. However, the insurance company reserves the right to ask for original documents as and when required.

5. Who will be paid the Claim?

The claim will be payable to the insured person. However, if the insured person is not in a position to give a valid discharge of claim settlement to the insurance company, additional documents such as heirship certificate or guardianship certificate may be asked.

6. Can I go to any hospital?

Yes, you can visit any hospital for inpatient treatment including free Government and trust hospitals as long as the facility is: a) Licensed by the Government authorities to provide medical care in accordance with the laws of Pakistan
b) Is primarily engaged in providing diagnostic and laboratory tests, medical evaluations, medical treatment and services, and surgical facilities
c) Has 24 hours-a-day nursing service by registered graduate nurses under the permanent supervision of in-house Physicians in charge
d) Maintains proper in-patient facilities with documented protocols and procedures
e) Maintains a daily medical record for each of its patients, which is readily accessible to the insurance company.

7. When will the claim be paid? How will the claim be paid?

All valid claims will be paid within three (3) working days upon completion of all required documents. Claim will be paid by way of crossed cheque drawn in favour of the claimant, mobile money or any other medium as agreed between parties from time to time.

8. In what circumstances will my claim not be paid?

The claim will not be paid in the event of the following: a) Suicide, assault, murder, self-destruction or self-inflicted injury, while sane or insane, or any attempt there at; under the influence of contraband drugs/drinks
b) Natural catastrophes, war, declared or undeclared, or any act of war or insurrection, or as a result of a strike, riot, civil commotion
c) The commission or attempted commission of an act that would subject the person to civil or criminal penalties, or the contravention of any law
d) Pregnancy, childbirth, abortion and any complication thereof
e) Filing of a fake claim or submission of fake or forged documents or claimant’s inability to complete any of the claim requirements
f) In the event of non-payment of premium and non-availability of cover in the month when the loss has occurred
g) If the hospitalisation due to sickness occurs within fifteen (15) days of enrolment i.e. during the waiting period h) Any pre-existing conditions

9. Under what conditions my subscription under UPaisa Healthy Aap will be terminated?

a) Cessation of UPaisa Healthy App by any reason whatsoever
b) Insured person may cancel his insurance for a full refund of annual premium paid within Fourteen (14) days of enrolment date by notifying the group policy holder or the insurance company for cancellation, in written or by telephone and provided that no claim has been filed under the Policy. No premium refund shall be allowed in the event of any claims is filed under this policy irrespective of whether the claim is paid or rejected by the insurance company.
c) in case monthly instalment of annual premium is paid, individual customer can cancel the policy any time in which case future monthly instalments will not be payable however no refund for monthly instalments already paid will be allowed.
d) Insured person’s failure to pay premium within the period of thirty (30) days of due date. Coverage will continue during the said grace period of thirty (30) days and any unpaid premiums will be collected from claim proceeds. The coverage will lapse if premium remains unpaid within grace period. In case the insured person opted for monthly instalments of annual premium, any unpaid monthly instalments of annual premium will be the first charge from claim proceeds payable under the policy.
e) The insured person’s death or permanent total disablement.
f) Upon payment of maximum claim allowed under the policy during applicable coverage period
g) The insured person ceases to be a UPaisa customer
h) The insured person’s decision not to continue with the product and communication of that to us using the customer service touch points
i) Non-payment of applicable premium on due date or within applicable grace period
j) Filing of fake claim or submission of forged documents
k) The insured person attains maximum age allowed under this product

10. Where can I contact in case of questions, enquiries or complaints?

1- Call at UPaisa Healthy Family helpline 021-3319297
2- Upaisa Customers - Ufone Subscribers: 7777 , Other Mobile Operator: 042-111-786-365, Franchise/Retailers:8265
3- Email at helpdesk.pakistan@waada.com