Hafiz Plus Plan is underwritten by EFU Life and distributed by Hello Doctor

EFU Life is a leading life insurance company and is part of largest insurance group in Pakistan which provides insurance coverage to millions of Pakistanis.

Hello Doctor is a Healthtech Platform and is also acting as Corporate Insurance Agent for EFU Life responsible for acquiring and servicing customers.

Jazz Telecom is facilitating this offering but shall not be responsible for any grievance of the Jazz Customer relating to Hafiz Plan and EFU Life Insurance’s or Hello Doctor’s performance of its obligation

DEFINITIONS

In these provisions:

HAAFIZ PLUS PLAN means a term assurance product which provides a guaranteed level of life insurance protection against death, accidental permanent total disability or major medical illness treatment

ACCIDENT means accidental bodily injury which is caused solely by violent, external and accidental means resulting directly and independently of all other causes.

AUTHORIZED REPRESENTATIVE means an official of the Company who has been authorized by the Company to transact business on behalf of the Company under this Policy.

COMPANY means EFU Life Assurance Limited

ELIGIBLE PERSON means customers of the Group Policy Holder, male or female Pakistani nationals, who is eligible for insurance cover under this policy in accordance with Clause 2 of these provisions and conditions.

COMMENCEMENT DATE means the date on which the cover becomes effective which will be from 00:01 hours on the 1st day of next month following the date on which the premium is paid after acceptance of the application by the Member.

GROUP POLICY HOLDER means Pakistan Mobile Communications Limited or Jazz.

ENROLLMENT DATE means the date on which the Member was initially enrolled under this Policy.

ENROLLMENT MONTHIVERSARY DATE means a period of one month of the date on which an Insured Person was initially enrolled under this Policy.

CORPORATE INSURANCE AGENT means Hello Doctor (Private) Limited responsible for providing Telehealth services , enrolling and servicing customers.

MAJOR MEDICAL ILLNESS CONDITIONS means one or more of the following:

• 1. Cancer
• 2. Heart Attack
• 3. Stroke
• 4. Kidney & Renal Failure
• 5. Blindness & Deafness
• 6. Major Organ Transplant

MOBILE NETWORK OPERATOR means Pakistan Mobile Communications Limited, a company duly incorporated and registered under the Companies Ordinance 1984 of Pakistan and having its registered office at 1-A Kohistan Road, DHQ-1 F-8 Markaz, Islamabad, Pakistan.

MEMBER means an Eligible Person who is to be included in this policy after giving his valid documented or recorded consent to purchase this insurance and pay required premium amount.

NOMINEE means a person or persons appointed by the Member (under the provisions of the Insurance Ordinance 2000) to receive the benefits payable under the policy.

POLICY TERM means the period of one month beginning from the first day of a calendar month and ending on the last day of same calendar month.

RENEWAL DATE means any subsequent monthiversary of the Commencement Date.

RENEWAL ENROLLMENT means Re-enrolment of the Member into this Policy upon payment of premium on Renewal Date.

SICKNESS means sickness or disease contracted for the first time after the Commencement Date or Renewal Date.

Words importing the singular number include the plural number and vice versa and words of masculine gender shall include the feminine unless the context otherwise requires.

2. ELIGIBILITY

The eligible persons for this Policy are the present and future customers of the Group Policy Holder who are within the Eligibility Age range i.e. 18 to 51 years and have given their valid consent to opt for insurance cover under this policy. Any Member shall not be eligible for multiple enrollments at a single point in time.

3. EFFECTIVE DATE OF INDIVIDUAL ASSURANCE

Member will become eligible from 1st day of next calendar month following the date on which the premium is paid after acceptance of the application by the Member.

4. EVIDENCE OF AGE

Evidence of age of a Member satisfactory to the Company will be required before any benefit in respect of him/her is paid under this Policy and if after commencement of the insurance cover hereunder the date of birth of any Member is found to have been incorrectly notified to the Company, the Company shall notify the Group Policyholder of the adjustment to be made under this Policy in respect of such incorrect notification. No benefit whatsoever shall be payable under the Policy if the correct age of the Member is found to be more than maximum eligibility age of 51 years.

5. AMOUNT & CALCULATION OF PREMIUM

Premiums under this Policy are payable by the Group Policy Holder at such office/ offices of the Company as the Company may designate in writing to the Group Policy Holder from time to time. The Company may authorize the Insurance Broker to collect premium from the Group Policy Holder on its behalf. Such authorization will be in writing and provided to the Group Policy Holder.

Premiums are due by the 1st of each calendar month for all such eligible Members, who are to be covered as per the terms and conditions of the Policy. At the time of initial enrollment of the Member and at each subsequent Renewal Enrollment, the Group Policy Holder will calculate the monthly premium as per the following table:

The coverage will start from the 1st day of the next month. Where full premium for an insured Member is not paid the Benefit amount will be adjusted on Pro rata basis as per below variant table:

Silver Plan:

Gold Plan

Platinum Plan

6. BENEFITS

Upon receipt of due proof in writing that the Member has, whilst the Policy is in full force and effect, suffered any of the event(s) set out below, the Company, subject to the exclusions set out below and the terms and conditions contained herein, shall pay the following Benefits.

DEATH BENEFIT:

On death of the Member, whilst the Policy is in full force and effect, the amount of benefit payable shall be determined according to the Plan Category chosen by the Member from the table given hereunder:

Plan Category	Monthly Education Continuation Benefit for 12 months (PKR)	Monthly Income Continuation Benefit for 12 months (PKR)
Silver	2,000	10,000
Gold	3,000	15,000
Platinum	5,000	20,000

ADDITIONAL ACCIDENTAL DEATH BENEFIT:

If the Member dies as a result of injuries caused solely by violent, external and accidental means and there is evidence of a visible contusion or wound on exterior of the body except in the case of drowning or of an internal injury revealed by an autopsy, and that such death occurred within 90 days of the accident solely as a result of the same injury and not as an indirect result of any fit, physical defect, illness or disorder, the Company, upon receipt of and due investigation of the claim, will pay an amount shown in the Table of Death Risk below, in addition to any benefits under the Policy.

TABLE OF ACCIDENTAL DEATH RISK

Plan Category	Sum Assured (PKR)
Silver	250,000
Gold	350,000
Platinum	500,000

ACCIDENTAL PERMANENT TOTAL DISABILITY BENEFIT:

If the Member whilst the Policy is in full force has sustained injuries caused solely by violent external and accidental means and within 90 days of the accident suffers the losses set out in the Table of Benefits of Accidental Disability solely as a result of the same injuries, the Company, upon receipt of and due investigation of the claim, will pay an amount depending on the type of loss as provided in the Table of benefits of Accidental Disability below.

MAJOR MEDICAL ILLNESS REIMBURSEMENT BENEFIT:

If the Member is diagnosed with any of the critical illnesses defined in this Policy under this benefit and has incurred medical expenses on account of treatment of the same illness, the Company, upon receipt of and due investigation of the claim, will pay an actual reimbursement amount up to the limit assigned as per the selected category to Member in addition to any benefit under the policy.

Plan Category	Maximum Reimbursement Amount Limit (PKR)
Silver	25,000
Gold	35,000
Platinum	50,000

There will only be one treatment allowed on the life of a Member in his lifetime.

The coverage will start from the 1st day of the next month. Where full premium for an insured Member is not paid any benefit amount will be adjusted on Pro rata basis as per above variant wise tables.

7. CESSATION OF MEMBERSHIP

Insurance Cover shall cease on any of the following:

• a) Member’s death or total disability.
• b) Member having attained the age of 51 years.
• c) Non-payment of premium by the Member when due.
• d) Any other date on which the Member ceases to be eligible for insurance cover for any fraudulent or criminal reason affecting the insurance cover hereunder. Decision of the court shall be final in such cases.

8. EXCLUSIONS

No benefit will be paid if the death or disability of the Member results directly, wholly or partly, as a result of or related to:

• a) Intentional self-inflicted injury or its attempt, murder, suicide and violation of law;
• b) War, strikes, riots, civil commotion and any natural or man-made perils (including chemical, nuclear, biological, and radiological) that results in the declaration of a state of emergency on a local or national level;

No benefit will be paid if the illness of the Member results directly, wholly or partly, as a result of or related to:

• a) Any major medical illness that was diagnosed prior to the commencement of the coverage (within three months from the enrollment/ re-enrollment date);

9. ASSIGNMENT

The insurance cover provided for under this Policy and the benefits payable hereunder are not assignable.

10. CLAIMS

In case of any claim under the benefit(s) covered against in this policy, the same shall be notified to the Company. The Member or the Nominee at its own expense, shall furnish all information necessary to determine whether the Benefit Claimed is payable or not to the Member or the Nominee.

Written notice of claim must be presented to and received at the Main Office of the Company within three-hundred and sixty five days (365) days after the date of event giving rise to the claim. Otherwise the claim shall be invalid.

Company, upon receipt of such notice, will furnish forms for filing proof of Claim. The forms along with standard claim requirements quoted by the Company must be completed and returned to within fifteen (15) days from claim notification date for which the claim is made. Such forms may include, but not limited to, the following documents.

• a) Copy of Death certificate issued by NADRA / Union Council
• b) Copy of CNIC of claimant and nominee and deceased member
• c) Claimant Statement Form
• d) Attending Physician’s Statement Form/Report
• e) Police & MLO Report (in case of accidental causes)
• f) Hospital Death Certificate
• g) Past Medical records
• h) Disability claim forms
• i) Past medical records
• j) Treatment record giving dates of admission and discharge, diagnosis and treatment given
• k) Medical Certificate issued by treating doctor
• l) Any other document deemed to be necessary for claim assessment and finalization

The insurance cover effected hereunder shall carry no paid-up or surrender value.

Claim will be processed by the Company following the submission of the claim documents to the Company or an entity authorized by the Company.

11. RENEWAL PRIVILEGE

This Policy is issued for the period shown in the Policy Schedule and may be renewed by the Member on subsequent Renewal Date subject to the conditions hereof. Renewal will be effected by the payment of the required premium when due.

12. CHANGE OF OWNERSHIP

If the business of the Group Policy Holder is transferred to or succeeded by any person or corporation then, subject to the consent of the Company, the payment of premium under this Policy may at the option of such person or corporation be continued in which case such person or corporation shall as from the date of such transfer or succession take the place of and be treated for all purposes of this Policy as being the Group Policy Holder hereof.

13. TERMINATION OF THIS POLICY

The Company reserves the right to terminate the Policy by giving 90 days’ notice. It is clarified that any termination shall not affect the obligations of Group Policy Holder and Company assumed at any time prior to the effective date of termination. Further, the Company reserves the right to give the Group Policy Holder three months’ written notice to add, alter or repeal the terms and conditions of the Policy hereof.

Notwithstanding anything to the contrary in this Policy, the termination of this Policy shall have the following effect:

• a) No individual enrollment shall be entertained under this Policy after the time of termination.

14. LAW

The policy is governed by and interpreted according to the laws of Islamic Republic of Pakistan.

15. STATUTORY FUND

Under the provisions of the Insurance Ordinance 2000 this policy and any additional benefits shall be referable to the Conventional Business Statutory Fund of the Company. The Company may by endorsement to the Policy change the Statutory Fund(s) to which the policy and any additional benefits are referable.

DISCLAIMER/ TERMS OF USE of Telemedicine Services:

TERMS OF USE

1. Services Provided:

• • Video/Audio primary care medical consultations from PMC certified general practitioner.
• • Appointment booking for in-house primary care consultation by PMC certified general practitioner.
• • Access to HD electronic medical records for HD application users.
• • Provisional access to awareness/preventive care recorded medical sessions by PMC-certified doctors. (as and when available)
• • Provisional access to fitness-related workout sessions by certified HD fitness trainers. (as and when available)
• • Provisional access to healthy culinary sessions (as and when available)

2. Use of Telemedicine Services is NOT FOR EMERGENCIES:

Hello Doctor services are primary care services and will only be used for non-emergency conditions.

3. Privacy:

Hello Doctor is HIPAA compliant and maintain privacy as per the standards of Health Insurance Portability and Accountability Act.

8. Limitations of Tele-Health:

Tele health is limited to the consultation where physical examination through touching can be bypassed (in case of non-emergency conditions)

9. Complaints and Disputes:

Complaints and disputes can be highlighted via UAN number (042 111 333 033) or contacting via email address [email protected] turn around time would be 48 working hours

10. Requirements

Apart from registration and mobile application, user would require.

• High speed uninterrupted internet for video calling.
• GSM/Landline number to call on UAN for consultation.
• Internet and customer availability at booked time to avail appointed consultation.