Adamjee Insurance Company Limited (hereafter “the Company”), having received an Application Form and the premium from the Applicant named in the said Application Form attached herewith as “Insured” and the said Application Form and Declaration together with any other statement, report or any other document leading to the issue of this policy subsequent to the acceptance and agreement by the Company and the Applicant of the above said documents to serve as the basis of this Contract, by this policy agree, subject to the terms and conditions of this Policy and on proof to the satisfaction of the Company of the compensation becoming payable to the title of the Insured, to pay the Capital Sum Insured/ Appropriate Benefit as the case may be.
SCOPE OF COVER
The company hereby agrees, subject to the terms, conditions and exclusions contained herein, to pay to the Insured a sum as compensation for any loss or damage as described under different sections here under but not exceeding the Sum Insured specified for the specific section in the Schedule and subject to applicable deductible excess.
“Accident” means a sudden, unforeseen, and unexpected physical event beyond the control of the insured caused by external, visible and violent means.
“Air Travel” means the act of boarding an aircraft for the purpose of flying therein and alighting there from following a flight.
“Checked – In Baggage” means the baggage handed over by the Insured and accepted by the carrier (airline) for transportation in the same carrier in which the Insured is going to travel and for which the carrier has issued a baggage receipt to the Insured.
“Common Carrier” means any commercial airline or ship or vessel operating under a license from a relevant authority for the transportation of passengers and cargo for hire.
“Company” means Adamjee Insurance Company Limited.
“Deductible Excess” means the amount of expenses to be incurred by the Insured before the compensation under the cover shall become payable and shall not be reimbursed by the Company.
“Dependent” means the lawful spouse of the Insured not above the age of 60 years and any non-earning child of the Insured below the age of 18 years. 2
“Disease” means an Illness, disorder or ailment suffered by the Insured and certified by a physician or surgeon.
“Effective Date of Coverage” means the Start Date of Cover as shown on the Policy Schedule. Cover cannot start after an Insured Journey has begun.
“Family” means the primary Insured, his/her lawful spouse below the age of 60 years or Insured and his/ her children below the age of 18 years.
“Felonious Assault” means an act of violence against the Insured or a Traveling Companion requiring medical treatment in a Hospital.
“Geographical Coverage” means outside country of residence.
“Hospital/Nursing Home” means any institution that is generally recognized as a hospital in the foreign country concerned and it is established for indoor care and treatment of sickness or injuries and is under the constant direction of a qualified physician.
“Immediate Family Member” shall mean an Insured persons‟ legally wedded spouse; siblings; siblings in law; parents; parents in law; legal guardian; ward; step parents; who reside in Pakistan.
“Inclement Weather” means any severe, catastrophic weather conditions, which delays the scheduled arrival or departure of a common carrier. This does not include normal, seasonal climatic/ weather changes.
“Injury” means accidental bodily injury solely and directly caused by external, violent, visible and evident causes.
“Insured” means the person whose name appears on the Policy, aged between 6 months and 65 years with an optional extension up to their 85th birthday to whom premium has been paid and who is a permanent resident of the Country of Policy Issuance. For Family Plan Insured Person will mean the person whose name appear on the Policy Schedule as an Insured Person, his/her spouse, and his/her children below the age of 18 years and also whose names appears on the Policy and with respect to whom Premium has been paid and who are permanent residents of the country of policy issuance.
“Insurable Event” shall mean an event, loss or damage for which the Insured shall be compensated under this policy.
“Period of Insurance” means the period chosen by the Insured Person as per the Policy Schedule, for which premium has been paid, starting from the departure Date of Cover as shown on the Policy Schedule and expiring at the end of the chosen period.
“Physician” means a person who is qualified to practice medicine or is a surgeon and has a valid license issued by the appropriate authority for the same, provided that this person is not a member of the Insured‟s Family.
“Policy” means Insured‟s Application Form, the Schedule, the Company‟s covering letter to the Insured and any endorsement attaching to or forming part thereof, either at inception or during the Period of Insurance.
“Pre-existing condition” means the chronic Illnesses, or aliments and consequences of such illnesses or aliments existing or known to exist at the commencement of the Trip abroad, even if the same had not been treated, or for illnesses treated or for which medical advice has been sought in the last 6 months before commencement of the Trip abroad including their consequences.
“Reasonable Additional Expenses” means any expenses for meals and lodging which are necessarily incurred by the Insured as the result of a Trip Interruption or Trip Delay and does not include meals and lodging provided by the Common Carrier or any other party free of charge.
“Reasonable and Customary Charges” means usual amount charged for treatment, supplies or medical services in the locality where such expense is incurred and does not include charges that would not have been made if no insurance existed.
“Schedule” means the Schedule of Benefits attached to this policy.
“Serious Illness” An injury, which in the opinion of the Company‟s medical team involves risk of death.
“Service Provider” means any person, organization or institution that provides services to the Insured for an Insured Event covered under this policy and that is liable to be paid by the Company.
“Sum Insured” means the maximum amount of coverage, as specified in the Schedule attached to this Policy, that the Insured is entitled to in respect of each benefit and as applicable per Trip under this Policy.
“Sound Natural Teeth” means natural teeth that are either unaltered or are fully restored to their normal function and are Disease-free, have no decay and are not more susceptible to Injury than unaltered natural teeth.
“Traveling Companion” means an individual or individuals traveling with the Insured during the policy Period, provided that, the Insured and such individual(s) is/ are also insured under the Company‟s Travel Policy. 4
“Third Party Administrator (TPA)” means such person or persons as may be appointed by the Company from time to time to provide assistance to the Insured in terms of this policy.
“Trip” means booked and planned travel out of, and back to Pakistan.
“Trip Duration” means the length of time period commencing from the date when the Insured travels out of Pakistan and ending on the date of return of the Insured to Pakistan, both days inclusive and calculated according to Pakistan Standard Time (PST).
“Valuables” means photographic, audio, video, computer and any other electronic equipment, telecommunications and electrical equipment, telescopes, binoculars, antiques, watches, jewellery, furs and articles made of precious stones and metals.
“Usual Country of Residence” means the country where the Policy was issued (Pakistan).
“Usual Place of Residence” means the permanent residence of the Insured in the Usual Country of Residence.