Introduction

eSewa Care is a healthcare package tailored to offer financial security and easy access to essential health services. Developed in collaboration with Himalayan Everest Insurance (HEI) and various healthcare service providers, eSewa Care provides the coverage of 230,000 Rs at just Rs 360 a year.

Insurance Coverage

Following are the risk coverage under eSewa Care:

1. Hospital bed charge coverage up to Rs. 10,000 per day, at a rate of Rs. 1,000 per day.
2. Death & Disability up to Rs. 120,000/-
3. Accidental Medical Rs. 100,000/-

Other benefits

In addition to insurance coverage, eSewa Care purchasers can enjoy discounts of up to 30% at various healthcare service providers across the country. With collaborations with over 40 service providers, eSewa Care ensures that its customers receive added value and savings on healthcare services.

Claim process:

Claim segregation:

1. Accidental Treatment: Up to Rs. 100,000/-
2. Hospital Bed Charge: Up to Rs. 10,000/- (per day Rs. 1,000/- for 10 days)
3. Accidental Death: Rs. 100,000/-
4. Funeral Expenses: Rs. 10,000/-
5. Funeral Transportation: Rs. 10,000/-

Note: Claims for bill amounts of accidental insurance less than Rs. 2,500/- will be reimbursed up to Rs. 1,000/-. This is applicable to school students and teacher only.

Required Documents:

a. Claim Form:will be provide after contacting eSewa/Himalayan Everest Insurance

b. Accidental Treatment:

1. Doctor’s prescription
2. Hospital Card
3. Payment bills
4. Police report (in case of Road Accident)

c. Hospital Bed Charge:

1. Hospital admission document
2. Discharge summary
3. Payment bills

d. Accidental Death, Funeral Expenses & Funeral Transportation:

1. Death certificate
2. Police report (in case of Road Accident)
3. Payment bills

Note: Original documents are required for the claim process.

Terms & Conditions:

1. Only treatment carried out in hospitals will be eligible for claims.
2. Claim can be requested only after 24 hours of the purchase.
3. Notify within 35 days after paying the bills.
4. Can be purchased from Age 2 years to 60 years only.

Note: Every hospital, that are legally registered under Nepal Government will be counted for the claim.

What is not covered in Accidental & Hospitalization Insurance?

1. Pre-existing disease treatments are not covered.
2. Complications of pregnancy, miscarriage, abortion birth control sterilization, or infertility treatment.
3. Mental or nervous breakdown, congenital or heredity defects or conditions such as HIV/AIDS or any sexually transmitted disease, alcoholism or substance abuse self-inflicted injury suicide or any attempt, and organ transplants elective surgery.
4. Prostheses cosmetic plastic or reconstructive surgery unless it results from an insured accidental injury.
5. Hospital expenses incurred outside of Nepal.
6. Routine eye tests dental treatment or other examinations and/or tests not incidental to treatment or diagnosis of an insured injury sickness or disease.
7. Hospitalization expenses incurred outside of Nepal.
8. Hospitalization expenses incurred for any person over the age of sixty (60).

Claim Process:

1. Customer needs to contact eSewa/HEI
2. Fill up the claim form
3. Provide requested documents
4. eSewa/HEI will verify the documents
5. HEI will provide the claim amount within 10-15 working days after receiving all the requested documents.