Jubilee General Insurance Company Limited

(Formerly New Jubilee Insurance Company Limited)

2nd Floor, Jubilee Insurance House, I.I. Chundrigar Road
P.O Box 4795, Karachi-74000, Pakistan
UAN: (021) 111-654-111
Tel: (021) 3814 2900
Toll-Free: 0800-03786
Fax: (021) 3241 6728, 3243 8738
Email: info@jubileegeneral.com.pk, buyonline@jubileegeneral.com.pk
Website: www.jubileegeneral.com.pk/https://www.getinsurance.pk

Lifestyle Care Insurance +

(Health Critical Illness Coverage)

POLICY DOCUMENT

PREAMBLE AND OPERATIVE CLAUSE

This Policy is granted by Jubilee General Insurance Company Ltd. (hereinafter called “the
Company”) to the person(s) described in the Policy Schedule as the Policy Owner(s) on the
life of the person mentioned therein as the Life Assured.

The proposal, declaration(s), and any statement(s) made by the Policy Owner(s) and Life
Assured in connection with this Policy shall be the basis of this contract, which provides that
in consideration of receipt and realisation by the Company of the Premium mentioned in the
Policy Schedule, the Company will pay to the Life Assured, Nominee(s), successor(s) or
assignee(s) of the Policy Owner(s), the specified Benefit Assured on the happening of the
event described in the Policy Schedule as the Event Assured Against.

The liability of the Company is at all times subject to the Policy Schedule, Standard Policy
Conditions and any special conditions or endorsements issued by the Company and attached
to this Policy, all of which are part of the contract evidenced by this Policy.

This is a digitally signed copy of the policy which may be verified for authenticity by logging
on to our website https://online.jubileegeneral.com.pk/manage

(*) Jubilee General Insurance Company is registered and supervised by the Securities and
Exchange Commission of Pakistan
 Issue Date as specified in
the Policy Schedule means the
1. DEFINITIONS date on which the Policy is
issued.
In any part of the Policy, the Standard
Policy Conditions and any endorsements Life Assured as specified in
any word or expression to which a the Policy Schedule means the
specified meaning has been attached shall person on whose life the Policy
bear such specified meaning wherever it has been issued
may appear and, where the context so
admits the masculine shall include the
feminine and vice versa and the singular ‘Medical 2nd Opinion(MSO)’ means
shall include the plural and vice versa. International Medical 2nd Opinion from
Mediguide International, a world leading
Medical Assistance provider from more
Business Day is any day other than a
than 100 top class medical centers and
holiday on which banks generally are open
hospitals across the world including USA,
for business in Karachi. For the purposes Canada, Europe and Asia.
of these Standard Policy Conditions any
notice, instruction, request or Premium
received by the Company at an appointed
place determined in accordance with
Condition 2.4 after 12.00 p.m. on any
Business Day will be treated by the
Company as being received on the
following Business Day.

Commencement Date as specified in the Online Doctor’s consultation:

Policy Schedule mean the date from which the Means Online Audio/Video doctor
consultation through our partner “Ring A
first Policy Year would commence.
Doctor” as under

Company means Jubilee General - 02 General Physician Consultation Per

Insurance Company Ltd.. year/ per policy

- 01 Specialist Consultation Per

Critical Illness means one of the medical or year/per policy.
other conditions or surgical procedures
defined in the Appendix.
Nominee means the person(s)
who stands designated by the Policy
Owner to receive the Benefit Assured
under the Policy on the death of the Life
Assured.
PolicyAnniversaryis an anniversary of
the commencement date
Policy Month means a month
commencing on the Commencement Date and
thereafter commencing on the
corresponding date, or if there is no
corresponding date, the last date of each
succeeding month.
Policy Schedule means the schedule
issued by the Company outlining the main
features of the Policy to which it is
attached.
Policy Year means a year commencing on
the Commencement Date or an
anniversary thereof.
Pre-existing Conditions for the
purposes of this Policy means any injury,
illness, condition or symptom:

a. for which treatment, or

medication, or advice, or
diagnosis has been sought or
received or was foreseeable
prior to the Issue Date of this
Policy for the Life Assured, or
b. which originated or was known
by the Policy Owner or the Life
Assured to exist prior to the
Issue Date of this Policy,
whether or not treatment, or
medication, or advice or
diagnosis was sought or
received.
If this Policy is issued or its
benefits are amended subsequent to the
issue of the Policy, the Issue Date shall
be the date specified in the relevant
endorsement, as the Issue Date of this
Policy.
Premium is the amount, in
accordance with Condition 6, in
consideration of which the Policy has
been issued.
Premium Payment Period means the
number of years, as specified in the
Policy Schedule, for which the
Premium is payable
Statutory Fund means a Fund, as as the Company may from time to
defined in Insurance Ordinance 2000, time appoint. The Company will
established by the Company in its records not act upon any such instruction,
to which this Policy and the attached notification or request until it is
Supplementary Contract(s) shall be received at an appointed place.
referable.

Sum Assured means the Life Sum 3. BENEFIT ASSURED

Assured or the Critical Illness Sum
Assured specified in the Policy Schedule, The Benefit Assured is:
as the case may be.
The Critical Illness Sum Assured,
specified in the Policy Schedule,
2. GENERAL payable in case of happening of the Event
Assured Against mentioned in Condition
Misrepresentation and concealment of 4. below
material facts

I. Any deliberate false statement or 4. EVENTS ASSURED AGAINST

declaration made by the Life
Assured or Policy Owner(s) in The suffering of the Life Assured
connection with the Policy or any from a Critical Illness during the Term
concealment of information which of the Policy, as specified in the Policy
ought to be made known to the Schedule, while this Policy is in force.
Company shall render the Policy
null and void and the unearned Set out are the definitions of the Critical
portion of Premiums, if any, paid Illnesses covered by this Policy.
under the Policy will be refunded.
The Covered normal day diseases include,
II. Assignment
a) Cancer
The Policy may be assigned by the b) Open Chest Coronary Artery
Policy Owner(s) in accordance with Bypass Surgery
Section 71 of the Insurance c) Heart Attack (Myocardial
Ordinance 2000. The Company Infarction)
assumes no responsibility as to the d) Kidney Failure
validity, effect and sufficiency of e) Stroke
any assignments made by the f) Major Organ Transplant
Policy Owner(s). g) Paralysis

2.3 In the event of currency reform or

a change in denomination all
amounts shown in the Policy shall
be deemed to be converted at the
equivalent Rupee rate published by
the State Bank of Pakistan.

2.4 Written directions, notifications or

requests as provided for the Policy
should be given to the Company in
the form prescribed by the
Company at the Head Office of the
Company, or at such other place(s)
The Company reserves the right to review surgery has to be confirmed by a
the Definitions of Critical Illnesses, at any specialist.
time. The review would be based on the
advancement in medical technology Excluded are:
and/or reinsurance terms. The Company Angioplasty
may amend the definition of a Critical Any other intra-arterial procedures
Illness as a result of this review. The Key-hole surgery
Company may also add or remove one or
more Critical Illness(es) in the list of c. Heart Attack (Myocardial
covered Critical Illnesses. Infarction)
The death of a portion of the heart
The Company will inform of the revision in
muscle as a result of inadequate blood
Definitions to the Policy Owner before any
supply to the relevant area. Diagnosis
such change at least thirty (30) days
has to be confirmed by a specialist and
before any such change becomes
evidenced by all of the following
effective.
criteria:

a. Cancer i. a history of typical chest pain

A disease manifested by the presence ii. newcharacteristic
of a malignant tumour characterised electrocardiogram changes
by the uncontrolled growth and spread iii. elevation of infarction specific
of malignant cells, and the invasion of enzymes, Troponins or other
tissue. Diagnosis has be confirmed by biochemical markers
a specialist and evidenced by definite
histology. The term cancer also Excluded are:
includes leukaemia and malignant i. Non-ST-segment elevation
diseases of the lymphatic system such myocardial infarction
as Hodgkin’s Disease. (NSTEMI) with only
elevation of Troponin I or T
Excluded are: ii. Other acute Coronary
Any CIN stage (cervical intraepithelial Syndromes (e.g.
neoplasia) stable/unstable Angina
Any pre-malignant tumour pectoris)
Any non-invasive cancer (cancer in iii. Silent myocardial infarction
situ)
Prostate cancer stage 1 (T1a, 1b, 1c) d. Kidney Failure (End Stage Renal
Basal cell carcinoma and squamous Disease)
cell carcinoma End stage renal disease presented as
Malignant melanoma stage IA (T1a N0 chronic irreversible failure of both
M0) kidneys to function, as a result
Any malignant tumour in the presence of which either regular renal dialysis
of any Human Immunodeficiency (hemodialysis or peritoneal
Virus. dialysis) is instituted or renal
transplantation is carried out.
b. Coronary Artery (Bypass) Surgery Diagnosis has to be confirmed by
The actual undergoing of open chest a specialist.
surgery for the correction of two or
more coronary arteries, which are e. Stroke
narrowed or blocked, by coronary Any cerebrovascular incident
artery bypass graft (CABG). The producing permanent neurological
surgery must have been proven to be sequelae and including infarction
necessary by means of coronary of brain tissue, haemorrhage and
angiography and realisation of the embolisation from an extra cranial
 source. Diagnosis has to be after surviving the Critical Illness for thirty
confirmed by a specialist and (30) days but before the Critical Illness
evidenced by typical clinical benefit is admitted, the Benefit Assured
symptoms as well as typical findings would be payable either under Condition
in CCT Scan or MRI of the brain. 4.
Evidence of neurological deficit for
at least 3 months has to be The Policy will terminate once the Benefit
produced. Assured has been paid.

Excluded are: Medical Second Opinion (MSO) Benefit:

International Medical Second opinion from
i. Transient ischemic attacks Mediguide International for more than 100
(TIA) top hospitals across the world
ii. Traumatic injury of the
brain
iii. Neurological symptoms due 5. PREMIUMS
to migraine
iv. Lacunar strokes without i. Premiums are payable as set out in
neurological deficit the Policy Schedule. The company
reserves the right to review the
f. Major Organ Transplantation amount of Premium payable under
The actual undergoing of a the Policy at any time. The review
transplantation as the recipient of a would be based on actual claims
heart, lung, liver, pancreas, experience under all policies of the
small bowel, kidney or bone marrow. same type as this Policy, issued by
Realisation of the transplantation has the Company. The premium may
to be confirmed by a specialist. be increased or decreased as a
result of the review.
g. Paralysis
Total and irreversible loss of use of ii. The company will inform the
two or more limbs through paralysis revised Premium to the Policy
due to accident or sickness of the Owner at least thirty (30) days
spinal cord. These conditions have to before any change in the Premium
be medically documented by a becomes effective.
specialist for at least 3 months.
Excluded is: iii. Premiums must be paid, for the
Paralysis due to Guillain-Barré- Premium Payment Period, at the
Syndrome frequency set out in the Policy
Schedule. The period of grace
This Policy takes effect after 90 days of allowed for the payment of each
the Commencement Date of this Policy. Premium shall be thirty (30) days
No claim in case of Critical Illness will be from the date, the Premium is due.
paid unless the Life Assured survives for Payment of Premium shall be
thirty (30) days after the Critical Illness is construed as having been paid to
diagnosed or the surgical procedure takes the Company when the whole of
place whichever is later. The Benefit the Premium is received by the
Assured under Condition 4.ii. would be Company or if paid other than in
payable if the Life Assured dies within cash, realised in the accounts of
thirty (30) days after the Critical Illness is the Company.
diagnosed or the surgical procedure takes
place, whichever is later. iv. In the event of the happening of
Event Assured Against within the
In case if the Life Assured suffers a grace period, the Sum Assured
Critical Illness and subsequently dies, payable will be reduced by the
amount of any outstanding
Premium.
6. EVIDENCE AND PAYMENT OF A
CLAIM After the payment of the claim, the Policy
shall be terminated. Benefit will only be
No benefit will be payable under Critical paid if payment of Premium has not been
Illness unless the Policy Owner notifies the discontinued and there are no arrears of
Company in writing within 90 days of the Premium under the Policy when the claim
diagnosis of the Critical Illness. is received.

The Company may require the Life The cost of all medical reports and other
Assured / claimant to sign any necessary evidences would be borne by the Policy
consent form to allow the Company to Owner.
receive the results of any medical
examination and/or tests. Failure to Medical Second Opinion (MSO):
provide the necessary consent will result Utilization Procedure
in the immediate cancellation of any
Patient (Policy Holder or his/her spouse or
benefit under this Policy. In this event, his/her Children) is diagnosed with a condition
there will be no refund of any Premiums which is Covered under Medical Second Opinion,
paid prior to the cancellation of the Policy. Mediguide Covers any Medical Condition

No claim will be paid unless satisfactory The member calls MediGuide’s local service
evidence is received by the Company that center (111-11-2273) to establish eligibility and
the Life Assured has suffered a Critical
initiates the Medical Second Opinion service.
Illness or has died, as the case may be.

Before payment of a claim can be Patient must sign a form consenting to the
considered, the Company will require a release of their medical records and details. The
completed claim form which the Company
doctor will then prepare the relevant patient
will supply and a report from the
registered medical practitioner in charge medical records for MediGuide.
of the case. Before any claim payment is
made, the Company may also require title MediGuide will identify 3 medical centers
of the claimant and proof of age of the
Life Assured.
available to provide the review and gives the
names to the patient and doctor.
In case of a Critical Illness claim, the
Company may also require the Life Patient and doctor choose the medical center
Assured to be examined by a medical
examiner to be appointed by the Company they wish to use for the Medical Second Opinion
or ask for any other evidence the from the list of 3 provided.
Company considers reasonable to consider
the claim. Examples of the other evidence
Within 10 business days of receipt of medical
the Company may require are:
records, both the patient and/or doctor will
• Reports on tests or investigations receive a written review from the selected
carried out to make the diagnosis medical center of the original diagnosis and a
• Reports from the Life Assured’s
medical practitioner
proposed treatment plan, subject to data
• Reports from any consultant protection
physicians or surgeons who the Life
Assured has consulted
• A report from a consultant appointed
by the Company confirming the
diagnosis
Online Doctor’s consultation Utilization Process:
8. EXCEPTIONS/EXCLUSIONS
After receiving Jubilee General’s Health Product
documents, you will receive an automated email from
No benefit will be payable in the event of
Ring A Doctor stating your entitlement along with the
login details. Critical Illness being caused or aggravated
either directly or indirectly by:
Please go to the website www.ringadoctor.com or
download APP from Store: i. wilful self-inflicted injury by/to the
App Store: https://apple.co/2GmTfqC Life Assured or unreasonable
Play Store: http://bit.ly/2v9rmaQ failure to seek or follow medical
advice.
Login with credential provided in your email received
from ring a doctor. List of all available online doctors
ii. addiction of the Life Assured to
will appear in the application to choose from.
alcohol or drugs.
If you have issues, please contact:
iii. intemperance, illegal drug taking,
contact@ringadoctor.com felony or any crime committed by
the Life Assured
Direct: 92 (051) 2260 001 Mobile: +92 342 099 0990
UAN : +92 (051) 111 362 867 iv. flying in an aircraft other than as a
fare paying passenger in a
commercially licensed passenger
7. SUICIDE aircraft.

Where in the opinion of the Company, v. any form of war, invasion,

death results directly or indirectly from hostilities(whether war be declared
suicide occurring during the first 13 or not), civil war, rebellion, riots,
months following the Issue Date, or the date insurrections, military or usurped
of Reinstatement, the Sum Assured shall not power, terrorism, or wilful
be payable and the Policy shall terminate participation in acts of violence
without value.
vi. any mental, neurological or 11.REINSTATEMENT
functional disorder.
Once the Policy has lapsed, it
vii. participating in sports or pastimes may be reinstated on the written
of a hazardous nature including request of the Policy Owner, at the
(but not limited to) racing, discretion of the Company, subject
athletics, swimming, parachuting, to terms and conditions as the
parascending, potholing. Company may require.
mountaineering and hotair
ballooning The Reinstatement would be
subjectto receipt in full by the
viii. infection with Human Company,ofall Premiums due
Immunodeficiency Virus (HIV) or under the Policy and
variants (including Acquired acceptance by the Policy Owner of
Immune Deficiency Syndrome revised terms and conditions
(AIDS)) or AIDS Related Complex specifiedbythe Company.
(ARC).

ix. any Pre-existing Conditions, unless 12.NOMINEE

fully disclosed to the Company and
accepted on terms confirmed by The Policy Owner may designate and
the Company in writing prior to the change the nominee(s) under the Policy.
Issue Date of this Policy The Benefit Assured under this Policy, in
case of death, shall be payable in equal
Exclusion for Medical Second Opinion shares to the surviving nominee(s) if more
( MSO): than one have been designated, unless
otherwise provided.
Mediguide is able to review any medical
Diagnosis with a MSO with the
exception of the following
circumstances: 13.INCONTESTABILITY
1. No diagnosis
The Policy shall become incontestable,
2. No evaluation by a treating except where due Premiums have not
physician been paid, after it has been in force for
For > 1 years two years from the later of, the Issue
Date, date of Reinstatement, date of
3. Condition is acute or life alteration / enhancement of benefits
threatening (requires immediate
provided under the Policy and / or change
medical intervention)
in premium payment mode. No
4. An in person evaluation is required representation made in the proposal, or in
(e.g. mental illness) any other document leading to the Issue,
Reinstatement, alteration / enhancement
of benefits provided under the Policy and /
or change in premium payment mode,
9. SURRENDER VALUE shall constitute a cause for rescinding the
Policy after it becomes incontestable,
This Policy does not have any Surrender except that a willful misstatement of
Value. material fact(s) which was knowingly
made to the Company, and was relied
10. VARIATION IN SUM ASSURED upon by the Company, shall make the
Policy voidable at the option of the
After the Policy is issued, its Sum Assured Company.
may not be increased or decreased.
14. INADVERTENT ACCEPTANCE OF
PREMIUM

Any inadvertent acceptance by the

Company of any Premium or part thereof when
no longer due will not constitute a waiver of
any of these Standard Policy Conditions and
the amount in question shall be refunded.
15. TAXATION AND LEGISLATION

15.1 The Company shall be entitled to

make such deductions (of actual or
estimated amounts) which, in the
opinion of the Company, are
appropriate from any of the
 benefits receivable under the Policy
on account of any tax, duty, levy 16. CURRENCY
or other imposition which may
from time to time be imposed by Unless it is otherwise provided for by the
any legislation, order, regulation or Policy Schedule, all benefits and Premiums
otherwise upon the Company or under the Policy are payable at the Head
upon the payees and for which the Office of the Company for the time being,
Company may be liable to account in the currency of Pakistan.
in respect of the provision of any of
the aforesaid benefits to the 17. MIS-STATEMENT OF AGE OR SEX
payees.
Any mis-statement of age or sex of the
15.2 In the event of any change in Life Assured shall be rectified by making
taxation becoming effective after an equitable adjustment to either the
the Commencement Date in benefits and/or the Premiums under the
relation either to the Company or Policy. Provided that if the age of the Life
the benefits referred to in 16.1 Assured at the Commencement Date is
above in respect of which in the higher than the maximum entry age or
opinion of the Company a lower than the minimum, at which the
deduction by the Company should Company writes the Policy, then the Policy
be permitted but which is not so would be void from its inception at the
permitted by these Conditions, discretion of the Company.
such modification of these
Conditions shall be made by the
Company and notified to the 18. LATE SETTLEMENT OF CLAIMS
person who in the opinion of the
Company holds legal title to the Where payment on Policy becomes due
Policy as the Company shall and person entitled thereto has compiled
consider requisite to take account with all the requirements, including the
of such change. filing of complete papers, for claiming the
payment, the Company shall, if it fails to
15.3 Should there be any change in the make payment within a period of
law or taxation practice affecting ninety(90) days from which the payment
the Policy or the Fund or should becomes due or the date on which
the right of the Company to invest claimant complies the requirements,
in assets of its own choosing be whichever is later, pay as liquidity
affected by legislation or otherwise damages a sum calculated in accordance
or should there be a change in with Section 118(2) of Insurance
circumstances which in the opinion Ordinance 2000 on the amount so payable
of the Company renders it provided that such failure was due to the
impractical or impossible to give circumstances not beyond the control of
full effect to all of these Standard the Company.
Policy Conditions, these Standard
Policy Conditions and the benefits
conferred by the Policy may be 19. CHANGE TO STANDARD
varied by the Company in such POLICY CONDITIONS
manner as the Company deems
appropriate to enable these None of these Standard Policy Conditions
Conditions to take effect as nearly may be waived or modified except by an
as possible. endorsement issued by the Company and
signed by an authorized official thereof,
except where otherwise provided for in
these Standard Policy Conditions.
20. PROPER LAW

Unless it is otherwise provided for, the

Policy, the Policy Schedule, these
Standard Policy Conditions and any
endorsements shall be construed in
accordance with and governed by the law
of Pakistan.

21. Policy Cancellation & Refund:

This policy can be cancelled at any time

during the period of insurance. Premium
refund will only be applicable if policy in
cancelled within Free Look Period with
assigned reasons and only if no claim is
open or paid on the policy. Refund
premium will be net of all Administrative
charges incurred by the Company.

22. Credit Card/Online Payment

Coverage purchased by credit card is

subject to validation and acceptance by
the credit card company and the Card
issuing bank.

23. Confidential Information

All information provided shall be kept for

Company’s use and will not be shared with
third parties, vendors &/or contractors.
Please note that Credit card information is
also not stored by the Company and that
Company shall not be liable for any
fraudulent usage of your Card. Company
maintains secured technology processes
to safeguard the information provided.

24. CUSTOMER SERVICE & GRIEVANCES REDDRESSAL:

(i). In case of any query or

complaint/grievance, Policy Holder may
approach office at the following address:
Health Insurance Administration,
2nd Floor, PNSC Building,
Lalazar, M. T. Khan Road,
Karachi-74000, Pakistan
Phone: 021-3811 4000, 021-3565 7885-6
Facsimile: 021-35611349
E-mail: customer.services@jubileehealth.com
(ii). In case Policy Holder is not satisfied with
the decision of the above office, or have not
Received any response within 10 days, then
Policy Holder may contact the following official
for Resolution:

Jubilee General Insurance Company

Limited (Formerly New Jubilee Insurance Company Limited)
2nd Floor, Jubilee Insurance House,
I.I. Chundrigar Road, P.O.BOX 4795,
Karachi. 74000, Pakistan
UAN: (021) 111-654-111,
Tel: 021- 38142900
Fax: 021- 32416728, 32438738
Email: Info@jubileegeneral.com.pk
Website: www.jubileegeneral.com.pk
https://www.getinsurance.pk