covid19.neoperk.com
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URL:
https://covid19.neoperk.com/
Submission: On November 19 via api from JP — Scanned from JP
Submission: On November 19 via api from JP — Scanned from JP
Form analysis 1 forms found in the DOM
<form id="regForm" class="form-horizontal" novalidate="novalidate">
<div class="tab " style="display: block;">
<div class="row">
<div class="col-sm-4">
<img class="img-fluid" src="https://covid19.neoperk.com/assets/img/insurance-left.jpg">
</div>
<div class="col-sm-8">
<h4>Select Your Age Group</h4>
<p>
</p>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="age_group" id="inlineRadio1" value="1">
<label class="form-check-label" for="inlineRadio1">3 months to 55 Years</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="age_group" id="inlineRadio2" value="2">
<label class="form-check-label" for="inlineRadio2">56 Years to 60 Years</label>
</div>
<p></p>
</div>
</div>
</div>
<div id="plan-list" class="tab">
</div>
<div class="tab">
<h2>Terms and Conditions for your Covid-19 Policy</h2>
<p>Please read the below terms and conditions of the policy that you are availing. We care for your well being, and we strongly suggest that you read the below text precisely and provide your approval before moving forward</p>
<ol style="list-style-type: upper-alpha;">
<li> Master Policy will be provided basis below declaration <ol style="list-style-type: lower-roman;">
<li>Neither me nor my any family member or close associate is suffering from COVID-19 or Quarantined /I or we have not met any COVID-19 affected person in last 15 days</li>
<li>I am not living with and sharing the same address as that of person(s) who is/were Diagnosed with COVID-19 or Quarantined</li>
<li>Have Not travelled to international destination in 45 day immediately preceding the Certificate Period Start Date</li>
</ol>
</li>
<li>Maximum Cumulative Sum Insured allowed for a single person cannot be greater than 2,00,000 under multiple policies.</li>
<li>Kindly be noted, this master policy is provided basis declaration that product will be provided to only Customers of captioned organizations and cannot be marketed in open market as well as employee employer relationship. Company reserves
the right to verify relationships at any point of time. If no relationship is found, then the claim will not be honoured and liability lies on the intermediary. <br> Any one of (i)Hospitalization Cover or (iv) Quarantine Cover will be payable
at a time. <br> The total amount payable under Covers (i),(ii),(iii),(iv) shall not exceed 100% of the Sum Insured </li>
</ol>
<div>
<div class="text-align: center;">
<h4>Specific Exclusions</h4>
</div>
<div></div>
</div>
<div>
<span> </span>
</div>
<div>
<table border="1" cellspacing="0" cellpadding="2">
<tbody>
<tr>
<td colspan="7" height="21">
<span>Specific Exclusions</span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>1</span>
</td>
<td colspan="6">
<span>Waiting Period: The Policy shall not cover Hospitalization or Quarantine within 15 days of Certificate Period Start Date.</span>
</td>
</tr>
<tr>
<td height="47" align="center">
<span>2</span>
</td>
<td colspan="6">
<span>Co-habitation: No claim shall be payable where the Insured Person was living with and sharing the same address as that of person(s) who were Diagnosed with COVID-19 or Quarantined at the time of Proposal.</span>
</td>
</tr>
<tr>
<td height="51" align="center">
<span>3</span>
</td>
<td colspan="6">
<span>Unauthorized Testing center: Testing done at a Diagnostic center other than the ones authorized by the Union Health Ministry of India. shall not be recognized under this Policy.</span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>4</span>
</td>
<td colspan="6">
<span>Out of India: Diagnosis and/or Treatment taken outside India is not covered.</span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>5</span>
</td>
<td colspan="6">
<span>Undefined Conditions: Treatment taken for any condition or disease other than COVID-19 is not covered 6.Self-Quarantine: Self-Quarantine is not covered.</span>
</td>
</tr>
<tr>
<td height="37" align="center">
<span>7</span>
</td>
<td colspan="6">
<span>Negative or Inconclusive Reports: If the test report is negative or if Insured Person is ‘Patients under investigation’ (PUI) with inconclusive reports, no claim will be admissible under Hospitalization Cover of this
Policy.</span>
</td>
</tr>
<tr>
<td height="40" align="center">
<span>8</span>
</td>
<td colspan="6">
<span>Breach of law (Code: Excl 10): Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.</span>
</td>
</tr>
<tr>
<td height="45" align="center">
<span>9</span>
</td>
<td colspan="6">
<span>Cluster Containment operations carried out by State or Central Government to contain the spread of SARS-CoV2 virus. Any self-isolation as a result of such Cluster Containment operations will not be considered as Quarantine and is
not covered under this Policy.</span>
</td>
</tr>
<tr>
<td height="67" align="center">
<span>10</span>
</td>
<td colspan="6">
<span>Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a Medical Practitioner as part of Hospitalization claim or
day care procedure (Code:Excl14): 11.Domiciliary/OPD Treatment: Any expenses incurred on Domiciliary Hospitalization and OPD treatment.</span>
</td>
</tr>
<tr>
<td height="84" align="center">
<span>12</span>
</td>
<td colspan="6">
<span>Excluded Providers (Code: Excl 11): Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the
Policyholders/Certificate Holders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.(For updated and detailed
list of Excluded Providers refer website- <a href="http://www.reliancegeneral.co.in/" target="_blank" rel="noopener">www.reliancegeneral.co.in</a> ) </span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>13</span>
</td>
<td colspan="6">
<span>Investigation & Evaluation (Code: Excl04)</span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>14</span>
</td>
<td colspan="6">
<span>Expenses related to any admission primarily for diagnostics and evaluation purposes</span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>15</span>
</td>
<td colspan="6">
<span>Any diagnostic expenses which are not related or not incidental to the current Diagnosis and treatment are excluded</span>
</td>
</tr>
<tr>
<td height="39" align="center">
<span>16</span>
</td>
<td colspan="6">
<span>Lockdown: Lockdown means an emergency protocol that prevents people from leaving an area or a state of isolation or restricted access instituted as a security measure by the Government. Any self-isolation as a result of such
Lockdown will not be considered as Quarantine and is not covered under this Policy.</span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>17</span>
</td>
<td colspan="6">
<span>Willful Act/Negligence: Willful acts or willful gross negligence of the Insured Person.</span>
</td>
</tr>
<tr>
<td height="20" align="center">
<span>18</span>
</td>
<td colspan="6">
<span>Unproven Treatments-Code (Code: Excl 16): Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant
medical documentation to support their effectiveness.</span>
</td>
</tr>
<tr>
<td height="21" align="center">
<span>19</span>
</td>
<td colspan="6">
<span>All Standard terms and conditions of product are applicable.</span>
</td>
</tr>
</tbody>
</table>
</div>
<div class="form-check text-center mt-2 mb-2">
<input class="form-check-input" name="agree" type="checkbox" id="defaultCheck1">
<label class="form-check-label" for="defaultCheck1"> I have read and accept the terms and conditions </label>
</div> <input type="hidden" name="receipt_id" id="receipt_id" class="form-control">
</div>
<div class="tab">
<h4 align="left">KYC Detail</h4>
<p>Please provide the following details so that we can process your policy as soon as possible. By submitting the below form you confirm that all the details provided below are to the best of your knowledge</p>
<div class="row">
<div class="col-md-3 mb-3">
<label for="first_name">First Name</label>
<input type="text" name="first_name" id="first_name" class="form-control" placeholder="" required="" autocomplete="off">
</div>
<div class="col-md-3 mb-3">
<label for="middle_name">Middle Name</label>
<input type="text" name="middle_name" id="middle_name" class="form-control" placeholder="" autocomplete="off">
</div>
<div class="col-md-3 mb-3">
<label for="last_name">Last Name</label>
<input type="text" name="last_name" id="last_name" class="form-control" placeholder="" required="" autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-md-3 mb-3">
<label for="dob">Date Of Birth</label>
<input type="text" name="dob" id="dob" class="form-control hasDatepicker" placeholder="dd-mm-yyyy" required="" autocomplete="off">
</div>
<div class="col-md-3 mb-3">
<label for="age">Age</label>
<input type="text" name="age" id="age" class="form-control" placeholder="" required="" autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-md-3 mb-3">
<label for="email_id">Email Id</label>
<input type="text" name="email_id" id="email_id" class="form-control" placeholder="" required="" autocomplete="off">
</div>
<div class="col-md-3 mb-3">
<label for="phone_no">Phone Number</label>
<input type="text" name="phone_no" id="phone_no" class="form-control" placeholder="" required="" autocomplete="off">
</div>
</div>
<div class="mb-4">
<label for="address">Address</label>
<input type="text" class="form-control" name="address" placeholder="1234 Main St" required="">
</div>
<div class="mb-3">
<label for="address2">Address 2 <span class="text-muted">(Optional)</span></label>
<input type="text" class="form-control" name="address2" placeholder="Apartment or suite">
</div>
<div class="row">
<div class="col-md-4 mb-3">
<label for="state">State</label>
<select name="state" class="form-control" id="state">
<option value="" selected="selected">Select Any</option>
<option value="1">Andaman and Nicobar Islands</option>
<option value="2">Andhra Pradesh</option>
<option value="3">Arunachal Pradesh</option>
<option value="4">Assam</option>
<option value="5">Bihar</option>
<option value="6">Chandigarh</option>
<option value="7">Chhattisgarh</option>
<option value="8">Dadra and Nagar Haveli</option>
<option value="9">Daman and Diu</option>
<option value="10">Delhi</option>
<option value="11">Goa</option>
<option value="12">Gujarat</option>
<option value="13">Haryana</option>
<option value="14">Himachal Pradesh</option>
<option value="15">Jammu and Kashmir</option>
<option value="16">Jharkhand</option>
<option value="17">Karnataka</option>
<option value="18">Kenmore</option>
<option value="19">Kerala</option>
<option value="20">Lakshadweep</option>
<option value="21">Madhya Pradesh</option>
<option value="22">Maharashtra</option>
<option value="23">Manipur</option>
<option value="24">Meghalaya</option>
<option value="25">Mizoram</option>
<option value="26">Nagaland</option>
<option value="27">Narora</option>
<option value="28">Natwar</option>
<option value="29">Odisha</option>
<option value="30">Paschim Medinipur</option>
<option value="31">Pondicherry</option>
<option value="32">Punjab</option>
<option value="33">Rajasthan</option>
<option value="34">Sikkim</option>
<option value="35">Tamil Nadu</option>
<option value="36">Telangana</option>
<option value="37">Tripura</option>
<option value="38">Uttar Pradesh</option>
<option value="39">Uttarakhand</option>
<option value="40">Vaishali</option>
<option value="41">West Bengal</option>
</select>
</div>
<div class="col-md-4 mb-3">
<label for="city">City</label>
<select id="city" name="city" class="form-control">
<option value="">--- Select ---</option>
</select>
</div>
<div class="col-md-2 mb-3">
<label for="zip">Zip</label>
<input type="text" class="form-control" name="pincode" placeholder="" required="">
</div>
</div>
<div class="row">
<div class="col-sm-12">
<h6>ID Proof</h6>
</div>
<div class="col-md-3 mb-3">
<label for="id_proof_type">Document Type</label>
<select name="id_proof_type" class="form-control" required="">
<option value="" selected="selected">Select</option>
<option value="1">Aadhar Card</option>
<option value="2">Pan Card</option>
<option value="3">Passport</option>
<option value="4">Votor ID</option>
</select>
</div>
<div class="col-md-3 mb-3">
<label for="id_proof_no">Document No.</label>
<input type="text" name="id_proof_no" id="id_proof_no" class="form-control" maxlength="50" placeholder="" required="" autocomplete="off">
</div>
<div class="col-md-6 mb-3">
<label for="id_proof">Attach Document</label>
<div class="input-group">
<input type="file" name="id_proof" id="id_proof" class="custom-file-input">
<label class="custom-file-label" for="id_proof">Choose file</label>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<h6>Address Proof</h6>
</div>
<div class="col-md-3 mb-3">
<label for="address_proof_type">Document Type</label>
<select name="address_proof_type" class="form-control" required="">
<option value="" selected="selected">Select</option>
<option value="1">Aadhar Card</option>
<option value="2">Pan Card</option>
<option value="3">Passport</option>
<option value="4">Votor ID</option>
<option value="5">Electricity Bill</option>
<option value="6">Bank Passbook / Statement</option>
</select>
</div>
<div class="col-md-3 mb-3">
<label for="address_proof_no">Document No.</label>
<input type="text" name="address_proof_no" id="address_proof_no" class="form-control" maxlength="50" placeholder="" required="" autocomplete="off">
</div>
<div class="col-md-6 mb-3">
<label for="address_proof">Attach Document</label>
<div class="input-group">
<input type="file" name="address_proof" id="address_proof" class="custom-file-input">
<label class="custom-file-label" for="address_proof">Choose file</label>
</div>
</div>
</div>
</div>
<div id="tab-preview" class="tab">
</div>
<div class="text-center">
<button type="button" id="prevBtn" class="btn btn-secondary" onclick="nextPrev(-1)" style="display: none;">Previous</button>
<button type="button" id="nextBtn" class="btn btn-success" onclick="nextPrev(1)">Next</button>
</div>
<div style="text-align:center;margin-top:40px;">
<span class="step active"></span>
<span class="step"></span>
<span class="step"></span>
<span class="step"></span>
</div>
</form>Text Content
*
1.
SELECT YOUR AGE GROUP
3 months to 55 Years
56 Years to 60 Years
TERMS AND CONDITIONS FOR YOUR COVID-19 POLICY
Please read the below terms and conditions of the policy that you are availing.
We care for your well being, and we strongly suggest that you read the below
text precisely and provide your approval before moving forward
1. Master Policy will be provided basis below declaration
1. Neither me nor my any family member or close associate is suffering from
COVID-19 or Quarantined /I or we have not met any COVID-19 affected
person in last 15 days
2. I am not living with and sharing the same address as that of person(s)
who is/were Diagnosed with COVID-19 or Quarantined
3. Have Not travelled to international destination in 45 day immediately
preceding the Certificate Period Start Date
2. Maximum Cumulative Sum Insured allowed for a single person cannot be greater
than 2,00,000 under multiple policies.
3. Kindly be noted, this master policy is provided basis declaration that
product will be provided to only Customers of captioned organizations and
cannot be marketed in open market as well as employee employer relationship.
Company reserves the right to verify relationships at any point of time. If
no relationship is found, then the claim will not be honoured and liability
lies on the intermediary.
Any one of (i)Hospitalization Cover or (iv) Quarantine Cover will be payable
at a time.
The total amount payable under Covers (i),(ii),(iii),(iv) shall not exceed
100% of the Sum Insured
SPECIFIC EXCLUSIONS
Specific Exclusions 1 Waiting Period: The Policy shall not cover Hospitalization
or Quarantine within 15 days of Certificate Period Start Date. 2 Co-habitation:
No claim shall be payable where the Insured Person was living with and sharing
the same address as that of person(s) who were Diagnosed with COVID-19 or
Quarantined at the time of Proposal. 3 Unauthorized Testing center: Testing done
at a Diagnostic center other than the ones authorized by the Union Health
Ministry of India. shall not be recognized under this Policy. 4 Out of India:
Diagnosis and/or Treatment taken outside India is not covered. 5 Undefined
Conditions: Treatment taken for any condition or disease other than COVID-19 is
not covered 6.Self-Quarantine: Self-Quarantine is not covered. 7 Negative or
Inconclusive Reports: If the test report is negative or if Insured Person is
‘Patients under investigation’ (PUI) with inconclusive reports, no claim will be
admissible under Hospitalization Cover of this Policy. 8 Breach of law (Code:
Excl 10): Expenses for treatment directly arising from or consequent upon any
Insured Person committing or attempting to commit a breach of law with criminal
intent. 9 Cluster Containment operations carried out by State or Central
Government to contain the spread of SARS-CoV2 virus. Any self-isolation as a
result of such Cluster Containment operations will not be considered as
Quarantine and is not covered under this Policy. 10 Dietary supplements and
substances that can be purchased without prescription, including but not limited
to Vitamins, minerals and organic substances unless prescribed by a Medical
Practitioner as part of Hospitalization claim or day care procedure
(Code:Excl14): 11.Domiciliary/OPD Treatment: Any expenses incurred on
Domiciliary Hospitalization and OPD treatment. 12 Excluded Providers (Code: Excl
11): Expenses incurred towards treatment in any Hospital or by any Medical
Practitioner or any other provider specifically excluded by the Insurer and
disclosed in its website / notified to the Policyholders/Certificate Holders are
not admissible. However, in case of life threatening situations or following an
accident, expenses up to the stage of stabilization are payable but not the
complete claim.(For updated and detailed list of Excluded Providers refer
website- www.reliancegeneral.co.in ) 13 Investigation & Evaluation (Code:
Excl04) 14 Expenses related to any admission primarily for diagnostics and
evaluation purposes 15 Any diagnostic expenses which are not related or not
incidental to the current Diagnosis and treatment are excluded 16 Lockdown:
Lockdown means an emergency protocol that prevents people from leaving an area
or a state of isolation or restricted access instituted as a security measure by
the Government. Any self-isolation as a result of such Lockdown will not be
considered as Quarantine and is not covered under this Policy. 17 Willful
Act/Negligence: Willful acts or willful gross negligence of the Insured Person.
18 Unproven Treatments-Code (Code: Excl 16): Expenses related to any unproven
treatment, services and supplies for or in connection with any treatment.
Unproven treatments are treatments, procedures or supplies that lack significant
medical documentation to support their effectiveness. 19 All Standard terms and
conditions of product are applicable.
I have read and accept the terms and conditions
KYC DETAIL
Please provide the following details so that we can process your policy as soon
as possible. By submitting the below form you confirm that all the details
provided below are to the best of your knowledge
First Name
Middle Name
Last Name
Date Of Birth
Age
Email Id
Phone Number
Address
Address 2 (Optional)
State Select Any Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh
Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi
Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka
Kenmore Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram
Nagaland Narora Natwar Odisha Paschim Medinipur Pondicherry Punjab Rajasthan
Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand Vaishali West
Bengal
City --- Select ---
Zip
ID PROOF
Document Type Select Aadhar Card Pan Card Passport Votor ID
Document No.
Attach Document
Choose file
ADDRESS PROOF
Document Type Select Aadhar Card Pan Card Passport Votor ID Electricity Bill
Bank Passbook / Statement
Document No.
Attach Document
Choose file
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