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    Critical Illness Plan Request

    K9care Plan Details

    DEFINITIONS

    Accidental Injury

    means sudden, unforeseen and involuntary event caused by external, visible and violent means leading to bodily harm, excluding illness or disease solely and directly caused by it, which is verified and certified by a licensed veterinarian as mentioned in Section 2 of this Plan.

    Breed

    means a specific group of domestic animals having homogeneous appearance (phenotype), homogeneous behaviour, and/or other characteristics that distinguish it from other organisms of the same species.

    Critical illness (under critical illness plan)

    means the diseases or the disease conditions or the syndromes as specifically mentioned under K9care critical illness plan.

    Consultation/Examination Fee

    means a fee charged by a licensed veterinarian to meet with a pet owner to discuss the facts of his or her pet’s case that leads to diagnosis of an injury, illness or disease as mentioned under this plan.

    Emergency / Emergency Care

    means management for an illness or injury which results in symptoms which occur suddenly and unexpectedly and requires immediate care by a Licensed Veterinarian to prevent death or serious long-term impairment of your Pet’s health.

    Heart disorders (under critical illness plan)

    means Arteriosclerosis, Atrial fibrillation, Cardiac arrhythmia, Cardiomyopathy, Congestive heart failure, Endocarditis, Myocardial effusion, Myocarditis and Mitral valve insufficiency, Thrombosis and pericardial Effusion.

    Home visits

    means visits to your vet outside of normal surgery hours for treatment unless your vet considers your pet can't be moved or couldn't wait until normal surgery hours to be seen.

    Hospitalization

    means admission in a Hospital for ‘In-pet Care’.

    In-pet Care / Medical Treatment

    means treatment for which the covered pet has to stay in a hospital for a covered event and or has to undergo treatment or procedure without having to stay in the hospital.

    Internal cancers (under critical illness plan)

    means cancer affecting internal organs of the insured pet specifically affecting oesophagus, stomach, small/large intestines, lung, liver, pancreas, kidney, endocrine organs, blood and brain and does not include skin, skeletal muscle, bone, mammary/salivary gland, testicles, eye and oral cavity which are obviously visible outside the body.

    Laboratory Tests

    means tests conducted under controlled, scientific conditions in a laboratory or similar setting where a test (such as a blood test or urinalysis procedure) is performed by a licensed medical laboratorian on a specimen taken from the pet.

    Licensed Veterinarian/ Veterinarian/Vet

    means a person who holds a valid registration from the Veterinary Council of India (VCI) Or state veterinary Council and is thereby entitled to practice veterinary medicine within its jurisdiction; and is acting within its scope and jurisdiction of license. Licensed Veterinarian should not be the Pet Owner himself/herself or close member of the family of the pet owner.

    Major illness

    means the diseases or the disease conditions or the syndromes as mentioned in Section 1 of this Plan.

    Major Soft Tissue Surgeries

    means any surgical procedures as mentioned in Section 4 of this Plan.

    Medical Expenses

    means those expenses that a covered pet owner has necessarily and actually incurred for medical treatment of his / her pet on account of Illness or Accident on the advice of a licensed veterinarian, as long as these are no more than what would have been payable if the Pet had had not been covered under the plan and no more than other hospitals or veterinarian in the same locality would have charged for the same medical treatment.

    Normal Surgery Hours

    shall mean the Vet’s regular hours as per their hospital/clinic/practice time.

    Notification of Claim

    means the process of intimating a claim to us through any of the recognized modes of communication.

    Pet

    means the beneficiary covered under this plan on the payment of plan charges.

    Pet Owner

    means the pet owner as mentioned in the plan summary

    Plan

    means the Plan Summary and the Plan Details.

    Plan Charges

    shall mean the amount paid by the pet owner towards availing the plan for his/her pet for the duration as per the plan summary.

    Plan Limit

    means the amount as stated in the Plan Summary against the Section/Cover for each pet covered under it.

    Plan Period

    means the period between the commencement date and the expiry date specified in the Plan Summary and includes both the commencement date as well as the expiry date.

    Disease /Conditions Existing Prior to Purchasing the Plan

    means any condition, ailment or injury or related condition(s) for which there were signs or symptoms and / or were diagnosed and / or for which medical advice / treatment was received prior to the first Plan issued by the us.

    Reasonable and Customary Charges

    means the charges for services, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury involved.

    Surgery or Surgical Procedure

    means manual and / or operative procedure (s) required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure of diseases, relief from suffering and prolongation of life, performed in a hospital or day care centre by a licensed veterinarian.

    Third Party

    means any individual or a party who is not a family member, business associate or an employee of the pet owner and is not directly part of this contract as mentioned in Section 3 of this Plan.

    Unproven/Experimental treatment

    means the treatment including drug or experimental therapy which is not based on established medical practice in India, is treatment experimental or unproven.

    You, Your, Yours, Yourself, Plan-holder, Person(s)

    means the Individual Pet Owner whose pet will be treated as a beneficiary under this plan.

    ABOUT YOUR COVER

    K9CARE CRITICAL ILLNESS PLAN

    If Your pet is diagnosed as suffering from any of the critical illness or undergoing Specialised Therapy or treatment as specified below, during the Plan Period, we will pay You all the Reasonable and Customary Charges that are Medically Necessary and Incurred by You in respect of an admissible hospitalization claim up to the plan limit mentioned in Your Plan Summary.

    Provided that,

    1. This Critical illness or undergoing Specialised Therapy or treatment has happened to your Pet for the first time in Pet’s life.
    2. We will not make any payment if Your Pet is diagnosed or observed as suffering from a critical Illness and is hospitalized within 90 days from the commencement date of the first Plan with us.
    3. No payment under this section shall be made if the critical Illness is a consequence of or arising out of any Disease/Conditions Existing Prior to Purchasing the Plan.

    What we will cover:

  • Consultation /Examination fee of a Licensed Veterinarian
  • Emergency Care provided by a Licensed Veterinarian
  • Surgeries carried out by a Licensed Veterinarian.
  • Laboratory Tests for diagnosis as advised by your Veterinarian.
  • X-Rays, MRI, CT SCAN for diagnosis.
  • Hospitalization / Boarding charges at a Licensed Veterinary Hospital.
  • Legally prescribed drugs and medications by your Veterinarian.

    • Critical Illness or specialized therapy shall mean any of the following, which your Pet may have been diagnosed with during the Plan Period and are specifically defined as below:

  • Internal Cancers/tumours (Benign or malignant)
  • Heart disorders
  • Renal/kidney failure
  • Liver failure/cirrhosis
  • Major head trauma involving skull fractures
  • Trauma causing injuries to internal organs
  • Toxicity due to ingestion of hazardous chemicals or drug Overdose
  • Diaphragmatic hernia
  • Gastric dilatation and volvulus
  • Heartworm disease/ Dirofilariasis

    • AMOUNT THAT YOU NEED TO PAY FROM YOUR POCKET IN CASE OF A CLAIM

  • Under K9care Comprehensive Protection Plan, if your pet is less than 8 years of age at the time of a claim event, we will deduct INR 1000 or 5% of claim amount (whichever is higher) from each admissible claim.
  • Under K9care Critical illness Plan, if your pet is less than 8 years of age at the time of a claim event, we will deduct INR 2000 or 10% of claim amount (whichever is higher) from each admissible claim.
  • We will pay 75% of the admissible claim amount if your pet is over 8 years of age at the time of the claim event.
  • We will pay 50 % of the admissible claim amount if your pet is over 10 years of age at the time of the claim event.

    • TERMS & CONDITIONS APPLICABLE TO THESE PLANS

    Throughout the Plan period, the below mentioned steps are to be adhered:

  • Your pet must be fitted with a microchip and you must provide microchip details along with all the relevant data of you and your pet which would be part of your plan summary including photographs of your pet while taking the plan for identification purposes.
  • For Renal / kidney failure and Liver Failure, we will pay a onetime lump sum Benefit of 50% of Plan Limit and the plan will cease to exist.
  • Your pet must be over 8 weeks and under 8 years of age to be eligible for coverage under this plan, on taking the plan for the first time.
  • This Plan shall cease immediately and there will be no refund of plan charges if any information provided at the time of buying this plan is found to be false, wrong or if information has not disclosed, in respect of the Pet.
  • Coverage of this plan will be in the geographical bounds of India only.
  • Maintain your pet’s health and well-being.
  • Provide a secure and safe environment for your pet to prevent injury, illness, theft or straying.
  • Control your pet to prevent injury to a person or another animal and damage or destruction to any property.
  • Your pet must be kept vaccinated against distemper, hepatitis, leptospirosis, parvovirus, Rabies, kennel cough and Corona vaccines of good, branded companies, complying with WHO norms for manufacture and testing.
  • Your pet must have regular de-worming and flea treatments and should be provided with a healthy diet.
  • You must take any actions recommended by a vet to prevent or reduce the risk of injury/illness.
  • If your pet is unwell /injured, you must arrange for a vet to examine and treat your pet as soon as possible.
  • Your pet is covered under this plan only on payment of the plan charges.
  • Your plan will be in force from the plan start date and remain in force till plan end date as mentioned in your plan summary.
  • In the event, you decide to transfer the ownership to your family member or relative, or any other person you must inform us about the same, within 7 working days of such transfer. We will update the terms and conditions along with other relevant documents to reflect the same. In case, we are not informed about the ownership transfer, the coverages will discontinue.
  • You may also nominate an immediate family member of yours to notify us on behalf of you, only if you are critically ill or injured.
  • In case you have obtained option of paying Plan Charges using EMI (equated monthly instalments) You must make payment of instalments, failing which, the Plan will become null and void and no claims will be admissible.
  • You must agree:
    1. To give us all relevant and material information, documents and access to all relevant and material medical records of the covered Pet, so that we may administer your plan and deal with your claims.
    2. That your vet has your permission to give us all relevant and material information that we ask for about your covered pet. If a charge is made for this, you must pay for the charge.
  • At no point in time, shall the total claims payable during the plan period, exceed the total Plan Limit as mentioned in the Plan Summary.

    • WHAT IS NOT COVERED?

    Preventive, routine treatments, examinations or check-ups, vaccinations, routine tick, flea, mites or de-worming treatments, wound dressing, General skin/Eyes/Dental, ortho, routine check-up and problems, clipping nails, bathing, de-matting, routine spaying or routine castrating/neutering, any inherited conditions or diseases, any congenital anomaly, cosmetic surgeries, and dental scaling of your pet are not covered under this Plan.

  • In case the regular upkeep of the pet is not maintained in the form of vaccinations, regular check-ups, grooming and routine treatments as necessary, no payment will be paid under this plan arising due to lack of such care shall be denied.
  • No payment shall be made under this plan if the Surgical Procedure is a consequence of or arising out of any pre-existing condition/disease.
  • Any other condition that is not mentioned above, will not be covered under this plan.
  • Any Homeopathic and Herbal medications.
  • Any Treatment or prescription by a non-licensed Veterinarian.
  • Any treatment that is in any way connected with your pet being pregnant, subsequent complic
  • The treatment of or training for diagnosed behavioural problems.
  • Home visits or visits to your vet outside of normal surgery hours for treatment unless your vet considers your pet can't be moved or couldn't wait until normal surgery hours to be seen.
  • Food, even if prescribed/recommended by a vet.
  • Supplements and probiotics, any medical or tracking device, pet accessories these are products you can purchase without a prescription. We don't pay for these even if prescribed/recommended by a vet.
  • Malicious or wilful injury or neglect or gross negligence to your pet caused by you or your agent or your employees or members of your family.
  • Injury or illness due to endangering event like an organized fight.
  • Any dogs classified as dangerous dogs by State or Central Government Authority.
  • The confiscation or destruction of your pet by Government or Public Authorities, or under applicable Indian Laws.
  • Any amount related to incident occurring outside the geographical limits of India.
  • Any amount related to cost or fees for procedure/surgery for experimental or unproven treatment.
  • Any charge or fees made by your Vet to complete a claim form or to provide information to support your claim.
  • In case there is a transfer of ownership but we have not been informed about the same.
  • Any liability which is covered/insured under any other liability plan.
  • Treatment for teeth or gums if they're damaged due to tooth decay, dental or gum disease.
  • If your pet is used for guarding commercial property or used for hunting and such similar purposes.
  • Pet is in the premises where alcohol is commercially sold and consumed.
  • Any damage or injury caused to human or to the animal which falls within the purview of section 377 of the Indian penal code.
  • Any injuries or Damage caused by war, invasion, act of foreign enemy hostilities or war like operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular rising, military rising, rebellion, revolution, insurrection or military or usurped power.
  • Any injuries or illnesses or diseases caused to the Pet by ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel the radioactive toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
  • Claim under this plan shall be payable only on the basis of confirmed diagnosis.
  • If any claim under this Plan is in any respect fraudulent or unfounded, all benefits paid and/or payable in relation to that claim shall be forfeited and (if appropriate) recovered. In addition, all covers with respect to the Pet owner shall be cancelled from Plan Period commencement date without any refund of Plan Charges.

    • HOW TO GET BENEFIT UNDER THESE PLANS?

    Notification and Procedure

    In the event of any accidental injury or illness or condition that may result in a claim under this plan, the below procedure should be followed:

  • Any claim to be reported within 24 hours from date of diagnosis (for illness) or date of incident (for injuries)
  • The customer must keep all the reports of diagnosis that has led to the treatment.
  • The treatment should be video recorded along with the pet, the date and the microchip number on the scanner visible clearly in the video (approximately 2 minutes of the treatment).

    • Reimbursement Facility can be availed from a licensed hospital within India of Your Choice Wherein You will have to make the payment directly to the Hospital and submit the documents to us for processing the reimbursement of the claim amount (within 30 days of completion of treatment).

    In case of a claim arising due to injury to a third party because of your pet, you will need to inform us within 24 hours of such claim being intimated to you.

    We shall have the rights to investigate the facts of the case at our own expense and the Pet Owner shall co-operate with the us for all such matters. We, based on the data collected via this investigation shall make recommendations to the Pet Owner and their legal representatives who are expected to follow through on them in the court. Any additional such legal expenses paid by the pet owner in course of this action will be paid by us within the plan limits.

    We may refuse to reimburse you for any expenses for which you cannot provide headed invoices, receipts or bills or any handwritten bills not on a letterhead and/or without the signature and seal from the person raising the bill.

    Within 30 days of completion of treatment, you should submit all original documents (self-attested) pertaining to the treatment as mentioned in the List of Documents.

    You can reach out to us for settling your losses at +91 88-8081-8081 or write to us at k9care@petpal.in

    List of Documents Required

    K9CARE CRITICAL ILLNESS PLAN

    Photograph of the pet immediately before the treatment and Photograph of the Pet post treatment, a video recording approximately 2 minutes long of the actual treatment, Dated consultation Papers, prescriptions and bills for each item, Final Hospital bill with items purchased against each date, Complete medical history with timelines and dated diagnostic Reports, Pre-numbered paid receipt for each financial transaction involving current claim, Complete vaccination reports from the veterinarian (if required by us), Scan copy of your cancelled cheque Or Screenshot of your bank account number with your name, bank account number and IFSC.

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