Key Terms and Conditions for Elder Care
PREAMBLE:
These Terms and Conditions (hereafter any use of the expression"Terms and Conditions" in this Document shall mean the contents of this Document, i.e., these Terms and Conditions) will govern the relationship between You and Livlong Protection & Wellness Solutions Limited (which hereinafter may be referred as “Livlong” or “LPWSL” or “Livlong 365”) in relation to the Product which You have purchased from Livlong 365. The Product is being offered to You on the basis of the information collected by Livlong 365 and provided by You at the time of enrolling for the Product.
Your access to the Services covered by the Product shall be subject to uninterrupted receipt of consideration which is due and payable by You within timelines stipulated by Livlong 365, and full compliance with these Terms and Conditions. If You are purchasing the Product for someone else (i.e. a Beneficiary), then You shall ensure that the Beneficiary:
a.
must have given You consent to purchase the Product on his/her behalf and
b.
also accepts and acts in compliance with these Terms and Conditions.
DEFINITIONS:
a.
Benefits refer to the actual services that are made available to You and the Beneficiary by LivLong 365 under the Product.
b.
Product and Product Coverage refers to the bundle of elder care services offered by Livlong 365, which are described in these Terms and Conditions and/or the Product Brochure provided to You.
c.
Beneficiary refers to the individual who will receive Benefits provided as part of the purchased Product. If You are buying the Product for Yourself, then the expression “Beneficiary” shall be understood to refer to “You”.
d.
Counselor means a qualified counseling or clinical psychologist.
e.
Doctor referred to individually and collectively, means a Registered Medical Practitioner of Allopathy, who may be either a General Practitioner and/or a Specialist.
f.
General Practitioner means a Doctor possessing an MBBS degree and licensed to practice medicine in India.
g.
Healthcare Manager (HCM) means a Paramedical Healthcare professional who coordinates with Patients and plan subscribers to record and update their health parameters. The HCM may get involved with activities including visiting the patient’s home to capture the medical history and vital parameters or collect blood samples to share for Laboratory testing.
h.
Healthcare Concierge means a Healthcare professional who virtually assists in resolving a patient’s healthcare queries and can facilitate scheduling appointments across Livlong network of care providers. A concierge will be accessible through the Livlong Helpdesk toll-free number.
i.
Health Check-up means a thorough physical examination that includes a variety of tests depending on the age, sex and prevailing physical conditions to make sure that there is nothing wrong with the Beneficiary’s health.
j.
Home Care shall mean health care or supportive care provided by a professional caregiver in the individual home or place of residence where the patient/ Beneficiary resides or is residing as opposed to care provided in group accommodations like clinics or nursing homes.
k.
Livlong Wallet Points means non-cash tokens present in Livlong 365 Wallet which may be exchanged for availing Livlong Benefits, or availing discounts on Livlong Benefits, subject to applicable terms and conditions in a manner similar to cash.
l.
Livlong/ Livlong 365 Wallet refers to an online repository of non-cash valuable consideration (tokens), that You will have access to.
m.
Network Provider means physician, hospital, clinic, diagnostic center or other health provider enlisted by or associated with Livlong 365 to provide medical services to a Beneficiary.
n.
Physical OPD Consultations refer to consultations that take place upon Patient Beneficiary’s visits to Doctors and which are conducted in person with a Doctor or a Specialist at a clinic or an Out-patient department of a hospital.
o.
Platform means the website www.livlong.com and/or mobile application named ‘Livlong 365: Products for all’, owned and operated by Livlong 365.
p.
Product Brochure includes the Product purchase documents, brochure and all other documents that has have been provided to the Beneficiary at the time of enrolling for the Product and includes flyers, inclusions and exclusions, other terms and conditions etc.
q.
Product Coverage refers to the extent and nature to which the bundle of Benefits that will be available to the Beneficiary as part of the Product are available to the Beneficiary.
r.
Specialist means any Doctor possessing, at the least, an M.D., M.S., or equivalent qualification and licensed to practice medicine in India.
s.
Sum Amount shall refer to the amount of periodic payments that You will be required to make, at such intervals and in such manner as prescribed by Livlong 365, in order to continue to access the Product and Benefits hereunder.
t.
Teleconsultation means a chat-based, text, audio or video consultation over the internet or any other digital communication medium between a Doctor and You wherein information is exchanged for the purpose of diagnosis, prescription, and subsequent treatment, health education and/or counseling by the Doctor.
u.
You (including its grammatical variations) mean the individual(s) who purchase(s) the Product, as well as any family members named as beneficiaries at the time of purchasing the Product and allowed as part of the purchased Product.
PRODUCT BENEFITS AND INCLUSIONS:
The benefits indicated in the section below are an indicative list of wellness benefits included across multiple Products. For specific Benefits available to the Beneficiary under the Product, please refer to the “Specific Inclusions” sub-section in the “Key Benefits” section or within the Product Brochure.
a.
Consultations: Based on Beneficiary’s Product Coverage, he/she will be given access to either physical consultation or Teleconsultations with either a General Practitioner or a physician of an appropriate identified specialty. A GeneralPractitioner’s consultation would help with common and low-risk health ailments (such as fever, headache, stomachache, acidity, etc.). Additionally, based on Product Coverage, the Beneficiary may be allowed consultations with specialists such as Dermatologist(s), Orthopedic Practitioner(s), Diabetologist(s), Pediatrician(s), Gynecologist(s), etc. Consultations could be availed free of charge up to a specific limit (number/ frequency of consultations) or at a discount based on Beneficiary’sProduct Coverage. If indicated within Beneficiary’s Product, Beneficiary may be able to use Livlong 365 Wallet Points as part or full payment against the invoice amount for consultations.
b.
Comprehensive Health Check-up: Based on the Beneficiary’sProduct Coverage he/she will be able to avail full body check-up packages as part of the Product. Such a check-up may include a combination of any number of laboratory tests (such as Liver Function Tests, Kidney Function Test, Lipid Profile tests, Urine Routine tests, CBC, etc.).
c.
Laboratory & Diagnostic Tests: Based on the Beneficiary’sProduct Coverage, he/she will receive upto 50% discount on prescribed laboratory and diagnostic tests for availing services from a Livlong 365 Network Provider. If indicated within the Beneficiary’s Product, Beneficiary may be able to use Livlong 365 Wallet Points as part or full payment against the invoice amount for laboratory and diagnostics tests. Laboratory tests would include but may not be limited to Biochemistry, Serology, Pathology, Immunology, Virology, Radiology, etc.
d.
Medications: Based on the Beneficiary’s Product Coverage, he/she will receive upto 20% discount on prescribed medications obtained from a Livlong 365 Network Provider. If indicated within Beneficiary’s Product, Livlong 365 Wallet Points may be used as part or full payment against the invoice amount.
e.
Home Care Services: Based on Beneficiary’s Product Coverage, Beneficiary may receive upto 20% discount on prescribed Home Care Services whenever prescribed by an attending Physician. Home Care Services could include Physiotherapy services, hour-wise nursing supervision, hour-wise medical attendant supervision, etc. All Home Care Services would need a valid prescription/ recommendation from a Registered Medical Practitioner. If indicated within Beneficiary’s Product Coverage, Beneficiary may be able to use Livlong 365 Wallet Points as part or full payment against the invoice amount.
f.
Physical OPD Consultations: Based on the Beneficiary’sProduct Coverage, he/she will receive upto 30% off on prescribed physical OPD consultations for availing services from a Livlong 365 Network Provider. Non-network physical OPD consultations could also be reimbursed upto a specific amount for a specific number of consultations as per Product Coverage.
g.
Wallet(s): Wallets containing Livlong 365 Wallet Points can be utilized concurrently, within the permissible limits ofBeneficiary’s product, whether individually or collectively.
h.
Discount benefits: Discounts for medicines, labs, and doctor consultations can only be availed with using the respective Livlong 365 Wallet Points, available along with the purchased product. Multiple discount benefits cannot be utilized simultaneously.
i.
Health Care Manager (HCM): A Healthcare professional will be available to the Beneficiary to assist with health-related concerns. Depending on Beneficiary’sProduct Coverage, Beneficiary may be entitled to:
j.
Fall and Health Vitals Monitoring Devices: Based on Product Coverage, Livlong 365 shall provide an option to assist in fall and vitals monitoring using a remote monitoring device (either through a Watch, pendant, AI camera, bedside monitor, Health ring, etc.) to the Beneficiary.
k.
Emergency Response Service: Based on the Product features, the Beneficiary may opt to have access to round the clock Ambulance Service which can be triggered either through the SOS button available on the Health Vitals Watch, or through a phone call, or automatically when fall detection happens on Health Vitals Watch.
l.
Multipurpose OPD Benefits: Based on the subscribed plan, beneficiaries may be entitled to monthly OPD benefits in the form of Wallet Points that can be used to avail services related to medicines, diagnostics, Doctor consultations, and essential Home Care Services. Wallet coins usage may be limited to a monthly and aggregate sub-limits based on the plan type.
Potential Risks and Compliance Measures:
By accessing the Benefits, You understand that Livlong 365 does not guarantee any specific outcome to any of the benefits that are provided to the Beneficiary. You also understand that accessing the Benefits may have certain inherent risk.
a.
Emergency Response Service: Emergency Response Service availability may vary depending on the Beneficiary’sgeographic location and volume of demand at the time.
b.
Fall and Health Vitals Monitoring Devices: The Health Vitals monitoring device is integral for providing Emergency Response Services and determining Beneficiary’s location and deploying Ambulance. In the event of its loss, Beneficiary understands that it will be difficult for Livlong 365 or (as the case may be) its service providers to dispatch Ambulance to the location of the Beneficiary in the event of an emergency. Therefore, Beneficiary is solely responsible for the safekeeping and care of the provided Health Vitals Monitoring Devices.
REIMBURSEMENT OF CLAIMS AND AVAILMENTS AGAINST OPD SERVICES INCLUDED IN PURCHASED PACKAGES:
Livlong may occasionally define a specific coverage amount or a service quantity that can be reimbursed or availed against OPD services as part of its packages. Customers need to adhere to the below terms and conditions while raising claims or availing of these OPD services:
General terms and Conditions applicable to claims against all type of OPD Services:
a.
All claims will need to be supported by appropriate documentation that proves:
b.
The reimbursement claims processing time for uncontested cases, free of any queries, is stipulated at 7 days from the date of submission of claim. This turnaround time is applicable under the condition that the submitted cases do not require additional clarifications or corrections. Any deviations from this stipulation may result in delays in the claim processing timeline.
c.
The cashless claim processing time for uncontested cases, free of any queries, is stipulated at 3 hours from the date and time of submission of claim. This turnaround time is applicable under the condition that the submitted cases do not require additional clarifications or corrections. Any deviations from this stipulation may result in delays in the claim processing timeline.
d.
Depending on the specific inclusions within your package, claims can be raised either for a cashless mode of availment of service or for reimbursement of service where the service has been provided by a service provider other than Livlong 365.
e.
Where both reimbursement as well as cashless claim benefits are included in the package, Livlong 365 will attempt to first provide fulfilment of claim in a cashless mode within its network. Only if Livlong 365 is unable to fulfil the claim through its network of service providers, can the customer avail the service in a reimbursement mode.
f.
Unless otherwise specified in the policy benefit details, the date of service mentioned in any of the documents tagged within the claim, needs to be after the package purchase date. This applies to all prescriptions, reports, bills and any other documents submitted as part of the claim.
g.
Unless otherwise specified, a mandatory waiting period of seven (7) days will apply from the date of purchase of package before a claim can be raised.
h.
All supporting physician prescription and clinical notes should contain:
i.
Customers expecting a reimbursement should ensure submission of KYC documents for Bank account verification. For the purpose of KYC verification, customers and their family members will need to submit their PAN card details, proof of address and as well as a cancelled cheque in the name of the Primary subscriber.
j.
Reimbursement against claims will be credited only to KYC approved bank accounts of the Primary subscriber of the package. Reimbursement of claims raised against family members will also be credited to the Primary subscriber’saccount.
k.
Customers should update bank account details if there is a change in KYC or account details prior to submission of claims.
l.
Readable scans of only original documents will be accepted as supporting documents. Claims with photocopies shared as supporting documents will be rejected.
m.
Prescription, clinical notes, and the bills submitted as evidence against a claim should mention the same patient’s name.
n.
Claims initiated in the name of family members will only be acceptable where the purchased package allows for more than one member coverage. For claims made on behalf of a family member, the prescription, clinical notes and the bills should be in the name of the family member against whom the claim is made.
o.
If a claim is found to be fraudulent, Livlong 365 reserves the right to blacklist the subscriber. A blacklisted subscriber will not be allowed to raise further claims against their purchased package.
p.
A subscriber could be blacklisted for reasons including but not limited to, editing, tampering, modifying, forging, digitally manipulating, or overwriting a bill, clinical note or prescription.
q.
Livlong 365 maintains a list of blacklisted providers. Any services availed from blacklisted providers as indicated by the claim documents, will be rejected.
r.
Family members of subscribers can be tagged against a package only once in a policy period. Once tagged, members cannot be changed or removed from the package until the package expires. Claims can be raised only against family members tagged within the package.
s.
If additional evidence is needed against a claim, Livlong 365 may request for more documentation from the subscriber.
t.
If additional evidence is needed against a claim, Livlong 365 may request for more documentation from the subscriber.
u.
Ailment/Illness – Ailment/Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function and requires medical treatment.
v.
Acute Condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery.
w.
Chronic Condition - A chronic condition is defined as a disease, illness or injury that has one or more of the following characteristics:
x.
If a subscriber would like to dispute a rejected claim, they can raise a claim review by sending the necessary documentation explaining the dispute along with the claim details to the email ID support@livlong.com.
y.
The amount defined under the package benefit is non-transferable and non-refundable. In the event that a particular amount of benefit lies unclaimed at the time of expiry of the package, such amount cannot be transferred even if an additional package is purchased. Benefit amount defined under the package cannot be converted in monetary format or withdrawn.
z.
Some packages may apply a co-pay or a co-deductible amount as part of the claim process. Respective amount will be deducted against the claimed amount before processing the claims.
aa.
Livlong 365 reserves the right to reinvestigate a historically approved case if it is suspected to be fraudulent subsequently. Subscribers are liable to repay the claimed amount if such approved claims have been subsequently proven to be fraudulent or wrongly approved. Livlong 365 can also adjust these amounts against any subsequent claims raised by the subscriber.
ab.
Livlong 365 reserves the right to modify or update these terms and conditions at any time during the policy period. Livlong 365 reserves the right to terminate or suspend the OPD benefits against a specific package at its sole discretion. Customers will be notified of any changes.
ac.
Outpatient benefits will not cover any services associated with IPD or inpatient treatment, procedures, or follow-ups.
ad.
If included within your purchased plan, only those consultations conducted by BAMS, BHMS physicians registered with MCI/NMC registries will be eligible for Ayush-related claims.
af.
A specific listing of documentation guidelines applicable for different category of claims is indicated below. These are applicable over and over the general terms and conditions listed above. For any category of service other than those listed below, the general terms and Conditions listed above will be applicable.
GENERAL TERMS:
You understand that the Beneficiary’s enjoyment of the Benefits of the Product irrespective of the Benefit being accessed, or the Product Coverage, will be bound by the following general conditions:
a.
The Benefits under the Product Coverage must be utilized within one (1) year of activation of the Product. Any unutilized Benefits cannot be carried forward, even if the Product is subsequently renewed.
b.
Non-utilization of the Benefits will be treated as forfeiture of the same.
c.
The Benefits cannot be redeemed for cash, Wallet Points, exchanged for any valuable consideration or substituted for any alternate benefits.
d.
The Benefits are made available to Beneficiary and may only be utilized by Beneficiary. Depending on the Product Coverage there may be restrictions on the number as well as relation of Beneficiary (to You) and/ or dependents who may avail the Product Benefits.
e.
Livlong 365 may not be able to ensure the availability of the Benefits at all times, there may be situations, either within or without Livlong 365’s control that may at any time impact availability of any Benefit at any particular time.
f.
The Benefits like Teleconsultations, Lab Tests, Health Check-up, etc., can be availed at Our Network Providers as well as empaneled Healthcare Service Providers.
g.
The list of such Network Providers and empaneled Healthcare Service Providers will be updated from time to time and can be obtained from the Livlong 365 Platform or by calling our customer care at [1800 2020 600]. Livlong 365 will assist in scheduling appointments for consultation and diagnostic tests at a time convenient to the Beneficiary.
h.
As part of the Teleconsultations Livlong 365 shall provide access to a General Practitioner and any other empaneled Specialists for Teleconsultation services. Livlong 365 does not assume any liability for any adverse event, harm, loss or damage arising out of or in relation to any opinion, actual or alleged errors, commission or omissions and representations made by such General Practitioner or Specialist.
i.
It is agreed and understood that any person represented as a “HCM, Concierge or Wellness Coach” by Livlong 365 are not providing and shall not be deemed to have provided any medical advice. You understand that they merely provide a suggestion for the Beneficiary’s consideration and it is a choice left to You and the Beneficiary to adhere to the suggestions.
j.
Wellness Checks will be provided by a qualified Doctor via Teleconsultation. The Wellness Check will be conducted once a month for the duration specified in the agreement for specified Products in which this feature is made available.
k.
Reimbursement against Wallet is applicable for services available both within and outside the Livlong 365 Network Provider. Unless otherwise specified as part of the Product Brochure, generally utilization of Wallet Points is restricted to a range between Rs.750 to Rs.1000 per transaction per Beneficiary. For the Elder care program, there is no limit set for Wallet use.
l.
Based on your Product coverage there may be restrictions applicable on the number of times that the wallet can be used. The Subscriber will be required to pay the balance amount out-of-pocket, with cash, if the transaction amount is higher than the permitted range for a given transaction under the Product Coverage.
m.
Claims for reimbursements for services administered through Non-Livlong 365 Network Providers, will need to be supported by:
n.
Subject to these Terms and Conditions, Livlong 365 reserves the right, at its sole discretion, to change the nature of the Product, Product Coverage and any included Benefits at any time based on prevailing market practices and the evolution of Livlong 365's business model.
o.
For further details, please refer to the consolidated Terms and conditions listed on our website.
PROCESS FOR AVAILING BENEFITS:
The Benefits shall be accessed and administered exclusively through the Platform. You or the Beneficiary may access the Benefits by logging into the Platform and viewing Beneficiary’sdashboard.
a.
Access Lab tests, Medicines, Physical OPD Consultations, Home Care, Teleconsultation, Lifestyle Management Services with following steps:
b.
Process for onboarding customers and initiating coaching sessions for applicable Benefits:
STORAGE OF RECORDS:
All Teleconsultations / audios / videos / transcripts / prescriptions / email and hard copy correspondences that take place on any Platform associated with Livlong 365 and any Benefit accessed by You or the Beneficiary shall be recorded, saved and stored for record-keeping purposes in accordance with the Livlong 365 Privacy Policy, as well as Data Collection Notice. Livlong 365 may review this data from time to time for quality evaluation and service delivery improvement purposes. However, under normal circumstances, Livlong 365 will not access any information that identifies Beneficiary and shall either omit, mask or anonymizeBeneficiary’s personal information at the time of quality evaluation.
PAYMENT OF PRODUCT CONSIDERATION:
To avail Benefits as provided in the Product Brochure, in addition to compliance with these Terms and Conditions, You are required to pay to Livlong 365 a Sum Amount fixed on the basis of Your Product Coverage.
This Sum Amount shall be paid at the intervals, and in the manner prescribed by Livlong 365, for the entire duration of Your availing the Product and Benefits under it.
In the event of cancellation of the Product, any Sum Amount either owed by You to LivLong 365 or vice-e-versa shall be refunded once access to Product and Benefits thereunder have been fully and finally restricted. Refunds, if any will only be payable if none of the service benefits as defined under the plan have been used. There will be no refund issued against the Health monitoring device.
PAYMENT OF PRODUCT CONSIDERATION:
You may cancel access to this Product upon giving a notice in writing to us at support@livlong.com.
Partial cancellation of the Product shall not be permitted. The Benefits cannot be clubbed with any other existing or new insurance policy.
SUSPENSION OF PRODUCT:
Livlong 365 reserves the right to suspend access to this Product and all Benefits thereunder at any time, pending investigation, without liability, on grounds of non-payment of periodic Sum Amount to Livlong 365, any misrepresentation, non-disclosure of material facts, or if You and/ or Beneficiary commit, or Livlong 365 have reason to believe that You and/ or Beneficiary have committed, fraud. In such cases, there will be no refund of the any sum amount paid by You.
REFUND POLICY:
You understand and confirm that Livlong shall not be liable for refunding back any amount to You, if You fail to cancel within thirty (30) days of making payment for Product. Further, Livlong shall also not be liable to refund any amount to You, if You have availed the Benefits under the Product Coverage of Livlong 365, at any point of time.
LIMITATION OF LIABILITY:
To the fullest extent permitted by law, in no event will Livlong 365 or its contractors or agents (including HSPs) or any of their directors, officers, employees, agents or content or service providers (collectively, the “Protected Entities”) be liable for any direct, indirect, special, incidental, punitive, exemplary or consequential damages (including, without limitation, loss of business, revenue, profits, goodwill) arising from, or directly or indirectly related to, the use of, reliance on, or the inability to use or rely on, the Platform or the Benefits, materials and functions related thereto whether or not Livlong 365 has been warned, or been made aware of the possibility of such damages or could have reasonably foreseen such damages.
Under no circumstances will Livlong 365 bear any liability for inaction, incompetence, or other failures by a third-party service provider, either in the form of information accessed on the Platform, or in the form or services of out-of-Network healthcare service providers that You or the Beneficiary choose to visit.
Livlong 365 does not bear any liability in the event any Service Provider engaged by Livlong 365, either directly or incidentally, engages in any illegal or criminal activity.
Livlong 365 shall not be compelled to produce any records, books, or documents in connection to the Platform, Product Coverage, or any of the Benefits offered unless otherwise under the authority of the appropriate court, tribunal or governmental authority.
RENEWAL OF PRODUCT:
After completion of the initial period of Benefits as mentioned in the Product Brochure, any renewal of the Product will be at the sole discretion of Livlong 365. You may or may not be able to access the same features or components that were part of the existing Product Coverage.
GRIEVANCE REDRESSAL:
In case of any grievance relating to the Product or the Benefits, Beneficiary may reach out to us at the following:
Email address: grievance@livlong.com
Number:1800 2020 600
JURISDICTION AND DISPUTE RESOLUTION:
This document shall be governed by and to be interpreted in accordance with the Laws of India. All disputes and differences, however arising out of or in connection with this Product shall be resolved through arbitration by sole arbitrator who will be appointed mutually. The arbitration shall be governed by the Arbitration and Conciliation Act, 1996 as amended from time to time. The seat and venue of arbitration shall be Mumbai, Maharashtra. Subject to the aforesaid, the competent courts of Mumbai, Maharashtra shall have jurisdiction to grant urgent interim reliefs to the Parties.
Terms & Policies
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