Policy Terms and Conditions

1. Definitions intends to live for most of the Policy Year being one hundred eighty-five (185) days
or more and which will be shown as the place of residence in our records.
For the purposes of interpretation and understanding of the product the Company has 1.11 Assistance Service Provider means the service provider specified in the
defined, herein below some of the important words used in the product and for the Policy Schedule or as appointed by the Company from time to time.
remaining language and the words the Company believes to mean the normal meaning of
the English language as explained in the standard language dictionaries. The words and 1.12 Cashless Facility means a facility extended by the insurer to the Insured
expressions defined in the Insurance Act, IRDA Act, regulations notified by the Insurance where the payments, of the costs of treatment undergone by the insured in accordance
Regulatory and Development Authority (“Authority”) and circulars and guidelines issued by with the Policy terms and conditions, are directly made to the network Provider
the Authority shall carry the meanings described therein. The terms and conditions, by the company to the extent pre-authorization approved.
insurance coverage and exclusions, other benefits, various procedures and conditions 1.13 Certificate of Insurance means the certificate the Company issues to an
which have been built-in to the product are to be construed in accordance with the Insured Member evidencing cover under the Policy.
applicable provisions contained in the product.
1.14 Claim means a demand made in accordance with the terms and conditions of the
The terms defined below have the meanings ascribed to them wherever they appear in this Policy for payment of the specified Benefits in respect of the Insured Member as
Policy and, where appropriate. covered under the Policy.
1.1 Accidental/Accident is a sudden, unforeseen and involuntary event caused 1.15 Claimant means a person who possesses a relevant and valid Insurance Policy
by external and visible means. which is issued by the Company and is eligible to file a Claim in the event of a
1.2 Act of God Perils means and includes lightening, storm, tempest, flood, covered loss.
inundation, subsidence, landslide, earthquake, cyclone, tsunami, volcano and 1.16 Common Carrier means any civilian land or water conveyance or Scheduled
other similar calamities; Airline in each case operated under a valid license for the transportation of
1.3 Actively at Work Refers to an employee who is actually at work on his/her passengers for hire.
eligibility date and performing each and every duty of his/her present occupation 1.17 Company (also referred as Insurer/We/Us) means Care Health
on a customary and fulltime basis. An employee shall also be deemed actively at Insurance Limited.
work if he/she is on annual leave and is not absent from work due to long term
illness, irrecoverable condition. If an employee is not actively at work on his/her 1.18 Complementary Practitioner refers to a or practitioner who specializes in
eligibility date, he/she will not be covered. at least one of the following acupuncture, osteopathy, chiropractic or Chinese
traditional medicine and is qualified and registered in the country where the out-
1.4 Activities of Daily Living Applies to a member (who is eligible for cover patient treatment is to take place and is recognized by the Company.
under this policy) and who is aged at least five 5 years old who can perform atleast
3 out 6 the following activities: 1.19 Condition Precedent shall mean a Policy term or condition upon which the
Insurer's liability under the Policy is conditional upon.
- Dressing: The ability to put on, take off, secure, and unfasten all garments and as
appropriate, any braces, artificial limbs, or other surgical appliances; 1.20 Congenital Anomaly refers to a condition(s) which is present since birth, and
which is abnormal with reference to form, structure or position :
- Feeding: The ability to feed one’s self once food has been prepared and made
available; (a) Internal Congenital Anomaly – Congenital anomaly which is not in the
visible and accessible parts of the body.
- Mobility: The ability to move indoors from room to room on level surfaces;
(b) External Congenital Anomaly – Congenital anomaly which is in the visible
- Toileting: The ability to use the lavatory or otherwise manage bowel and bladder and accessible parts of the body.
functions so as to maintain a satisfactory level of personal hygiene;
1.21 Co-payment is a cost-sharing requirement under a health insurance policy that
- Transferring: the ability to move from a bed to an upright chair or wheelchair and provides that the policyholder/insured will bear a specified percentage of the
vice versa; admissible claim amount. A co-payment does not reduce the sum insured.
- Washing: The ability to wash in the bath or shower (including getting into and out 1.22 Cover End Date means the date specified in Annexure 'A'(Certificate of
of the bath or shower) or wash satisfactorily by other means. Insurance) for the respective Insured Member on which the Insured Member's
1.5 Age means the completed age of the Insured Member as on his last birthday. cover under the Policy expires.

1.6 Alternative Treatments are forms of treatments other than treatment 1.23 Cover Period means the period commencing from the Cover Start Date and
“Allopathy” or “modern medicine” and include Ayurveda, Unani, Sidha and ending on the Cover End Date for each Insured Member as specified in Annexure
Homeopathy in the Indian context. 'A' (Certificate of Insurance).

1.7 Ambulance means a road vehicle operated by a licensed/ authorized service 1.24 Cover Start Date: means the date specified in Annexure 'A' (Certificate of
provider and equipped for the transport and paramedical treatment of persons Insurance) for the respective Insured Member on which the Insured Member's
requiring medical attention. cover under the Policy commences.

1.8 Annexure means the document attached and marked as Annexure to this 1.25 Day Care Centre means any institution established for day care treatment of
Policy. illness and/or injuries or a medical setup within a hospital and which has been
registered with the local authorities, wherever applicable, and is under the
1.9 Any one illness (not applicable for Travel and Personal Accident supervision of a registered and qualified medical practitioner AND must comply
Insurance) means continuous period of illness and includes relapse within 45 with all minimum criteria as under—
days from the date of last consultation with the Hospital/Nursing Home where
treatment was taken. (a) has qualified nursing staff under its employment;
1.10 Area/Area of Cover Refers to one of the following as stated on Policy (b) has qualified Medical Practitioner/s in-charge;
Schedule and/or endorsement: (c) has a fully equipped operation theatre of its own, where Day Care
(a) Zone 1:Worldwide: worldwide Treatment is carried out.
(b) Zone 2:Worldwide excluding USA: worldwide excluding the USA and US (d) maintains daily records of patients and will make these accessible to the
Minor Outlying Islands insurance company's authorized personnel.
(c) Zone 3:Asia: Afghanistan, Bangladesh, Bhutan, Brunei, Cambodia, China, 1.26 Day Care Treatment means medical treatment, and/ or Surgical Procedure
Hong Kong, India, Indonesia, Japan, Kazakhstan, Kyrgyzstan, Laos, Macau, which is :
Malaysia, Maldives, Mongolia, Myanmar, Nepal, North Korea, Pakistan, (a) undertaken under general or local anesthesia in a Hospital/ Day Care
Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Tajikistan, C e n t re i n l e s s t h a n 2 4 h o u r s b e c a u s e o f te c h n o l o g i c a l
Thailand, Timor-Leste, Turkmenistan, Uzbekistan, Vietnam. advancement, and
(d) Zone 4:Indian Sub continental + South East Asia (excluding SINGAPORE) (b) which would have otherwise required a Hospitalization of more than 24
(e) Zone 5:India hours.
Insured member's principal country of residence must be in a country within Treatment normally taken on an out-patient basis is not included in the scope of
his/her selected area of cover. this definition.
Principal Country of Residence : The country where the Insured lives or As listed in Annexure “I”
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1.27 Deductible is a cost-sharing requirement under a health insurance policy that 1.38 Hospitalization (not applicable for Overseas Travel Insurance)
provides that the Insurer will not be liable for a specified rupee amount in case of means admission in a Hospital for a minimum period of 24 consecutive 'In-patient
indemnity policies and for a specified number of days/hours in case of hospital Care' hours except for specified procedures/treatments, where such admission
cash policies which will apply before any benefits are payable by the insurer. A could be for a period of less than 24 consecutive hours.
deductible does not reduce the Sum Insured.
1.39 Immediate Family Member means an Insured Member's lawful spouse,
Note: Under this Policy, deductible for a specified number of days/hours is children only.
applicable on the following Benefits in addition to the deductible applicable on
1.40 Indemnity/Indemnify means compensating the Policy Holder/Insured
Indemnity / hospital cash benefits:
Member up to the extent of Expenses incurred, on occurrence of an event which
Temporary Total Disablement and Convalescence Benefit results in a financial loss and is covered as the subject matter of the Insurance
Cover.
1.28 Dental Treatment means a treatment related to teeth or structures
supporting teeth including examinations, fillings (where appropriate), crowns, 1.41 Illness means a sickness or a disease or a pathological condition leading to the
extractions and surgery. impairment of normal physiological function and requires medical treatment.
1.29 Dependent means a person who is a member of the Primary Insured Member's (a) Acute condition - Acute condition is a disease, illness or injury that is likely to
family who is legally wedded spouse, natural or legally adopted child, dependent respond quickly to treatment which aims to return the person to his or her
parents, dependent parent-in-law, dependent brothers , dependent sisters and state of health immediately before suffering the disease/ illness/ injury
who is named in Annexure “A” to the Policy as an Insured Member; which leads to full recovery
1.30 Dependent Child refers to a child (natural or legally adopted), who is financially (b) Chronic condition - A chronic condition is defined as a disease, illness, or
dependent on the Primary Insured Member or proposer and does not have injury that has one or more of the following characteristics:
his/her independent sources of income.
I. It needs ongoing or long-term monitoring through consultations,
1.31 Disclosure to Information Norm : The Policy shall be void and all premium examinations, check-ups, and /or tests;
paid hereon shall be forfeited to the Company, in the event of misrepresentation,
II. It needs ongoing or long-term control or relief of symptoms;
mis-description or non-disclosure of any material fact.
III. It requires rehabilitation for the patient or for the patient to be
1.32 Domiciliary Hospitalization means medical treatment for an
specially trained to cope with it;
illness/disease/injury which in the normal course would require care and
treatment at a Hospital but is actually taken while confined at home under any of IV. It continues indefinitely;
the following circumstances:
V. It recurs or is likely to recur.
(a) The condition of the patient is such that he/she is not in a condition to be
1.42 Injury means accidental physical bodily harm excluding illness or disease solely
removed to a Hospital, or
and directly caused by external, violent and visible and evident means which is
(b) The patient takes treatment at home on account of non-availability of room verified and certified by a Medical Practitioner.
in a Hospital. 1.43 In-patient Care (not applicable for Overseas Travel Insurance)
1.33 Diagnosis means pathological conclusion drawn by a registered medical means treatment for which the Insured Member has to stay in a Hospital for more
practitioner, supported by acceptable Clinical, radiological, histological, than 24 hours for a covered event.
histo- pathological and laboratory evidence wherever applicable. 1.44 Insured Event means an event that is covered under the Policy; and which is in
1.34 Emergency Care (Emergency) means management for an illness or injury accordance with the Policy Terms & Conditions.
which results in symptoms which occur suddenly and unexpectedly, and requires 1.45 Insured Member (Insured) means a person whose name specifically appears
immediate care by a medical practitioner to prevent death or serious long term under Insured in the Annexure A or the Certificate of Insurance and is a covered
impairment of the insured member's health. group member.
1.35 Grace Period means the specified period of time immediately following the 1.46 Intensive Care Unit (ICU) means an identified section, ward or wing of a
premium due date during which payment can be made to renew or continue a Hospital which is under the constant supervision of a dedicated Medical
Policy in force without loss of continuity benefits such as waiting periods and Practitioner(s), and which is specially equipped for the continuous monitoring and
coverage of Pre-existing Diseases. Coverage is not available for the period for treatment of patients who are in a critical condition, or require life support
which no premium is received. facilities and where the level of care and supervision is considerably more
1.36 Hazardous Activities (or Adventure sports) means any sport or activity sophisticated and intensive than in the ordinary and other wards.
or Adventure sport, which is potentially dangerous to the Insured whether he is 1.47 ICU Charges or (Intensive care Unit) Charges means the amount
trained or not. Such sport/activity includes stunt activities of any kind, adventure charged by a Hospital towards ICU expenses on a per day basis which shall include
racing, base jumping, biathlon, big game hunting, black water rafting, BMX stunt/ the expenses for ICU bed, general medical support services provided to any ICU
obstacle riding, bobsleighing/ using skeletons, bouldering, boxing, canyoning, patient including monitoring devices, critical care nursing and intensivist charges
caving/ pot holing, cave tubing, rock climbing/ trekking/ mountaineering, cycle
racing, cyclo cross, drag racing, endurance testing, hand gliding, harness racing, hell 1.48 Maternity expenses shall include—
skiing, high diving (above 5 meters), hunting, ice hockey, ice speedway, jousting, (a) Medical treatment expenses traceable to childbirth (including complicated
judo, karate, kendo, lugging, risky manual labor, marathon running, martial arts, deliveries and caesarean sections incurred during hospitalization).
micro – lighting, modern pentathlon, motor cycle racing, motor rallying,
parachuting, paragliding/ parapenting, piloting aircraft, polo, power lifting, power (b) expenses towards lawful medical termination of pregnancy during the
boat racing, quad biking, river boarding, scuba diving, river bugging, rodeo, roller policy period.
hockey, rugby, ski acrobatics, ski doo, ski jumping, ski racing, sky diving, small bore 1.49 Medical Advice means any consultation or advice from a Medical Practitioner
target shooting, speed trials/ time trials, triathlon, water ski jumping, weight lifting including the issue of any prescription or follow-up prescription.
or wrestling of any type.
1.50 Medical Expenses means those expenses that an Insured Member has
1.37 Hospital (not applicable for Overseas Travel Insurance) means any necessarily and actually incurred for medical treatment on account of Illness or
institution established for in-patient care and day care treatment of illness and/or Accident on the advice of a Medical Practitioner, as long as these are no more than
injuries and which has been registered as a hospital with the local authorities under would have been payable if the Insured Member had not been insured and no
the Clinical Establishments (Registration and Regulation) Act, 2010 or under the more than other Hospitals or doctors in the same locality would have charged for
enactments specified under the Schedule of Section 56(1) of the said Act OR the same medical treatment.
complies with all minimum criteria as under:
1.51 Medical Practitioner (not applicable for Overseas Travel
(a) has qualified nursing staff under its employment round the clock; Insurance) is a person who holds a valid registration from the Medical Council
(b) has at least 10 in-patient beds in towns having a population of less than of any State or Medical Council of India or Council for Indian Medicine or for
10,00,000 and at least 15 in-patient beds in all other places; Homeopathy set up by the Government of India or a State Government and is
thereby entitled to practice medicine within its jurisdiction; and is acting within the
(c) has qualified Medical Practitioner(s) in charge round the clock; scope and jurisdiction of license.
(d) has a fully equipped operation theatre of its own where surgical procedures For Benefits / optional Extensions effective outside India:
are carried out;
Medical Practitioner means a person who holds a valid registration issued by the
(e) maintains daily records of patients and makes these accessible to the Medical Council/Statutory Regulatory Authority for Medical Education in that
Country and is thereby entitled to practice medicine within its jurisdiction; and
insurance company's authorized personnel. is acting within the scope and jurisdiction of license.
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1.52 Medically Necessary (not applicable for Overseas Travel ii. For which medical advice or treatment was recommended by, or received
Insurance) means any treatment, tests, medication, or stay in Hospital or part from, a physician within 48 months prior to the effective date of the policy
of a stay in Hospital which: issued by insurer or its reinstatement
(a) Is required for the medical management of the Illness or Injury suffered by 1.72 Pre-hospitalization Medical Expenses Means Medical Expenses incurred
the Insured Member; during pre-defined number of days preceding the hospitalization of the Insured
Member, provided that :
(b) Must not exceed the level of care necessary to provide safe, adequate and
appropriate medical care in scope, duration, or intensity; i. Such Medical Expenses are incurred for the same condition for which the
Insured Member's Hospitalization was required, and
(c) Must have been prescribed by a Medical Practitioner;
ii. The In-patient Hospitalization claim for such Hospitalization is admissible by
(d) Must conform to the professional standards widely accepted in
the Insurance Company.
international medical practice or by the medical community in India.
1.53 Network Provider (not applicable for Overseas Travel Insurance) 1.73 Prescription Refers to out-patient drugs (excluding supplements, vitamins and
means the Hospitals enlisted by an Insurer, TPA or jointly by an Insurer and TPA to traditional medicine) and dressings as prescribed by a medical practitioner for the
provide medical services to an Insured by a Cashless Facility. treatment of a medical condition covered by your member's plan. For avoidance
of doubt, prescription will not include vitamins nor supplements nor over the
1.54 Newborn baby means baby born during the Policy Period and is aged counter medication even if they are prescribed by a medical practitioner.
up to 90 days.
1.74 Preventive Care means any kind of treatment taken as a pro-active care
1.55 Nominee means the person named in the Certificate of Insurance who is measure without actual requirement or symptoms of a disease or illness.
nominated to receive the benefits under this Policy in accordance with the terms
of the Policy, if the Insured Member is deceased. 1.75 Primary Insured Member means employee or a member of any group who
satisfies and continues to satisfy the eligibility criteria specified in the Certificate of
1.56 Non-Allopathic Medical Practitioner for the purpose of Alternative Insurance and who is named in Annexure “A” to the Policy as an Insured Member.
Forms of Medicine means a Medical Practitioner qualified and practicing
Ayurveda or Unani or Sidha or Homeopathic forms of Medicine for treatment of 1.76 Qualified Nurse (not applicable for Overseas Travel Insurance) is a
Illness/Injury, and registered as per Indian Medicine Central Council Act, 1970. person who holds a valid registration from the Nursing Council of India or the
Nursing Council of any state in India.
1.57 Non-Network Provider means any hospital, day care centre or other
1.77 Reasonable and Customary Charges (not applicable for Overseas
provider that is not part of the network.
Travel Insurance) means the charges for services or supplies, which are the
1.58 Notification of Claim means the process of intimating a claim to the insurer or standard charges for the specific provider and consistent with the prevailing
TPA through any of the recognized modes of communication. charges in the geographical area for identical or similar services, taking into
account the nature of the Illness/ Injury involved.
1.59 OPD Treatment (Out-patient Care) is one in which the Insured visits a
clinic/hospital or associated facility like a consultation room for diagnosis and 1.78 Rehabilitation means assisting an Insured Member who, following a medical
treatment based on the advice of a Medical Practitioner. The Insured is not condition, requires assistance in physical, vocational, independent living and
admitted as a day care or in-patient. educational pursuits to restore him to the position in which he was in, prior to such
medical condition occurring.
1.60 Physiotherapist refers to a person who is licensed to practice as a
physiotherapist where the treatment is to take place and is recognized as a 1.79 Renewal defines the terms on which the contract of insurance can be renewed
physiotherapist. on mutual consent with a provision of grace period for treating the renewal
continuous for the purpose of gaining credit for pre-existing diseases, time-bound
1.61 Preferred Provider means the Hospital empanelled by the Company or TPA
exclusions and for all waiting periods.
and enlisted on the Preferred Provider Network List, specified in the Policy
Schedule (and as updated by the Company from time to time). 1.80 Room Rent means the amount charged by a Hospital towards Room &
Boarding expenses and shall include the associated medical expenses.
An updated list of 'Preferred Provider Network' may be obtained from the
Company's website or the call centre. 1.81 Single Private Room means an air conditioned room in a Hospital where a
single patient is accommodated and which has an attached toilet (lavatory and
1.62 Policy means these Policy Terms & Conditions, Optional Extensions (if any), the
bath). Such room type shall be the most basic and the most economical of all
Proposal Form, Policy Schedule, Endorsements, Certificate of Insurance Member
accommodations available as a Single room in that Hospital.
List and Annexures which form part of the policy contract and shall be read
together. 1.82 Scheduled Airline means any civilian aircraft operated by a civilian scheduled
air carrier holding a certificate, license or similar authorization for civilian
1.63 Policy Schedule is a Schedule attached to and forming part of this Policy.
scheduled air carrier transport issued by the country of the aircraft's registry, and
1.64 Policy Currency refers to the currency in which Benefit sum insured define which in accordance therewith flies, maintains and publishes tariffs for regular
under the policy and cashless claims will be paid in same currency. Policy currency passenger service between named cities at regular and specified times, on regular
must be selected by policyholder at policy commencement date. or chartered flights operated by such carrier.
1.65 Policy Year means a period of one year commencing on the Policy Period Start 1.83 Senior Citizen means any person who has completed sixty or more years of
Date or any anniversary thereof. age as on the date of commencement or renewal of the policy.
1.66 Policyholder (also referred as You) means the person or the entity who is 1.84 Service Provider means any person, organization, institution that has been
the Group Administrator and named in the Policy Schedule as the Policyholder. empanelled with the Company to provide Services specified under the benefits.
1.67 Policy Period means the period commencing from the Policy Period Start 1.85 Subrogation (Applicable to other than Health Policies and health sections of
Date and ending on the Policy Period End Date of the Policy as specifically Travel and PA policies) means the right of the Insurer to assume the rights of the
appearing in the Policy Schedule. Insured Member to recover expenses paid out under the Policy that may be
recovered from any other source.
1.68 Policy Period End Date means the date on which the Policy expires, as
specifically appearing in the Policy Schedule. 1.86 Sum Insured (Coverage Amount) means the amount specified against each
Benefit for Member in the Policy Schedule which represents Our maximum
1.69 Policy Period Start Date means the date on which the Policy commences, as
liability for that Insured Member for any and all Claims incurred in respect of that
specifically appearing in the Policy Schedule.
Insured Member during the Cover Period.
1.70 Post-hospitalization Medical Expenses means Medical Expenses
1.87 Surgery/Surgical Procedure means manual and/or operative procedure(s)
incurred during pre-defined number of days immediately after the Insured
required for treatment of an Illness or Injury, correction of deformities and
Member is discharged from the Hospital provided that:
defects, diagnosis and cure of diseases, relief from suffering and prolongation of
i. Such Medical Expenses are incurred for the same condition for which the life, performed in a Hospital or a Day Care Centre by a Medical Practitioner.
Insured Member's Hospitalization was required and
1.88 Third Party Administrator or TPA means a company registered with the
ii. The inpatient Hospitalization claim for such Hospitalization is admissible by Authority, and engaged by an insurer, for a fee or by whatever name called and as
the Company. may be mentioned in the health services agreement, for providing health services
1.71 Pre-existing Diseases (not applicable for Overseas Travel as mentioned under IRDAI (TPA-Health Services) Regulations as amended from
Insurance) means any condition, ailment or injury or disease: time to time

i. That is/are diagnosed by a physician within 48 months prior to the effective 1.89 Twin Sharing Room means a Hospital room where at least two patients are
date of the policy issued by the insurer or its reinstatement or accommodated at the same time. Such room shall be the most basic and the most
economical of all accommodations available as twin sharing rooms in that Hospital.
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1.90 Unproven/Experimental Treatment means a treatment including drug Refers to a person (other than you, your member, or a business partner or a
experimental therapy which is not based on established medical practice in relative of yours or your member) has the primary degrees in the practice of
India, is treatment experimental or unproven. Allopathy and surgery following attendance at a recognized medical school and who
is licensed to practice Allopathy by the relevant licensing authority where the
1.91 Variable Medical Expenses means those Medical Expenses as listed below
treatment is given. By 'recognized medical school' we mean “a medical school
which vary in accordance with the Room Rent or Room Category or ICU Charges
which is listed in AVICENNA Directory, which is in collaboration with the World
applicable in a Hospital:
Health Organization and the World Federation for Medical Education”.
(a) Room, boarding, nursing and operation theatre expenses as charged by the
1.97 Network Provider means Hospitals enlisted by an insurer or by a Assistance
Hospital where the Insured Member availed medical treatment;
Service Provider together to provide services to an insured on payment by a
(b) Intensive Care Unit charges; cashless facility;
(c) Fees charged by surgeon, anesthetist, Medical Practitioner; 1.98 Qualified Nurse means a person who holds a valid registration issued by the
Nursing Council/Statutory Regulatory Authority for Medical Education in that
(d) Investigation expenses incurred towards diagnosis of ailment requiring
Country and thereby entitled to render Nursing Care within the scope and
Hospitalization.
jurisdiction of license.
Expenses related to the Hospitalization will be considered in proportion to the
1.99 Reasonable and customary (R&C) means charges or treatment for
room rent stated in the Policy.
medical care which shall be considered by the Company or by Company's medical
1.92 Migration means, the right accorded to health insurance policyholders advisers to be reasonable and customary to the extent that they do not exceed
(including all members under family cover and members of group health the general level of charges or treatment being made by others of similar standing
insurance policy), to transfer the credit gained for pre-existing conditions and time in the locality where the charges or treatment are incurred when giving like or
bound exclusions, with the same insurer. comparable treatment.
1.93 AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical If the charges are higher than customary or the treatment is not reasonable and
treatment procedures and interventions are carried out by AYUSH Medical customary, the Company will only pay the amount which is, in the Company's
Practitioner(s) comprising of any of the following: experience, customarily charged and Insured has to pay the rest.
(a) Central or State Government AYUSH Hospital or 1.100 Unproven/Experimental Treatment means a treatment, procedure
including drug experimental therapy and/or supply which is not based on
(b) Teaching hospital attached to AYUSH College recognized by the Central
established medical practice, is treatment experimental or unproven or
Government/Central Council of Indian Medicine/Central Council for
investigational when it does not comply with the following requirements:
Homeopathy;or
(a) It is medically accepted by a consensus of peer professionals and like
(c) AYUSH Hospital, standalone or co-located with in-patient healthcare
specialists with evidence-based medicine (best practices) that a beneficial
facility of any recognized system of medicine, registered with the local
effect and demonstrated efficacy for a specific diagnosis exists.
authorities, wherever applicable, and is under the supervision of a qualified
registered AYUSH Medical Practitioner and must comply with all the (b) It is supported by evidence-based medicine with conclusive clinical research
following criterion: and demonstrated benefits.
i. Having at least 5 in-patient beds; (c) The service, procedure, drug, or treatment must meet the standard of
practice guidelines accepted in the United States of America, regardless of
ii. Having qualified AYUSH Medical Practitioner in charge round the
the place where the service is performed. Drugs must have approval from
clock;
the Food and Drug Administration (FDA) in the United States for use for
iii. Having dedicated AYUSH therapy sections as required and/or has the diagnosed condition, or other federal or state government agency
equipped operation theatre where surgical procedures are to be approval required in the United States of America, independent of where
carried out; the medical treatment is incurred or bills issued.
iv. Maintaining daily records of the patients and making them accessible (d) All treatments must have passed through and completed all phases of
to the insurance company's authorized representative. human clinical trials, studies, and protocols under the supervision of
appropriate medical review, investigational review boards, hospital ethics
1.94 AYUSH Day Care Centre means and includes Community Health Centre
committees, and/or international scientific community or associations.
(CHC), Primary Health Centre (PHC), Dispensary, Clinic, Polyclinic or any such
centre which is registered with the local authorities, wherever applicable, and
having facilities for carrying out treatment procedures and medical or
surgical/para-surgical interventions or both under the supervision of registered 2. Scope of Cover
AYUSH Medical Practitioner (s) on day care basis without in-patient services and
General Conditions Applicable To All The Optional Benefits And Optional Extensions:
must comply with all the following criterion:
1. Deductible options available for Optional Benefit 1 (Hospitalization Expenses)
i. Having qualified registered AYUSH Medical Practitioner(s) in charge;
and its Optional Extensions are:
ii. Having dedicated AYUSH therapy sections as required and/or has
- On Per claim basis:
equipped operation theatre where surgical procedures are to be carried
out; - Rs.500/1000 – only available for geographies: India, Indian sub-
continental & south east Asia (excluding Singapore)
iii. Maintaining daily records of the patients and making them accessible to the
insurance company's authorized representative - No deductible/Rs.5k/10k/20k/30k/40k/50k/75k/1lac/2lacs/3lacs/
4lacs/5lacs/ 7.5lacs/10lac – Available for all geographies
‘Outside India': The following definitions are redefined:
- On aggregate claim basis: No deduc tible/5k/10k/20k/30k/
1.95 Hospital means any institution established for in-patient care and day care
40k/50k/75k/1lac/2lacs/3lacs/4lacs/5lacs/7.5lacs/10lac – Available for all
treatment of illness and/or injuries and which has been registered as a hospital
geographies
with the local authorities in that country or complies with all minimum criteria as
under: Deductible options available for Optional Extensions under Optional Benefit 5
(Personal Accident) and applicable only for geography “India”:
(a) has qualified nursing staff under its employment round the clock;
- On aggregate claim basis: No deductible/5k/10k/20k/30k/40k/
(b) has at least 10 in-patient beds in towns having a population of less than
50k/75k/1lac
10,00,000 and at least 15 in-patient beds in all other places;
2. The applicability of any Optional Benefit or Optional Extension is subject to the
(c) has qualified Medical Practitioner(s) in charge round the clock;
Policyholder having opted that Optional Benefit or Optional Extension and such
(d) has a fully equipped operation theatre of its own where surgical procedures applicability is specified in the Policy Schedule. Coverage will be restricted to the
are carried out; opted geographical scope.
(e) maintains daily records of patients and makes these accessible to the 3. Optional Extension will be available only when the respective Optional Benefit is
insurance company's authorized personnel. opted by Insured Member/Policyholder.
1.96 Medical Practitioner means a person who holds a valid registration issued by 4. All Claims shall be payable subject to the terms, conditions, wait periods and
the Medical Council/Statutory Regulatory Authority for Medical Education in that exclusions of the Policy and subject to availability of the Coverage amount against
Country and is thereby entitled to practice medicine within its jurisdiction; and is each and every Optional Benefit and Optional Extension.
acting within the scope and jurisdiction of license.

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4
5. Coverage Amount of any Optional Extension (excluding except Optional If an Insured Member is diagnosed with an Illness or suffers an Injury which
Extension 12: Corporate Floater of Optional Benefit 1) cannot be greater than requires the Insured Member to be admitted in a Hospital due to Medically
the Coverage Amount of its respective Optional Benefit (wherever applicable) Necessary conditions, during the Cover Period, and while the Policy in force for:
except Optional Benefit 5: Personal Accident & its Optional Extensions.
(a) In-patient Care (Hospitalization)
6. Coverage Amount of Optional Extension will always be a part of Coverage
The Company will indemnify the Medical Expenses incurred which are
Amount of its respective Optional Benefit except Optional Extension 12:
Reasonable and Customary Charges towards In-patient Care
Corporate Floater under Optional Benefit 1 (Hospitalization Expenses), Optional
Hospitalization of the Insured Member, maximum up to the Coverage
Extension 3: Vaccination, Optional Extension 5: Health Check-up, Optional
Amount as specified in the Certificate of Insurance, provided that the
Extension 6: Second Opinion, Optional Extension 7: Alternative methods of
Hospitalization is for a minimum period of 24 consecutive hours and was
Treatments under Optional Benefit 2: Out-patient Care and Optional Extensions
prescribed in written, by a Medical Practitioner, where Insured is covered
under Optional Benefit 5: Personal Accident.
for hospital charges incurred for eligible treatment given between
7. Any Optional Benefit or Optional Extension mentioned in the Policy Schedule admission and discharge of hospital such as:
can be availed either under Cashless or Reimbursement basis or both, which will
• diagnostic procedures
be specified in the Policy Schedule.
• surgical procedures
8. A Policyholder can opt either Optional Cover 11 (Limit on Illness / Surgeries /
Procedures) or Optional Cover 13 (Sub-limits on Hospitalization Expenses) but • operating theatre charges
not both under Optional Benefit 1 (Hospitalization Expenses)
• nursing care, drugs and dressings
9. All the limits and sub-limits mentioned here above are subject to modification
• surgical appliances used by the medical practitioner during surgery
based on the individual deal with the group as per Plan
except external prosthesis or orthosis or appliances
10. The wait periods opted for Named Ailments and Maternity should be less than or
• surgeons' and anaesthetists' charges
equal to PED wait period opted.
• intensive care unit charges
11. If Policyholder has opted for both Optional Extension 6: Parent Accommodation
and Optional Extension 7: Dependent Accommodation, then the Insured will be • high dependency unit, coronary care unit charges
entitled to claim only under one of the benefits at a time but not under both.
• physiotherapy while admitted for treatment of an eligible medical
12. Deductible, Co-payment is applicable on any Optional Benefit / Optional condition and when such treatment directly relates to it
Extension only if opted for. The Company shall be liable to make payment under
• occupational therapy and speech therapy while admitted for
the Policy for any Claim in respect of the Insured only when the Deductible (if
Treatment of a Medical Condition and when such Treatment directly
applicable), Co-payment (if applicable) on that Claim is exhausted.
relates to it, but we will not pay for such occupational therapy and
13. Currency of Coverage amount will be calculated on exchange rate available at the speech therapy when the Insured is admitted as an in-patient if these
beginning of the calendar month of the Risk start date. Treatments are purely for the convenience of the Insured or the
Medical Practitioner, and can be reasonably rendered in an
14. Wait periods for Named ailment and Pre-existing disease, if opted, will be
outpatient setting
applicable on Optional Benefit 1: Hospitalization Expenses and its Optional
Extensions, Optional Benefit 3:Daily Cash Allowance and Optional Benefit 4: • radiotherapy and/or chemotherapy
Convalescence Benefit
• computerized tomography, magnetic resonance imaging, x-rays
15. The maximum, total and cumulative liability of the Company towards an Insured and other such proven medical imaging techniques
Member, for any and all Claims arising under this Policy during the Cover Period,
• special nursing in hospital
on occurrence of an insured event in relation to that Insured Member, shall not
exceed the Coverage Amount of that Insured Member which is specified against b) Reconstructive Surgery
every Optional Benefit / Optional Extension, mentioned in the Policy Schedule. The Company will indemnify the Medical Expenses incurred which are
16. All the valid OPD claim expenses incurred by the Insured Member in a Cover Reasonable and Customary Charges, maximum up to the Coverage
Period will be payable / reimbursed by the Company. However, claim can be filed Amount as specified in the Certificate of Insurance, where the Company
with the Company, only quarterly during that Cover Period, as and when that indemnifies for initial treatment plan for reconstructive surgery and only
Insured Member may deem fit. In case first claim is filed in last quarter of the when it is medically necessary and subject to the following:
Cover Period, then claimant will be allowed 1 more filing. a) it is carried out to restore function after an accident or following
17. Admissibility of a Claim under Optional Benefit 1 (Hospitalization Expenses) is a surgery for an eligible medical condition, provided that the Insured
pre-condition to the admission of a Claim under Optional Extension 1 (Pre Member has been covered under this policy since before the
Hospitalization & Post Hospitalization Medical Expenses), Optional Extension 3 accident or surgery happened; and
(Alternative Treatments), Optional Extension 4 (Durable Medical Equipment), b) it must be done at a medically appropriate stage after the accident or
Optional Extension 5(Inpatient Rehabilitation), Optional Extension 6 (Parent surgery; and
Accommodation), Optional Extension 7 (Dependent Accommodation),
Optional Extension 9 (Room Rent Modification) c) the Company agrees to the cost of the treatment in writing before it
is done.
18. Linear interpolation & extrapolation methodology will be applied to calculate the
premium rates if an intermittent value of Coverage Amount is chosen by the (c) Surgical Implants
Policyholder The Company will indemnify the Medical Expenses incurred, maximum up
19. Option of Mid-term inclusion of a Member in the Policy will be only upon to the Coverage Amount as specified in the Certificate of Insurance, for
marriage or childbirth; Additional differential premium will be calculated on a pro medical device surgically implanted into the body as part of the treatment
rata basis (excluding any dental implants).
20. Coverage under Optional Benefit 3 (Daily cash Allowance), Optional Benefit 4 (d) Day Care Treatment
(Convalescence Benefit), Optional Benefit 5 (Personal Accident) & its Optional The Company will indemnify the Medical Expenses incurred which are
Extensions will be on Individual basis. Reasonable and Customary Charges towards Day Care Treatment of the
21. The Company will provide coverage under the Optional Benefits 5 and its Insured Member, up to the Coverage Amount specified in the Certificate of
Optional extensions 1, 2, 3, 6, 8, 9 & 13 to any Insured Event arising worldwide. Insurance provided that:
Coverage under Optional extensions 4, 5, 7, 10, 11 & 12 is available only in Indian a) the Day Care Treatment is listed as per the Annexure-I to Policy
geography Terms & Conditions; and
22. Under this Product, the Company will provide Policy Schedule to Policyholder b) the period of treatment of the Insured Member in Hospital/Day
and access of Certificate of Insurance will be provided to each Insured Member, Care Centre does not exceed 24 hours; and
therefore the references to the 'Policy Schedule' shall include references to the
'Certificate of Insurance'. c) the Day Care Treatment was taken on the advice of a Medical
Practitioner
23. In case of employer employee Group, Actively at work is eligibility criteria for
Coverage under the policy. (e) Radiotherapy and Chemotherapy for Cancer

1 Optional Benefit 1 : Hospitalization Expenses The Company will indemnify up to the Coverage amount specified in the
Certificate of Insurance, for the Medical Expenses incurred by the Insured

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5
 Member in respect of radiotherapy (the use of radiation) and 12. Arthritis, Gout and Rheumatism.
chemotherapy (the use of drugs) active treatment of Cancer.
(vii) This benefit is available for insured member whose treatment is
(f) Kidney Dialysis Treatment undertaken in India only
The Company will indemnify up to the Coverage amount specified in the (j) Pre-Hospitalization Medical Expenses and Post-
Certificate of Insurance, for the Medical Expenses incurred by the Insured Hospitalization Medical Expenses
Member in respect of Kidney Dialysis. The Company will indemnify the Insured Member for Relevant Medical
The Company will indemnify the Reasonable and Customary Charges Expenses incurred which are Medically Necessary, only through
actually incurred for haemodialysis or peritoneal dialysis received by the Reimbursement Facility, maximum up to the Coverage Amount, as
Insured as part of kidney failure treatment on a day care at a medical facility. specified in the Certificate of Insurance, provided that the Medical
Expenses so incurred are related to the same Illness/Injury for which the
Notwithstanding anything stated under exclusion clause 5.2.(47), the Company has accepted the Insured Member's Claim under Optional
Insured would be covered for 'Kidney Dialysis' up to the purview of this Benefit 1 (Hospitalization Expenses) and subject to the conditions specified
cover. below:
(g) Organ Transplant (i) Under Relevant Pre-hospitalization Medical Expenses, for a period of
The Company will indemnify the Insured Member, up to the amount 30 days immediately prior to the Insured Member's date of
specified against this Optional Extension in the Certificate of Insurance, admission to the Hospital, provided that the Company shall not be
Where the Company indemnifies for transplantation of kidneys, heart, liable to make payment for any Pre-hospitalization Medical Expenses
liver, lung or bone marrow required as a result of an eligible medical that were incurred before the Cover Start Date; and
condition and provided these organ(s) came from a relative or a legally
(ii) Under Relevant Post-hospitalization Medical Expenses, for a period
certified and verified source of donation.
of 60 days immediately after the Insured Member's date of discharge
The policy does not cover the costs of collecting donor organs (including from the Hospital.
but not limited to, transportation and administration costs) or any expenses
(iii) The number of consultations covered by this benefit is limited to
incurred by the donor.
once per day.
(h) Road Ambulance Cover
(iv) This benefit does not cover follow-up consultation or treatment
The company will indemnify up to the Coverage amount specified in the after the Insured Member is discharged from an in-patient
Certificate of Insurance, for the reasonable and Customary Charges rehabilitation facility.
necessarily incurred on availing Ambulance services offered by a Hospital or
(v) If the provisions of Clause 6.6(f) is applicable to a Claim, then:
by an Ambulance service provider, for the Insured Member's necessary
transportation provided that the necessity of such Ambulance a) The date of admission to Hospital for the purpose of this
transportation is certified by the treating Medical Practitioner and subject Benefit shall be the date of the first admission to the Hospital
to the conditions specified below: for the Illness deemed or Injury sustained to be Any One Illness;
and
(i) Such Transportation is from the place of occurrence of Medical
Emergency of the Insured Member, to the nearest Hospital; and/or b) The date of discharge from Hospital for the purpose of this
Benefit shall be the last date of discharge from the Hospital in
(ii) Such Transportation is from one Hospital to another Hospital for the
relation to the Illness deemed or Injury sustained to be Any
purpose of providing better Medical aid to the Insured Member,
One Illness.
following an Emergency.
(i) Domiciliary Hospitalization
(k) Conditions applicable for Hospitalization Expenses
The Company will indemnify the Insured Member, only through
(Optional Benefit 1):
Reimbursement Facility, maximum up to the Coverage Amount as specified
in the Certificate of Insurance, for the Medical Expenses incurred towards (a) Room/Boarding and nursing expenses as charged by the
Domiciliary Hospitalization, i.e., Coverage extended when Medically Hospital where the Insured Member availed medical
Necessary treatment is taken at home (as explained in Definition 1.32), treatment (Room Category):
subject to the conditions specified below: If the Insured Member is admitted in a Hospital room where the
(i) The Domiciliary Hospitalization continues for a period exceeding 3 Room Category opted is higher than the eligible Room Category as
consecutive days. specified in the Certificate of Insurance, then,
(ii) The Medical Expenses are incurred during the Cover Period. I. The Insured Member shall bear the ratable proportion of the
total Variable Medical Expenses (including applicable surcharge
(iii) The Medical Expenses are Reasonable and Customary Charges and taxes thereon) in the proportion of the difference
which are necessarily incurred. between the Room Rent actually incurred and the Room Rent
(iv) Any Pre Hospitalization and Post Hospitalization Medical Expenses of the entitled Room Category to the Room Rent actually
shall be payable under this Benefit. incurred.
(v) Any Maternity related expenses shall not be payable under this The Certificate of Insurance will specify the eligibility of Room
Benefit Category applicable for the Insured Member under the Policy
as follows:
(vi) Any Medical Expenses incurred for the treatment in relation to any of
the following diseases shall not be payable under this Benefit: 1) Single Private Room: If the Certificate of Insurance
states 'Single Private Room' as eligible Room Category, it
1. Asthma; means the maximum eligible Room Category in case of
2. Bronchitis; Hospitalization of the Insured Member payable by the
Company is limited to stay in a Single Private Room.
3. Chronic Nephritis and Chronic Nephritic Syndrome;
(b) Intensive Care Unit Charges (ICU Charges):
4. Diarrhoea and all types of Dysenteries including
Gastro-enteritis; If the Insured Member is admitted in an ICU where the ICU charges
incurred are higher than the ICU Charges specified in the Certificate
5. Diabetes Mellitus and Diabetes Insipidus; of Insurance, then the Insured Member shall bear the ratable
6. Epilepsy; proportion of the total Variable Medical Expenses (including
applicable surcharge and taxes thereon) in the proportion of the
7. Hypertension; difference between the ICU charges actually incurred and the ICU
8. Influenza, cough or cold; Charges specified in the Certificate of Insurance to the ICU charges
actually incurred.
9. All Psychiatric or Psychosomatic Disorders;
The Certificate of Insurance will specify the Limit of ICU Charges
10. Pyrexia of unknown origin for less than 10 days; applicable for the Insured Person under the Policy as follows:
11. Tonsillitis and Upper Respiratory Tract Infection including 1) If the Certificate of Insurance states the eligibility of ICU
Laryngitis and Pharyngitis; Charges of the Insured Member as 'no sub-limit', it means that
there is no separate restriction on ICU Charges incurred t
GROUP GLOBAL CARE - UIN: RHIHLGP21406V032021
6
 towards stay in ICU during Hospitalization. (ii) Birth through normal delivery, midwife fees (during labour only) and
medically necessary caesarean section for the childbirth delivery
(I) Advance Technology Methods:
costs up to the amount specified in Certificate of Insurance
The Company will indemnify the Insured Person up to
(iii) For birth through elective or non-medically necessary caesarean
Coverage Amount for expenses incurred under
section, the childbirth delivery costs will be limited up to the costs of
Optional Benefit 1 (Hospitalization Expenses) for
a normal delivery. Any complications arising from such delivery will
treatment taken through following advance technology
be paid up to the remainder of this Benefit. If we are not able to
methods:
determine that a caesarean section was medically necessary, we will
A. Uterine Artery Embolization and HIFU deem such elective caesarean section as not medically necessary.
B. Balloon Sinuplasty (e) The Company shall be liable to make payment for any 'Well Baby
Care' expenses or 'Well Mother Expenses', for any Claim arising
C. Deep Brain stimulation
under this Optional Extension, maximum up to Rs.5000 or up to the
D. Oral chemotherapy amount specified in Certificate of Insurance;
E. Immunotherapy- Monoclonal Antibody to be given Definitions for the purpose of this Optional Extension only:
as injection
i) Well Baby Care: 'Well Baby Care' is the routine medical care
F. Intra vitreal injections provided to a new born baby, which includes limited to
appropriate customary examinations required to assess the
G. Robotic surgeries
integrity and basic function of the child's organs and skeletal
H. Stereotactic radio surgeries structures carried out immediately following birth,
routine preventive care services and immunizations. For
I. Bronchical Thermoplasty
multiple birth babies born, subject to any benefit limit in place.
J. Vaporisation of the prostrate (Green laser
ii) Well Mother care: 'Well Mother Care' is routine medical care
treatment or holmium laser treatment)
provided to an insured female (Mother), immediately after
K. IONM - (Intra Operative Neuro Monitoring) giving birth to a new born baby, which includes routine
preventive care services and immunizations.
L. Stem cell therapy: Hematopoietic stem cells for (f) The Company shall be liable to make payment in respect of any
bone marrow transplant for haematological Hospitalization arising due to involuntary medical termination of
conditions to be covered pregnancy, as per India MTP Act, 1971(amended) and other
1.1 Optional Extension 1: Pre-Hospitalization Medical Expenses and applicable laws and rules;
Post-Hospitalization Medical Expenses Modification Notwithstanding anything stated under exclusion clause 5.2.(5) by opting
for this optional extension, the Insured would be covered for 'Maternity
Notwithstanding anything to the contrary in the Policy, by choosing this Optional
Expenses' and 'treatment related to childbirth' up to the purview
Extension, the Company agrees to modify:
of this cover.
a. the maximum amount
The amount specified in the Certificate of Insurance is for each:
b. the Duration
(i) Cover Period, even if there is more than one pregnancy in that Cover
as specified against this Optional Extension in the Certificate of Insurance, Period;
provided that:
(ii) Pregnancy, even if a pregnancy, which is eligible under this Benefit, falls
i) the Medical Expenses incurred are admissible under Hospitalization across the policy anniversary and provided the policy and including
Expenses (Optional Benefit 1 ) this benefit has been renewed for the subsequent Cover Period.
ii) the Company shall not be liable to make payment for any Pre- (iii) If there is a change applied to the benefit limit at policy renewal, the
hospitalization Medical Expenses that were incurred before the Cover following will apply:
Start Date unless it is continuation of Policy for the Insured; and
a) All eligible expenses incurred in the first year will be subject to
iii) the Company shall not be liable to make payment for any Post- the benefit limit that applies in year one.
hospitalization Medical Expenses that were incurred 60 days or more after
b) In the event that the benefit limit decreases in year two and this
the Cover End Date
updated amount has been reached or exceeded by eligible
1.2 Optional Extension 2: Maternity Expenses (Pregnancy and costs incurred in year one, no additional benefit amount will be
Childbirth) payable.
a) Pregnancy and Childbirth c) In the event that the benefit limit increases in year two, all
The Company will indemnify up to amount specified in the Certificate of eligible expenses incurred in the second year will be subject to
Insurance, for the Medical Expenses associated with Hospitalization of the the updated benefit limit that applies in year two, less the total
Insured Member for the pregnancy & delivery of a child, provided that: benefit amount reimbursed in year one.
b) Maternity Complications (Pre and Post natal complications)
(a) The Company will be liable to make payment under this Optional
Extension, only if the Insured Member who has delivered the child is The Company will indemnify up to the amount specified in the Certificate
the Primary Insured Member or the Primary Insured Member's of Insurance, for the Medical Expenses incurred in respect of the
spouse and over the age of eighteen (18) years of age. Hospitalization of the Insured Member for treatment of any of the
complications specified below, occurring after the completion of the
(b) The delivery occurs after the completion of the waiting period
waiting period as specified in the Certificate of Insurance:
(specified in the Certificate of Insurance) from the Cover Start Date
under this Policy where Wait period will apply once the Insured
Member attains age 18 years or above;
(c) The Company shall not be liable to make payment under this
Optional Extension in respect of an Insured Member more than
twice during that Insured Member's lifetime;
(d) The Company shall be liable to make payment for any :

(i) Pre- Hospitalization Medical Expenses (routine pre-natal care and

check-ups which includes common screening and follow-up tests as
required during a pregnancy) or Post- Hospitalization Medical
Expenses (routine post-natal care and check-ups) received by the
insured mother up to sixty (60) days of any Claim arising under this
Optional Extension, maximum up to Rs.50,000 or up to the amount
specified in Certificate of Insurance;

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7
 'Eligibility' criteria.
S. No Pre-Post Natal Complication
This benefit excludes treatment to the insured child (who is conceived by
1 Antiphospholipid syndrome assisted conception/assisted pregnancy) for any condition or complication
2 Cervical incompetence arising therefrom or associated therewith to assisted conception/assisted
pregnancy (such as but not limited to premature or multiple births), that has
3 Ectopic pregnancy arisen, or for which the need had arisen, during the first ninety (90) days
4 Gestational diabetes after birth.

5 Hydatidiform mole - molar pregnancy 1.3 Optional Extension 3: Alternative methods of Treatments

6 Hyperemesis gravidarum The Company will indemnify the Insured Member, up to the amount specified in
the Certificate of Insurance, towards Medical Expenses incurred with respect to
7 Obstetric cholestasis the Insured Member's medical treatment undergone at any AYUSH Hospitals or
health care facilities for any of the alternative treatments namely Ayurveda, Sidha,
8 Pre-eclampsia / Eclampsia
Unani and Homeopathy, subject to the conditions specified below:
9 Rhesus (RH) factor
(i) A Claim will be admissible under this Benefit only if the Claim is admissible
10 Miscarriage Requiring Immediate Surgical Treatment under 'In-patient Care' of Optional Benefit 1 (Hospitalization Expenses).
11 Post partum haemorrhage (ii) Medical Treatment should be rendered from a registered Medical
Practitioner who holds a valid practicing license in respect of such
12 Retained placental membrane Alternative Treatments; and
This benefit pays for treatment of an eligible medical condition which is due (iii) Such treatment taken is within the jurisdiction of India
and occurs to the Primary Insured Member or the Primary Insured
Notwithstanding anything stated under exclusion clause 5.2.(38), by opting for
Member's spouse over the age of eighteen (18) years during the pregnancy
this optional extension, the Insured would be covered for 'Non-Allopathic
prior to the delivery or after the delivery of child.
Treatment or treatment related to any unrecognized systems of medicine' up to
Coverage under this Optional Extension is available only after the the purview of this cover.
completion of the wait period (specified in Certificate of Insurance) where
This benefit is available for insured member whose treatment is undertaken in
Wait period will apply once the Insured Member attains age 18 years or
India only.
above.
1.4 Optional Extension 4: Durable Medical Equipment
Under post-natal complications, the Company will only pay for treatment
received within sixty (60) days following the delivery of child. This benefit is a) Durable Medical Equipment and Medical Aid
only payable where the Insured Member is covered under 'Maternity
The Company will indemnify up to the amount specified in the Certificate
Expenses' benefit.
of Insurance, for the Reasonable and Customary charges necessarily
This benefit does not cover: incurred by the Insured Member, for procuring, fitting or hiring instruments,
apparatuses or devices which are medically prescribed at the time of
• the costs of delivery of any child (including still born) whether such
discharge as a medical aid and limited to compression stockings, hearing
delivery is normal, by caesarean section or by any other assisted
aids, speaking aids (electronic larynx), standard wheelchairs, crutches,
means, or
orthopaedic supports/braces/corrective splints, orthotics and stoma
• any complication arising from elective or non-Medically Necessary supplies following an Hospitalization during the Cover Period and this
caesarean section birth, or benefit should be availed within 60 days of hospitalization or as defined by
medical practitioner in discharge summary.
• treatment of any Medical Condition which is due to and occurs
during the pregnancy prior to the delivery or after the delivery if the b) Artificial Limbs
pregnancy was a result of any form of assisted conception.
The Company will indemnify up to the amount specified in the Certificate
• Complications arising from infertility treatment. of Insurance, for the Reasonable and Customary charges necessarily
incurred by the Insured Member, for procuring necessary prosthetic or
Notwithstanding anything stated under exclusion clause 5.2.(5), by opting
artificial devices replacing body parts which is associated with fitting artificial
for this optional extension, the Insured would be covered for 'Maternity
limbs, its maintenance, consultation and necessary medical or surgical
Expenses' and 'treatment related to childbirth' up to the purview of this
procedures immediately following an Hospitalization during the Cover
cover.
Period and this benefit should be availed within 60 days of hospitalization or
c) New Born Accommodation as defined by medical practitioner in discharge summary.
This benefit provides cover to a new born child (less than 16 weeks), when The benefit is only payable following a surgery or an accident for an eligible
the mother who is an Insured Member under this benefit is receiving medical condition provided that the Insured has been covered under this
eligible in-patient treatment and the new born is required to stay in the policy since before the accident or surgery happened.
Hospital with the insured mother.
For the purpose of this Optional Extension, Durable Medical Equipment,
This benefit pays for new born nursery accommodation of a standard class Medical Aids, Artificial limbs or devices must satisfy the following
where the new born only receives nursery care during the stay in Hospital conditions:
and is paid from the Insured mother's benefit.
(a) Procurement amount of the durable medical equipment must not exceed
This benefit shall not pay if the new born child is hospitalized for treatment the reasonable purchase price of the durable medical equipment for
for any medical condition of the new born child, or any new born child's relevant geography/location.
preventive diagnostic procedures, such as routine swabs, blood typing and
hearing tests or any medically necessary follow-up investigations and (b) Spectacles, Thermometer, contact lenses, hearing aids, blood pressure
treatment. monitoring machine and diabetes monitoring machine are not included in
the list of durable medical equipment for the purpose of this Optional
d) Acute New Born Cover Extension.
The Company will indemnify up to the amount specified in the Certificate (c) Any Durable Medical Equipment or device cannot be procured more than
of Insurance, for the treatment of acute medical condition, provided there once.
is no underlying congenital condition, developed in a new born baby
including nursing of pre-mature baby (i.e. where birth is prior to 37 weeks (d) The Durable Medical Equipment, Medical Aid or device is not part of the
gestation) in Neonatal Intensive Care Unit (NICU). The common acute care for a chronic condition or terminal illness condition or vegetative state
medical conditions for new born babies include neonatal jaundice, colic, of insured.
diarrhea, constipation, vomiting and ear infection. In addition to the foregoing, the Company will also indemnify the reasonable
This benefit covers acute medical conditions resulting in Hospitalization repair charges, up to the amount specified in the Certificate of Insurance, incurred
received by a new born baby during the first thirty (30) days after birth. towards the repair of the purchased prosthetic devices or other purchased
After thirty (30) days, such Hospitalization Medical Expenses can be durable medical equipment originally obtained under this Optional Extension
covered under the main benefits of the insured baby's plan by way of provided this benefit is available under the policy and the Insured Member is
addition of dependent, all premiums due being paid and subject to covered under the in-forced Policy.

GROUP GLOBAL CARE - UIN: RHIHLGP21406V032021

8
 Notwithstanding anything stated under exclusion clause 5.2.(14), by opting for 1.8 Optional Extension 8: Sub-limit on Fees charged by a Surgeon,
this optional extension, the Insured would be eligible to claim for 'expenses Anesthetist and Medical Practitioner
related to Durable Medical Equipment', Medical Aid up to the purview of this
Notwithstanding anything to the contrary in the Policy, by choosing this Optional
cover.
Extension, the Company agrees to make payment towards Fees paid to the
1.5 Optional Extension 5: Inpatient Rehabilitation Surgeon, Anesthetist and Medical Practitioner under any admissible Claim shall be
limited to the percentage (%) of claim amount, as specified in the Certificate of
The Company will indemnify up to an amount, as specified in the Certificate of
Insurance.
Insurance, towards rehabilitation of the Insured Member.
1.9 Optional Extension 9: Room Rent Modification
The scope of cover under Optional Benefit 1 (Hospitalization Expenses) is
extended to cover Medical Expenses incurred for treatment of rehabilitation at a Notwithstanding anything to the contrary in the Policy, by choosing this Optional
government authorized rehabilitation center, following Medically necessary Extension, the Company agrees to the following under this Policy:
hospitalization, during the Cover Period:
a) Non-ICU Room Category:
i. it is an integral part of treatment for an eligible medical condition ; and
The Company agrees to make payment for Medical Expenses incurred
ii. it is carried out by a medical practitioner specialized in rehabilitation; and under Non-ICU room category under any admissible Claim shall be limited
to the percentage (%) of the Coverage Amount per day or Rs.15,000 per
iii. it is carried out in a rehabilitation hospital or unit which is recognized by
day whichever is lower, or specific Room Category or No Sub-limit or Sub-
Government ; and
limit on Single Private Room rent (in amts.), as specified in Certificate of
iv. The costs have been agreed, in writing, by the Company before the Insurance
rehabilitation begins.
b) ICU Room Category:
Subject to the limit(s) specified in the Certificate of Insurance against this Optional
The Company agrees to make payment for Medical Expenses incurred
Extension, the Company will reimburse the Reasonable and Customary Charges
under ICU room category under any admissible Claim shall be limited to
for in-patient rehabilitation of up to twenty-eight (28) days.
twice the percentage (%)opted for Non ICU Room Category of the
For cases such as in severe central nervous system damage caused by external Coverage Amount per day or Rs.30,000 per day whichever is lower, as
trauma, the Company will not pay for in-patient rehabilitation for more than one specified in the Certificate of Insurance.
hundred eighty (180) days.
Note: No Sub-limit for Coverage Amount if either Twin Sharing Room or
Notwithstanding anything stated under exclusion clauses 5.2.(26), by opting for No sub-limit or Sub-limit on Single Private Room rent (in amts.) is opted
this optional extension, the Insured would be covered for 'treatment related to under Non ICU Room Category
Rehabilitation measures' only up to the purview of this cover.
1.10 Optional Extension 10: Proportion Charge waive off
1.6 Optional Extension 6: Parent Accommodation
Notwithstanding anything to the contrary in the Policy, by opting this Optional
a) The Company will indemnify the Insured Member, up to the amount Extension, the Insured Member will not bear the ratable Proportion on Variable
specified in the Certificate of Insurance, for the expenses actually Medical Expenses except Room Rent and ICU related charges as per Clause 2.1
incurred towards accommodation in the hospital of the Parent, (K).
during the Hospitalization of a Child (who is an Insured Member)
1.11 Optional Extension 11: Limit on Illness/Surgeries/Procedures
due to any covered Injury or Illness suffered during the Cover Period,
provided that: a) Notwithstanding anything to the contrary in the Policy, by choosing this
Optional Extension, the Company agrees to make payment for Medical
i. Claim is admitted under Optional Benefit 1 (Hospitalization
Expenses incurred in respect of below mentioned treatments under any
Expenses); and
admissible Claim under the Hospitalization Expenses (Optional Benefit 1),
ii. The Hospitalized child's age should be less than 12 years of limited to the amount opted against each defined treatment, as specified in
Age; and Certificate of Insurance
iii. T h e H o s p i t a l i ze d C h i l d ' s P a re n t , w h o i s av a i l i n g b) Sub-limit opted on any defined treatment cannot be greater than the
accommodation, should be covered under this Policy as Coverage Amount opted under Hospitalization Expenses (Optional
Insured Member for the same Cover Period; and Benefit 1) and can be chosen in any combination from the below:
iv. The treating Medical Prac titioner cer tifies that the
Hospitalized Child requires min. Hospitalization for at least Treatment Set Treatment
XX consecutive days as specified in Certificate of Insurance.
1 Cataract
b) The Company will reimburse the Reasonable and Customary
Charges for an extra bed actually incurred by one parent staying in 2 Total Knee Replacement
Hospital with the child in case of outside India and up to 2 (two) 3 Treatment for each and every Ailment / Procedure
parents within India; mentioned below:
c) The Company will pay only one benefit entitlement of either Parent i. Surgery for treatment of all types of Hernia
accommodation or Dependent accommodation, if opted for. ii. Hysterectomy
1.7 Optional Extension 7: Dependent Accommodation iii. Surgeries for Benign Prostate Hypertrophy (BPH)
a) The Company will indemnify the Insured Member, up to the amount iv. Surgical treatment of stones of renal system
specified in the Certificate of Insurance, for the expenses actually incurred
4 Treatment for each and every Ailment / Procedure
towards accommodation in the hospital of an Immediate Family Member,
mentioned below:
during the Hospitalization of an Insured Member due to any covered Injury
or Illness suffered during the Cover Period, provided that: i. Treatment of Cerebrovascular and
Cardiovascular disorders
i. Claim is admitted under Optional Benefit 1 (Hospitalization
ii. Treatments/Surgeries for Cancer
Expenses); and
iii. Treatment of other renal complications and
ii. The Insured Member's Immediate Family Member is also covered Disorders
under this Policy as Insured Member for the same Cover Period; and
iv. Treatment for breakage of bones
iii. The treating Medical Practitioner certifies that the Hospitalized
Insured member requires Hospitalization for min. XX consecutive
c) This benefit is available for insured member whose treatment is undertaken
days as specified in Certificate of Insurance.
in India only
b) The Company will reimburse the Reasonable and Customary Charges for
1.12 Optional Extension 12: Corporate Floater
an extra bed actually incurred by one dependent Insured Member in case of
outside India and up to 2 (two) dependent Insured Members within India; If an Insured Member has exhausted his respective original Coverage Amount
under Optional Benefit 1 (Hospitalization Expenses), and further incurs any
c) The Company will pay only one benefit entitlement of either Parent
medical expenses, the same would be payable from the Coverage Amount of
accommodation or Dependent accommodation, if opted for.
Corporate Floater (as specified in the Certificate of Insurance). The amount
payable under this Optional Extension for an Insured Member shall be restricted

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 to any of the following conditions, as specified in the Certificate of Insurance:- Subject to the availability of this benefit for Insured Member, the Company will pay
for the consultations and the cost of the implants, injections, patches, tablets or
(i) Restricted to Named Illnesses and up to the Coverage Amount of Optional
any other medically approved form of administration of medications, when it is
Benefit 1 for an Insured Member; Or
medically indicated and resulting from a medical intervention rather than for relief
(ii) Restricted only up to the Coverage Amount of Optional Benefit 1 for an of menopausal symptoms. There must be a clear treatment plan from the
Insured Member; practitioner with an end point and expected outcome.
Named illnesses which are referred above are: Notwithstanding anything stated under exclusion clauses 5.2.(56), by opting for
this optional extension, the Insured would be covered for 'Hormone
· Cancer;
Replacement Therapy' up to the purview of this cover and covered only during
· End Stage Renal Failure; Post Hospitalization.
· Multiple Sclerosis; 1.16 Optional Extension 16: Infertility Treatment
· Major Organ Transplant; The Company will indemnify up to the amount specified in the Certificate of
Insurance, for the Medical Expenses incurred by the Insured Member in respect
· Heart Valve Replacement;
of investigations into infertility up to the point of cause of infertility and diagnosis
· Coronary Artery Bypass Graft / Angioplasty (PTCA); only.
· Stroke excluding transient ischemic attack (TIA); The Company shall not be liable to make payment under this Optional Extension
in respect of an Insured Member (both male and female) more than once during
· Paralysis;
that Insured Member's lifetime
· Myocardial Infarction
Notwithstanding anything stated under exclusion clauses 5.2.(8), by opting for this
· Brain surgery optional extension, the Insured would be covered for 'treatment related to
infertility' up to the purview of this cover.
· Road traffic accident with the following conditions:
1.17 Optional Extension17–Doctor On Call and / or Doctor on Chat
· Head injury or
Up on the Insured Member’s request, the Company shall arrange for a Doctor on
· Fractures in two or more limbs (upper / lower) or
Call and / or Doctor on Chat from a Medical Practitioner. The Medical
· RTA injury requiring ventilation support Information /advice will be based only on the information and documentation
provided to Medical Practitioner. This Optional Extension is for additional
Notes:
information purposes only and does not and should not be deemed to substitute
i) The maximum and cumulative liability of the Company will be up to the Insured Member’s visit or consultation to an independent Medical
Corporate Floater Coverage Amount, collectively for all insured members Practitioner.
under the policy.
Note: This benefit is available only in Company's or Assistance Service Provider's
ii) This benefit is available for insured member whose treatment is undertaken network
in India only
1.18 Optional Extension18: International Emergency Medical Assistance
1.13 Optional Extension 13: Sub-limits on Hospitalization Expenses
(a) Medical Evacuation:
a) Notwithstanding anything to the contrary in the Policy, by choosing this
a. The Company will indemnify up to the Coverage Amount specified
Optional Extension, the Company's maximum liability to make payment for
in the Certificate of Insurance for the reasonable cost incurred for
Medical Expenses incurred under any admissible Claim, in respect of
the Medical Evacuation of the Insured Member in an Emergency
Hospitalization due to Surgeries under the Hospitalization Expenses
through an Ambulance or any other transportation and evacuation
(Optional Benefit 1) shall be limited to amount opted, as specified in
services (including necessary medical care en-route forming part of
Certificate of Insurance
the treatment) for any Illness contracted or Injury sustained by the
b) This benefit is available for insured member whose treatment is undertaken Insured Member during the Period of Insurance, provided that:
in India only
(i) The treating Medical Practitioner certifies in writing
1.14 Optional Extension 14: Outside Area of Cover that the severity or the nature of the Insured
Member's Illness or Injury warrants the Insured
Not with standing anything contrary in the Policy, by opting for this Optional
Member's Emergency medical evacuation;
Extension, coverage for medically necessary emergency hospitalization under
Optional Benefit 1 (Hospitalization Expenses) is provided which arises suddenly (ii) These transportation expenses are limited to transporting
whilst Insured member is outside his/her Geographical scope of cover, subject to the Insured Member from the place of contracting or
acceptance by the Company, up to the limit as specified in the Certificate of sustaining such Illness or Injury to the nearest appropriate
Insurance. Hospital;
The coverage nevertheless provided for temporary stay up to maximum of forty- (iii) This Optional benefit will be provided on a cashless basis if the
five (45) days per trip and not exceeding ninety (90) days in a year, outside the costs are certified and authorized by the Company or the
selected area of cover. The coverage is no longer effective for stays of over forty- Assistance Service Provider in advance, unless the Insured
five days per trip or exceeds the maximum ninety (90) days in a year outside the Member has a Life Threatening Medical Condition and the
selected area of cover, whichever occurs earlier. Insured Member (or his representatives) arrange for the
Medical evacuation at their own cost and expense in which
In consultation with the treating medical practitioner, the company retains the
case the Company will indemnify the costs incurred on the
right to determine what constitutes 'emergency hospitalization patient
Medical evacuation in accordance with the terms of this
treatment'.
Optional Benefit;
This benefit does not provide cover:
(iv) Payment under this Optional Benefit is subject to a Claim for
(a) for treatment of any condition if the member travelled outside his area of the Illness or Injury which requires Hospitalization and is
cover to get treatment (whether or not that was the only reason) or for any Medically Necessary.
treatment which was, or may have reasonably been known about, before
b) Documents to be submitted for any Claim under this Optional
the travel commenced ; or
Extension :
(b) for any aspect of pregnancy or childbirth whilst the member is outside area
It is a condition precedent to the Company's liability under this Optional
of cover of this policy. Once the treating medical practitioner certifies that
Extension that the following information and documentation shall be
the eligible medical condition is stabilized or the member's health status
submitted to the Company or the Assistance Service Provider immediately
allows him/her to travel back to his area of cover, the company shall stop
and in any event within 30 days of the event giving rise to the Claim under
paying for such emergency hospitalization in-patient treatment or once the
this Optional Extension:
benefit limits has attained whichever occurs earlier.
(i) Medical reports and transportation details issued by the evacuation
1.15 Optional Extension 15: Hormone Replacement Therapy
agency, prescriptions and medical report by the attending Medical
The Company will indemnify up to the amount specified in the Certificate of Practitioner furnishing the name of the Insured Member and details
Insurance, for the Medical Expenses incurred by the Insured Member towards of treatment rendered along with the statement confirming the
undergoing Hormone Replacement Therapy. necessity of evacuation;

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 (ii) Documentary proof for all expenses incurred towards the Medical Notwithstanding anything stated under exclusion clauses 5.2.(36) by opting for
Evacuation. this optional extension, the Insured would be covered for 'Vaccination Expenses',
up to the purview of this cover.
(b) REPATRIATION OF MORTAL REMAINS
2.4 Optional Extension 4: Prescribed Pharmacy Expenses
If the Insured Member dies solely and directly due to an Accident, the Company
will indemnify for the costs of repatriation of the mortal remains of the Insured The Company will indemnify the Insured Member, up to the amount specified in
Member or up to an equivalent amount, for a local burial or cremation at the place the Certificate of Insurance, for the Pharmacy Expenses incurred in respect of
where death has occurred. that Insured Member, provided that :
Documents to be submitted for any Claim under this Optional Extension : (a) The treating Medical Practitioner has prescribed such medicine for medical
treatment covered by this policy ;
It is a condition precedent to the Company's liability under this Optional Extension
that the following information and documentation shall be submitted to the (b) Any Pharmacy related expenses covered under Hospitalization, Pre-
Company or the Assistance Service Provider immediately and in any event within Hospitalization Medical Expenses, Post-Hospitalization Medical Expenses,
30 days of the event giving rise to the Claim under this Optional Extension: will not be covered under this Optional Extension.
(i) Copy of the death certificate providing details of the place, date, time, and 2.5 Optional Extension 5: Health Check-up
the circumstances and cause of death;
The Company will indemnify the Insured member, up to the amount specified in
(ii) Copy of the postmortem certificate, if conducted; the Certificate, for the Medical Expenses incurred for any eligible consultation in
respect of that Insured Member's Health check-up tests (as specified in the
(iii) Documentary proof for expenses incurred towards disposal of the mortal
Certificate of Insurance).
remains;
2.6 Optional Extension 6: Second Opinion
(iv) In case of transportation of the body of the deceased to the Place of
Residence, the receipt for expenses incurred towards preparation and If the Insured Member is diagnosed with any Major Illness during the Cover
packing of the mortal remains of the deceased and also for the Period, then up on that Insured Member's request, the Company shall arrange for
transportation of the mortal remains of the deceased. a Second Opinion from a Medical Practitioner regarding the diagnosis of such
Major Illness.
2 Optional Benefit 2 : Out-Patient Care
Second Opinion will be based only on the information and documentation
The Company will indemnify the Insured Member, up to the Coverage Amount as
provided to the Company, which will be shared with the Medical Practitioner, and
specified in the Certificate of Insurance, for the Optional Benefit/Optional
is subject to the conditions specified below:
Extensions opted by the Policyholder towards Out-Patient Treatment, subject to
the sub limits (specified in the Certificate of Insurance- Number of visits or/and a) This Optional Extension can be availed maximum once by an Insured
per visit limit specified) against each Optional Extension. Member during the Cover Period for each Major Illness.
Notwithstanding anything stated under exclusion clauses 5.2.(22), by opting for b) The Insured Member is free to choose whether or not to obtain the
this optional Benefit, the Insured would be covered for 'Out-Patient Treatment' Second Opinion and, if obtained under this Optional Extension, then
up to the purview of this cover. whether or not to act on it.
'Day Care Treatment' which is covered under 'Hospitalization', will not be c) This Optional Extension is for additional information purposes only and
covered under this Optional Benefit / Optional Extensions. does not and should not be deemed to substitute the Insured Member's
visit or consultation to an independent Medical Practitioner.
Medical Consultations:
d) The Company does not provide a Second Opinion or make any
The Company will indemnify the Insured Member, up to the Coverage Amount as
representation as to the adequacy or accuracy of the same, the Insured
specified in the Certificate of Insurance, for the Out-patient Consultations taken
Member's or any other person's reliance on the same or the use to which
from a Medical Practitioner and Specialist during the Cover Period.
the Second Opinion is put.
2.1 Optional Extension 1: Sub-limits on Medical consultations
e) The Company does not assume any liability for and shall not be responsible
Notwithstanding anything to the contrary in the Policy, by choosing this Optional for any actual or alleged errors, omissions or representations made by any
Extension, the Company's maximum liability on 'Medical Consultations' is limited Medical Practitioner or in any Second Opinion or for any consequences of
to: actions taken or not taken in reliance thereon.
a. No. of Visits or/and f) The Policyholder/Insured Member shall hold the Company harmless for
any loss or damage caused by or arising out of or in relation to any opinion,
b. Amount per Visit
advice, prescription, actual or alleged errors, omissions or representations
as specified against this Optional Extension in the Certificate of Insurance. made by the Medical Practitioner or for any consequences of any action
taken or not taken in reliance thereon.
2.2 Optional Extension 2: Prescribed Diagnostic Tests
g) Any Second Opinion provided under this Optional Extension shall not be
The Company will indemnify up to the amount as specified in the Certificate of
valid for any medico-legal purposes.
Insurance, for the Medical Expenses incurred towards undergoing Prescribed
Diagnostic Tests by the Insured Member, provided that: h) The Second Opinion does not entitle the Insured Member to any
consultation from or further opinions from that Medical Practitioner.
(a) The treating Medical Practitioner has prescribed such diagnostic tests; and
i) This benefit is available only in Company's or Assistance Service Provider's
(b) Hospitalization is not required for performing such tests.
network
This prescribed diagnostic tests are diagnostic scans limited to computerized
j) For the purposes of this Optional Extension only:
tomography, magnetic resonance imaging, positron emission tomography,
ultrasound scans (pelvis, abdomen, thyroid gland and breast), mammogram, bone (a) Second Opinion means an additional medical opinion obtained by
densitometry, x-rays and gait scans and laboratory tests and pathology received as the Company from a Medical Practitioner, solely on the Insured
part of an outpatient treatment and not part of health screening or preventative Member's express request in relation to a Major Illness, which the
measures. Insured Member has been diagnosed with, during the Cover Period.
Such treatment must be under the medical supervision of a medical practitioner. (b) Major Illness means one of the following only:
Medical supervision means that the reason for referral, where applicable, has been
1. Benign Brain Tumor
initiated by the medical practitioner who has requested such diagnostic scans.
2. Cancer
2.3 Optional Extension 3: Vaccination
3. End Stage Lung Failure
The Company will indemnify up to the amount specified in the Certificate of
Insurance, for the Expenses incurred by the Insured Member up to age of 4. Myocardial Infraction
10 years, towards Vaccination of the Insured Member, provided that any one of
5. Coronary Artery Bypass Graft
the below condition is specified in Certificate of Insurance:
6. Heart Valve Replacement
(a) All Vaccines as prescribed by treating Medical Practitioner or
7. Coma
(b) Vaccination so administered is approved by the World Health Organization
(WHO) and as prescribed by treating Medical Practitioner. 8. End Stage Renal Failure

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 9. Stroke Notwithstanding anything stated under exclusion clauses 5.2.(18), by opting for
this optional extension, the Insured would be covered for 'Psychiatric Treatment'
10. Major Organ Transplant
up to the purview of this cover.
11. Paralysis
This benefit must be pre-authorized by the Company.
12. Motor Neuron Disorder
2.10 Optional Extension 10: Physiotherapy, occupational and speech
13. Multiple Sclerosis Treatment or Therapy
14. Major Burns The Company will indemnify up to the amount specified in the Certificate of
Insurance, for the Medical Expenses incurred by the Insured Member towards
15. Total Blindness
undergoing Physiotherapy, occupational and speech Treatment or Therapy.
2.7 Optional Extension 7: Alternative methods of Treatments
Such treatment must be given by a qualified practitioner who is recognized by us
(on OPD basis)
and registered to practice this where the eligible treatment is given.
The Company will indemnify the Insured Member, up to the amount specified in
This Benefit is payable only following in-patient treatment for an eligible medical
the Certificate of Insurance, towards Medical Expenses incurred on out-patient
condition provided that the Insured has been covered under the policy since
basis with respect to the Insured Member's medical treatment undergone at any
before the in-patient treatment commenced. Treatment given by any of these
AYUSH Hospital or health care facilities for any of the alternative treatments
practitioners must be under the medical supervision of a medical practitioner.
namely Ayurveda, Sidha, Unani and Homeopathy, subject to the conditions
Medical supervision means that the reason for referral, where applicable, has been
specified below:
initiated by the medical practitioner who has defined a diagnosis.
(i) Medical Treatment should be rendered from a registered Medical
There must be a clear treatment plan from the practitioner with an end point and
Practitioner who holds a valid practicing license in respect of such
expected outcome.
Alternative Treatments; and
2.11 Optional Extension 11: Outpatient Surgical Procedure
(ii) Such treatment taken is within the jurisdiction of India.
The Company will indemnify for any outpatient surgical procedure received as
Insured Member can also opt for sub-limit on the following under this
part of an out-patient treatment that do not require hospitalization or day-care
Optional Extension:
treatment, up to the amount specified in the Certificate of Insurance. This shall
a. No. of Visits or/and include one (1) post-surgery consultation within ninety (90) days from the date of
the surgical procedure.
b. Amount per Visit
3 Optional Benefit 3 : Daily Cash Allowance
as specified against this Optional Extension in the Certificate of Insurance.
The Company will pay a fixed amount, as specified against this Optional Benefit in
a) Notwithstanding anything stated under exclusion clause 5.2.(38), by opting
the Certificate of Insurance, for each continuous and completed period of
for this optional extension, the Insured would be covered for 'Non-
24 hours of Hospitalization of an Insured Member, subject to the conditions
Allopathic Treatment or treatment related to any unrecognized systems of
specified below:
medicine' up to the purview of this cover. This benefit is available for insured
member whose treatment is undertaken in India only. (i) The Company shall not be liable to make payment under this Optional
Benefit until the deductible (in no. of days) opted (as specified in the
2.8 Optional Extension 8: Extended Alternative methods of
Certificate of Insurance) is exhausted
Treatments
(ii) The Company is liable to make payment under this Optional Benefit up to a
The Company will indemnify up to the amount specified in the Certificate of
maximum defined number of days (as specified in the Certificate of
Insurance, for Medical expenses incurred towards the consultation and treatment
Insurance) in a Cover Period.
given by a qualified Complementary Practitioner for Reasonable and Customary
Charges actually incurred for courses of Chiropractic Treatment, Acupuncture, (iii) This Benefit is valid only during the Cover Period and only for Medically
Osteopathy and Traditional Chinese Medicine received by the Insured as part of Necessary In-patient Hospitalization of that Insured Member.
an Out-patient Treatment at a medical facility.
4 Optional Benefit 4 : Convalescence Benefit
Such treatment must be given by a qualified practitioner (other than the
If the Insured Member undergoes Medically Necessary Hospitalization, during the
Policyholder or , Insured or a member of the Insured's family member) who is
Cover Period, then Company will pay the amount specified against this Optional
registered to practice this where the treatment is given. A referral letter from a
Benefit in the Certificate of Insurance, for every completed period (which has
Medical Practitioner is required for any chiropractic treatment, osteopathy,
defined number of days, as specified in the Certificate of Insurance) of
acupuncture and traditional Chinese medicine, stating the reason for the Insured
hospitalization for each Claim provided that:
Member to have such treatment. Treatment given by a chiropractor,
acupuncturist, osteopath, or Chinese Physician must be under the Medical (i) The Company shall be liable to make payment under this benefit for any
Supervision of a Medical Practitioner. Claim in respect of the Insured Member only when the Minimum
Hospitalization Duration (Deductible) on that Claim is exhausted.
There must be a clear treatment plan from the chiropractor, acupuncturist,
osteopath and Chinese Physician with an end point and expected outcome. (ii) This Benefit will be payable for a maximum of 2 times in a Cover Period (for
different injury causing events leading to Hospitalization) and maximum 3
Insured Member can also opt for sub-limit on the following under this Optional
payments per hospitalization.
Extension:
The combination of Coverage Amount, Minimum Hospitalization Duration and
a. No. of Visits or/and
Period of Hospitalization should be same for all the policies under the group
b. Amount per Visit
5 Optional Benefit 5: Personal Accident Cover
as specified against this Optional Extension in the Certificate of Insurance.
The Company will provide coverage under Benefits 5(a), 5(b) and 5(c) of Benefit
Notwithstanding anything stated under exclusion clause 5.2.(38), by opting for 'Personal Accident Cover' to any Insured Event arising worldwide. In case any
this optional extension, the Insured would be covered for 'Non-Allopathic Claim is admissible under Benefit 5(a) 'Accidental Death', Coverage under the
Treatment or treatment related to any unrecognized systems of medicine' up to Policy for that Insured Member shall immediately and automatically terminate.
the purview of this cover. However, the family members of the deceased, who are other Insured Members
under the Policy, shall continue to be covered under this Policy. The Company's
2.9 Optional Extension 9: Psychiatric Treatment
liability will commence subject to the availability of the Coverage Amount and
The Company will indemnify up to the amount specified in the Certificate of while the policy is in force for insured events namely Accidental Death, Permanent
Insurance, for the Consultations incurred by the Insured Member towards Total Disablement and Permanent Partial Disablement which are explained
undergoing psychiatric treatment. below:
Insured Member can also opt for sub-limit on the following under this Optional (a) Optional Benefit 5 (a): Accidental Death
Extension:
If the Insured Member suffers an Injury during the Cover Period, which
a. No. of Visits or/and directly results in the Insured Member's death within 12 months from the
date of Accident (including date of Accident), the Company will pay the
b. Amount per Visit
Coverage Amount as specified in the Certificate of Insurance against
as specified against this Optional Extension in the Certificate of Insurance. 'Optional Benefit 5: Personal Accident'.

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 (b) Optional Benefit 5 (b): Permanent Total Disablement
[Link]. Insured Events Amount payable = % of the
i. If the Insured Member suffers an Injury during the Cover Period, Coverage Amount specified
which directly results in the Insured Member's Permanent Total in the Certificate of
Disablement within 12 months from the date of Accident (including date of Insurance against Optional
Accident), the Company will pay the amount as specified against 'Optional Benefit 5 (c)
Benefit 5: Personal Accident'in the Certificate of Insurance and as per the
VIII Loss of ring finger
'PTD Table' below :
a) Three phalanges 5%
[Link]. Insured Events Amount payable = % of b) Two phalanges 3%
the coverage amount c) One phalanx 2%
specified in the Certificate
IX Loss of little finger
of Insurance against
a) Three phalanges 4%
Optional Benefit 5 (b)
b) Two phalanges 3%
1 Total and irrecoverable loss of sight of both eyes, 100% c) One phalanx 2%
or of the actual loss by physical separation of two
X Loss of metacarpus
entire hands or two entire feet, or one entire hand
a) First or second 3%
and one entire foot, or the total and irrecoverable
b) Third, fourth or fifth 2%
loss of sight of one eye and loss by physical
separation of one entire hand or one entire foot XI Permanent partial disablement not otherwise Such percentage of the
provided for under Sr. No. I to X inclusive Sum Insured as
II Total and irrecoverable loss of 100%
determined in accordance
(a) use of two hands or two feet; or
with the medical
(b) one hand and one foot; or
assessment carried out by
(c) sight of one eye and use of one hand or one foot
the Company's
III Total and irrecoverable loss of sight of one eye, or of 50% Network Hospital
the actual loss by physical separation of one entire provided that the
hand or one entire foot percentage under Insured
Event Sr. No. XI shall not
IV Total and irrecoverable loss of use of a hand or a foot 50%
exceed 50% of the Sum
without physical separation
Note: For the purpose of Insured Events II to X, loss means either Insured.
actual physical separation or total and
V Paraplegia or Quadriplegia or Hemiplegia 100% irrecoverable loss only.
Note: For the purpose of Sr. No. I to IV above, physical separation of a hand or foot shall mean separation of the It is further agreed that in case of multiple events, the Company's maximum liability shall not exceed the amount
hand at or above the wrist, and of the foot at or above the ankle. specified against this benefit.
It is further agreed that in case of multiple events, the Company's maximum liability shall not exceed the amount 5.1 Optional Extension 1: Temporary Total Disablement (TTD)
specified against this benefit.
Optional Extension 15: Outpatient Surgical Procedure
ii. For the purpose of this Benefit only:
If the Injury suffered by the Insured Member immediately results in Temporary
(i) “Hemiplegia” means complete and irrecoverable paralysis of the arm, leg, Total Disablement of the Insured Member during the Cover Period, which
and trunk on the same side of the body; completely prevents Insured Member from performing each and every duty
pertaining to his employment or occupation, then the Company will pay a fixed
(ii) “Paraplegia” means complete and irrecoverable paralysis of the whole of
lump sum, for each continuous and completed week of that Insured Member's
the lower half of the body (below waist) including both the legs;
Temporary Total Disablement, as specified in the Certificate of Insurance,
(iii) “Quadriplegia” means complete and irrecoverable paralysis of all four limbs. provided that:
(c) Optional Benefit 5 (c): Permanent Partial Disablement (i) For a single claim, maximum duration till which this Optional Extension will
be payable is 100 weeks from the date of the Accident and if the Insured
If the Insured Member suffers an Injury during the Cover Period, which directly
Member is disabled for a part of a week, then only a proportionate part of
results in the Insured Member's Permanent Partial Disablement within 12 months
the weekly benefit will be payable.
from the date of Accident (including date of Accident), the Company will pay the
amount as specified against 'Optional Benefit 5: Personal Accident' in the (ii) For the purpose of this Optional Extension only, Temporary Total
Certificate of Insurance and as per the 'PPD Table' below : Disablement means the temporary and total inability of an Insured Member
to engage in his/her occupation/employment while that Insured Member is
[Link]. Insured Events Amount payable = % of the under the regular care of, and acting in accordance with, the instructions or
Coverage Amount specified on the written advice from the treating Medical Practitioner and is confined
in the Certificate of to bed.
Insurance against Optional
Benefit 5 (c) (iii) The Company will not pay any amount in excess of the Insured Member's
base weekly income and this will specifically exclude overtime, bonuses,
I Total and irrecoverable loss of hearing in: - tips, commissions, special compensation or any compensation of similar
a) Both ears 75% nature.
b) One ear 20%
(iv) The Company's liability to make payment under this Optional Extension
II Loss of toes shall commence only upon completion of the excess period (in number of
a) All 20% days), as specified in the Certificate of Insurance.
b) Both phalanges of great toes bilateral 5%
c) Both phalanges of one great toe 2% (v) If a Claim arising out of an Injury is admissible under Optional Benefit 5.(b)
d) Both phalanges of other than great 1% or 5.(c), then a Claim arising out of the same Injury shall not be admitted
toes for each toe under 'Temporary Total Disablement'.

III Loss of four fingers and thumb of one hand 40% (vi) If an Insured Member suffers a relapse / recurrence of Temporary
Total Disablement after a Claim has been admitted under this Optional
IV Loss of four fingers of one hand 35% Extension and during the Cover Period due to the same or related causes,
V Loss of thumb the subsequent period of Temporary Total Disablement shall be deemed
a) Both phalanges 25% to be a continuation of the prior period of Temporary Total Disablement,
b) One phalanx 10% unless the Insured Member has worked for at least 7 (Seven) days between
the 2 (Two) periods. For the purpose of this provision, the Excess Period
VI Loss of index finger specified in the Certificate of Insurance shall be calculated from the
a) Three phalanges 10% commencement of the Temporary Total Disablement in each Claim
b) Two phalanges 8%
c) One phalanx 4% 5.2 Optional Extension 2: Permanent Total Disablement Improvement

VII Loss of middle finger (i) Notwithstanding anything contrary to the coverage terms and conditions
a) Three phalanges 6% stated under Clause 5 (b) ( 'Permanent Total Disablement'), the Company
b) Two phalanges 4% agrees to pay the amount as specified against this Optional Extension in the
c) One phalanx 2% Certificate of Insurance and as per the 'PTD Table' stated under Clause

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 6(b), in case the Insured Member suffers an Injury during the Cover Period, (iii) Has not attained 25 years of Age at Cover Start date
which directly results in the Insured Member's Permanent Total
5.9 Optional Extension 9: Marriage Allowance
Disablement within 12 months from the date of Accident (including date of
Accident). If a Claim for any Insured Event under Accidental Death (Optional Benefit 5 (a))
or Permanent Total Disablement (Optional Benefit 5 (b)) of the Policy has been
(ii) The Coverage amount applicable under this Optional Extension will be in
admitted, then in addition to any amount payable under that Optional Benefit, the
addition to the amount payable under Benefit 'Permanent Total
Company will pay a fixed lump sum, towards the marriage expenses of an
Disablement'.
unmarried son (of Age 21 Years or above, as on the date of the Injury of the
(iii) Claim pay-out under this Optional Extension triggers only when claim pay- Insured Parent) or unmarried daughter (of Age 18 Years or above, as on the date o f
out is triggered under Benefit 5 (b). the Injury of the Insured Parent) of the Insured Member.
5.3 Optional Extension 3: Permanent Partial Disablement 5.10 Optional Extension 10: Home Modification
Improvement
The Company will indemnify the relevant expenses incurred during the Cover
(i) Notwithstanding anything contrary to the coverage terms and conditions Period, as specified in the Certificate of Insurance, for the reasonable and
stated under Clause 5© (Benefit 'Permanent Partial Disablement'), the necessary modification of the Insured Member's regular place of residence, to
Company agrees to pay the amount as specified against this Optional facilitate the Insured Member's activities of daily living, consequent to an Injury,
Extension in the Certificate of insurance and as per the 'PPD Table' stated resulting in a Claim which is payable under Optional Benefit 5.(b): Permanent
under Clause 5 (c), in case the Insured Member suffers an Injury during the Total Disablement and provided that:
Cover Period, which directly results in the Insured Member's Permanent
1. The expenses incurred shall not exceed the reasonable level of charges for
Partial Disablement within 12 months from the date of Accident (including
similar alterations.
date of Accident).
2. The modifications are carried out in the house where Insured Member
(ii) The Coverage amount applicable under this Optional Extension will be in
resides after Injury, within India.
addition to the amount payable under Benefit 'Permanent Partial
Disablement'. Additional conditions specific to Optional Extension 10:
(iii) Claim pay-out under this Optional Extension triggers only when claim pay- a) The modifications are exclusively for the benefit of the Insured Member
out is triggered under Benefit 5 ©. only
5.4 Optional Extension 4: Accidental Hospitalization b) The modifications are carried out within 3 (three) months from the Insured
Member's intimation of claim under Optional Benefit 5.(b): Permanent
If the Insured Member's medically necessary Hospitalization occurs solely and
Total Disablement
directly due to Injury suffered by that Insured Member, then the Company will
indemnify the Medical Expenses incurred for such Hospitalization, provided that: c) The expenses are not related to repair of normal wear and tear or r
enovation or improvisation of existing set-up
(i) The Hospitalization is on the written advice of a Medical Practitioner; and
d) This Optional Extension will be applicable only if the Policyholder has opted
(ii) The Hospitalization commences within 7 (seven) days from the date of
for Optional Benefit 5.(b): Permanent Total Disablement
occurrence of the Injury.
5.11 Optional Extension 11: Vehicle Modification
5.5 Optional Extension 5: Medical Extension
The Company will indemnify the relevant expenses incurred during the Cover
If the Insured Member's medically necessary Hospitalization or Out Patient
Period, as specified in the Certificate of Insurance, for the reasonable and
Treatment occurs solely and directly due to Injury suffered by that Insured
necessary modification of the Insured Member's Vehicle, to facilitate the Insured
Member, then the Company will indemnify the Medical Expenses incurred for
Member's activities of daily living, consequent to an Injury, resulting in a Claim
such Hospitalization or Out Patient Treatment, provided that:
which is payable under Optional Benefit 5.(b): Permanent Total Disablement and
1. The Hospitalization/Out Patient Treatment undergone, is on the written provided that:
advice of a Medical Practitioner; and
a) The Vehicle so modified is the same Vehicle being used by the Insured
2. The Hospitalization/Out Patient Treatment commences within 7 (seven) member before the occurrence of such Injury.
days from the date of occurrence of the Injury.
b) The expenses incurred shall not exceed the reasonable level of charges for
5.6 Optional Extension 6: Funeral Expenses similar Vehicle modification.
If the Insured Member's demise happens and the Claim is payable under Optional Additional conditions specific to Optional Extension 11:
Benefit 5(a), then the Company will pay a fixed lump sum, towards conducting the
e) The modifications are exclusively for the benefit of the Insured Member
funeral ceremony of the Insured Member.
only.
5.7 Optional Extension 7: Ambulance Service
f) The modifications are carried out within 3 (three) months from the Insured
If a Claim for any event under Benefit 5(a) or Benefit 5 (b) or Benefit 5 (c) or Member's intimation of claim under Optional Benefit 5.(b): Permanent
Optional Extension 4 (Accidental Hospitalization) or Hospitalization expenses Total Disablement
under Optional Extension 5 (Medical Extension) of the Policy has been admitted,
g) The expenses are not related to repair of normal wear and tear or
the Company will indemnify up to the amount as specified against this Optional
renovation or improvisation of existing set-up.
Extension in the Certificate of Insurance, in addition to any amount payable under
that Benefit / Optional Extension, for the reasonable expenses necessarily h) This Optional Extension will be applicable only if the Policyholder has opted
incurred on availing Ambulance services offered by a Hospital or by an Ambulance for Optional Benefit 5.(b): Permanent Total Disablement.
service provider for the Insured Member's necessary transportation to the
5.12 Optional Extension 12: Mobility Extension
nearest Hospital in case of an Emergency provided that the necessity of the
Ambulance transportation is certified by the treating Medical Practitioner. The Company will indemnify the reasonable and customary charges necessarily
incurred by the Insured Member, for procuring medically necessary prosthetic
5.8 Optional Extension 8: Children's Education
devices (artificial devices replacing body parts, including artificial legs, arms or
If a Claim for any Insured Event under Accidental Death (Optional Benefit 5 (a)) eyes), orthopedic braces (including but not limited to arm, back or neck braces) and
or Permanent Total Disablement (Optional Benefit 5 (b)) of the Policy has been durable medical equipment (including but not limited to wheelchairs and Hospital beds)
admitted, then in addition to any amount payable under that Optional Benefit, the which fulfills the Insured Member's basic medical needs, consequent to
Company will pay the amount specified in the Certificate of Insurance against this an Injury for which a Claim is payable under Optional Benefit 5.(b) and provided that
Optional Extension, for the education of the Insured Member's child subject to such devices or equipment are procured on the written advice of the treating
following conditions: Medical Practitioner.
(a) A valid document establishing the Age of child and relationship between For the purpose of this Optional Extension only, durable medical equipment or
the child and the Insured Member is submitted. devices should satisfy the following minimum criteria:
(b) For the purpose of this Optional Extension, “Child” means a child (natural 1. Procurement amount must not exceed the reasonable purchase price of
or legally adopted), who is : the durable medical equipment; and
(i) Financially dependent on the Insured Member; 2. Spectacles, contact lenses, hearing aids, blood pressure monitoring
machine and diabetes monitoring machine are not included in the list of
(ii) Does not have his independent sources of income; and
durable medical equipment for the purpose of this Optional Extension.

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 Notwithstanding anything stated under exclusion clause 5.2.(14), by opting for diagnostic tests / treatments incurred by the Insured Member for Vision care.
this optional extension, the Insured would be covered for 'expenses related to
The Company will pay for the Reasonable and Customary fees charged for
Durable Medical Equipment' up to the purview of this cover.
corrective spectacle lenses along with frame and contact lenses as prescribed by
5.13 Optional Extension 13: Disappearance the ophthalmologist or optometrist. This benefit also pays for one eye
examination carried out by an ophthalmologist or optometrist per Cover Period.
(a) The Company shall admit its liability under this optional extension, if the
Insured Member's full body cannot be located within a period of This benefit does not pay for tinted / reactive lenses, sunglasses, non-corrective
consecutive 365 Days after a forced landing, stranding, sinking or wrecking contact lenses, lasik / laser eye surgery, medical or surgical treatment of the eye(s)
of a Common Carrier wherein the Insured Member was a fare paying and/or similar, whether prescribed or not.
passenger or in any event arising as a result of any Acts of God Perils during
the Cover Period, where it is reasonable to believe that such Insured
Member has died as a result of an Injury. 3 Additional Optional Benefits
(b) The Company will only pay, when the nominee or legal heir provides a
1. Optional Benefit A: Network limited to Preferred Providers
legally binding indemnity bond or any other document as required by the
Company which guarantees, that the amount the Company pays will be Notwithstanding anything to the contrary in the Policy, it is hereby declared
repaid to the Company, if it is later found that the Insured Member survived that, the Company will indemnify the Medical Expenses incurred for
such an Accident / Injury for which the Company had paid the Claim. Hospitalization under Optional Benefit 1, Optional Benefit 2 only if a Claim
is incurred in a Hospital which is on the Preferred Provider Network List, as
6 Optional Benefit 6: Dental Care
specified in the Certificate of Insurance.
The Company will indemnify up to the amount specified in the Certificate of
If any Claim is incurred in a Hospital which is not on the updated Preferred
Insurance, for the Dental Expenses incurred by the Insured Member towards the
Provider Network List, the Insured Member shall bear a Co-payment up to
following:
15% (in addition to any other applicable Copay or deductible) or as
1. Dental consultations - Emergency Palliative Treatment of Dental pain and specified in the Certificate of Insurance of the final claim amount assessed
minor procedures by the Company.
2. Conservative – per tooth 2. Optional Benefit B: Modification of Wait Period
a. Amalgam 1 - 5 surfaces, Permanent Notwithstanding anything to the contrary in the Policy, it is hereby stated
that the waiting periods specified under Clause 5.1 are modified as
b. Metallic Inlay, 1 - 5 surfaces, Permanent (Gold Inlay)
specified below:
c. Composite resin 1- 5 surfaces, Permanent
Description Revised Waiting Period
3. Extractions - per tooth
Modification of 'Initial Wait Period' Option to modify the Initial Wait
a. Simple extraction - erupted tooth or exposed root Period to 30 days
b. Complicated extraction, tooth or root partially bony 'Pre-Existing Diseases' Modification Option to make the Wait Period
3 / 12 / 24 / 36/48 months
c. Removal of impacted, completely bony
'Named Ailments' Modification Option to make the Wait Period
4. Radiology 3 / 12/24 months
a. X-ray intra-oral / bitewing
i. Modification of Initial wait Period
b. Posterior - anterior or lateral skull and facial bone survey film
(i) Expenses related to the treatment of any illness within 30 days
c. Each additional x-ray bitewing from the first policy commencement date shall be excluded
except claims arising due to an accident, provided the same are
d. Panoramic x-ray
covered.
5. Periodontal
(ii) This exclusion shall not, however, apply if the Insured Person
a. Provision splinting - extracoronal has Continuous Coverage for more than twelve months.
b. Gingivectomy or ginigivoplasty Per tooth (iii) The referred waiting period is made applicable to the
enhanced sum insured in the event of granting higher sum
c. Root amputation - per root
insured subsequently.
6. Endontic
ii. Modification of 'Named Ailments' Wait Period
a. Root canal– x-ray included
(i) Expenses related to the treatment of the listed Conditions,
b. Therapeutic pulotomy (excluding final restoration) surgeries/treatments shall be excluded until the expiry of XX
months of continuous coverage after the date of inception of
Subject to any Waiting Period applicable under this Optional Extension as
the first policy with the Company. This exclusion shall not be
specified in Certificate of Insurance.
applicable for claims arising due to an accident.
Accidental Damage to natural teeth following the accident:
(ii) In case of enhancement of sum insured the exclusion shall apply
Subject to availability of this benefit, the Company will indemnify up to the amount afresh to the extent of sum insured increase.
specified in the Certificate of Insurance, for the initial treatment required
(iii) If any of the specified disease/procedure falls under the waiting
immediately within thirty (30) days following damage to natural teeth caused by an
period specified for pre-Existing diseases, then the longer of
accident and provided the Insured has been covered under the policy since before
the two waiting periods shall apply.
the accident happened.
(iv) The waiting period for listed conditions shall apply even if
Benefit is not payable if:
contracted after the policy or declared and accepted without a
(i) injury caused when professional sports without appropriate mouth
specific exclusion.
protection was worn;
(v) If the Insured Person is continuously covered without any break
(ii) the damage was caused by normal wear and tear;
as defined under the applicable norms on portability stipulated
(iii) the damage was caused by tooth brushing or any other oral hygiene by IRDAI, then waiting period for the same would be reduced
procedure; to the extent of prior coverage.
(iv) the damage was caused as the result of consumption of food or drink (vi) List of specific diseases/procedures:
even if it contained a foreign body;
1. Any treatment related to Arthritis (if non-infective),
(v) damage was not apparent within 7 days of impact which caused the injury. Osteoarthritis and Osteoporosis, Gout, Rheumatism,
Spinal Disorders(unless caused by accident), Joint
Note: All dental treatment must be carried out by a dentist.
Replacement Surgery(unless caused by accident)
7 Optional Benefit 7: Vision Care
2. Surgical treatments for Benign ear, nose and throat
The Company will indemnify up to the amount specified in the Certificate of (ENT) disorders and surgeries (including but not limited
Insurance, for the Medical Expenses related to consultations / prescribed to Adenoidectomy, Mastoidectomy, Tonsillectomy and

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 Tympanoplasty), Nasal Septum Deviation, Sinusitis and The following special conditions are available and as applicable to the Optional benefits
rted disorders and their Optional Extensions (if opted):
3. Treatment of Sinusitis, Rhinitis and Tonsillitis 1. Area of Cover
4. Benign Prostatic Hypertrophy The Company will pay up to the amount specified in the Certificate of Insurance
for Medical Expenses towards ailments incurred in area or area of cover specified
5. Cataract
in Certificate of Insurance, subject to the following terms for admissibility of Claim
6. Dilatation and Curettage under this Special Conditions:
7. Fissure / Fistula in Anus, Hemorrhoids / Piles, Pilonidal Sinus, 1. Cashless Facilities / reimbursement can be availed in accordance with the
perianal abscess Certificate of Insurance.
8. Ulcers and Erosions of Gastro-Intestinal Tract 2. Notwithstanding anything stated under exclusion clause 5.2.(23), the
Insured would be covered for 'Treatment received in area of cover' as
9. Gastro-oesophageal reflux diseases(GERD)
specified in Certificate of Insurance, up to the purview of this cover.
10. Surgery of Genito-urinary system unless necessitated by
3. Notwithstanding anything stated under 'Payment Terms' clause 6.6.(a), the
malignancy
Insured would be covered for 'Treatment received in area of cover' as
11. All types of Hernia, Hydrocele & Varicocele specified in Certificate of Insurance, up to the purview of this cover.
12. Hysterectomy for menorrhagia or Fibromyoma or prolapse of 4. For all admissible reimbursement Claims, currency exchange rate is the rate
uterus unless necessitated by malignancy on date of payment of Medical Expenses to the Hospital made by Insured
Member or Date of Loss in case of benefit shall apply.
13. Internal tumours, skin tumours, cysts, nodules, polyps including
breast lumps (each of any kind) unless malignant 5. The member's principal country of residence must be in a country within
his/her selected area of cover. The member's level declaration specifies a
14. Kidney Stone / Ureteric Stone / Lithotripsy / Gall Bladder Stone
Principal Country of Residence and if the Company found the member
15. Myomectomy for fibroids declaration and actual status is different, then country specific regulations
may impact a person's eligibility to be a member. The Company may be
16. Varicose veins and varicose ulcers
required to apply legitimate international sanctions to this policy and may be
17. End stage liver disease unable to meet its full obligations under the terms of this policy where to do
so would render it subject to legal action under international or domestic
18. Pancreatitis
law. The Company and other service providers will not provide cover or
19. Procedures for Retinal disorders pay claims under this policy if doing so would expose the Company or the
service provider to a breach of international economic sanctions, laws or
20. Arthroscopic Knee Surgeries/ACL Reconstruction/Meniscal and
regulations. If a potential breach is discovered, where possible the Company
Ligament Repair
will advise the member in writing.
21. All treatment related to thyroid disorders
2. Floater Cover
22. Organ transplant surgeries
(a) The maximum liability of the Company, for any and all Claims arising under
iii. Modification of 'Pre-existing Disease' Wait Period: this Policy, on occurrence of an insured event during the Cover Period shall
not exceed the Coverage Amount which is specifically mentioned in the
(i) Expenses related to the treatment of a pre-existing Disease (PED)
Certificate of Insurance.
and its direct complications shall be excluded until the expiry of XX
months of continuous coverage after the date of inception of the b) Only for the purpose of 'Floater Cover', 'Coverage Amount' is modified
first policy with insurer. and defined as below:
(ii) In case of enhancement of sum insured the exclusion shall apply Coverage Amount: The amount specified in the Certificate of Insurance
afresh to the extent of sum insured increase. which represents the Company's maximum, total and cumulative liability for all
Insured Members, for any and all Claims specifically mentioned against each &
(iii) If the Insured Person is continuously covered without any break as
every Optional Benefit/Optional Extension individually and collectively incurred
defined under the portability norms of the extant IRDAI (Health
during the Cover Period.
Insurance) Regulations, then waiting period for the same would be
reduced to the extent of prior coverage. 3. Co-payment
(iv) Coverage under the policy after the expiry of XX months for any Notwithstanding anything to the contrary in the Policy, it is hereby stated that the
pre-existing disease is subject to the same being declared at the time Insured Member will bear a Co-payment, as specified in the Certificate of
of application and accepted by Insurer Insurance, in accordance with Clause 6.5 and Company's liability shall be
restricted to the balance amount payable.
iv. The Waiting Periods as defined in Clauses 3.2(i), 3.2(ii), and 3.2(iii) shall be
applicable individually for each Insured Member and Claims shall be The Co-payment shall be applicable to each and every claim for each Insured
assessed accordingly. Member as defined in the Policy.
v. If Coverage for Optional Benefits or Optional Extensions is added afresh at 4. Deductible
the time of renewal, the Wait Periods as defined above shall be applicable
The Claim amount assessed by the Company towards Insured Member(s), made
afresh to the newly added Optional Benefits (as applicable) or Optional
during the Cover Period shall be reduced by a Deductible, as specified in the
Extensions (as applicable), from the time of such renewal
Certificate of Insurance. The Company shall be liable to make payment under the
Note: Wait periods, if opted, will be applicable on Optional Benefit 1: Hospitalization Expenses and its Policy for any Claim in respect of the Insured Member only when the Deductible
Optional Extensions, Optional Benefit 3: Daily Cash Allowance and Optional Benefit 4: Convalescence
Benefit. on that Claim is exceeded.

3. Optional Benefit C: Cover during duty For the purpose of this Special Condition, Deductible may be on 'per Claim
amount' basis or 'number of Days' basis or 'aggregate Claim amount' basis.
The Company's liability under this Special Condition for Optional Benefit 5
(Personal Accident), is restricted to 'duration of the duty period' only or 5. Premium Installment facility
'specified event' as specified in Certificate of Insurance. Notwithstanding anything to the contrary in the Policy, it is hereby stated that:
4. Optional Benefit D: Cover restricted to Accident a. The Premium Installment shall be paid to the Company (subject to
The Company's liability under this Special Condition, for Optional Benefit 1 realization) by the respective due dates as mentioned in the Policy.
(Hospitalization Expenses) and its Optional extensions (as applicable) or b. Grace Period in case of Single Premium Policies is of 30 days.
Optional Benefit 2 (Out-patient Care) and its Optional extensions (as
applicable), is restricted to Injury caused (during the Cover Period) solely c. Relaxation period for the Policies with Installment Option would be as
and directly due to an Accident that occurs during the Cover Period, as under-
specified in certificate of Insurance.
Installment Option Relaxation Period for Premium Payment under
Installment Option
4. Special Conditions Quarterly/Half-yearly 15 days for each Installment

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 (ii) This Optional Benefit is for additional information purposes only and does
not and should not be deemed to substitute the Insured Member's visit/
d. Premium Installment Term options available are on Quarterly or Half-
consultation to an independent Medical Practitioner.
yearly basis. Premium payment to be made immediately following the
Premium Installment Due Date before the expiry of relaxation period to (iii) The company do not provide the services under this Optional Benefit or
continue this Policy without loss of continuity benefits. make any representation as to the adequacy or accuracy of the same, the
Insured Member's or any other person's reliance on the same or the use to
e. Premium Installment Due Date' means the day on which applicable
which the services under this Optional Benefit are put.
Premium Installment Term ends. If the Premium Installment is not received
by the Company in full before the expiry of relaxation period, this Policy (iv) The company do not assume any liability for and shall not be responsible for
shall cease to operate from the unpaid installment due date and the any actual or alleged errors, omissions or representations made by any
Company shall not be liable under this Policy for any Claim occurring Medical Practitioner or in any service under this Optional Benefit or for any
thereafter, nor shall any refund of premium become due under the Policy. consequences of actions taken or not taken in reliance thereon.
f. Coverage is not available for the period for which premium is not received (v) The Insured Member shall indemnify the Company and hold the company
by the Company and the Company shall not be liable for any Claimswhich harmless for any loss or damage caused by or arising out of or in relation to
are incurred from the due date of installment till the date due installment any opinion, advise, prescription, actual or alleged errors, omissions or
is paid. representations made by the Medical Practitioner or service provider or
for any consequences of any action taken or not taken in reliance thereon.
6. Additional Services
Terms for admissibility of Claim under this Optional Benefit:
The Company or Assistance Service Provider will arrange for the Insured
Member to avail any of the following services , subject to details as specified in the (i) Claim under this Optional Benefit can be claimed only under Cashless
Certificate of Insurance, value added services as follows: Facility in accordance with the Policy.
i. Medical Service Provider Referral Authorizing any Claim under this Optional Benefit does not affect the
Coverage Amount under the Policy.
The Company shall provide to the Insured Member, upon request, with the
name, address, telephone number and, if available, office hours of
physicians, hospitals, clinics, dentists and dental clinics (collectively “Medical
Service Providers”). The Company shall not be responsible for providing 5. Exclusions
medical diagnosis or treatment. Although the Company shall make such
1. Wait Periods applicable under this Policy:
referrals, it cannot guarantee the quality of the Medical Service Providers
and the final selection of a Medical Service Provider shall be the decision of The following standard wait periods are not applicable under this Policy
the Insured Member. The Company, however, will exercise care and unless opted by Policyholder/Insured Member:
diligence in selecting the Medical Service Providers.
• Initial wait period
ii. Arrangements of Appointments with Local Doctors for Treatment
• Named Ailment wait period
The Company shall assist the Insured Member by arranging for
• Pre-existing disease wait period
appointments with local doctors for treatment.
2. Permanent Exclusions:
iii. Health Portal: The Insured Member may access health related information
and services such as health risk assessment, Special rates for OPD, The following list of permanent exclusions is applicable to all the Optional
Diagnostics and Pharmacy through network providers etc as available on Benefits and Optional Extensions of Optional Benefits.
the Company's website
Any Claim in respect of any Insured Member for, arising out of or directly or
iv. Medical Translation Service indirectly due to any of the following shall not be admissible unless expressly
stated to the contrary elsewhere in the Policy.
The Company will arrange for the provision of medical translation to the
Insured Member over the telephone. 1) Any item or condition or treatment specified in List of Non-Medical
Items (Annexure - II).
v. Delivery of Essential Medicine
2) Any pre-existing injury / illness or disability and any complications
The Company will arrange to deliver to the Insured Member essential
thereof and its associated medical conditions unless we had agreed
medicine, drugs and medical supplies that are necessary for a User's care
otherwise in writing;
and/or treatment but which are not available at the Insured Member's
location. The delivery of such medicine, drugs and medical supplies will be 3) Excluded Providers: Code- Excl11
subject to the laws and regulations applicable locally. The Company will not
Expenses incurred towards treatment in any hospital or by any
pay for the costs of such medicine, drugs or medical supplies and any
Medical Practitioner or any other provider specifically excluded by
delivery costs thereof.
the Insurer and disclosed in its website / notified to the policyholders
vi. Embassy Referral are not admissible. However, in case of life threatening situations
following an accident, expenses up to the stage of stabilization are
The Company shall provide the address, telephone number and hours of
payable but not the complete claim.
opening of the nearest appropriate consulate and embassy worldwide.
Note: Refer Annexure – III of the Policy Terms & Conditions for list of
vii. Emergency Document Delivery
excluded hospitals.
The Company shall assist the Insured Member to arrange for emergency
4) Any condition caused by or associated with any sexually transmitted disease
document to be delivered to the Insured Member's Immediate Family
except arising out of HIV;
Member, upon the Insured Member's request to do so.
5) Maternity: Code Excl18
viii. Home Care Assistance
a. Medical treatment expenses traceable to childbirth (including
If the medical condition of the Insured Member is of such gravity as to
complicated deliveries and caesarean sections incurred during
require qualified nurse, the Company will assist such Insured Member to
hospitalization) except ectopic pregnancy;
provide reference of such qualified nurse.
b. Expenses towards miscarriage (unless due to an accident) and lawful
ix. Diet and nutrition consultation
medical termination of pregnancy during the policy period.
The Company shall assist the Insured Member by arranging for
6) Any treatment directly related to surrogacy whether the member is acting
appointments with local diet and nutrition consultation.
as surrogate, or is the intended parent;
x. Crisis Management Services provided by companies
7) Any treatment begun or for which the need has arisen during the first
The Company will arrange to provide emergency alerts for the country the ninety (90) days after birth, for any child conceived by artificial means or any
Insured Member is travelling. form of assisted conception or if the child is born via surrogacy;
It is declared by the Company that: 8) Sterility and Infertility: Code- Excl17
(i) The Insured Member is free to choose whether or not to obtain the Expenses related to sterility and infertility. This includes:
additional services and, if obtained under this Optional Benefit, then
(i) Any type of contraception, sterilization
whether or not to act on it.

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17
 (ii) Assisted Reproduction services including artificial insemination and 21) Change-of-Gender treatments: Code- Excl07
advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
Expenses related to any treatment, including surgical management, to
(iii) Gestational Surrogacy change characteristics of the body to those of the opposite sex;
(iv) Reversal of sterilization; 22) Out-patient treatment;
9) Treatment taken from anyone who is not a Medical Practitioner or from a 23) Treatment received outside India;
Medical Practitioner who is practicing outside the discipline for which he is
24) Domiciliary hospitalization or treatment;
licensed or any kind of self-medication;
25) Investigation & Evaluation(Code- Excl04)
10) Charges incurred in connection with routine eye examinations and ear
examinations, dentures, crowns, artificial teeth and all other similar external a) Expenses related to any admission primarily for diagnostics and
appliances and / or devices whether for diagnosis or treatment; evaluation purposes only are excluded.
11) Refractive Error: (Code- Excl15) b) Any diagnostic expenses which are not related or not incidental to
the current diagnosis and treatment are excluded;
Expenses related to the treatment for correction of eye sight due to
refractive error less than 7.5 dioptres 26) Rest Cure, rehabilitation and respite care- Code- Excl05
12) Unproven Treatments: Code- Excl16 a) Expenses related to any admission primarily for enforced bed rest
and not for receiving treatment. This also includes:
Expenses related to any unproven treatment, services and supplies for or in
connection with any treatment. Unproven treatments are treatments, i. Custodial care either at home or in a nursing facility for
procedures or supplies that lack significant medical documentation to personal care such as help with activities of daily living such as
support their effectiveness bathing, dressing, moving around either by skilled nurses or
assistant or non-skilled persons.
13) Expenses incurred on advanced treatment methods other than as
mentioned in clause 2.1 (l) ii. Any services for people who are terminally ill to address
physical, social, emotional and spiritual needs;
14) Any expenses incurred on providing or fitting any external prosthesis or
orthosis or appliance or medical aids or durable medical equipment of any 27) An Insured Member operating or learning to operate any aircraft, or
kind, like wheelchairs, walkers, crutches, ambulatory devices, unless performing duties as a member of the crew on any aircraft or Scheduled
allowed under the Policy; Airline or any airline personal;
15) Treatments received in heath hydros, nature cure clinics, spas or similar 28) An Insured Member flying in an aircraft other than as a fare paying
establishments or private beds registered as a nursing home attached to passenger in a Scheduled Airline;
such establishments or where admission is arranged wholly or partly for
29) Participation in actual or attempted felony, riot, civil commotion or criminal
domestic reasons. (Code- Excl13)
misdemeanor or activity;
16) Treatment of any external Congenital Anomaly or Illness or defects or 30) Professional fees charged by a member of the Insured Member's
anomalies including their associated medical conditions or chronic medical immediate family or by a person normally resident in the household of the
conditions or vegetative state cover (on the basis of declaration by the Insured or under his employment.
treating doctor) or treatment relating to external birth defects;
31) Training for or participating in professional sport of any kind or any sport
We define vegetative state as a condition of profound non-responsiveness for which the insured receives a salary or monetary reimbursement,
with no sign of awareness or consciousness or a functioning mind, even if including grants or sponsorship;
the Insured can open their eyes and breathe unaided, and the person does
32) The Insured Member serving in any branch of the military, navy, air force
not respond to stimuli such as calling their name or touching. This state must
or any branch of armed forces or any paramilitary forces;
have remained for at least four (4) weeks with no sign of improvement or
there could be no recovery; 33) Radioactive contamination whether arising directly or indirectly ionizing
radiation, toxic, explosive or other hazardous properties of nuclear
17) Treatment whilst staying in a hospital for more than ninety (90)
material;
continuous days for permanent neurological damage on the basis of
declaration by the treating doctor. It is stated that treatment upto 90 days 34) Circumcision unless necessary for treatment of an Illness or as may be
for permanent neurological damage will be covered under this policy. necessitated due to an Accident;
18) Treatment of mental retardation, arrested or incomplete development of 35) Dietary supplements and substances that can be purchased without
mind of a person, subnormal intelligence or mental intellectual disability prescription, including but not limited to Vitamins, minerals and organic
substances unless prescribed by a medical practitioner as part of
19) Obesity/ Weight Control(Code- Excl06)
hospitalization claim or day care procedure (Code- Excl14);
Expenses related to the surgical treatment of obesity that does not fulfill all
36) All preventive care, Vaccination including Inoculation and Immunizations
the below conditions:
(except in case of post-bite treatment) and tonics
1) Surgery to be conducted is upon the advice of the Doctor
37) All expenses related to donor treatment, including screening, surgery to
2) The surgery/Procedure conducted should be supported by clinical remove organs from the donor, in case of transplant surgery;
protocols
38) Non-Allopathic Treatment or treatment related to any unrecognized
3) The member has to be 18 years of age or older and systems of medicine;
4) Body Mass Index (BMI); 39) War (whether declared or not) and war like occurrence or invasion, acts
of foreign enemies, hostilities, civil war, rebellion, revolutions,
a) greater than or equal to 40 or
insurrections, mutiny, military or usurped power, seizure, capture, arrest,
b) greater than or equal to 35 in conjunction with any of the restraints and detainment of all kinds;
following severe co-morbidities following failure of less invasive
40) Breach of law: Code- Excl10
methods of weight loss:
Expenses for treatment directly arising from or consequent upon any
i. Obesity-related cardiomyopathy Insured Person committing or attempting to commit a breach of law with
criminal intent;
ii. Coronary heart disease
iii. Severe Sleep Apnea
41) Act of self-destruction or self-inflicted Injury, attempted suicide or suicide
iv. Uncontrolled Type2 Diabetes while sane or insane or Illness or Injury attributable to consumption, use,
misuse or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens;
20) Cosmetic or plastic Surgery: Code- Excl08
42) Any charges incurred to procure documents related to treatment or Illness
Expenses for cosmetic or plastic surgery or any treatment to change
pertaining to any period of Hospitalization or Illness or any administration
appearance unless for reconstruction following an Accident, Burn(s) or
costs or any other charges of a non-medical nature in connection with the
Cancer or as part of medically necessary treatment to remove a direct and
provision and/or performance of medical supplies and/or services;
immediate health risk to the insured. For this to be considered a medical
necessity, it must be certified by the attending Medical Practitioner 43) Personal comfort and convenience items or services including but not

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18
 limited to T.V. (wherever specifically charged separately), charges for access or are incurred for social or domestic reasons or for reasons which are not
to cosmetics, hygiene articles, body care products and bath additives, as well directly connected with treatment or where the Hospital has effectively
as similar incidental services and supplies; become the place of domicile or permanent abode;
44) Expenses related to any kind of RMO charges, Service charge, Surcharge, 63) Any charges made by the medical practitioner, hospital, laboratory or any
night charges levied by the hospital under whatever head or any room such medical services which are not reasonable and customary;
upgrades, menu items not included as standard or visitors meals;
64) Genetic tests nor for any counselling made necessary following genetic
45) Nuclear, chemical or biological attack or weapons, contributed to, caused tests, even when those tests are undertaken to establish whether or not
by, resulting from or from any other cause or event contributing the Insured may be genetically disposed to the development of a medical
concurrently or in any other sequence to the loss, claim or expense. For the condition in the future. This is because such tests are carried out for
purpose of this exclusion: urposes of establishing whether a medical condition might develop and not
for the treatment of a medical condition;
(a) Nuclear attack or weapons means the use of any nuclear weapon or
device or waste or combustion of nuclear fuel or the emission, 65) Insured Person suffering from or has been diagnosed with or has been
discharge, dispersal, release or escape of fissile/ fusion material treated for Down's Syndrome/Turner's Syndrome/Sickle Cell Anaemia/
emitting a level of radioactivity capable of causing any Illness, Thalassemia Major/G6PD deficiency prior to the first Policy Start Date,
incapacitating disablement or death; then costs of treatment related to or arising from the disorder whether
directly or indirectly will be treated as a Pre-existing Disease and will not be
(b) Chemical attack or weapons means the emission, discharge,
covered within first 48 months from the date of first issuance of the Policy.
dispersal, release or escape of any solid, liquid or gaseous chemical
compound which, when suitably distributed, is capable of causing any 66) Ear or body piercing and tattoing or treatment needed as a result of any of
Illness, incapacitating disablement or death; these;
(c) Biological attack or weapons means the emission, discharge, 67) Any charges for treatment incurred during a period for which the premium
dispersal, release or escape of any pathogenic (disease producing) is not paid;
micro-organisms and/or biologically produced toxins (including
68) Any claim or part of a claim in which the member has to pay a deductible or
genetically modified organisms and chemically synthesized toxins)
co-insurance (where applicable). In such a claim, we will only pay the balance
which are capable of causing any Illness, incapacitating disablement
of the claim after we have deducted the excess (or deductible or co-
or death;
insurance) amount;
In addition to the foregoing, any loss, claim or expense of whatsoever nature
Note: In addition to the foregoing, any loss, claim or expense of whatsoever nature
directly or indirectly arising out of, contributed to, caused by, resulting from,
directly or indirectly arising out of, contributed to, caused by, resulting from, or in
or in connection with any action taken in controlling, preventing,
connection with any action taken in controlling, preventing, suppressing,
suppressing, minimizing or in any way relating to the above is also excluded.
minimizing or in any way relating to the above Permanent Exclusions shall also be
46) Impairment of an Insured Member's intellectual faculties by abuse of excluded.
stimulants or depressants unless prescribed by a medical practitioner
47) Continuous ambulatory peritoneal dialysis; Coverage for 'Continuous
ambulatory peritoneal dialysis' is available on OPD basis and as part of Pre-
Post hospitalization expenses. 6. Claims Intimation, Assessment and Management
48) Treatment for Alcoholism, drug or substance abuse or any addictive 1. Upon occurrence of any Illness or Injury that may give rise to a Claim
condition and consequences thereof. Code- Excl12 under this Policy, then as a condition precedent to the Company's
49) Alopecia wigs and/or toupee and all hair or hair fall treatment and products liability under the Policy, the Insured Member shall undertake all of the
including any investigations; all forms of acne; following:
50) Any treatment taken in a clinic, rest home, convalescent home for the (a) Claims Intimation
addicted, detoxification center, sanatorium, home for the aged, remodeling (i) If any Illness is diagnosed or discovered or any Injury is suffered
clinic or similar institutions; or any other contingency occurs which has resulted in a Claim
51) Any medical or physical condition or treatment or service, which is or may result in a Claim under the Policy, the Insured Member
specifically excluded under the Policy Schedule including the associated (or Nominee or legal heir if the Insured Member is deceased),
medical conditions shown on the endorsement; shall notify the Company either at Company call Centre or in
writing immediately.
52) Cryopreservation or harvesting or storage of stem cells as a preventive
measure against possible disease/illness/injury. (ii) Claim must be filed within 30 days from the date of discharge
from the hospital in case of hospitalization and actual date of
53) Hazardous or Adventure sports: Code- Excl09 loss in case of non-hospitalization benefits.
Expenses related to any treatment necessitated due to participation as a Note: 6.1 (a) (i) and 6.1 (a) (ii) are precedent to admission of liability under
professional in hazardous or adventure sports, including but not limited to, the policy.
para-jumping, rock climbing, mountaineering, rafting, motor racing, horse
racing or scuba diving, hand gliding, sky diving, deep-sea diving (iii) If the Insured Member is to undergo planned Hospitalization, the
Insured Member shall give written intimation to the Company of the
54) Remicade, Avastin or similar injectable treatment not part of In-patient care proposed Hospitalization at least 48 hours prior to the planned date
hospitalization or Day care treatment; of admission to Hospital.
55) All bank or credit or foreign exchange charges when the claims payment is (iv) The following details are to be provided to the Company at the time
made in a currency other than the policy currency upon the member's of intimation of Claim:
request;
I Policy Number ;
56) Hormone Replacement Therapy;
II Name of Primary Insured Member;
57) The evacuation would involve moving Insured Member from a ship, oil-rig
platform or similar off-shore location; III Name and unique identification number
of the Insured Member in respect of whom the Claim is
58) The Company have not been Inform about the medical condition within being made;
30 days of the condition becoming an emergency (unless this was not
reasonably possible); IV Nature of Illness or Injury and the Benefit and/or
Optional Extension under which the Claim is being
59) Any treatment of impotence or any consequence of it; made;
60) All types of learning disorders, educational problems, behavioural V Date and place of Injury or Death and/or date and place
problems, physical development or psychological development including of admission to Hospital (as applicable);
assessment or grading of such problems;
VI Name and address of the attending Medical Practitioner
61) Dental, Orthodontics, Periodontics, Endodontics or any preventative and Hospital;
dentistry no matter who gives the treatment;
VII Date of admission to Hospital or proposed date of
62) Charges for residential stays in Hospital which are not medically necessary

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 admission to Hospital for planned Hospitalization; Claim has been provided under Reimbursement Facility and/or the
Company specifically states that a particular Benefit is payable only
VIII Any other information / document as required by the
under Reimbursement Facility, all the information and
Company to assess the Claim, in case fraud is suspected.
documentation specified in Clause 6.1 and Clause 6.4 shall be
(v) A Claim has to be notified to the Company within 24 hours or before submitted to the Company at Insured Member's own expense,
discharge (whichever is earlier) for Emergency Hospitalization. immediately and in any event within 30 days of Insured Member's
discharge from Hospital.
2. Claims Procedure
(ii) The Company shall give an acknowledgement of collected
(a) Cashless :
documents. However, in case of any delayed submission, the
Cashless facility is available only at Network Hospitals of the Company may examine and relax the time limits mentioned upon
Company or Assistance Service Provider. The Insured the merits of the case.
Members can avail cashless facility at the time of admission into
(iii) In case a reimbursement claim is received after a Pre-Authorization
a Network Hospital, by presenting the health card, provided by
letter has been issued for the same case earlier, before processing
the Company under this Policy, along with a valid photo
such claim, a check will be made with the Network Provider whether
identification document (like: Voter ID card / Driving License /
the Pre-authorization has been utilized. Once such check and
Passport / PAN Card / any other identification documentation
declaration is received from the Network Provider, the case will be
as approved by the Company).
processed.
(b) In addition to the above, in order to avail cashless facility, the
(iv) For Claim settlement under reimbursement, the Company will pay
following procedure must be followed:
the Insured Member. In the event of death of the Insured Member,
(i) Pre-authorization: the Insured Member must call the the Company will pay the nominee (as named in the Certificate of
Company or Assistance Service Provider call centre Insurance) and in case of no nominee, to the legal heirs or legal
(1800-102-4488) and request authorization for the representatives of the Insured Member whose discharge shall be
proposed treatment by way of submission of a treated as full and final discharge of its liability under the Policy.
completed pre-authorization form at least 48 hours
(v) Date of Loss' under Reimbursement Facility is the 'Date of
prior before the commencement of a planned
Admission' to Hospital in case of Hospitalization & actual Date of
Hospitalization or within 24 hours of admission to
Loss for non-Hospitalization related Benefits.
Hospital, if the Hospitalization is required in an
Emergency. (vi) Insured Member (or Nominee or legal heir if the Insured Member is
deceased) shall (at his expense) give the documentation specified at
(ii) The Company will process the request for authorization
Clause 6.4 and any additional documentation specified in the Benefit
after having obtained accurate and complete
provision and/or Optional Extension under which the Claim is being
information in respect of the Illness or Injury for which
made to the Company immediately and in any event within 30 days of
cashless facility is sought to be availed. The Company or
the occurrence of the Injury.
Assistance Service Provider will confirm in writing
authorization or rejection of the request to avail cashless 3. Policyholder's and Insured Member's duty at the time of Claim
facility for the Insured Member's Hospitalization.
(a) The Insured Member shall check the updated list of Network
(iii) If the request for availing cashless facility is authorized by Hospitals before submission of a pre-authorization request for
the Company or Assistance Service Provider, then cashless facility; and
payment for the Medical Expenses incurred in respect of
(b) As a condition precedent for a Claim to be considered under this
the Insured Member shall not have to be made to the
Policy:
extent that such Medical Expenses are covered under
this Policy and fall within the amount authorized in (i) All reasonable steps and measures must be taken to avoid or
writing by the Company for availing cashless facility. minimize the quantum of any Claim that may be made under
Payment in respect of co-payments (if applicable) or this Policy.
within Deductible (if applicable) or any other costs and
(ii) Intimation of the Claim, notification of the Claim and
expenses not authorized under the cashless facility shall
submission or provision of all information and documentation
be made directly by the Insured Member to the
shall be made promptly and in any event in accordance with the
Network Hospital. All original bills and evidence of
procedures and within the timeframes specified in Clause 6 of
treatment for the Medical Expenses incurred in respect
the Policy.
of the Hospitalization of the Insured Member and all
other information and documentation specified at (iii) The Insured Member will, at the Company request submit
Clause 6.4 shall be submitted to the Network Hospital himself/herself for a medical examination by the
immediately and in any event before the Insured Company's/Assistance Service Provider nominated Medical
Member's discharge from Hospital. Practitioner as often as the Company consider reasonable and
necessary. The cost of such medical examination shall be borne
(iv) In case Policyholder/Insured Member cannot avail the
by the Company.
cashless facility, payment for the treatment will have to be
made by the Insured Member to the Network Hospital, (iv) The Company's/Assistance Service Provider Medical
following which a Claim for reimbursement may be Practitioner and representatives shall be given access and co-
made to the Company and the same will be operation to inspect the Insured Member's medical and
considered by the Company subject to the Policy. Hospitalization records and to investigate the facts and
examine the Insured Member.
(c) The list of updated Network Hospitals is available with the Company
or Assistance Service Provider and is subject to amendment or (v) The Company shall be provided with complete documentation
modification of the Network Hospitals and/or the extent of cashless and information which the Company has requested to establish
facilities available at particular Network Hospitals from time to time. the Company liability for the Claim, its circumstances and its
quantum.
(d) Before availing the cashless facility, Policyholder or the Insured
Member is required to check the applicable list of Network 4. Claim Documents
Providers for the area where he intends to avail the cashless facility
(a) The following information and documentation shall be submitted to
through the call center number as provided in the Certificate of
the Company /Assistance Service Provider in accordance with the
Insurance.
procedures and within the timeframes specified in Clause 6 of the
(e) Health card issued by the Company shall not be used Policy in respect of all Claims:
(i) On termination or cancellation of this Policy (i) Duly completed and signed Claim form, in original;
(ii) After Cover End Date (ii) Identity proof with photo, Age proof and Address Proof;
(iii) On death of Insured Member (iii) Medical Practitioner's referral letter advising Hospitalization;
(f) Re-imbursement : (iv) Medical Practitioner's prescription advising drugs / diagnostic
tests / consultation;
(i) It is agreed and understood that in all cases where intimation of a

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 (v) Original bills, receipts and discharge card from the Hospital / (b) For all admissible reimbursement Claims and benefit (fixed pay-out)
Medical Practitioner; Claims, the exchange rate on the date of loss shall be applied.
(vi) Original bills from pharmacy / chemists; (c) If the Assistance Service Provider or the Company requests that bills
or vouchers in a local language or vernacular be accompanied by an
(vii) Original pathological / diagnostic test reports and payment
appropriate translation into English then the costs of such translation
receipts;
must be borne by the Policyholder or the Insured Member.
(viii) Indoor case papers (if applicable);
(d) The Claim amount assessed for any Benefit or for any Optional
(ix) Accident proof - First Information Report/ final police report, if Extensions would be deducted from the Coverage Amount and for
applicable; the unexpired Policy Period, balance Coverage Amount shall be
available.
(x) Disability Certificate from Government Medical Board, Fitness
Certificate, Medical Prescription (e) The Company shall have no liability to make payment of a Claim
under the Policy in respect of an Insured Member, once the Coverage
(xi) Post mortem report, if conducted;
Amount for that Insured Member is exhausted.
(xii) Any other information/document as required by the Company
or Assistance Service Provider to assess the Claim, in case fraud (f) If the Insured Member suffers a relapse within 45 days of the date of
is suspected. discharge from the Hospital for which a Claim has been made, then
such relapse shall be deemed to be part of the same Claim and all the
(b) Only in the event that original bills, receipts, prescriptions, reports or limits for Any One Illness under this Policy shall be applied as if they
other documents have already been given to any other insurance were under a single Claim.
company or to a reimbursement provider The Company will accept
properly verified photocopies of such documents attested by such (g) Under cashless facility, the payment of Claims shall be made to the
other insurance company/reimbursement provider along with an Network Hospital and the Company discharge would be complete
original certificate of the extent of payment received from such and final.
insurance company/reimbursement provider. (h) For the Reimbursement Claims, the Company will pay to the Primary
(c) The Company will only accept bills/invoices which are made in the Insured Member unless specified otherwise in the Certificate of
Insured Member's name. Insurance. In the event of death of the Primary Insured Member,
unless specified otherwise in the Certificate of Insurance, the
(d) The Company may give a waiver to one or few of the above Company will pay the nominee (as named in Annexure A to the
mentioned documents depending upon the case. Policy) and in case of no nominee to the legal heir of the Primary
(e) However, claims filed even beyond the timelines mentioned above Insured Member whose discharge shall be treated as full and final
should be considered if there are valid reasons for any delay. discharge of its liability under the Policy.

(f) Additional Claim documents for Personal Accident (i) The Company shall settle or reject any Claim within 30 days of
(Optional Benefit 5): receipt of all the necessary documents / information as required for
settlement of such Claim and sought by the Company. The Company
It is a condition precedent to the Company's liability under these shall provide the Policyholder / Insured Member an offer of
Benefits that the following information and documentation shall be settlement of Claim and upon acceptance of such offer by the
submitted to the Company immediately and in any event within Policyholder / Insured Member, the Company shall make payment
30 days of the event giving rise to the Claim under these Benefits: within 7 days from the date of receipt of such acceptance. However, if
1. Medical reports giving the details of the Accident, nature of a claim warrants an investigation in the opinion of the Company, then
Injury and the details of treatment provided, Admission and the Company shall settle the claim within 45 days from the date of
Death Summary, Accident Report receipt of last necessary document. In case there is delay in the
payment beyond the stipulated timelines from the date of receipt of
2. Original Death Certificate; if applicable last necessary document to the date of payment of claim, the
3. Disability Certificate issued by CMO (Chief Medical Officer) as Company shall pay additional amount as interest at a rate which is 2%
appointed by the Hospital Authorities; if applicable above the bank rate prevalent at the beginning of the financial year in
which the claim is reviewed by it. For the purpose of this clause, 'bank
4. A newspaper cutting about accident (if available) rate' shall mean the existing bank rate as notified by Reserve Bank of
5. Certificate from Bank for outstanding amount of loan India, unless the extent regulation requires payment based on some
other prescribed interest rate.
5. Claim Assessment
(j) The Claim shall be paid only for the Cover Period in which the
(a) The Company shall scrutinize the Claim and supportive documents, Insured event which gives rise to a Claim under this Policy occurs.
once received. In case of any deficiency, the Company may call for any
additional documents or information as required, based on the (k) The Company may change the Assistance Service Provider or utilize
circumstances of the Claim. the service of any other assistance service provider by giving written
notification to the Policyholder.
(b) All admissible Claims under this Policy shall be assessed by the
Company in the following progressive order:
(i) If a room/ ICU accommodation has been opted for where 7. General Terms and Conditions
the rent or category is higher than the eligible limit for that Insured 7.1 A. Eligibility
Member under the Policy, then, the Insured Member shall bear the To be eligible for cover under this Policy, and unless otherwise
ratable proportion of the Variable Medical Expenses (including accepted by the Company in writing and shown in the Policy
surcharge or taxes thereon) in the proportion of the room rent Schedule a member must be:
actually incurred less room rent limit and divided by room rent
actually incurred. a) a Primary Insured Member, aged eighteen (18) and
above as specified in the Certificate of Insurance. In
(ii) If any sub-limits on Medical Expenses are applicable as specified in the case of an Employer-employee Policy, if an employee is
Certificate of Insurance, the Company's liability to make payment not actively at work on his/her eligibility date, he/she will
shall be limited to the extent of the applicable sub-limit for that become eligible for coverage as soon as he/she becomes
Medical Expense. actively at work; and
(iii) Co-payments and Deductibles, if any, shall be applicable on the b) family member(s) of the Primary Insured Member, aged 1 day
amount payable by the Company after applying Clause 6.5.(b)(I), (ii). above as specified in the Certificate of Insurance and/or being
(c) The Claim amount assessed in Clause 6.5(b) above would be able to perform all the activities of daily living.
deducted from the Coverage Amount of respective Optional For a family member who cannot perform all activities of daily living
Benefit or Optional Extension. on the Primary Insured Member's eligibility date, he/she becomes
6. Payment Terms eligible for coverage only when he/she can perform all activities of
daily living.
(a) This Policy covers only medical treatment taken entirely within India
and within area of cover as shown in the Certificate of Insurance. Please note:

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21
 (I) Any new born baby born to a Primary Insured Member may be under this Policy.
added to this policy and enjoy cover commencing from time of
7.4 Material Change
birth provided all the following factors are fulfilled:
• the eligibility of cover in this policy for the Primary Insured It is a condition precedent to the Company's liability under the Policy that
Member includes cover for his/her children and they are the Policyholder shall immediately notify the Company in writing of any
insured on a non-contributory basis and material change in the risk on account of change in nature of occupation or
• the Company will add that new born baby into this policy business at his own expense or any material information that the Insured
within thirty (30) days from the time of birth upon Member and/or Policyholder is aware of, or could reasonably be expected
intimation from the Policyholder. to know, that relates to questions in the Proposal Form and which is relevant
to the Company in order to accept the risk of insurance and if so on what
However, the Company will require details of the baby's
terms. The Insured Member/Policyholder must exercise the duty of
medical history if the baby has been adopted or was born after
disclosure to Company before Renewal, extension, variation, endorsement.
taking any prescription or non-prescription drug or other
The Company may, in its discretion, adjust the scope of cover and / or the
treatment which increases fertility, or as the result of any
premium paid or payable, accordingly.
method of assisted conception such as IVF.
7.5 Records to be maintained
In such circumstances the Company reserve the right to apply
particular restrictions to the cover offered by the Company and will Policyholder and the Insured Members shall keep an accurate record
notify the Insured Member of those terms as soon as reasonably containing all relevant medical records and shall allow the Company or the
possible. This may limit baby's cover for existing medical conditions. Company representatives to inspect such records. Policyholder or the
This would mean that the baby will not be covered for treatment Insured Member shall furnish such information as the Company may
carried out for medical conditions which existed prior to joining, such require under this Policy at any time during the Cover Period and up to
as treatment in a Special Care Baby Unit and you will be liable for three years after the Policy Period End Date, or until final adjustment (if
these costs. any) and resolution of all Claims under this Policy.
(ii) Cover for the eligible family member must be same of the 7.6 No constructive Notice
Primary Insured Member.
Any knowledge or information of any circumstance or condition in relation
When a new member becomes eligible, the Policyholder must to Policyholder, the Insured Members which is in the Company possession
write to the Company within thirty (30) days from the eligibility and other than that information expressly disclosed in the Proposal Form or
date of that member to apply for his/her cover. If the application otherwise in writing to the Company, shall not be held to be binding or
is approved, the Company will then update the membership prejudicially affect the Company or absolve the Policyholder or Insured
listing and issue an endorsement to this policy accordingly. from their duty of disclosure.
B. Mid-term Addition/ Deletion of Insured Members 7.7 Complete Discharge
a) Mid-term addition of an Insured Member Payment made by the Company to Policyholder / to the Insured Member or
their legal representatives / to the Hospital, as the case may be, of any
Any person may be added as an Insured Member during
Medical Expenses or compensation or benefit under the Policy shall in all
the Policy Period provided that his application for cover has
cases be complete and construed as an effectual discharge in favor of the
been accepted by the Company, additional premium, on
Company.
pro-rata basis in respect of such Member has been
received by the Company and the Company has issued an 7.8 Multiple Policies
endorsement confirming the addition of such person as an
a. In case any Insured Member is covered under more than one
Insured Member.
indemnity insurance policies, with the Company or with other
As a condition precedent to our liability, the insurers, the Policyholder/Insured Member shall have the right to
Policyholder/Insured Member will take reasonable steps to settle the Claim with any of the Company, provided that the Claim
establish the good health and suitability of their family amount payable is up to the Coverage Amount of such Policy.
members as appropriate and shall not permit to insure any
b. In case the Claim amount under a single policy exceeds the Coverage
Insured Member and/or his/her family member known by
Amount, then Policyholder/Insured Member shall have the right to
the Policyholder/Insured Member at the date of enrolment
choose the companies with whom the Claim is to be settled. Further,
in the policy to be in need of or likely to require in-
policyholder/Insured Member shall have the right to choose the
patient treatment, day-care treatment and out-patient
companies from whom he/she wants to claim the balance amount.
treatment, unless such facts are fully disclosed to and
Insured shall only be indemnified the hospitalization costs in
accepted by us in writing prior to commencement of
accordance with terms & conditions of chosen Policy.
cover for your member concerned.
c. Policyholder/Insured Persons shall also have the right to prefer claims
b) Mid-term deletion of an Insured Member (applicable in
from other policy / policies for the amounts disallowed under the
case of Employer-employee groups)
earlier chosen policy / policies, even if the sum insured is not
Name of any Insured Member who is covered under exhausted.
the Policy and whose name specifically appears in 7.9 Free Look Period
Annexure A may be deleted on Policyholder's request,
during the Policy Period. Refund of premium shall be i. The Policyholder/Insured Member may, within 15 days from the
made on pro-rata basis provided that Primary Insured receipt of the Policy document, return the Policy stating reasons for
Member or any of his Dependent has not made any his objection, if the Policyholder disagrees with any Policy terms and
Claim during the Cover Period under this Policy. conditions.
7.2 Duty of disclosure and Fraud ii. If no Claim has been made under the Policy, the Company will refund
the premium received after deducting proportionate risk premium
If any untrue or incorrect statements are made or there has been a
for the period on cover, expenses for medical examination and stamp
misrepresentation, misdescription or non-disclosure of any material
duty charges. If only part of the risk has commenced, such
particulars or any material information having been withheld in the Proposal
proportionate risk premium shall be calculated as commensurate
Form or accompanying document or if a Claim is fraudulently made or any
with the risk covered during such period. All rights under the Policy
fraudulent means or devices are used by Policyholder, the Insured Member
will immediately stand extinguished on the free look cancellation of
or any one acting on his / their behalf, the Company shall have no liability to
the Policy.
make payment of any Claims and the premium paid shall be forfeited to the
Company on cancellation of the Policy. or the Company may adjust the iii. Provision for Free look period is not applicable and available at the
scope of cover and / or the premium paid or payable, accordingly. time of renewal of the Policy.
7.3 Observance of Terms and Conditions 7.10 Policy Disputes
The due observance and fulfillment of the terms and conditions of this Any and all disputes or differences under or in relation to the validity,
Policy (including the realization of premium by their respective due dates construction, interpretation and effect to this Policy shall be determined by
and compliance with the specified procedure on all Claims) in so far as they the Indian Courts and in accordance with Indian law.
relate to anything to be done or complied with by Policyholder or the 7.11 Renewal Notice
Insured Member, shall be a condition precedent to the Company's liability

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22
 a. The Coverage will automatically terminate on the Cover End Date. i. Where the Policy covers only the Primary Insured Member, this
All renewal applications and requisite premium shall be given to the Policy shall stand null and void from the date and time of demise
company on or before the Cover End Date provided the policy is in of the Primary Insured Member.
force and in any event before the expiry of the Grace Period. The
ii. Where the Policy covers other Insured Members, this Policy
Policyholder shall give the company written notice along with the
shall continue till the end of Cover Period for the other Insured
renewal application of any material changes to the risk insured under
Members. If the other Insured Members wish to continue with
the Policy. If no such written notice is received by the company along
the same Policy, the Company will renew the Policy subject to
with the renewal application, it shall be deemed that there is no
the appointment of a Primary Insured Member provided that:
material change to the risk.
I. Written notice in this regard is given to the Company before
For the purpose of this provision, Grace Period means a period of 30
the Cover End Date; and
days immediately following the Cover End Date during which a
payment can be made to renew this Policy without loss of continuity II. A Person who satisfies the Company's criteria to become a
benefits. Coverage is not available for the period for which premium Primary Insured Member. The criteria being:
is not received by the Company and the Company shall not be liable
(a) He / She should become a member of the Group
for any Claims incurred during such period. This Clause is applicable
against whom the Master policy is issued.
at member level.
(b) He / She should satisfy the age limit criteria as
b. The company will ordinarily not refuse to renew the Policy except on
mentioned in the product.
grounds of fraud, moral hazard or misrepresentation or non-co-
operation by the Insured. This policy can be renewed subject to e. Termination for the Insured Member's cover shall automatically
Master Policy renewability based on agreed terms. terminate on the earliest occurrence of any of the following events:
c. The Company may revise the renewal premium payable under the i. the date the policy is terminated or expired;
Policy provided that revisions to the renewal premium are in
ii. the date the Primary Insured Member's coverage is terminated;
accordance with the IRDAI rules and regulations as applicable from
time to time. Change in rates will be applicable only post approval by iii. in case of employer employee, the employee is not working for
the Authority and be effective from the date of launch of the revised Policyholder and in case of non-employer employee is not part of
Product and shall be applied only prospectively thereafter for new the group
policies and at the date of renewal for renewals.
iv. death of Insured Member;
d. Renewal shall be offered lifelong. The Insured Member shall be given
v. if outside the agreed Principal Country of Residence unless
an option to port this Policy into any other health insurance product
otherwise agreed by us in writing;
of the Company and credit shall be given for number of years of
continuous coverage under this Policy for the standard wait periods. vi. non-payment of premium for this policy;
e. This product may be withdrawn / modified by the company after due vii. if there shall be any misrepresentation, non-disclosure or fraud on
approval from the IRDAI. In case this product is withdrawn / modified the part of the Policyholder and/or the Insured Member;
by the company, this Policy can be renewed under the then prevailing
viii. the expiry of the policy year where the Primary Insured
Health Insurance Product or its nearest substitute approved by
Member or his/her spouse has reached age sixty-five (65) or as
IRDAI subject to Underwriting. The company shall duly intimate
specified in Certificate of Insurance;
Policyholder atleast three months prior to the date of such
withdrawal / modification of this product and the options available to ix. the dependant ceases to be a dependent; or
Insured Member at the time of renewal of this policy.
x. if there is a breach of any regulation and/or law and/or economic
f. No loading based on individual claim experience shall be applicable sanctions.
on renewal premium payable. 7.13 Limitation of Liability
7.12 Cancellation / Termination
Any Claim under this Policy for which the notification or intimation of
a. The Company may at any time, cancel this Policy on grounds of Claim is received 12 calendar months after the event or occurrence
misrepresentation, mis-description or non-disclosure of any material giving rise to the Claim shall not be admissible, unless the Policyholder
particulars or any material information having been withheld or if a or the Insured Member proves to the Company satisfaction that the
Claim is fraudulently made or any fraudulent means or devices are delay in reporting of the Claim was for reasons beyond the Insured
used by Policyholder/Insured member or any one acting on Member's control.
Policyholder/Insured member behalf. The Company shall have no 7.14 Communication
liability to make payment of any claims and the premium paid shall be
forfeited ab initio to the Company and no refund of premium shall be a. Any communication meant for the Company must be in writing
effected by the Company, by giving 15 days' notice in writing by and be delivered to its address shown in the Policy Schedule/
Registered Post Acknowledgment Due/recorded delivery to Certificate of Insurance. Any communication meant for the
Policyholder/Insured member last known address. Policyholder or Insured Member will be sent by the Company
to his last known address or the address as shown in the Policy
b. Policyholder/Primary Insured Member may also give 15 days' notice Schedule / Certificate of Insurance.
in writing, to the Company, for the cancellation of this Policy, in which
case the Company shall from the date of receipt of the notice cancel b. All notifications and declarations for the Company must be in
the Policy and refund the premium for the unexpired period of this writing and sent to the address specified in the Policy
Policy at the short period scales as mentioned below, provided that Schedule / Certificate of Insurance. Agents are not authorized
no refund shall be made for those Insured Member who has incurred to receive notices and declarations on the Company's behalf.
Claim under the Policy. c. Notice and instructions will be deemed served 10 days after
c. Refund % to be applied on total premium received as on the date of posting or immediately upon receipt in the case of hand
receipt of the cancellation request delivery, facsimile or e-mail.
7.15 Alterations in the Policy
Cancellation period up to (x months) from Refund%
This Policy constitutes the complete contract of insurance. No
Cover Start Date in case of single premium
change or alteration shall be valid or effective unless approved in
policy
writing by the Company, which approval shall be evidenced by a
written endorsement signed and stamped by the Company.
1 month 75
7.16 Out of all the details of the various benefits provided in the Policy
3 months 50 Terms and Conditions, only the details pertaining to benefits chosen
6 months 25 by policyholder as per Policy Schedule shall be considered relevant
7.17 Electronic Transactions
Beyond 6 months 0
The Policyholder and Insured Member agrees to adhere to and
d. In case of demise of the Primary Insured Member, comply with all such terms and conditions as the Company may

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23
 prescribe from time to time, and hereby agrees and confirms that all Courier: Any of Our Branch Office or corporate office
transactions effected by or through facilities for conducting remote
The Policyholder/Insured Member may also approach the grievance
transactions including the Internet, World Wide Web, electronic
cell at any of the Company's branches with the details of his/her
data interchange, call centers, tele-service operations (whether
grievance during the Company's working hours from Monday to
voice, video, data or combination thereof) or by means of electronic,
Friday.
computer, automated machines network or through other means of
telecommunication, established by or on behalf of the Company, for Exclusively for Senior Citizens, the Company has a separate
and in respect of the Policy or its terms shall constitute legally binding extension on the Customer Service Toll Free Number. This separate
and valid transactions when done in adherence to and in compliance customer service channel prioritizes and routes any kind of request /
with the Company's terms and conditions for such facilities, as may be grievance raised by Senior Citizens through various fast track internal
prescribed from time to time. Any terms and conditions related to escalations leading to lesser Turn-Around-Time (TAT) for request /
electronic transactions shall be within the approved Policy Terms and grievance addressal
Conditions.
(b) If the Policyholder / Insured Member is not satisfied with the
7.18 Continuity Benefits Company's redressal of the Policyholder's / Insured Member's
grievance through one of the above methods, the Policyholder /
The company will grant continuity of benefits which were available to
Insured Member may contact the Company's Head of
the Insured Members under a group insurance policy in the
Customer Service at:
immediately preceding Cover Period provided that:
Head – Customer Services,
i. The company shall be liable to provide continuity of only those
benefits (for e.g: Initial wait period, wait period of Specific Care Health Insurance Limited
Diseases etc)which are applicable under the Policy; (Formerly known as Religare Health Insurance Company Limited)
ii. The Insured Members to whom continuity benefits will be Unit No. 604 - 607, 6th Floor, Tower C,
provided should be covered under the group insurance policy;
Unitech Cyber Park, Sector-39,
iii. Insured Members covered under this Policy shall have the right
to migrate from this Policy to an individual health insurance Gurugram -122001 (Haryana)
policy or a family floater policy offered by the company and the [Link]
credit for wait periods would be given in the opted individual [Link]
health insurance policy or a family floater policy offered by the
company. Application for this Policy is made within 45 days (c) If the Policyholder / Insured Member is not satisfied with the
before, but not earlier than 60 days from the expiry of that Company's redressal of the Policyholder's / Insured Member's
group insurance policy. grievance through one of the above methods, the Policyholder /
Insured Member may approach the nearest Insurance Ombudsman
iv. Insured Member can apply only at the time of renewal of the for resolution of the grievance. The contact details of Ombudsmen
group Policy. offices are mentioned on the next page:
7.19 Obligation in respect to minor
If an Insured Member is less than 18 years of age, the Primary Insured
Member shall be responsible for ensuring compliance with all terms
and conditions of this Policy on behalf of that Insured Member.
7.20 Nominee
The Primary Insured Member can at the inception or at any time
before the expiry of the Policy, make the nomination for the purpose
of payment of Claims.
Any change of nomination shall be communicated to the Company in
writing and such change shall be effective only when an endorsement
to the Policy is made by the Company.
In case of any Insured Member other than the Primary Insured
Member under the Policy, for the purpose of payment of Claims in
the event of death, the default nominee would be the Primary
Insured Member.
7.21 Proximate Clause
The Company covers the Policyholder/Insured Member only to the
extent of Proximity cause which means active and efficient cause that
sets in motion a chain of events which brings about a result, without
the intervention of any force started and working actively from a
new and independent source.
7.22 Sanctions and Compliance with Laws
This insurance does not apply to the extent that trade or economic
sanctions or other similar laws or regulations prohibit the coverage
provided by this insurance.
7.23 Grievances
The Company has developed proper procedures and effective
mechanism to address complaints by the customers. The Company is
committed to comply with the Regulations, standards which have
been set forth in the Regulations, Circulars issued by the Authority
(IRDAI) from time to time in this regard.
(a) If the Policyholder / Insured Member has a grievance that the
Policyholder / Insured Member wishes the Company to
redress, the Policyholder / Insured Member may contact the
Company with the details of the grievance through:
Website: [Link]
Email: customerfirst@[Link]
Contact No.: 1800-102-6655, 1800-102-4488

GROUP GLOBAL CARE - UIN: RHIHLGP21406V032021

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 Office of the Ombudsman Contact Details Jurisdiction of Office (Union
Territory, District)

AHMEDABAD Insurance Ombudsman, Gujarat , Dadra & Nagar Haveli,

Office of the Insurance Ombudsman, Daman and Diu
Jeevan Prakash Building, 6th Floor,
Tilak Marg, Relief Road, AHMEDABAD-380 001.
Tel : 079-25501201/02/05/06
E-mail : [Link]@[Link]

BENGALURU Insurance Ombudsman, Karnataka

Office of the Insurance Ombudsman,
24th Main Road, Jeevan Soudha Bldg., JP Nagar, 1st Phase,
BENGALURU - 560 078.
Tel No: 080-22222049/22222048
Email: [Link]@[Link]

BHOPAL Insurance Ombudsman, Madhya Pradesh & Chhattisgarh

Office of the Insurance Ombudsman,
Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel,
Near New Market, BHOPAL (M.P.)-462 023.
Tel : 0755-2769201/9202 , Fax : 0755-2769203
E-mail : [Link]@[Link]

BHUBANESHWAR Insurance Ombudsman, Orissa

Office of the Insurance Ombudsman,
62, Forest Park, BHUBANESHWAR-751 009.
Tel : 0674-2596455/2596003 , Fax : 0674-2596429
E-mail: [Link]@[Link]

CHANDIGARH Insurance Ombudsman, Punjab , Haryana, Himachal Pradesh,

Office of the Insurance Ombudsman, Jammu & Kashmir, Chandigarh
S.C.O. No.101-103, 2nd Floor, Batra Building. Sector 17-D,
CHANDIGARH-160 017.
Tel : 0172-2706468/2705861, Fax : 0172-2708274
E-mail: [Link]@[Link]

CHENNAI Insurance Ombudsman, Tamil Nadu, Pondicherry Town and

Office of the Insurance Ombudsman, Karaikal (which are part of
Fathima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI-600 018. Pondicherry)
Tel : 044-24333668 /24335284, Fax : 044-24333664
E-mail : [Link]@[Link]

DELHI Insurance Ombudsman, Delhi

Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Bldg., Asaf Ali Road, NEW DELHI-110 002.
Tel : 011 - 23232481 / 23213504
E-mail : [Link]@[Link]

GUWAHATI Insurance Ombudsman, Assam , Meghalaya, Manipur, Mizoram,

Office of the Insurance Ombudsman, Arunachal Pradesh, Nagaland and
“Jeevan Nivesh”, 5th Floor, Near Panbazar Overbridge, S.S. Road, Tripura
GUWAHATI-781 001 (ASSAM).
Tel : 0361 - 2632204 / 2602205
E-mail : [Link]@[Link]

HYDERABAD Insurance Ombudsman, Andhra Pradesh, Telangana and Yanam

Office of the Insurance Ombudsman, – a part of Territory of Pondicherry
6-2-46, 1st Floor, Moin Court, Lane Opp. Saleem Function Palace, A.C.
Guards, Lakdi-Ka-Pool, HYDERABAD-500 004.
Tel : 040 - 67504123 / 23312122, Fax : 040-23376599
E-mail : [Link]@[Link]

JAIPUR Insurance Ombudsman, Rajasthan

Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005.
Tel : 0141-2740363
Email : [Link]@[Link]

ERNAKULAM Insurance Ombudsman, Kerala, Lakshadweep, Mahe – a part of

Office of the Insurance Ombudsman, Pondicherry
2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, M.G. Road,
ERNAKULAM-682 015.
Tel : 0484-2358759/2359338, Fax : 0484-2359336
E-mail : [Link]@[Link]

KOLKATA Insurance Ombudsman, West Bengal, Andaman & Nicobar

Office of the Insurance Ombudsman, Islands, Sikkim
4th Floor, Hindustan Bldg. Annexe, 4, [Link], Kolkata – 700 072.
Tel : 033-22124339/22124340, Fax : 033-22124341
E-mail : [Link]@[Link]

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 Office of the Ombudsman Contact Details Jurisdiction of Office (Union
Territory, District)

LUCKNOW Insurance Ombudsman, Districts of Uttar Pradesh :

Office of the Insurance Ombudsman, Laitpur, Jhansi, Mahoba, Hamirpur,
6th Floor, Jeevan Bhawan, Phase-2, Nawal Kishore Road, Hazaratganj, Banda, Chitrakoot, Allahabad,
LUCKNOW-226 001. Mirzapur, Sonbhabdra, Fatehpur,
Tel : 0522 -2231331/2231330, Fax : 0522-2231310 Pratapgarh, Jaunpur,Varanasi, Gazipur,
E-mail : [Link]@[Link] Jalaun, Kanpur, Lucknow, Unnao,
Sitapur, Lakhimpur, Bahraich,
Barabanki, Raebareli, Sravasti, Gonda,
Faizabad, Amethi, Kaushambi,
Balrampur, Basti, Ambedkarnagar,
Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur,
Chandauli, Ballia, Sidharathnagar.

MUMBAI Insurance Ombudsman, Goa,

Office of the Insurance Ombudsman, Mumbai Metropolitan Region
3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz(W), excluding Navi Mumbai & Thane
MUMBAI-400 054.
Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
Email: [Link]@[Link]

NOIDA Office of the Insurance Ombudsman, State of Uttaranchal and the following
Bhagwan Sahai Palace Districts of Uttar Pradesh: Agra,
4th Floor, Main Road, Aligarh, Bagpat, Bareilly, Bijnor,
Naya Bans, Sector 15, Budaun, Bulandshehar, Etah, Kanooj,
Distt: Gautam Buddh Nagar, Mainpuri, Mathura, Meerut,
U.P-201301. Moradabad, Muzaffarnagar, Oraiyya,
Tel.: 0120-2514250 / 2514252 / 2514253 Pilibhit, Etawah, Farrukhabad,
Email: [Link]@[Link] Firozbad, Gautambodhanagar,
Ghaziabad, Hardoi, Shahjahanpur,
Hapur, Shamli, Rampur, Kashganj,
Sambhal, Amroha, Hathras,
Kanshiramnagar, Saharanpur

PATNA Office of the Insurance Ombudsman, Bihar, Jharkhand

1st Floor, Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur,
Patna 800 006.
Tel.: 0612-2680952
Email: [Link]@[Link]

PUNE Insurance Ombudsman, Maharashtra,

Office of the Insurance Ombudsman, Area of Navi Mumbai and Thane
Jeevan Darshan Bldg., 2nd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, excluding Mumbai Metropolitan
Narayan Peth, Pune – 411 030. Region.
Tel: 020-32341320
Email: [Link]@[Link]

The updated details of Insurance Ombudsman are available on website of IRDAI: [Link], on the website of General Insurance Council: [Link], on the Company's website
[Link] or from any of the Company's offices. Address and contact number of Executive Council of Insurers –
Office of the 'Executive Council of Insurers'
3rd Floor, Jeevan Seva Annexe,
S.V. Road, Santacruz(W),
Mumbai – 400 054.
Tel : 022-26106889/671/980
Fax : 022-26106949
Email- inscoun@[Link]

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Annexure 1 - List of Day Care Surgeries

1. Cardiology Related: 45. LABYRINTHECTOMY FOR SEVERE VERTIGO

1. CORONARY ANGIOGRAPHY 46. STAPEDECTOMY UNDER GA
2. Critical Care Related: 47. STAPEDECTOMY UNDER LA
2. INSERT NON- TUNNEL CV CATH 48. TYMPANOPLASTY (TYPE IV)
3. INSERT PICC CATH ( PERIPHERALLY INSERTED CENTRAL 49. ENDOLYMPHATIC SAC SURGERY FOR MENIERE'S DISEASE
CATHETER )
50. TURBINECTOMY
4. REPLACE PICC CATH ( PERIPHERALLY INSERTED CENTRAL
51. ENDOSCOPIC STAPEDECTOMY
CATHETER )
52. INCISION AND DRAINAGE OF PERICHONDRITIS
5. INSERTION CATHETER, INTRA ANTERIOR
53. SEPTOPLASTY
6. INSERTION OF PORTACATH
54. VESTIBULAR NERVE SECTION
3. Dental Related:
55. THYROPLASTY TYPE I
7. SPLINTING OF AVULSED TEETH
56. PSEUDOCYST OF THE PINNA - EXCISION
8. SUTURING LACERATED LIP
57. INCISION AND DRAINAGE - HAEMATOMA AURICLE
9. SUTURING ORAL MUCOSA
58. TYMPANOPLASTY (TYPE II)
10. ORAL BIOPSY IN CASE OF ABNORMAL TISSUE PRESENTATION
59. REDUCTION OF FRACTURE OF NASAL BONE
11. FNAC
60. THYROPLASTY TYPE II
12. SMEAR FROM ORAL CAVITY
61. TRACHEOSTOMY
4. ENT Related:
62. EXCISION OF ANGIOMA SEPTUM
13. MYRINGOTOMY WITH GROMMET INSERTION
63. TURBINOPLASTY
14. T Y M PA N O P L A S T Y ( C LO S U R E O F A N E A R D R U M
PERFORATION/RECONSTRUCTION OF THE AUDITORY OSSICLES) 64. INCISION & DRAINAGE OF RETRO PHARYNGEAL ABSCESS
15. REMOVAL OF A TYMPANIC DRAIN 65. UVULO PALATO PHARYNGO PLASTY
16. KERATOSIS REMOVAL UNDER GA 66. ADENOIDECTOMY WITH GROMMET INSERTION
17. OPERATIONS ON THE TURBINATES (NASAL CONCHA) 67. ADENOIDECTOMY WITHOUT GROMMET INSERTION
18. T Y M PA N O P L A S T Y ( C LO S U R E O F A N E A R D R U M 68. VOCAL CORD LATERALISATION PROCEDURE
PERFORATION/RECONSTRUCTION OF THE AUDITORY OSSICLES)
69. INCISION & DRAINAGE OF PARA PHARYNGEAL ABSCESS
19. REMOVAL OF KERATOSIS OBTURANS
70. TRACHEOPLASTY
20. STAPEDOTOMY TO TREAT VARIOUS LESIONS IN MIDDLE EAR
5. Gastroenterology Related:
21. REVISION OF A STAPEDECTOMY
71. CHOLECYSTECTOMY AND CHOLEDOCHO-JEJUNOSTOMY/
22. OTHER OPERATIONS ON THE AUDITORY OSSICLES DUODENOSTOMY/GASTROSTOMY/EXPLORATION COMMON
BILE DUCT
23. MYRINGOPLASTY (POST-AURA/ENDAURAL APPROACH AS WELL
AS SIMPLE TYPE -I TYMPANOPLASTY) 72. ESOPHAGOSCOPY, GASTROSCOPY, DUODENOSCOPY WITH
POLYPECTOMY/ REMOVAL OF FOREIGN BODY/DIATHERMY OF
24. FENESTRATION OF THE INNER EAR
BLEEDING LESIONS
25. REVISION OF A FENESTRATION OF THE INNER EAR
73. PANCREATIC PSEUDOCYST EUS & DRAINAGE
26. PALATOPLASTY
74. RF ABLATION FOR BARRETT'S OESOPHAGUS
27. TRANSORAL INCISION AND DRAINAGE OF A PHARYNGEAL
75. ERCP AND PAPILLOTOMY
ABSCESS
76. ESOPHAGOSCOPE AND SCLEROSANT INJECTION
28. TONSILLECTOMY WITHOUT ADENOIDECTOMY
77. EUS + SUBMUCOSAL RESECTION
29. TONSILLECTOMY WITH ADENOIDECTOMY
78. CONSTRUCTION OF GASTROSTOMY TUBE
30. EXCISION AND DESTRUCTION OF A LINGUAL TONSIL
79. EUS + ASPIRATION PANCREATIC CYST
31. REVISION OF A TYMPANOPLASTY
80. SMALL BOWEL ENDOSCOPY (THERAPEUTIC)
32. OTHER MICROSURGICAL OPERATIONS ON THE MIDDLE EAR
81. COLONOSCOPY ,LESION REMOVAL
33. INCISION OF THE MASTOID PROCESS AND MIDDLE EAR
82. ERCP
34. MASTOIDECTOMY
83. COLONSCOPY STENTING OF STRICTURE
35. RECONSTRUCTION OF THE MIDDLE EAR
84. PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
36. OTHER EXCISIONS OF THE MIDDLE AND INNER EAR
85. EUS AND PANCREATIC PSEUDO CYST DRAINAGE
37. INCISION (OPENING) AND DESTRUCTION (ELIMINATION) OF THE
INNER EAR 86. ERCP AND CHOLEDOCHOSCOPY
38. OTHER OPERATIONS ON THE MIDDLE AND INNER EAR 87. PROCTOSIGMOIDOSCOPY VOLVULUS DETORSION
39. EXCISION AND DESTRUCTION OF DISEASED TISSUE OF THE NOSE 88. ERCP AND SPHINCTEROTOMY
40. OTHER OPERATIONS ON THE NOSE 89. ESOPHAGEAL STENT PLACEMENT
41. NASAL SINUS ASPIRATION 90. ERCP + PLACEMENT OF BILIARY STENTS
42. FOREIGN BODY REMOVAL FROM NOSE 91. SIGMOIDOSCOPY W / STENT
43. OTHER OPERATIONS ON THE TONSILS AND ADENOIDS 92. EUS + COELIAC NODE BIOPSY
44. ADENOIDECTOMY 93. UGI SCOPY AND INJECTION OF ADRENALINE, SCLEROSANTS

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 BLEEDING ULCERS 143. SPLENIC ABSCESSES LAPAROSCOPIC DRAINAGE
6. General Surgery Related: 144. UGI SCOPY AND POLYPECTOMY STOMACH
94. INCISION OF A PILONIDAL SINUS / ABSCESS 145. RIGID OESOPHAGOSCOPY FOR FB REMOVAL
95. FISSURE IN ANO SPHINCTEROTOMY 146. FEEDING JEJUNOSTOMY
96. SURGICAL TREATMENT OF A VARICOCELE AND A HYDROCELE OF 147. COLOSTOMY
THE SPERMATIC CORD
148. ILEOSTOMY
97. ORCHIDOPEXY
149. COLOSTOMY CLOSURE
98. ABDOMINAL EXPLORATION IN CRYPTORCHIDISM
150. SUBMANDIBULAR SALIVARY DUCT STONE REMOVAL
99. SURGICAL TREATMENT OF ANAL FISTULAS
151. PNEUMATIC REDUCTION OF INTUSSUSCEPTION
100. DIVISION OF THE ANAL SPHINCTER (SPHINCTEROTOMY)
152. VARICOSE VEINS LEGS - INJECTION SCLEROTHERAPY
101. EPIDIDYMECTOMY
153. RIGID OESOPHAGOSCOPY FOR PLUMMER VINSON SYNDROME
102. INCISION OF THE BREAST ABSCESS
154. PANCREATIC PSEUDOCYSTS ENDOSCOPIC DRAINAGE
103. OPERATIONS ON THE NIPPLE
155. ZADEK'S NAIL BED EXCISION
104. EXCISION OF SINGLE BREAST LUMP
156. SUBCUTANEOUS MASTECTOMY
105. INCISION AND EXCISION OF TISSUE IN THE PERIANAL REGION
157. EXCISION OF RANULA UNDER GA
106. SURGICAL TREATMENT OF HEMORRHOIDS
158. RIGID OESOPHAGOSCOPY FOR DILATION OF BENIGN
107. OTHER OPERATIONS ON THE ANUS STRICTURES
108. ULTRASOUND GUIDED ASPIRATIONS 159. EVERSION OF SAC
109. SCLEROTHERAPY, ETC. 160. UNILATERAL
110. L A P A R O T O M Y F O R G R A D I N G LY M P H O M A W I T H 161. ILATERAL
SPLENECTOMY/LIVER/LYMPH NODE BIOPSY
162. LORD'S PLICATION
111. THERAPEUTIC LAPAROSCOPY WITH LASER
163. JABOULAY'S PROCEDURE
112. APPENDICECTOMY WITH/WITHOUT DRAINAGE
164. SCROTOPLASTY
113. INFECTED KELOID EXCISION
165. CIRCUMCISION FOR TRAUMA
114. AXILLARY LYMPHADENECTOMY
166. MEATOPLASTY
115. WOUND DEBRIDEMENT AND COVER
167. INTERSPHINCTERIC ABSCESS INCISION AND DRAINAGE
116. ABSCESS-DECOMPRESSION
168. PSOAS ABSCESS INCISION AND DRAINAGE
117. CERVICAL LYMPHADENECTOMY
169. THYROID ABSCESS INCISION AND DRAINAGE
118. INFECTED SEBACEOUS CYST
170. TIPS PROCEDURE FOR PORTAL HYPERTENSION
119. INGUINAL LYMPHADENECTOMY
171. ESOPHAGEAL GROWTH STENT
120. INCISION AND DRAINAGE OF ABSCESS
172. PAIR PROCEDURE OF HYDATID CYST LIVER
121. SUTURING OF LACERATIONS
173. TRU CUT LIVER BIOPSY
122. SCALP SUTURING
174. PHOTODYNAMIC THERAPY OR ESOPHAGEAL TUMOUR AND
123. INFECTED LIPOMA EXCISION LUNG TUMOUR
124. MAXIMAL ANAL DILATATION 175. EXCISION OF CERVICAL RIB
125. PILES 176. LAPAROSCOPIC REDUCTION OF INTUSSUSCEPTION
126. A)INJECTION SCLEROTHERAPY 177. MICRODOCHECTOMY BREAST
127. B)PILES BANDING 178. SURGERY FOR FRACTURE PENIS
128. LIVER ABSCESS- CATHETER DRAINAGE 179. SENTINEL NODE BIOPSY
129. FISSURE IN ANO- FISSURECTOMY 180. PARASTOMAL HERNIA
130. FIBROADENOMA BREAST EXCISION 181. REVISION COLOSTOMY
131. OESOPHAGEAL VARICES SCLEROTHERAPY 182. PROLAPSED COLOSTOMY- CORRECTION
132. ERCP - PANCREATIC DUCT STONE REMOVAL 183. TESTICULAR BIOPSY
133. PERIANAL ABSCESS I&D 184. LAPAROSCOPIC CARDIOMYOTOMY( HELLERS)
134. PERIANAL HEMATOMA EVACUATION 185. SENTINEL NODE BIOPSY MALIGNANT MELANOMA
135. UGI SCOPY AND POLYPECTOMY OESOPHAGUS 186. LAPAROSCOPIC PYLOROMYOTOMY( RAMSTEDT)
136. BREAST ABSCESS I& D 7. Gynecology Related:
137. FEEDING GASTROSTOMY 187. OPERATIONS ON BARTHOLIN’S GLANDS (CYST)
138. OESOPHAGOSCOPY AND BIOPSY OF GROWTH OESOPHAGUS 188. INCISION OF THE OVARY
139. ERCP - BILE DUCT STONE REMOVAL 189. INSUFFLATIONS OF THE FALLOPIAN TUBES
140. ILEOSTOMY CLOSURE 190. OTHER OPERATIONS ON THE FALLOPIAN TUBE
141. COLONOSCOPY 191. DILATATION OF THE CERVICAL CANAL
142. POLYPECTOMY COLON 192. CONISATION OF THE UTERINE CERVIX

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 193. THERAPEUTIC CURETTAGE WITH COLPOSCOPY / BIOPSY / 243. SPINAL CORD STIMULATION
DIATHERMY / CRYOSURGERY
244. MOTOR CORTEX STIMULATION
194. LASER THERAPY OF CERVIX FOR VARIOUS LESIONS OF UTERUS
245. STEREOTACTIC RADIOSURGERY
195. OTHER OPERATIONS ON THE UTERINE CERVIX
246. PERCUTANEOUS CORDOTOMY
196. INCISION OF THE UTERUS (HYSTERECTOMY)
247. INTRATHECAL BACLOFEN THERAPY
197. LOCAL EXCISION AND DESTRUCTION OF DISEASED TISSUE OF
248. ENTRAPMENT NEUROPATHY RELEASE
THE VAGINA AND THE POUCH OF DOUGLAS
249. DIAGNOSTIC CEREBRAL ANGIOGRAPHY
198. INCISION OF VAGINA
250. VP SHUNT
199. INCISION OF VULVA
251. VENTRICULOATRIAL SHUNT
200. CULDOTOMY
9. Oncology Related:
201. SALPINGO-OOPHORECTOMY VIA LAPAROTOMY
252. RADIOTHERAPY FOR CANCER
202. ENDOSCOPIC POLYPECTOMY
253. CANCER CHEMOTHERAPY
203. HYSTEROSCOPIC REMOVAL OF MYOMA
254. IV PUSH CHEMOTHERAPY
204. D&C
255. HBI-HEMIBODY RADIOTHERAPY
205. HYSTEROSCOPIC RESECTION OF SEPTUM
256. INFUSIONAL TARGETED THERAPY
206. THERMAL CAUTERISATION OF CERVIX
257. SRT-STEREOTACTIC ARC THERAPY
207. MIRENA INSERTION
258. SC ADMINISTRATION OF GROWTH FACTORS
208. HYSTEROSCOPIC ADHESIOLYSIS
259. CONTINUOUS INFUSIONAL CHEMOTHERAPY
209. LEEP
260. INFUSIONAL CHEMOTHERAPY
210. CRYOCAUTERISATION OF CERVIX
261. CCRT-CONCURRENT CHEMO + RT
211. POLYPECTOMY ENDOMETRIUM
262. 2D RADIOTHERAPY
212. HYSTEROSCOPIC RESECTION OF FIBROID
263. 3D CONFORMAL RADIOTHERAPY
213. LLETZ
264. IGRT- IMAGE GUIDED RADIOTHERAPY
214. CONIZATION
265. IMRT- STEP & SHOOT
215. POLYPECTOMY CERVIX
266. INFUSIONAL BISPHOSPHONATES
216. HYSTEROSCOPIC RESECTION OF ENDOMETRIAL POLYP
267. IMRT- DMLC
217. VULVAL WART EXCISION
268. ROTATIONAL ARC THERAPY
218. LAPAROSCOPIC PARAOVARIAN CYST EXCISION
269. TELE GAMMA THERAPY
219. UTERINE ARTERY EMBOLIZATION
270. FSRT-FRACTIONATED SRT
220. LAPAROSCOPIC CYSTECTOMY
271. VMAT-VOLUMETRIC MODULATED ARC THERAPY
221. HYMENECTOMY( IMPERFORATE HYMEN)
272. SBRT-STEREOTACTIC BODY RADIOTHERAPY
222. ENDOMETRIAL ABLATION
273. HELICAL TOMOTHERAPY
223. VAGINAL WALL CYST EXCISION
274. SRS-STEREOTACTIC RADIOSURGERY
224. VULVAL CYST EXCISION
275. X-KNIFE SRS
225. LAPAROSCOPIC PARATUBAL CYST EXCISION
276. GAMMAKNIFE SRS
226. REPAIR OF VAGINA ( VAGINAL ATRESIA )
277. TBI- TOTAL BODY RADIOTHERAPY
227. HYSTEROSCOPY, REMOVAL OF MYOMA
278. INTRALUMINAL BRACHYTHERAPY
228. TURBT
279. ELECTRON THERAPY
229. URETEROCOELE REPAIR - CONGENITAL INTERNAL
280. TSET-TOTAL ELECTRON SKIN THERAPY
230. VAGINAL MESH FOR POP
281. EXTRACORPOREAL IRRADIATION OF BLOOD PRODUCTS
231. LAPAROSCOPIC MYOMECTOMY
282. TELECOBALT THERAPY
232. SURGERY FOR SUI
283. TELECESIUM THERAPY
233. REPAIR RECTO- VAGINA FISTULA
284. EXTERNAL MOULD BRACHYTHERAPY
234. PELVIC FLOOR REPAIR( EXCLUDING FISTULA REPAIR)
285. INTERSTITIAL BRACHYTHERAPY
235. URS + LL
286. INTRACAVITY BRACHYTHERAPY
236. LAPAROSCOPIC OOPHORECTOMY
287. 3D BRACHYTHERAPY
237. NORMAL VAGINAL DELIVERY AND VARIANTS
288. IMPLANT BRACHYTHERAPY
8. Neurology Related:
289. INTRAVESICAL BRACHYTHERAPY
238. FACIAL NERVE PHYSIOTHERAPY
290. ADJUVANT RADIOTHERAPY
239. NERVE BIOPSY
291. AFTERLOADING CATHETER BRACHYTHERAPY
240. MUSCLE BIOPSY
292. CONDITIONING RADIOTHEARPY FOR BMT
241. EPIDURAL STEROID INJECTION
293. EXTRACORPOREAL IRRADIATION TO THE HOMOLOGOUS BONE
242. GLYCEROL RHIZOTOMY
GRAFTS

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 294. RADICAL CHEMOTHERAPY 335. EXCISION AND DESTRUCTION OF DISEASED TISSUE OF THE
EYELID
295. NEOADJUVANT RADIOTHERAPY
336. OPERATIONS ON THE CANTHUS AND EPICANTHUS
296. LDR BRACHYTHERAPY
337. CORRECTIVE SURGERY FOR ENTROPION AND ECTROPION
297. PALLIATIVE RADIOTHERAPY
338. CORRECTIVE SURGERY FOR BLEPHAROPTOSIS
298. RADICAL RADIOTHERAPY
339. REMOVAL OF A FOREIGN BODY FROM THE CONJUNCTIVA
299. PALLIATIVE CHEMOTHERAPY
340. REMOVAL OF A FOREIGN BODY FROM THE CORNEA
300. TEMPLATE BRACHYTHERAPY
341. INCISION OF THE CORNEA
301. NEOADJUVANT CHEMOTHERAPY
342. OPERATIONS FOR PTERYGIUM
302. ADJUVANT CHEMOTHERAPY
343. OTHER OPERATIONS ON THE CORNEA
303. INDUCTION CHEMOTHERAPY
344. REMOVAL OF A FOREIGN BODY FROM THE LENS OF THE EYE
304. CONSOLIDATION CHEMOTHERAPY
345. REMOVAL OF A FOREIGN BODY FROM THE POSTERIOR CHAMBER
305. MAINTENANCE CHEMOTHERAPY
OF THE EYE
306. HDR BRACHYTHERAPY
346. REMOVAL OF A FOREIGN BODY FROM THE ORBIT AND EYEBALL
10. Operations on the salivary glands & salivary ducts:
347. CORRECTION OF EYELID PTOSIS BY LEVATOR PALPEBRAE
307. INCISION AND LANCING OF A SALIVARY GLAND AND A SALIVARY SUPERIORIS RESECTION (BILATERAL)
DUCT
348. CORRECTION OF EYELID PTOSIS BY FASCIA LATA GRAFT
308. EXCISION OF DISEASED TISSUE OF A SALIVARY GLAND AND A (BILATERAL)
SALIVARY DUCT
349. DIATHERMY/CRYOTHERAPY TO TREAT RETINAL TEAR
309. RESECTION OF A SALIVARY GLAND
350. ANTERIOR CHAMBER PARACENTESIS / CYCLODIATHERMY /
310. RECONSTRUCTION OF A SALIVARY GLAND AND A SALIVARY CYCLOCRYOTHERAPY / GONIOTOMY / TRABECULOTOMY AND
DUCT FILTERING AND ALLIED OPERATIONS TO TREAT GLAUCOMA
311. OTHER OPERATIONS ON THE SALIVARY GLANDS AND SALIVARY 351. ENUCLEATION OF EYE WITHOUT IMPLANT
DUCTS
352. DACRYOCYSTORHINOSTOMY FOR VARIOUS LESIONS OF
11. Operations on the skin & subcutaneous tissues: LACRIMAL GLAND
312. OTHER INCISIONS OF THE SKIN AND SUBCUTANEOUS TISSUES 353. LASER PHOTOCOAGULATION TO TREAT RATINAL TEAR
313. SURGICAL WOUND TOILET (WOUND DEBRIDEMENT) AND 354. BIOPSY OF TEAR GLAND
REMOVAL OF DISEA SED TISSUE OF THE SKIN AND
355. TREATMENT OF RETINAL LESION
SUBCUTANEOUS TISSUES
14. Orthopedics Related:
314. LOCAL EXCISION OF DISEASED TISSUE OF THE SKIN AND
SUBCUTANEOUS TISSUES 356. SURGERY FOR MENISCUS TEAR
315. OTHER EXCISIONS OF THE SKIN AND SUBCUTANEOUS TISSUES 357. INCISION ON BONE, SEPTIC AND ASEPTIC
316. SIMPLE RESTORATION OF SURFACE CONTINUITY OF THE SKIN 358. CLOSED REDUCTION ON FRACTURE, LUXATION OR
AND SUBCUTANEOUS TISSUES EPIPHYSEOLYSIS WITH OSTEOSYNTHESIS
317. FREE SKIN TRANSPLANTATION, DONOR SITE 359. SUTURE AND OTHER OPERATIONS ON TENDONS AND TENDON
SHEATH
318. FREE SKIN TRANSPLANTATION, RECIPIENT SITE
360. REDUCTION OF DISLOCATION UNDER GA
319. REVISION OF SKIN PLASTY
361. ARTHROSCOPIC KNEE ASPIRATION
320. OTHER RESTORATION AND RECONSTRUCTION OF THE SKIN
AND SUBCUTANEOUS TISSUES. 362. SURGERY FOR LIGAMENT TEAR
321. CHEMOSURGERY TO THE SKIN. 363. SURGERY FOR HEMOARTHROSIS/PYOARTHROSIS
322. DESTRUCTION OF DISEASED TISSUE IN THE SKIN AND 364. REMOVAL OF FRACTURE PINS/NAILS
SUBCUTANEOUS TISSUES
365. REMOVAL OF METAL WIRE
323. RECONSTRUCTION OF DEFORMITY/DEFECT IN NAIL BED
366. CLOSED REDUCTION ON FRACTURE, LUXATION
324. EXCISION OF BURSIRTIS
367. REDUCTION OF DISLOCATION UNDER GA
325. TENNIS ELBOW RELEASE
368. EPIPHYSEOLYSIS WITH OSTEOSYNTHESIS
12. Operations on the Tongue:
369. EXCISION OF VARIOUS LESIONS IN COCCYX
326. INCISION, EXCISION AND DESTRUCTION OF DISEASED TISSUE OF
370. ARTHROSCOPIC REPAIR OF ACL TEAR KNEE
THE TONGUE
371. CLOSED REDUCTION OF MINOR FRACTURES
327. PARTIAL GLOSSECTOMY
372. ARTHROSCOPIC REPAIR OF PCL TEAR KNEE
328. GLOSSECTOMY
373. TENDON SHORTENING
329. RECONSTRUCTION OF THE TONGUE
374. ARTHROSCOPIC MENISCECTOMY - KNEE
330. OTHER OPERATIONS ON THE TONGUE
375. TREATMENT OF CLAVICLE DISLOCATION
13. Ophthalmology Related:
376. HAEMARTHROSIS KNEE- LAVAGE
331. SURGERY FOR CATARACT
377. ABSCESS KNEE JOINT DRAINAGE
332. INCISION OF TEAR GLANDS
378. CARPAL TUNNEL RELEASE
333. OTHER OPERATIONS ON THE TEAR DUCTS
379. CLOSED REDUCTION OF MINOR DISLOCATION
334. INCISION OF DISEASED EYELIDS

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 380. REPAIR OF KNEE CAP TENDON 431. INCISION OF THE HARD AND SOFT PALATE
381. ORIF WITH K WIRE FIXATION- SMALL BONES 432. EXCISION AND DESTRUCTION OF DISEASED HARD AND SOFT
PALATE
382. RELEASE OF MIDFOOT JOINT
433. INCISION, EXCISION AND DESTRUCTION IN THE MOUTH
383. ORIF WITH PLATING- SMALL LONG BONES
434. OTHER OPERATIONS IN THE MOUTH
384. IMPLANT REMOVAL MINOR
16. Pediatric surgery Related:
385. K WIRE REMOVAL
435. EXCISION OF FISTULA-IN-ANO
386. POP APPLICATION
436. EXCISION JUVENILE POLYPS RECTUM
387. CLOSED REDUCTION AND EXTERNAL FIXATION
437. VAGINOPLASTY
388. ARTHROTOMY HIP JOINT
438. D I L ATAT I O N O F AC C I D E N TA L C AU S T I C S T R I C T U R E
389. SYME'S AMPUTATION
OESOPHAGEAL
390. ARTHROPLASTY
439. PRESACRAL TERATOMAS EXCISION
391. PARTIAL REMOVAL OF RIB
440. REMOVAL OF VESICAL STONE
392. TREATMENT OF SESAMOID BONE FRACTURE
441. EXCISION SIGMOID POLYP
393. SHOULDER ARTHROSCOPY / SURGERY
442. STERNOMASTOID TENOTOMY
394. ELBOW ARTHROSCOPY
443. I N F A N T I L E H Y P E R T R O P H I C P Y L O R I C S T E N O S I S
395. AMPUTATION OF METACARPAL BONE PYLOROMYOTOMY
396. RELEASE OF THUMB CONTRACTURE 444. EXCISION OF SOFT TISSUE RHABDOMYOSARCOMA
397. INCISION OF FOOT FASCIA 445. MEDIASTINAL LYMPH NODE BIOPSY
398. CALCANEUM SPUR HYDROCORT INJECTION 446. HIGH ORCHIDECTOMY FOR TESTIS TUMOURS
399. GANGLION WRIST HYALASE INJECTION 447. EXCISION OF CERVICAL TERATOMA
400. PARTIAL REMOVAL OF METATARSAL 448. RECTAL-MYOMECTOMY
401. REPAIR / GRAFT OF FOOT TENDON 449. RECTAL PROLAPSE (DELORME'S PROCEDURE)
402. REVISION/REMOVAL OF KNEE CAP 450. DETORSION OF TORSION TESTIS
403. AMPUTATION FOLLOW-UP SURGERY 451. EUA + BIOPSY MULTIPLE FISTULA IN ANO
404. EXPLORATION OF ANKLE JOINT 452. CYSTIC HYGROMA - INJECTION TREATMENT
405. REMOVE/GRAFT LEG BONE LESION 17. Plastic Surgery Related:
406. REPAIR/GRAFT ACHILLES TENDON 453. CONSTRUCTION SKIN PEDICLE FLAP
407. REMOVE OF TISSUE EXPANDER 454. GLUTEAL PRESSURE ULCER-EXCISION
408. BIOPSY ELBOW JOINT LINING 455. MUSCLE-SKIN GRAFT, LEG
409. REMOVAL OF WRIST PROSTHESIS 456. REMOVAL OF BONE FOR GRAFT
410. BIOPSY FINGER JOINT LINING 457. MUSCLE-SKIN GRAFT DUCT FISTULA
411. TENDON LENGTHENING 458. REMOVAL CARTILAGE GRAFT
412. TREATMENT OF SHOULDER DISLOCATION 459. MYOCUTANEOUS FLAP
413. LENGTHENING OF HAND TENDON 460. FIBRO MYOCUTANEOUS FLAP
414. REMOVAL OF ELBOW BURSA 461. BREAST RECONSTRUCTION SURGERY AFTER MASTECTOMY
415. FIXATION OF KNEE JOINT 462. SLING OPERATION FOR FACIAL PALSY
416. TREATMENT OF FOOT DISLOCATION 463. SPLIT SKIN GRAFTING UNDER RA
417. SURGERY OF BUNION 464. WOLFE SKIN GRAFT
418. INTRA ARTICULAR STEROID INJECTION 465. PLASTIC SURGERY TO THE FLOOR OF THE MOUTH UNDER GA
419. TENDON TRANSFER PROCEDURE 18. Thoracic surgery Related:
420. REMOVAL OF KNEE CAP BURSA 466. THORACOSCOPY AND LUNG BIOPSY
421. TREATMENT OF FRACTURE OF ULNA 467. EXCISION OF CERVICAL SYMPATHETIC CHAIN THORACOSCOPIC
422. TREATMENT OF SCAPULA FRACTURE 468. LASER ABLATION OF BARRETT'S OESOPHAGUS
423. REMOVAL OF TUMOR OF ARM/ ELBOW UNDER RA/GA 469. PLEURODESIS
424. REPAIR OF RUPTURED TENDON 470. THORACOSCOPY AND PLEURAL BIOPSY
425. DECOMPRESS FOREARM SPACE 471. EBUS + BIOPSY
426. REVISION OF NECK MUSCLE (TORTICOLLIS RELEASE ) 472. THORACOSCOPY LIGATION THORACIC DUCT
427. LENGTHENING OF THIGH TENDONS 473. THORACOSCOPY ASSISTED EMPYAEMA DRAINAGE
428. TREATMENT FRACTURE OF RADIUS & ULNA 19. Urology Related:
429. REPAIR OF KNEE JOINT 474. HAEMODIALYSIS
15. Other operations on the mouth & face: 475. LITHOTRIPSY/NEPHROLITHOTOMY FOR RENAL CALCULUS
430. EXTERNAL INCISION AND DRAINAGE IN THE REGION OF THE 476. EXCISION OF RENAL CYST
MOUTH, JAW AND FACE

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 477. DRAINAGE OF PYONEPHROSIS/PERINEPHRIC ABSCESS 525. KIDNEY RENOSCOPY AND BIOPSY
478. INCISION OF THE PROSTATE 526. URETER ENDOSCOPY AND TREATMENT
479. TRANSURETHRAL EXCISION AND DESTRUCTION OF PROSTATE 527. VESICO URETERIC REFLUX CORRECTION
TISSUE
528. SURGERY FOR PELVI URETERIC JUNCTION OBSTRUCTION
480. TRANSURETHRAL AND PERCUTANEOUS DESTRUCTION OF
529. ANDERSON HYNES OPERATION
PROSTATE TISSUE
530. KIDNEY ENDOSCOPY AND BIOPSY
481. OPEN SURGICAL EXCISION AND DESTRUCTION OF PROSTATE
TISSUE 531. PARAPHIMOSIS SURGERY
482. RADICAL PROSTATOVESICULECTOMY 532. INJURY PREPUCE- CIRCUMCISION
483. OTHER EXCISION AND DESTRUCTION OF PROSTATE TISSUE 533. FRENULAR TEAR REPAIR
484. OPERATIONS ON THE SEMINAL VESICLES 534. MEATOTOMY FOR MEATAL STENOSIS
485. INCISION AND EXCISION OF PERIPROSTATIC TISSUE 535. SURGERY FOR FOURNIER'S GANGRENE SCROTUM
486. OTHER OPERATIONS ON THE PROSTATE 536. SURGERY FILARIAL SCROTUM
487. INCISION OF THE SCROTUM AND TUNICA VAGINALIS TESTIS 537. SURGERY FOR WATERING CAN PERINEUM
488. OPERATION ON A TESTICULAR HYDROCELE 538. REPAIR OF PENILE TORSION
489. EXCISION AND DESTRUCTION OF DISEASED SCROTAL TISSUE 539. DRAINAGE OF PROSTATE ABSCESS
490. OTHER OPERATIONS ON THE SCROTUM AND TUNICA VAGINALIS 540. ORCHIECTOMY
TESTIS
541. CYSTOSCOPY AND REMOVAL OF FB
491. INCISION OF THE TESTES
492. EXCISION AND DESTRUCTION OF DISEASED TISSUE OF THE
TESTES
493. UNILATERAL ORCHIDECTOMY
494. BILATERAL ORCHIDECTOMY
495. SURGICAL REPOSITIONING OF AN ABDOMINAL TESTIS
496. RECONSTRUCTION OF THE TESTIS
497. IMPLANTATION, EXCHANGE AND REMOVAL OF A TESTICULAR
PROSTHESIS
498. OTHER OPERATIONS ON THE TESTIS
499. EXCISION IN THE AREA OF THE EPIDIDYMIS
500. OPERATIONS ON THE FORESKIN
501. LOCAL EXCISION AND DESTRUCTION OF DISEASED TISSUE OF
THE PENIS
502. AMPUTATION OF THE PENIS
503. OTHER OPERATIONS ON THE PENIS
504. CYSTOSCOPICAL REMOVAL OF STONES
505. CATHETERISATION OF BLADDER
506. LITHOTRIPSY
507. BIOPSY OFTEMPORAL ARTERY FOR VARIOUS LESIONS
508. EXTERNAL ARTERIO-VENOUS SHUNT
509. AV FISTULA - WRIST
510. URSL WITH STENTING
511. URSL WITH LITHOTRIPSY
512. CYSTOSCOPIC LITHOLAPAXY
513. ESWL
514. BLADDER NECK INCISION
515. CYSTOSCOPY & BIOPSY
516. CYSTOSCOPY AND REMOVAL OF POLYP
517. SUPRAPUBIC CYSTOSTOMY
518. PERCUTANEOUS NEPHROSTOMY
519. CYSTOSCOPY AND "SLING" PROCEDURE.
520. TUNA- PROSTATE
521. EXCISION OF URETHRAL DIVERTICULUM
522. REMOVAL OF URETHRAL STONE
523. EXCISION OF URETHRAL PROLAPSE
524. MEGA-URETER RECONSTRUCTION

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Annexure II - List of Expenses Generally Excluded ("Non-medical") in Hospital Indemnity Policy

Sr. No. List - I - Optional Item Sr. No. List - I - Optional Item

1 Baby Food 47 Lumbo Sacral Belt

2 Baby Utilities Charges 48 Nimbus Bed Or Water Or Air Bed Charges
3 Beauty Services 49 Ambulance Collar
4 Belts/ Braces 50 Ambulance Equipment
5 Buds 51 Abdominal Binder
6 Cold Pack/hot Pack 52 Private Nurses Charges- Special Nursing Charges
7 Carry Bags 53 Sugar Free Tablets
8 Email / Internet Charges 54 Creams Powders Lotions (toiletries Are Not Payable, Only Prescribed
Medical Pharmaceuticals Payable)
9 Food Charges (other Than Patient's Diet Provided By Hospital)
10 Leggings 55 Ecg Electrodes
11 Laundry Charges 56 Gloves
12 Mineral Water 57 Nebulisation Kit
13 Sanitary Pad 58 Any Kit With No Details Mentioned [delivery Kit, rthokit, Recovery Kit, Etc]
14 Telephone Charges 59 Kidney Tray
15 Guest Services 60 Mask
16 Crepe Bandage 61 Ounce Glass
17 Diaper Of Any Type 62 Oxygen Mask
18 Eyelet Collar 63 Pelvic Traction Belt
19 Slings 64 Pan Can
20 Blood Grouping And Cross Matching Of Donors Samples
d 65 Trolly Cover
21 Service Charges Where Nursing Charge Also Charge 66 Urometer, Urine Jug
22 Television Charges 67 Ambulance
23 Surcharges 68 Vasofix Safety

24 Attendant Charges
25 Extra Diet Of Patient (other Than That Which Forms Part Of Bed Charge)
26 Birth Certificate
27 Certificate Charges
28 Courier Charges
29 Conveyance Charges
30 Medical Certificate
31 Medical Records
32 Photocopies Charges
33 Mortuary Charges
34 Walking Aids Charges
35 Oxygen Cylinder (for Usage Outside The Hospital)
36 Spacer
37 Spirometre
38 Nebulizer Kit
39 Steam Inhaler
40 Armsling
41 Thermometer
42 Cervical Collar
43 Splint
44 Diabetic Foot Wear
45 Knee Braces (long/ Short/ Hinged)
46 Knee Immobilizer/shoulder Immobilizer

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Annexure II - List of Expenses Generally Excluded ("Non-medical") in Hospital Indemnity Policy

Sr. No. List - II - Items that are to be subsumed into Room Charges Sr. No. List III – Items that are to be subsumed into
Procedure Charges

1 Baby Charges (unless Specified/ indicated) 1 Hair Removal Cream

2 Hand Wash 2 Disposables Razors Charges (for Site Preparations)
3 Shoe Cover 3 Eye Pad
4 Caps 4 Eye Sheild
5 Cradle Charges 7 Camera Cover
6 Comb 6 Dvd, Cd Charges
7 Eau-de-cologne / Room Freshners 7 Gause Soft
8 Foot Cover 8 Gauze
9 Gown 9 Ward And Theatre Booking Charges
10 Slippers 10 Arthroscopy And Endoscopy Instruments
11 Tissue Paper 11 Microscope Cover
12 Tooth Paste 12 Surgicalblades, Harmonicscalpel, Shaver
13 Tooth Brush 13 Surgical Drill
14 Bed Pan 14 Eye Kit
15 Face Mask 15 Eye Drape
16 Flexi Mask 16 X-ray Film
17 Hand Holder 17 Boyles Apparatus Charges

18 Sputum Cup 18 Cotton

19 Disinfectant Lotions 19 Cotton Bandage
20 Luxury Tax 20 Surgical Tape
21 Hvac 21 Apron
22 House Keeping Charges 22 Torniquet
23 Air Conditioner Charges 23 Orthobundle, Gynaec Bundle
24 Im Iv Injection Charges
25 Clean Sheet
26 Blanket/warmer Blanket
27 Admission Kit
28 Diabetic Chart Charges
29 Documentation Charges / Administrative Expenses
30 Discharge Procedure Charges
31 Daily Chart Charges
32 Entrance Pass / Visitors Pass Charges
33 Expenses Related To Prescription On Discharge
34 File Opening Charges
35 Incidental Expenses / Misc. Charges (not Explained)
36 Patient Identification Band / Name Tag
37 Pulseoxymeter Charges

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Annexure II - List of Expenses Generally Excluded ("Non-medical") in Hospital Indemnity Policy

Sr. No. List IV – Items that are to be subsumed into costs of treatment

1 Admission/registration Charges
2 Hospitalisation For Evaluation/ Diagnostic Purpose
3 Urine Container
4 Blood Reservation Charges And Ante Natal Booking Charges
5 Bipap Machine

6 Cpap/ Capd Equipments

7 Infusion Pump– Cost
8 Hydrogen Peroxide\spirit\ Disinfectants Etc

9 Nutrition Planning Charges - Dietician Charges- Diet Charges

10 HIV Kit
11 Antiseptic Mouthwash
12 Lozenges
13 Mouth Paint
14 Vaccination Charges
15 Alcohol Swabes
16 Scrub Solution/sterillium
17 Glucometer & Strips
18 Urine Bag

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Annexure III - List of Hospitals where Claim will not be admitted

Hospital Name Address

Nulife Hospital And Maternity Centre 1616 Outram Lines,Kingsway Camp,Guru Teg Bahadur Nagar , New Delhi , Delhi

Taneja Hospital F-15,Vikas Marg, Preet Vihar , New Delhi , Delhi

Shri Komal Hospital & [Link]'s Nursing Home Opp. Radhika Cinema,Circular Road , Rewari , Haryana

Sona Devi Memorial Hospital & Trauma Centre Sohna Road, Badshahpur , Gurgaon , Haryana

Amar Hospital Sector-70,[Link], Mohali, Sector 70 , Mohali , Punjab

Brij Medical Centre K K 54, Kavi Nagar , Ghaziabad , Uttar Pradesh

Famliy Medicare A-55,Sector 61, Rajat Vihar Sector 62 , Noida , Uttar Pradesh

Jeevan Jyoti Hospital 162,Lowther Road, Bai Ka Bagh , Allahabad , Uttar Pradesh

City Hospital & Trauma Centre C-1,Cinder Dump Complex,Opposite Krishna Cinema Hall,Kanpur Road, Alambagh , Lucknow , Uttar Pradesh

Dayal Maternity & Nursing Home No.953/23,[Link], DLF Colony , Rohtak , Haryana

Metas Adventist Hospital No.24,Ring-Road,Athwalines, Surat , Surat , Gujarat

Surgicare Medical Centre Sai Dwar Oberoi Complex,[Link] Road,Lokhandwala,Near Laxmi Industrial Estate, Andheri , Mumbai , Maharashtra

Paramount General Hospital & I.C.C.U. Laxmi Commercial Premises,Andheri Kurla Road , Andheri , Mumbai , Maharashtra

Gokul Hospital Thakur Complex , Kandivali East , Mumbai , Maharashtra

Shree Sai Hospital Gokul Nagri I,Thankur Complex,Western Express Highway, Kandivali East , Mumbai , Maharashtra

Shreedevi Hospital Akash Arcade,Bhanu Nagar,Near Bhanu Sagar Theatre,[Link] Shetty Road, Kalyan D.C. , Thane , Maharashtra

Saykhedkar Hospital And Research Centre Pvt. Ltd. Trimurthy Chowk,Kamatwada Road,Cidco Colony , Nashik , Maharashtra

Arpan Hospital And Research Centre No.151/2,Imli Bazar,Near Rajwada, Imli Bazar , Indore , Madhya Pradesh

Ramkrishna Care Hospital Aurobindo Enclave,Pachpedhi Naka,Dhamtri Road,National Highway No 43, Raipur , Chhattisgarh

Gupta Multispeciality Hospital B-20, Vivek Vihar , New Delhi , Delhi

[Link] 3C/59,BP,Near Metro Cinema, New Industrial Township 1 , Faridabad , Haryana

Prakash Hospital D -12,12A,12B,Noida, Sector 33 , Noida , Uttar Pradesh

Aryan Hospital Pvt. Ltd. Old Railway Road,Near New Colony, New Colony , Gurgaon , Haryana

Medilink Hospital Research Centre Pvt. Ltd. Near Shyamal Char Rasta,132,Ring Road, Satellite , Ahmedabad , Gujarat

Mohit Hospital Khoya B-Wing,Near National Park,Borivali(E), Kandivali West , Mumbai , Maharashtra

Scope Hospital 628,Niti Khand-I, Indirapuram , Ghaziabad , Uttar Pradesh

Agarwal Medical Centre E-234,- , Greater Kailash 1 , New Delhi , Delhi

Oxygen Hospital Bhiwani Stand, Durga Bhawan , Rohtak , Haryana

Prayag Hospital & Research Centre Pvt. Ltd. J-206 A/1, Sector 41 , Noida , Uttar Pradesh

Karnavati Superspeciality Hospital Opposite Sajpur Tower, Naroda Road , Ahmedabad , Gujarat

Palwal Hospital Old G.T. Road,Near New Sohna Mod, Palwal , Haryana

B.K.S. Hospital No.18,1st Cross,Gandhi Nagar, Adyar , Bellary , Karnataka

East West Medical Centre No.711,Sector 14, Sector 14 , Gurgaon , Haryana

Jagtap Hospital Anand Nagar,Sinhgood Road , Anandnagar , Pune , Maharashtra

Dr. Malwankar's Romeen Nursing Home Ganesh Marg,Tagore Nagar , Vikhroli East , Mumbai , Maharashtra

Noble Medical Centre SVP Road, Borivali West , Mumbai , Maharashtra

Rama Hospital Sonepat Road,Bahalgarh, Sonipat , Haryana

[Link] Home & ICU Lake Bloom 16,17,18 Opposite Solaris Estate, [Link] No.6,Tunga Gaon, Saki-Vihar Road, Powai , Mumbai , Maharashtra

Sparsh Multy Specality Hospital & Trauma Care Center G.I.D.C Road, Nr Udhana Citizan [Link] , Surat , Gujarat

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 Hospital Name Address

Saraswati Hospital Divya Smruti Building, 1st Floor, Opp Toyota Showroom, Malad Link Road, Malad West , Mumbai , Maharashtra

Shakuntla Hospital 3-B Tashkant Marg,Near St. Joseph Collage, Allahabad , Uttar Pradesh

Mahaveer Hospital & Trauma Centre 76-E,Station Road, Panki , Kanpur , Uttar Pradesh

Eashwar Lakshmi Hospital Plot No. 9,Near Sub Registrar Office, Gandhi Nagar , Hyderabad , Andhra Pradesh

Amrapali Hospital Plot No. NH-34,P-2,Omega -1, Greater Noida , Noida , Uttar Pradesh

Hardik Hospital 29c,Budh Bazar, Vikas Nagar , New Delhi , Delhi

Jabalpur Hospital & Research Centre Pvt Ltd Russel Crossing,Naptier Town, Jabalpur , Madhya Pradesh

Panvel Hospital Plot No. 260A,Uran Naka, Old Panvel , Navi Mumbai , Maharashtra

Santosh Hospital L-629/631,Hapur Road, Shastri Nagar , Meerut , Uttar Pradesh

Sona Medical Centre 5/58,Near Police Station, Vikas Nagar , Lucknow , Uttar Pradesh

City Super Speciality Hospital Near Mohan Petrol Pump,Gohana Road, Rohtak , Haryana

Navjeevan Hospital & Maternity Centre 753/21,Madanpuri Road, Near Pataudi Chowk , Gurgaon , Haryana

Abhishek Hospital C-12,New Azad Nagar, Kanpur , Kanpur , Uttar Pradesh

Raj Nursing Home 23-A, Park Road , Allahabad , Uttar Pradesh

Sparsh Medicare and Trauma Centre Shakti Khand - III/54 ,Behind Cambridge School , Indirapuram, Ghaziabad , Uttar Pradesh

Saras Healthcare Pvt Ltd. K-112, SEC-12 ,Pratap Vihar , Ghaziabad , Uttar Pradesh

Getwell Soon Multispeciality Institute Pvt Ltd S-19, Shalimar Garden Extn. , Near Dayanand Park, Sahibabad , Ghaziabad , Uttar Pradesh

Shivalik Medical Centre Pvt Ltd A-93, Sector 34 , Noida , Uttar Pradesh

Aakanksha Hospital 126, Aaradhnanagar Soc,B/H. Bhulkabhavan School, Aanand-Mahal Rd. , Adajan , Surat , Gujarat

Abhinav Hospital Harsh Apartment,Nr Jamna Nagar Bus Stop, Goddod Road , Surat , Gujarat

Adhar Ortho Hospital Dawer Chambers,Nr. Sub Jail, Ring Road , Surat , Gujarat

Aris Care Hospital A 223-224, Mansarovar Soc,60 Feet, Godadara Road , Surat , Gujarat

Arzoo Hospital Opp. L.B. Cinema, Bhatar Rd. , Surat , Gujarat

Auc Hospital B-44, Gujarat Housing Board, Pandeshara , Surat , Gujarat

Dharamjivan General Hospital & Trauma Centre Karmayogi - 1, Plot No. 20/21, Near Piyush Point, Pandesara , Surat , Gujarat

Dr. Santosh Basotia Hospital Bhatar Road , Bhatar Road , Surat , Gujarat

God Father Hosp. 344, Nandvan Soc., B/H. Matrushakti Soc. , Puna Gam , Surat , Gujarat

Govind-Prabha Arogya Sankool Opp. Ratna-Sagar Vidhyalaya,Kaji Medan, Gopipura , Surat , Gujarat

Hari Milan Hospital L H Road , Surat , Gujarat

Jaldhi Ano-Rectal Hospital 103, Payal Apt., Nxt To Rander Zone Office, Tadwadi , Surat , Gujarat

Jeevan Path Gen. Hospital 2Nd. Fl., Dwarkesh Nagri, Nr. Laxmi Farsan, Sayan , Surat , Gujarat

Kalrav Children Hospital Yashkamal Complex, Nr. Jivan Jyot, Udhna , Surat , Gujarat

Kanchan General Surgical Hospital Plot No. 380, Ishwarnagar Soc, Bhamroli-Bhatar, Pandesara , Surat , Gujarat

Krishnavati General Hospital Bamroli Road , Surat , Gujarat

Niramayam Hosptial & Prasutigruah Shraddha Raw House, Near Natures Park , Surat , Gujarat

Patna Hospital 25, Ashapuri Soc - 2, Bamroli Road, Surat , Gujarat

Poshia Children Hospital Harekrishan Shoping Complex 1St Floor, Varachha Road , Surat , Gujarat

R.D Janseva Hospital 120 Feet Bamroli Road, Pandesara , Surat , Gujarat

Radha Hospital & Maternity Home 239/240 Bhagunagar Society, Opp Hans Society, L H Road, Varachha Road, Surat , Gujarat

Santosh Hospital L H Road , Varachha , Surat , Gujarat

Sparsh Multy Specality Hospital & Trauma Care Center G.I.D.C Road, Nr Udhana Citizan [Link] , Surat , Gujarat
Notes: 1. For an updated list of Hospitals, please visit the Company's website. 2. Only in case of a medical emergency, Claims would be payable if admitted in the above Hospitals on a reimbursement basis.

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SERVICE REQUEST FORM
For Change in Occupation / Nature of Job
(Refer Clause 7.4 of Policy Terms and Conditions)

To be filled in by Policyholder in CAPITAL LETTERS only.

If there is insufficient space, please provide further details on a separate sheet. All attached documents form part of this service request.
This form has to be filled in and submitted to the company whenever the nature of job / occupation of any insured covered under the Policy changes subsequent to the issuance of the Policy.

Policyholder Details

Mr. Ms. M/S. Policy No :

Name :
(First Name) (Middle Name) (Last Name)

Details of the Insured Persons for whom details are to be updated

Mr. Ms. M/S.

Name :
(First Name) (Middle Name) (Last Name)

Occupation :

Declaration
I hereby declare, on my behalf and on behalf of all persons insured, that the above statement(s), answer(s) and / or particular(s) given by me are true and complete
in all respects to the best of my knowledge and that I am authorized to provide / request for updation of the details on behalf of Insured Persons.

Date : / / (DD/MM/YYYY) Signature of the Policyholder :______________________________

Place : (On behalf of all the persons insured under the Policy)

Note: The Company shall update its record with respect to the information provided above. Subsequently, the Company may review the risk involved and may alter the coverage and / or
premium payable accordingly.

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