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HEALTH INSURANCE POLICY SENIOR CITIZENS 1 WHEREAS the insured designated in the Schedu e heret! has "# a $r!$!

!sa and dec arati!n dated as stated in the Schedu e %hich sha "e the "asis !& this C!ntract and is dee'ed t! "e inc!r$!rated herein has a$$ ied t! UNITE( IN(IA INSURANCE CO)PANY *hereina&ter ca ed the CO)PANY+ &!r the insurance hereina&ter set &!rth in res$ect !& $ers!n*s+na'ed in the Schedu e heret! *hereina&ter ca ed the INSURE( PERSON+ and has $aid $re'iu' as c!nsiderati!n &!r such insurance, NOW THIS POLICY WITNESSES that su"-ect t! the ter's. c!nditi!ns. e/c usi!ns and de&initi!ns c!ntained herein !r end!rsed. !r !ther%ise e/$ressed here!n the C!'$an# underta0es that i& during the $eri!d stated in the Schedu e !r during the c!ntinuance !& this $! ic# "# rene%a an# insured $ers!n sha c!ntract an# disease !r su&&er &r!' an# i ness *hereina&ter ca ed (ISEASE+ !r sustain an# "!di # in-ur# thr!ugh accident *hereina&ter ca ed IN1URY+ and i& such disease !r in-ur# sha re2uire an# such insured Pers!n. u$!n the ad3ice !& a du # 2ua i&ied Ph#sician4)edica S$ecia ist4)edica $ractiti!ner *hereina&ter ca ed )E(ICAL PRACTITIONER+ !r !& a du # 2ua i&ied Surge!n *hereina&ter ca ed SUR5EON+ t! incur h!s$ita isati!n4d!'ici iar# h!s$ita isati!n e/$enses &!r 'edica 4surgica treat'ent at an# Nursing H!'e4H!s$ita in India as herein de&ined *hereina&ter ca ed HOSPITAL+ as an in$atient. the C!'$an# %i $a# thr!ugh TPA t! the H!s$ita 4 Nursing H!'e !r the Insured Pers!n the a'!unt !& such e/$enses as are reas!na" # and necessari # incurred in res$ect there!& "# !r !n "eha & !& such Insured Pers!n "ut n!t e/ceeding the Su' Insured in aggregate in an# !ne $eri!d !& insurance stated in the schedu e heret!, In the e3ent !& an# c ai'4s "ec!'ing ad'issi" e under this sche'e. the c!'$an# %i $a# thr!ugh TPA t! the H!s$ita 4 Nursing H!'e !r the insured $ers!n the a'!unt !& such e/$enses as %!u d &a under di&&erent heads 'enti!ned "e !%. and as are reas!na" # and necessari # incurred there!& "# !r !n "eha & !& such Insured Pers!n. "ut n!t e/ceeding the Su' Insured in aggregate 'enti!ned in the schedu e heret!, A,R!!'. 7!arding and Nursing e/$enses as $r!3ided "# the H!s$ita 4Nursing H!'e n!t e/ceeding 18 !& the su' insured $er da# !r the actua a'!unt %hiche3er is ess, This a s! inc udes nursing care. R)O charges. I9 : uids47 !!d trans&usi!n4in-ecti!n ad'inistrati!n charges and si'i ar e/$enses, 7,ICU e/$enses n!t e/ceeding 68 !& the su' insured $er da# !r actua a'!unt %hiche3er is ess, C,Surge!n. Anaesthetist. )edica Practiti!ner. C!nsu tants. S$ecia ists :ees (,Anaesthesia. 7 !!d. O/#gen. O$erati!n Theatre Charges. surgica a$$ iances. )edicines ; (rugs. (iagn!stic )ateria s and <=ra#. (ia #sis. Che'!thera$#. Radi!thera$#. C!st !& Arti&icia Li'"s. c!st !& $r!sthetic de3ices i'$ anted during surgica $r!cedure i0e $ace'a0er. !rth!$aedic i'$ ants. in&ra cardiac 3a 3e re$ ace'ents. 3ascu ar stents, E,H!s$ita isati!n e/$enses *e/c uding c!st !& !rgan+ incurred &!r d!n!r in res$ect !& !rgan trans$ ant t! the insured, The c!'$an#>s ia"i it# under this head sha n!t e/ceed the t!ta SI !& the insured under the $! ic#,



N(,? The a'!unt $a#a" e under 1,6 C ; ( a"!3e sha "e at the rate a$$ ica" e t! the entit ed r!!' categ!r#, In case Insured !$ts &!r a r!!' %ith rent higher than the entit ed categ!r# as in 1,6 A a"!3e. the charges $a#a" e under 1,6 C ; ( sha "e i'ited t! the charges a$$ ica" e t! the entit ed categ!r#, E/$enses in res$ect !& the &! !%ing s$eci&ied i nesses %i "e restricted as detai ed "e !%? H!s$ita isati!n 7ene&its LI)ITS $er surger# RESTRICTE( TO a,Cataract. Hernia. a,Actua e/$enses incurred !r 6A8 !& th su' insured %hiche3er is ess H#sterect!'# ",)a-!r surgeries@ ",Actua e/$enses incurred !r BC8 !& th su' insured %hiche3er is ess @ )a-!r surgeries inc ude cardiac surgeries. "rain tu'!ur surgeries. $ace 'a0er i'$ antati!n &!r sic0 sinus s#ndr!'e. cancer surgeries. hi$. 0nee. -!int re$ ace'ent surger#, Pre and P!st H!s$ita isati!n e/$enses $a#a" e in res$ect !& each h!s$ita isati!n sha "e the actua e/$enses incurred su"-ect t! a 'a/i'u' !& 1C8 !& the Su' Insured The a"!3e i'its s$eci&ied are a$$ ica" e $er h!s$ita isati!n 4 surger#, E<PENSES ON )A1OR ILLNESSES CHAR5E( AS A TOTAL PACDA5E TO 7E SETTLE( WITH A CO=PAY ON EC?6C 7ASIS,

*N,7? C!'$an#Fs Lia"i it# in res$ect !& a c ai's ad'itted during the $eri!d !& insurance sha n!t e/ceed the Su' Insured $er $ers!n as 'enti!ned in the schedu e+ 6 6,1 (E:INITIONS? HOSPITAL 4 NURSIN5 HO)E 'eans an# instituti!n in India esta" ished &!r ind!!r care and treat'ent !& sic0ness and in-uries and %hich Either *a+ has "een registered as a H!s$ita !r Nursing H!'e %ith the !ca auth!rities and is under the su$er3isi!n !& a registered and 2ua i&ied )edica Practiti!ner, Or *"+ Sh!u d c!'$ # %ith 'ini'u' criteria as under?= i+ It sh!u d ha3e at east 1A in$atient "eds, ii+ :u # e2ui$$ed !$erati!n theatre !& its !%n %here3er surgica !$erati!ns are carried !ut, iii+ :u # 2ua i&ied Nursing Sta&& under its e'$ !#'ent r!und the c !c0, i3+ :u # 2ua i&ied (!ct!r *s+ sh!u d "e in=charge r!und the c !c0,

N,7? In c ass FCF t!%ns c!nditi!n !& nu'"er !& "eds "e reduced t! 1C,


The ter' F H!s$ita 4 Nursing H!'e F sha n!t inc ude an esta" ish'ent %hich is a $ ace !& rest. a $ ace &!r the aged. a $ ace &!r drug= addicts !r $ ace &!r a c!h! ics. a h!te !r a si'i ar $ ace,

2.2 2.3

FSurgica O$erati!nF 'eans 'anua and 4 !r !$erati3e $r!cedures &!r c!rrecti!n !& de&!r'ities and de&ects. re$air !& in-uries. diagn!sis and cure !& diseases. re ie& !& su&&ering and $r! !ngati!n !& i&e, E/$enses !n H!s$ita isati!n &!r 'ini'u' $eri!d !& 6G h!urs are ad'issi" e, treat'ents. A$$endect!'# C!r!nar# angi!gra$h# C!r!nar# angi!$ ast# (enta surger# (;C E#e surger# :racture4 dis !cati!n e/c uding hair ine &racture Radi!thera$# Lith!tri$s# Incisi!n and drainage !& a"cess C! !n!sc!$# Hae'! dia #sis H#dr!ce e H#sterect!'# Inguina 43entra 4 u'"i ica 4&e'!ra hernia Parentera che'!thera$# Pi es4 &istu a Pr!strate Sinusitis T!nsi ect!'# Li3er as$irati!n Sc er!thera$# H!%e3er. this ti'e i'it is n!t a$$ ied t! s$eci&ic

Or an# !ther surgeries 4 $r!cedures agreed "# the TPA4 C!'$an# %hich re2uire ess than 6G h!urs h!s$ita isati!n N!te? Pr!cedures4treat'ents usua # d!ne in !ut $atient de$art'ent are n!t $a#a" e under the $! ic# e3en i& c!n3erted as an in=$atient in the h!s$ita &!r '!re than 6G h!urs 6,G At the ince$ti!n !& the $! ic#. i& the insured dec ares the e/istence !& dia"etes. h#$ertensi!n. Ch! ester! . then the $! ic# %i n!t $a# &!r the e/$enses incurred &!r the direct treat'ent !& these i nesses, H!%e3er. !ther c!'$ icati!ns n!t ha3ing a direct "earing t! these i nesses "ut c!ntracted during the $! ic# $eri!d necessitating h!s$ita isati!n. such e/$enses %i "e rei'"ursed $r!3ided the# are n!t !ther%ise e/c uded as $er $! ic# c!nditi!n, An additi!na $re'iu' !& HC8 %i "e charged !n the "asic $re'iu', (O)ICILIARY HOSPITALISATION 7ENE:IT 'eans?= )edica treat'ent &!r a $eri!d e/ceeding three da#s &!r such i ness 4 disease 4 in-ur# %hich in the n!r'a c!urse %!u d re2uire care and treat'ent at a h!s$ita 4 nursing h!'e "ut actua # ta0en %hi st c!n&ined at h!'e in India under an# !& the &! !%ing circu'stances na'e #?= i+ ii+ The c!nditi!n !& the $atient is such that he 4 she cann!t "e re'!3ed t! the h!s$ita 4 nursing h!'e !r The $atient cann!t "e re'!3ed t! H!s$ita 4 Nursing h!'e &!r ac0 !& acc!''!dati!n therein


Su"-ect h!%e3er that d!'ici iar# h!s$ita isati!n "ene&its sha n!t c!3er? I+ II+ E/$enses incurred &!r $re and $!st h!s$ita treat'ent and E/$enses incurred &!r treat'ent &!r an# !& the &! !%ing diseases?= 1+ 6+ H+ G+ A+ I+ B+ E+ K+ 1C+ 11+ 16+ Asth'a 7r!nchitis Chr!nic Ne$hritis and Ne$hritic S#ndr!'e (iarrh!ea and a t#$e !& (#senteries inc uding 5astr!enteritis (ia"etes )e itus E$i e$s# H#$ertensi!n In& uenJa. C!ugh and C! d A Ps#chiatric !r Ps#ch!s!'atic (is!rders P#re/ia !& un0n!%n Origin &!r ess than 1C da#s T!nsi itis and U$$er Res$irat!r# Tract in&ecti!n inc uding Lar#ngitis and $harangitis Arthritis. 5!ut and Rheu'atis'

N!te? When treat'ent such as dia #sis. Che'!thera$#. Radi!thera$#,. etc is ta0en in the h!s$ita 4 nursing h!'e and the insured is discharged !n the sa'e da# the treat'ent %i "e c!nsidered t! "e ta0en under h!s$ita isati!n "ene&it secti!n, Lia"i it# !& the c!'$an# under this c ause is restricted as stated in the Schedu e attached heret!, H,C ANY ONE ILLNESS? = An# !ne i ness %i "e dee'ed t! 'ean c!ntinu!us $eri!d !& i ness and it inc udes re a$se %ithin GA da#s &r!' the date !& discharge &r!' the H!s$ita 4 Nursing H!'e %here treat'ent has "een ta0en, Occurrence !& the sa'e i ness a&ter a a$se !& GA da#s as stated a"!3e %i "e c!nsidered as &resh i ness &!r the $ur$!se !& this $! ic#,


PRE = HOSPITALISATION? = Re e3ant 'edica e/$enses incurred during $eri!d u$ t! HC da#s $ri!r t! H!s$ita isati!n !n disease 4 i ness 4 in-ur# sustained %i "e c!nsidered as $art !& c ai' as 'enti!ned under ite' 1,6 a"!3e,


POST HOSPITALISATION? = Re e3ant 'edica e/$enses incurred during $eri!d u$ t! IC da#s a&ter h!s$ita isati!n !n disease 4 i ness 4 in-ur# sustained %i "e c!nsidered as $art !& c ai' as 'enti!ned under ite' 1,6 a"!3e

3.3 )E(ICAL PRACTITIONER 'eans a $ers!n %h! h! ds a degree 4 di$ !'a !& a rec!gnised instituti!n and is registered "# )edica
res$ecti3e State !& India, The ter' )edica Practiti!ner %!u d inc ude Ph#sician. S$ecia ist and Surge!n,

C!unci !&

3.4 LUALI:IE( NURSE 'eans a $ers!n %h! h! ds a certi&icate !& a rec!gnised Nursing C!unci
attending )edica Practiti!ner,

and %h! is e'$ !#ed !n rec!''endati!n !& the

3.5 TPA 'eans a Third Part# Ad'inistrat!r %h! h! ds a 3a id License &r!' Insurance Regu at!r# and (e3e !$'ent Auth!rit# t! act as a THIR(
PARTY A()INISTRATOR and is e'$ane ed "# the C!'$an# &!r the $r!3isi!n !& hea th ser3ices as s$eci&ied in the agree'ent "et%een the C!'$an# and TPA G, E<CLUSIONS?= The c!'$an# sha n!t "e ia" e t! 'a0e an# $a#'ent under this $! ic# in res$ect !& an# e/$enses %hats!e3er incurred "# an# Insured Pers!n in c!nnecti!n %ith !r in res$ect !&? G,1 An# $re=e/isting c!nditi!n*s+ as de&ined in the $! ic#. unti GE '!nths !& c!ntinu!us c!3erage !& such insured $ers!n ha3e e a$sed. since ince$ti!n !& his4her &irst P! ic# %ith the C!'$an#, Pre=E/isting C!nditi!n4(isease de&initi!n An# c!nditi!n. ai 'ent !r in-ur# !r re ated c!nditi!n*s+ &!r %hich insured $ers!n had signs !r s#'$t!'s. and4!r %ere diagn!sed. and4!r recei3ed 'edica ad3ice4treat'ent. %ithin GE '!nths $ri!r t! his4her &irst $! ic# %ith the C!'$an#, An# disease !ther than th!se stated in c ause G,H. c!ntracted "# the Insured $ers!n during the &irst HC da#s &r!' the c!''ence'ent date !& the $! ic#, This c!nditi!n G,6 sha n!t h!%e3er. a$$ # in case !& the Insured $ers!n ha3ing "een c!3ered under this sche'e !r 5r!u$ Insurance Sche'e %ith an# !& the Indian Insurance C!'$anies &!r a c!ntinu!us $eri!d !& $receding 16 '!nths %ith!ut an# "rea0, MN!te? These e/c usi!ns G,1 and G,6 sha n!t h!%e3er a$$ # i&. a, ", G,H In the !$ini!n !& a Pane !& )edica Practiti!ners c!nstituted "# the C!'$an# &!r the $ur$!se. the Insured Pers!n c!u d n!t ha3e 0n!%n !& the e/istence !& the disease !r an# s#'$t!'s !r c!'$ aints there!& at the ti'e !& 'a0ing the $r!$!sa &!r insurance t! the C!'$an#, The insured had n!t ta0en an# c!nsu tati!n. treat'ent !r 'edicati!n. in res$ect !& the h!s$ita isati!n &!r %hich c ai' has "een !dged under the $! ic# $ri!r t! ta0ing the insurance,


(uring the &irst t%! #ears !& the !$erati!n !& the $! ic#. the e/$enses !n treat'ent !& diseases such as Cataract. 7enign Pr!static H#$erthr!$h#. H#sterect!'# &!r )en!rrhagia. !r :i"r!'#!'a. Hernia. H#dr!ce e. C!ngenita interna disease. :istu a in anus. $i es. Sinusitis and re ated dis!rders. 5a 7 adder St!ne Re'!3a . 5!ut ; Rheu'atis'. Ca cu us (iseases. 1!int Re$ ace'ent due t! (egenerati3e c!nditi!n and age=re ated Oste!arthiritis ; Oste!$!r!sis are n!t $a#a" e, I& these diseases *!ther than c!ngenita interna disease+ are $re=e/isting at the ti'e !& $r!$!sa the# %i n!t "e c!3ered e3en during su"se2uent $eri!d !& rene%a , I& the insured is a%are !& the e/istence !& c!ngenita interna disease "e&!re ince$ti!n !& $! ic#. the sa'e %i "e treated as $re=e/isting, In-ur# 4 disease direct # !r indirect # caused "# !r arising &r!' !r attri"uta" e t! in3asi!n. Act !& :!reign ene'#. War i0e !$erati!ns *%hether %ar "e dec ared !r n!t+


G,A a, Circu'cisi!n un ess necessar# &!r treat'ent !& a disease n!t e/c uded hereunder !r as 'a# "e necessitated due t! an accident. ", 3accinati!n !r in!cu ati!n !r change !& i&e !r c!s'etic !r aesthetic treat'ent !& an# descri$ti!n. such as c!rrecti!n !& e#e sight. etc c, $ astic surger# !ther than as 'a# "e necessitated due t! an accident !r as a$art !& an# i ness, G,I C!st !& s$ectac es and c!ntact enses. hearing aids, G,B (enta treat'ent !r surger# !& an# 0ind un ess necessitated "# accident and re2uiring h!s$ita isati!n, G,E C!n3a escence. genera de"i it#N run=d!%n c!nditi!n !r rest cure. C!ngenita e/terna disease !r de&ects !r an!'a ies. Steri it#. 9enerea disease. intenti!na se & in-ur# and use !& int!/icati!n drugs 4 a c!h! G,K A e/$enses arising !ut !& an# c!nditi!n direct # !r indirect # caused t! !r ass!ciated %ith Hu'an T=Ce L#'$h!tr!$ic 9irus T#$e III *HTL7 = III+ !r #'$hadin!$ath# Ass!ciated 9irus *LA9+ !r the )utants (eri3ati3e !r 9ariati!n (e&icienc# S#ndr!'e !r an# s#ndr!'e !r c!nditi!n !& a si'i ar 0ind c!''!n # re&erred t! as AI(S,

G,1C Charges incurred at H!s$ita !r Nursing H!'e $ri'ari # &!r diagn!sis /=ra# !r La"!rat!r# e/a'inati!ns !r !ther diagn!stic studies n!t c!nsistent %ith !r incidenta t! the diagn!sis and treat'ent !& $!siti3e e/istence !r $resence !& an# ai 'ent. sic0ness !r in-ur#. &!r %hich c!n&ine'ent is re2uired at a H!s$ita 4 Nursing H!'e G,11 E/$enses !n 3ita'ins and t!nics un ess &!r'ing $art !& treat'ent &!r in-ur# !r diseases as certi&ied "# the attending $h#sician G,11,1 In-ur# !r (isease direct # !r indirect # caused "# !r c!ntri"uted t! "# nuc ear %ea$!n 4 'ateria s G,16 Treat'ent arising &r!' !r tracea" e t! $regnanc# *inc uding 3! untar# ter'inati!n !& $regnanc#+ and chi d"irth. *inc uding caesarean secti!n+

4.13 Natur!$ath# Treat'ent. acu$ressure. acu$uncture. e/$eri'enta 4.14E/terna

and un$r!3en treat'ents4 thera$ies,

and !r dura" e )edica 4 N!n='edica e2ui$'ent !& an# 0ind used &!r diagn!sis and !r treat'ent inc uding CPAP. CAP(. In&usi!n $u'$ etc, A'"u at!r# de3ices i,e,. %a 0er. crutches. 7e ts. C! ars. Ca$s. S$ ints. S ings. 7races. St!c0ings. e ast!cre$e "andages. e/terna !rth!$aedic $ads. su" cutane!us insu in $u'$. etc,. !& an# 0ind, (ia"etic &!!t %ear. 5 uc!'eter 4 Ther'!'eter. a $ha 4 %ater "ed and si'i ar re ated ite's etc,. and a s! an# 'edica e2ui$'ent. %hich su"se2uent # used at h!'e etc, An# 0ind !& Ser3ice charges. Surcharges. Ad'issi!n :ees4Registrati!n Charges e3ied "# the h!s$ita ,

G,1A A,


A,1E3er# n!tice !r c!''unicati!n regarding h!s$ita isati!n !r c ai' t! "e gi3en !r 'ade under this P! ic# sha "e de i3ered in %riting at the address !& the TPA !&&ice as sh!%n in the Schedu e, Other 'atters re ating t! the $! ic# 'a# "e c!''unicated t! the $! ic# issuing !&&ice, A,6The $re'iu' $a#a" e under this P! ic# sha "e $aid in ad3ance, N! recei$t &!r Pre'iu' sha "e 3a id e/ce$t !n the !&&icia &!r' !& the c!'$an# signed "# a du # auth!rised !&&icia !& the c!'$an#, The due $a#'ent !& $re'iu' and the !"ser3ance and &u &i 'ent !& the ter's. $r!3isi!ns. c!nditi!ns and end!rse'ents !& this P! ic# "# the Insured Pers!n in s! &ar as the# re ate t! an#thing t! "e d!ne !r c!'$ ied %ith "# the Insured Pers!n sha "e a c!nditi!n $recedent t! an# ia"i it# !& the C!'$an# t! 'a0e an# $a#'ent under this P! ic#, N! %ai3er !& an# ter's. $r!3isi!ns. c!nditi!ns and end!rse'ents !& this $! ic# sha "e 3a id un ess 'ade in %riting and signed "# an auth!rised !&&icia !& the C!'$an#, A,HU$!n the ha$$ening !& an# e3ent %hich 'a# gi3e rise t! a c ai' under this P! ic# n!tice %ith &u $articu ars sha "e sent t! the TPA na'ed in the schedu e i''ediate # and in case !& e'ergenc# H!s$ita isati!n %ithin 6G h!urs &r!' the ti'e !& H!s$ita isati!n 4 (!'ici iar# H!s$ita isati!n, A,GA su$$!rting d!cu'ents re ating t! the c ai' 'ust "e &i ed %ith TPA %ithin B da#s &r!' the date !& discharge &r!' the h!s$ita , In case !& $!st=h!s$ita isati!n. treat'ent * i'ited t! IC da#s+. a c ai' d!cu'ents sh!u d "e su"'itted %ithin B da#s a&ter c!'$ eti!n !& such treat'ent, N!te? Wai3er !& this C!nditi!n 'a# "e c!nsidered in e/tre'e cases !& hardshi$ %here it is $r!3ed t! the satis&acti!n !& the C!'$an# that under the circu'stances in %hich the insured %as $ aced it %as n!t $!ssi" e &!r hi' !r an# !ther $ers!n t! gi3e such n!tice !r &i e c ai' %ithin the $rescri"ed ti'e= i'it, A,A The Insured Pers!n sha !"tain and &urnish the TPA %ith a !rigina "i s. recei$ts and !ther d!cu'ents u$!n %hich a c ai' is "ased and sha a s! gi3e the TPA 4 C!'$an# such additi!na in&!r'ati!n and assistance as the TPA 4 C!'$an# 'a# re2uire in dea ing %ith the c ai', An# 'edica $ractiti!ner auth!rised "# the TPA 4 C!'$an# sha "e a !%ed t! e/a'ine the Insured Pers!n in case !& an# a eged in-ur# !r disease re2uiring H!s$ita isati!n %hen and s! !&ten as the sa'e 'a# reas!na" # "e re2uired !n "eha & !& the TPA4C!'$an#, The C!'$an# sha n!t "e ia" e t! 'a0e an# $a#'ent under this $! ic# in res$ect !& an# c ai' i& such c ai' "e in an# 'anner &raudu ent !r su$$!rted "# an# &raudu ent 'eans !r de3ice %hether "# the Insured Pers!n !r "# an# !ther $ers!n acting !n his "eha &, I& at the ti'e %hen an# c ai' arises under this P! ic#. there is in e/istence an# !ther insurance *!ther than Cancer Insurance P! ic# in c! a"!rati!n %ith Indian Cancer S!ciet#+. %hether it "e e&&ected "# !r !n "eha & !& an# Insured Pers!n in res$ect !& %h!' the c ai' 'a# ha3e arisen c!3ering the sa'e !ss. ia"i it#. c!'$ensati!n. c!sts !r e/$enses. the C!'$an# sha n!t "e ia" e t! $a# !r c!ntri"ute '!re than its ratea" e $r!$!rti!n !& an# !ss. ia"i it#. c!'$ensati!n c!sts !r e/$enses, The "ene&its under this P! ic# sha "e in e/cess !& the "ene&its a3ai a" e under Cancer Insurance P! ic#,


5.9 1.

Renewal Clause: The Company shall renew this Policy if the Insured shall remit the requisite Premium to the Company prior to e piry of the Period of Insurance stated in the !chedule. The Company shall "e entitled to decline renewal if# any fraud% misrepresentation or suppression "y the Insured or on his "ehalf is found either in o"tainin& insurance or su"sequently in relation thereto or% the Company has discontinued issue of the Policy% in which e'ent the Insured shall howe'er ha'e the option for renewal under any similar Policy "ein& issued "y the Company# pro'ided howe'er% "enefits paya"le shall "e su"(ect to the terms contained in such other Policy.

2. a$



If the Insured fails to remit Premium for renewal "efore e piry of the Period of Insurance% "ut within 15 days thereafter% admissi"ility of any claim durin& the period of su"sequent Policy shall "e considered in the same manner as under a Policy renewed without "rea*. The Company howe'er shall not "e lia"le for any claim arisin& out of ailment suffered or hospitalisation commencin& in the interim period after e piry of the earlier Policy and prior to date of commencement of su"sequent Policy. The Insured may see* enhancement of !um Insured in writin& at or "efore payment of premium for renewal% which may "e &ranted at the discretion of the Company. +owe'er% notwithstandin& enhancement% for claims arisin& in respect of ailment% disease or in(ury contracted or suffered durin& a precedin& Policy period% lia"ility of the Company shall "e only to the e tent of the !um Insured under the Policy in force at the time when it was contracted or suffered


Cance ati!n C ause? The C!'$an# 'a# at an# ti'e cance the P! ic# !n gr!unds !& 'isre$resentati!n. &raud. n!n=disc !sure !& 'ateria &act !r n!n= c!!$erati!n "# the insured "# sending se3en da#s n!tice in %riting "# Registered A4( t! the insured at his ast 0n!%n address in %hich case the C!'$an# sha return t! the insured a $r!$!rti!n !& the ast $re'iu' c!rres$!nding t! the une/$ired $eri!d !& insurance i& n! c ai' has "een $aid under the $! ic#, The insured 'a# at an# ti'e cance this $! ic# and in such e3ent the C!'$an# sha a !% re&und !& $re'iu' at C!'$an#>s sh!rt $eri!d rate ta" e gi3en "e !% $r!3ided n! c ai' has !ccurred u$t! the date !& cance ati!n, PERIO( ON RISD U$t! !ne '!nth U$t! three '!nths U$t! si/ '!nths E/ceeding si/ '!nths A,1C RATE O: PRE)IU) TO 7E CHAR5E(, 14G th !& the annua rate 146 !& the annua rate H4Gth !& the annua rate :u annua rate,

I& an# dis$ute !r di&&erence sha arise as t! the 2uantu' t! "e $aid under the $! ic# * ia"i it# "eing !ther%ise ad'itted+ such di&&erence sha inde$endent # !& a !ther 2uesti!ns "e re&erred t! the decisi!n !& a s! e ar"itrat!r t! "e a$$!inted in %riting "# the $arties !r i& the# cann!t agree u$!n a sing e ar"itrat!r %ithin HC da#s !& an# $art# in3!0ing ar"itrati!n. the sa'e sha "e re&erred t! a $ane !& three ar"itrat!rs. c!'$rising !& t%! ar"itrat!rs. !ne t! "e a$$!inted "# each !& the $arties t! the dis$ute4di&&erence and the third ar"itrat!r t! "e a$$!inted "# such t%! ar"itrat!rs and ar"itrati!n sha "e c!nducted under and in acc!rdance %ith the $r!3isi!ns !& the Ar"itrati!n and C!nci iati!n Act. 1KKI, It is c ear # agreed and underst!!d that n! di&&erence !r dis$ute sha "e re&era" e t! ar"itrati!n as herein "e&!re $r!3ided. i& the C!'$an# has dis$uted !r n!t acce$ted ia"i it# under !r in res$ect !& this P! ic#, It is here"# e/$ress # sti$u ated and dec ared that it sha "e a c!nditi!n $recedent t! an# right !& acti!n !r suit u$!n this $! ic# that a%ard "# such ar"itrat!r4ar"itrat!rs !& the a'!unt !& the !ss !r da'age sha "e &irst !"tained,


A,16 I,

I& the C!'$an#. as $er ter's and c!nditi!ns !& the $! ic# sha disc ai' ia"i it# t! the Insured &!r an# c ai' hereunder and i& the Insured sha n!t %ithin 16 ca endar '!nths &r!' the date !r recei$t !& the n!tice !& such disc ai'er n!ti&# the TPA4 C!'$an# in %riting that he d!es n!t acce$t such disc ai'er and intends t! rec!3er his c ai' &r!' the TPA4C!'$an# then the c ai' sha &!r a $ur$!ses "e dee'ed t! ha3e "een a"and!ned and sha n!t therea&ter "e rec!3era" e hereunder, A 'edica 4surgica treat'ents under this $! ic# sha ha3e t! "e ta0en in India and ad'issi" e c ai's there!& sha "e $a#a" e in Indian currenc#, PAY)ENT O: CLAI) A c ai's under this $! ic# sha "e $a#a" e in Indian currenc#, A 'edica treat'ents &!r the $ur$!se !& this insurance %i ha3e t! ta0en in India !n #, Pa#'ent !& c ai' sha "e 'ade thr!ugh TPA t! the H!s$ita 4Nursing H!'e !r the Insured Pers!n as the case 'a# "e,

NO CLAI) (ISCOUNT The insured sha "e entit ed &!r N! C ai' (isc!unt !& A8 &!r e3er# c ai' &ree #ear su"-ect t! a 'a/i'u' !& 6A8 $r!3ided the $! ic# is rene%ed c!ntinu!us # %ith!ut "rea0, N,7? N! C ai' (isc!unt %i "e !st &u # i& $! ic# is n!t rene%ed %ithin the grace $eri!d a !%ed under the $! ic#,

COST O: HEALTH CHECD UP The insured sha "e entit ed &!r rei'"urse'ent !& the c!st !& )edica chec0=u$s !nce at the end !& " !c0 !& e3er# three under%riting #ears $r!3ided there are n! c ai's re$!rted during the " !c0, Such rei'"urse'ent sha "e restricted t! 18 !& the a3erage SI !& the $receding three #ears,



1, 6,

:!r a net%!r0ed h!s$ita . it sha 'ean the rate $re=agreed "et%een Net%!r0ed H!s$ita and the TPA &!r surgica 4 'edica treat'ent that is necessar#. cust!'ar# and reas!na" e &!r treating the c!nditi!n &!r %hich the insured $ers!n %as h!s$ita ised :!r an# !ther h!s$ita . it sha 'ean the c!st !& surgica 4 'edica treat'ent that is necessar#. cust!'ar# and reas!na" e &!r treating the c!nditi!n &!r %hich insured $ers!n %as h!s$ita ised t! the e/tent re ata" e t! such c!nditi!n,


IR(A RE5ULATIONS? This $! ic# is su"-ect t! Regu ati!ns !& IR(A *Pr!tecti!n !& P! ic#h! ders> ti'e, Interest+ Regu ati!ns. 6CC6 as a'ended &r!' ti'e t!


5RIE9ANCE RE(RESSAL? In the e3ent !& the $! ic#h! der ha3ing an# grie3ance re ating t! the insurance. he4she 'a# c!ntact an# !& the 5rie3ance Ce s at Regi!na O&&ices !& the C!'$an# !r O&&ice !& the Insurance O'"uds'an under the -urisdicti!n !& %hich the P! ic# Issuing O&&ice &a s,