Date: 22/03/2015

Policy Number: 30410704201500 Customer ID: 0000355120 Dear Dr. Subir Roy

Houseno.106 Shree Gaondevi Siddhi Chs, Devichapada Near Gaondevi Mandir, Dombivli West, -,

Mumbai, Maharashtra-421202 Mobile: 09930830118

Thank you for choosing Max Bupa as your preferred health insurance partner. At Max Bupa, we put your health first and are committed to provide you access to the very best of healthcare, backed by the highest standards of service.

Please find enclosed your Max Bupa Policy Kit which will help you understand your policy in detail and give you more information on how to access our services easily. Your policy kit includes the following:

Personalized Health Card: To access our wide range of hospitals for cashless hospitalization.

Insurance Certificate: Confirming your specific policy details like date of commencement, persons covered and specific conditions related to your plan.

Premium Receipt : Receipt issued for the premium paid by you.

Policy Terms and Conditions : For a clear understanding of policy coverages and exclusions.

Claim Form : For cashless as well as reimbursement of claims. Information sheet: This confirms the detail as per your conversation with the Health Insurance

Counsellor-Telesales. Annexure of Policyholder Servicing Turnaround Times as prescribed by Insurance Regulatory and

Development Authority (IRDA) Do visit us online at www.maxbupa.com to view and download our updated list of network hospitals in your city, download claim forms and for other useful information. You can register with us online using your policy number, date of birth & email id and access your policy details. In case of any further assistance, call us at 1800-3010-3333 (Toll Free) or email us at customercare@maxbupa.com. I request you to read your policy terms and conditions highlighted in the Customer Information Sheet of this document so that you are fully aware of your policy benefits. Assuring you of our best services and wishing you and your loved ones good health always. Yours Sincerely,

Somesh Chandra

Chief Operations Officer & Chief Quality Officer Important - Please read this document and keep in a safe place.

Corrigendum to Key Feature Document -Family First Maternity: Kindly note that under Heartbeat

Family First policy, Maternity Benefit are payable post a waiting period of 24 months from the policy

issuance as per plan eligibility. The Condition of minimum 3 adults / one male member for payment of

maternity claims as mentioned in the Key feature document (provided along with the proposal form)

shall not apply and may be ignored.

Free Look Period: We offer you a 15 day free look period. Please read your policy terms and conditions in the Customer Information Sheet of this document. If you are not satisfied, you have the option to cancel the policy within 15 days of the receipt of policy.

Key Benefits of your policy are as follows

Particulars Benefit Offering (on Annual Basis)

Hospitalization Expenses Upto Sum Insured

All Day Care Procedures Upto Sum Insured

Pre & Post Hospitalization Expenses Pre Hospitalization upto 30 days

Post Hospitalization upto 60 days

Maternity & New Born Baby Cover As per your plan

Organ Donor Upto Sum Insured

Health Check up As per your plan

Loyalty Benefit Bonus Points 10% of last paid premium (excluding service tax)

Or Enhanced Sum Insured 10% of expiring base Sum Insured maximum upto 50% of the current base sum insured.

Domiciliary Hospitalization Upto 5% of Sum Insured

Ambulance Cover Upto Sum Insured in case of network hospi tals

Upto Rs. 2000 in case of non-network hospitals

The major exclusions of your policy are as follows

Particulars Details

Initial waiting period 90 days (not applicable for renewal policies)

Pre Existing Disease * 48 months(Silver)/24 months(Gold and Platinum) since

inception of first policy with us

Specific waiting period for insured above the age of 60 years

24 months since inception of first policy with us

Personal Waiting Period * 24 months since inception of first policy with us

Permanent Exclusions + As mentioned in Policy Wording

+ Please refer to Customer Information Sheet in this policy document to know more

* Please refer to Policy Certificate to know conditions (if any)

You can reach us on 1800-3010-3333

This Page is Intentionally Left Blank.

Policy Document Insurance Certificate

Original Policyholder Details at the Time of First Risk Inception

Original Policyholder Name Subir Roy

Original Policyholders address Houseno.106 Shree Gaondevi Siddhi Chs, Devichapada Near Gaondevi Mandir, Dombivli West, Mumbai, -, Maharashtra - 421202

Premium Details

Net Premium (Rs.)

Service Tax (Rs.)

Education Cess (Rs.)

Secondary & Higher Education

Cess (Rs.)

Gross Premium (Rs.)

Gross Premium (Rs.) (in words)

16,804.00 2,017.00 40.00 20.00 18,881.00 Eighteen Thousand Eight Hundred Eighty One Only

Insured Details

Name of the Insured Person (s)

Age Gender Relationship with the Policy Holder

Pre Existing Condition#

Personal Waiting Period*

Mr. Subir Roy 31 M Applicant None

None

Ms. Sayantanee Sen Roy 26 F Spouse None None

Dr. Subir Roy Houseno.106 Shree Gaondevi Siddhi Chs, Devichapada Near Gaondevi Mandir, Dombivli West, Mumbai, -, Maharashtra - 421202

Branch Office

NOC

Policy Number 30410704201500

Policy Commencement Date

From 20/03/2015 00:00 a.m.

Policy Expiry date To 19/03/2017 23:59 p.m.

Sum Insured (Rs.) 17,00,000 Loyalty Benefit Increase in Sum Assured

Total Sum Insured 17,00,000 Heartbeat Individual No

Heartbeat Family Floater No

Heartbeat Family First Yes Plan opted for FamilyFirst Silver 1 lac + 15 lacs

Policy Period 2 year Renewal Due Date 19/03/2017

(* - Please refer clause 4.d of Part II of the schedule) (# - Pre Existing Conditions as disclosed by the customer or discovered by us during medical underwri ting)

Cover Details

Particulars Details Individual Sum Insured (only in case of Family First) 1,00,000

Floater Sum Insured (only in case of Family First) 15,00,000 Sum Insured 17,00,000

Co-pay (applicable at 65 years and above)

Name of the Insured Person(s) Max Bupa Contribution in

1st Policy Year

Max Bupa Contribution in 2nd

Policy Year (applicable for 2 year

policies only)

Mr. Subir Roy 100 100

Ms. Sayantanee Sen Roy 100 100

Permanent Exclusions (if any):

1

2

3

Optional Benefit/Feature Details

Optional Benefit/Feature (only for Silver SI options

of Individual and Family Floater Plans)

Effective [Y/N]

Deductible N

Optional Benefit/Feature Contribution of Max Bupa

Co-pay below 65 years N

Emergency Medical Evacuation (outside India)

Applicable Region (Only for Platinum Policies) No

Nominee Details

Nominee Name Sayantanee Sen Roy

Relationship Spouse

Agent Details

Agent Name Agent

Code

Agent

Contact No.

Agent

Landline No

Agent Address

NA NA NA NA ,

The stamp duty of Re.1 (Rupee one only) vide in challan no. F.10(16210)/ COS(HQ)/CD dated 16th October 2014 through e-stamp certificate No.IN-DL31147224239846M dated 10th November 2014. Service Tax Registration No.: AAFCM7916HST001.

For and on behalf of Max Bupa Health Insurance Co. Ltd.

Somesh Chandra

Chief Operations Officer & Chief Quality Officer Location: New Delhi

Date: 22/03/2015

This Page is Intentionally Left Blank.

Information Summary Sheet

Subject: Information summary of your Health Insurance Policy Dear Dr. Subir Roy, We welcome you to Max Bupa! Thank you for choosing a Max Bupa Health Insurance policy. This letter is with reference to your telephone conversation dated 20/03/2015 with our Health Insurance Counselor-Telesales for buying a health insurance policy. The information provided by you has been mentioned below and FamilyFirst Silver 1 lac + 15 lacs bearing 30410704201500 has been issued based on this information. You are requested to kindly go through the details mentioned below. In case of any discrepancy or further clarifications on information mentioned below or in the policy copy attached, please call us within 15 days of receipt of this letter. Our contact centre number is 1800-3010-3333.

Medical Questions

Within the last 2 years have you consulted a doctor or healthcare professional?

Within the last 7 years have you been to Hospital for an operation and/or an investigation (eg. Scan, X- Ray, biopsy or Blood test)?

Do you take tablets, medicines, or drugs on a regular basis?

Within the last 3 months have you experienced any health problems or medical conditions which you have not seen a doctor for?

Dr. Subir Roy Houseno.106 Shree Gaondevi Siddhi Chs, Devichapada Near Gaondevi Mandir, Dombivli West, Mumbai, -, Maharashtra - 421202

Branch Office

NOC

Policy Number 30410704201500

Policy Commencement Date

From 20/03/2015 00:00 a.m.

Policy Expiry date To 19/03/2017 23:59 p.m.

Sum Insured (Rs.) 17,00,000 Loyalty Benefit Increase in Sum Assured

Total Sum Insured 17,00,000 Heartbeat Individual No

Heartbeat Family Floater No

Heartbeat Family First Yes Plan opted for FamilyFirst Silver 1 lac + 15 lacs

Policy Period 2 year Renewal Due Date 19/03/2017

Mr. Subir Roy No Yes No No

Ms. Sayantanee Sen Roy

No No No No

Original Policyholder Details at the Time of First Risk Inception

Original Policyholder Name Subir Roy

Original Policyholders address Houseno.106 Shree Gaondevi Siddhi Chs, Devichapada Near Gaondevi Mandir, Dombivli West, Mumbai, -, Maharashtra - 421202

Premium Details

Net Premium (Rs.)

Service Tax (Rs.)

Education Cess (Rs.)

Secondary & Higher Education Cess (Rs.)

Gross Premium (Rs.)

Gross Premium (Rs.) (in words)

16,804.00 2,017.00 40.00 20.00 18,881.00 Eighteen Thousand Eight Hundred Eighty One Only

Insured Details

Name of the Insured Person (s)

Age Gender Relationship with the Policy Holder

Pre Existing Condition

Personal Waiting Period *

Mr. Subir Roy 31 M Applicant None

None

Ms. Sayantanee Sen Roy 26 F Spouse None

None

(* - Please refer clause 4.d of Part II of the schedule)

Cover Details

Particulars Details Individual Sum Insured (only in case of Family First) 1,00,000

Floater Sum Insured (only in case of Family First) 15,00,000 Sum Insured 17,00,000

Co-pay (applicable at 65 years and above)

Name of the Insured Person(s) Max Bupa Contribution in 1st

Policy Year

Max Bupa Contribution in 2nd Policy

Year (applicable for 2 year policies

only)

Mr. Subir Roy 100 100

Ms. Sayantanee Sen Roy 100 100

Permanent Exclusions (if any):

1

2

3

Optional Benefit/Feature Details

Optional Benefit/Feature (only for Silver SI options of Individual and Family Floater Plans)

Effective [Y/N]

Deductible N

Optional Benefit/Feature Contribution of Max Bupa

Co-pay below 65 years N

Emergency Medical Evacuation (outside India)

Applicable Region (Only for Platinum Policies) No

Nominee Details

Nominee Name Relationship

Sayantanee Sen Roy Spouse Agent Details

Agent Name Agent Code

Agent Contact No.

Agent Landline No

Agent Address

NA NA NA NA ,

For & on behalf of Max Bupa Health Insurance Co. Ltd.

Somesh Chandra

Chief Operations Officer & Chief Quality Officer Disclaimer: The Cover provided by us is subject to the policy terms and conditions. Please read the terms and

conditions carefully.

Date: 22/03/2015

Location: New Delhi

Premium ReceiptDear Dr. Subir RoyHouseno.106 Shree Gaondevi Siddhi Chs,Devichapada Near Gaondevi Mandir,Dombivli West,-,Mumbai,Maharashtra - 421202

We acknowledge the receipt of payment towards the premium of the following health insurance policy:

Policy Holders Name Dr. Subir Roy Policy Number 30410704201500

FamilyFirst Silver 1 lac + 15 lacs Plan Opted for Sum Insured (Rs) 17,00,000

Commencement Date# 20/03/2015 Expiry date 19/03/2017

Net Premium(Rs.) 16,804.00

Service Tax(Rs.) 2,017.00

Education Cess (Rs.) 40.00

Secondary & Higher Education Cess (Rs.) 20.00

Gross Premium (Rs.) 18,881.00

*Stamp Duty#Issuance of policy is subject to clearance of premium paidDetails of persons Insured:

Mr. Subir Roy 31 M Applicant 1,00,000Ms. Sayantanee Sen Roy 26 F Spouse 1,00,000

Name of person Insured Age Gender Relationship to policy holder Individual Cover(Rs.)(Only in case of Family First)

Somesh ChandraChief Operations Officer & Chief Quality Officer

For & On behalf of Max Bupa Health Insurance Co. Ltd.

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. For the purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax Act, 1961 and any amendments made thereafter. In the event of non-realization of premium, Tax benefits cannot be obtained against this premium receipt. For your eligibility and deductions please refer to provisions of Income Tax Act 1961 as modified and consult your tax consultant.

Service tax Registration number: AAFCM7916HST001

Location: New Delhi Date : 22/03/2015

This Page is Intentionally Left Blank.

Terms & Conditions of the Policy

1. Terms & Conditions

TheinsurancecoverprovidedunderthisPolicytotheInsuredPersonupto

theSumInsuredisandshallbesubjectto(a)thetermsandconditionsof

this Policy and (b) the receipt of premium, and (c) Disclosure to

Information Norm (including by way of the Proposal or Information

SummarySheet)forYourselfandonbehalfofallpersonstobeinsured.

Please inform Us immediately of any change in the address, state of

health,orofanyotherchangesaffectingYouoranyInsuredPerson.

2. Benefits

The Policy covers reasonable expenses incurred towards medical

treatment taken during the Policy Period for an Illness, Accident or

conditiondescribedbelowifthisiscontractedorsustainedbyanInsured

PersonduringthePolicyPeriodandsubjectalwaystotheSumInsured,

anysubsidiary limit specified in theProductBenefitsTable, the terms,

conditions, limitations and exclusions mentioned in the Policy and

eligibilityaspertheinsuranceplanoptedforintheProductBenefitsTable

andasshownintheScheduleofInsuranceCertificate:

2.1. Inpatient Care

WewillcoverMedicalExpensesfor:

(a) MedicalPractitionersfees

(b) Diagnosticsprocedures

(c) Medicines,drugsandconsumables

(d) Intravenous fluids, blood transfusion, injection administration

charges

(e) Operationtheatrecharges

(f) Thecostofprostheticsandotherdevicesorequipmentifimplanted

internallyduringaSurgicalProcedure.

(g) IntensiveCareUnitcharges

2.2. Hospital Accommodation

We will cover Reasonable Charges for Room Rent for Hospital

accommodation.

2.3. Pre- hospitalization Medical Expenses

Wewill coverMedical Expenses incurreddue to Illnessup to 30days

immediatelybeforeanInsuredPersonsadmissiontoaHospitalforthe

sameIllnessaslongasWehaveacceptedanInpatientCareHospitalization

claimunderSection2.1above.Pre-hospitalizationMedicalExpensescan

beclaimedasreimbursementonly.

2.4. Post-Hospitalization Medical Expenses

Wewill coverMedical Expenses incurreddue to Illnessup to 60days

immediately after an InsuredPersons discharge fromHospital for the

sameIllnessaslongasWehaveacceptedanInpatientCareHospitalization

claimunderSection2.1above.Post-hospitalizationMedicalExpensescan

beclaimedasreimbursementonly.

2.5. Day-Care Treatment

We will cover Medical Expenses for Day-Care Treatment where such

procedures/treatments are undertaken by an Insured Person in a

Hospital/DayCareCenterforacontinuousperiodoflessthan24hours.

WewillalsocovertheMedicalExpensesforChemotherapy,Radiotherapy,

Hemodialysis or any other procedure which requires a period of

specializedobservationorcareaftercompletionoftheprocedurewhere

suchprocedureisundertakenbyanInsuredPersoninaHospital/DayCare

Centerforacontinuousperiodoflessthan24hours.

AnyOPDTreatmentundertakeninaHospital/DayCareCenterwillnotbe

covered.

2.6. Domiciliary Treatment

WewillcoverMedicalExpensesformedicaltreatmenttakenathomeif

thiscontinuesforanuninterruptedperiodof3daysandtheconditionfor

which treatment is taken would otherwise have necessitated

Hospitalization as long as either (i) the attendingMedical Practitioner

confirmsthattheInsuredPersoncouldnotbetransferredtoaHospitalor

(ii)theInsuredPersonsatisfiesUsthataHospitalbedwasunavailable.

2.7. Maternity Benefits

1A. For Family Floater Policy only

WewillcoverMaternityExpensessubjecttothefollowing:

(a) ThisbenefitisavailableonlyunderaFamilyFloaterPolicy.

(b) ThisbenefitisavailableforYouorYourspouseprovidedYouandYour

spouse,botharecoveredunderthesamePolicy.

(c) FortheInsuredPersoninrespectofwhomaclaimismadeunder

Section2.7,sincethedateofcommencementofthefirstPolicyYear

providedthatcoverwillbeavailableunder theMaternityBenefit

onlyafter24monthsofcontinuouscoveragehaveelapsedsincethe

inceptionofthefirstPolicywithUs.

(d) Ourmaximumliabilityperpregnancywillbesubjecttothespecified

sub-limitasshownintheProductBenefitsTable;

1B. For Family First Policy only

WewillcoverMaternityExpensessubjecttothefollowing:

(a) ThisbenefitisavailabletoanadultfemaleInsuredPersononly;

(b) FortheInsuredPersoninrespectofwhomaclaimismadeunder

Section2.7,sincethedateofcommencementofthefirstPolicyYear

providedthatcoverwillbeavailableunder theMaternityBenefit

onlyafter24monthsofcontinuouscoveragehaveelapsedsincethe

inceptionofthefirstPolicywithUs;

(c) OurmaximumliabilityforMaternityBenefitsunderthePolicyforthe

Policy Period for all the Insured Persons will be subject to the

specifiedsub-limitasshownintheProductBenefitsTable.

2. We will cover Medical Expenses related to a Medically Necessary

terminationofpregnancysubjecttotheconditionsmentionedinSection

2.7above.

3. Thebenefit under Section2.7 (1A), 2.7 (1B) and2.7(2) abovemaybe

claimedonlytwiceduringthelifetimeofthePolicyincludinganyrenewal

thereof.

4. ThefollowingexpensesarenotcoveredunderMaternityBenefit:

(a) MedicalExpensesinrespectoftheharvestingandstorageofstem

cells when carried out as a preventivemeasure against possible

futureIllnesses.

(b) MedicalExpensesforectopicpregnancy.However,theseexpenses

arecoveredundertheInpatientCarebenefitunderSection2.1.

2.8 New Born Baby

IfWehaveacceptedaMaternityBenefitsclaimunderSection2.7above,

thenWewill:

a. Cover Medical Expenses towards the medical treatment of the

Insured Persons New Born Baby while the Insured Person is

HospitalizedforInpatientCarefordelivery.

b. CovertheNewBornBabyasanInsuredPersonuntiltheexpiryofthe

PolicyYearinwhichthebabyisbornwithoutthepaymentofany

additionalpremium.

c. CovertheReasonableChargesforvaccinationoftheNewBornBaby

forthevaccinationsshowninAnnexureItothisPolicyuntiltheNew

BornBabycompletesoneyear. IfthePolicyendsbeforetheNew

BornBabyhascompletedoneyear,then,Wewillonlycoversuch

vaccinationsuntilthebabycompletesoneyear,andonlyifWehave

acceptedthebabyasanInsuredPersonatthetimeofrenewaland

Youhavepaidthepremiumaccordingly.

2.9 Organ Donor

WewillcoverMedicalExpensesforanorgandonorstreatmentforthe

harvestingoftheorgandonatedprovidedthat:

a. ThedonationconformstoTheTransplantationofHumanOrgansAct

1994andtheorganisfortheuseoftheInsuredPerson;

b. TheInsuredPersonhasbeenMedicallyAdvisedtoundergoanorgan

transplant

Policy Document Part II

Wewillnotcover:

(a) Pre-hospitalization or post-hospitalization Medical Expenses or

screeningexpensesofthedonororanyotherMedicalExpensesasa

resultoftheharvestingfromthedonor;

(b) Costs directly or indirectly associatedwith the acquisition of the

donorsorgan.

2.10 Emergency ambulance

WewillcoverReasonableChargesforambulanceexpensesincurredto

transfertheInsuredPersonbysurfacetransportfollowinganEmergency

tothenearestHospitalwithadequatefacilitiesif:

a. The ambulance service is offered by a healthcare or ambulance

serviceprovider;and

b. Wehave accepted an In-patientHospitalization claimunder the

provisionsofSection2.1above;

2.11 Health Relationship Loyalty Program

IfthePolicyisrenewedwithUswithoutanybreak,eachInsuredPerson

will become eligible to participate in the Health Relationship Loyalty

ProgramannouncedbyUsfromtimetotime.Underthisprogram,You

maychooseanyoneofthefollowingoptions:

(a) Receive the vouchers offered by Us for availing certain specified

servicesandproducts;OR

(b) IncreasetheBaseSumInsured.

Itisagreedandunderstoodthat:

(i) Theseoptionsareavailableforindividual,FamilyFloaterandFamily

FirstPolicies;

(ii) The option chosen by You under Section 2.11would apply to all

InsuredPersonsforthatPolicyYear;

(iii) Once Youhaveopted for increasing theBase Sum Insuredunder

Section2.11 inanyPolicyYear, theoptionof choosing to receive

vouchersshallnotbeapplicableforthatPolicyinanysubsequent

PolicyYears,evenifthetotalincreasedSumInsuredhasreachedthe

maximumlimitpermittedunderthePolicy.

(iv) IftheoptiontoreceivevouchersischosenbyYou,then:

(1) IfthePolicyPeriodisoneyear,Weoffervouchers,ineitherelectronic

orphysicalform,worth10%ofthelastpremiumreceivedforavailing

certainspecifiedservicesandproducts.

(2) If the Policy Period is two years, We offer vouchers, in either

electronicorphysicalform,worth5%ofthelastpremiumreceived

onthecommencementofeachPolicyYearcommencingfromthe

secondPolicyYear.

(3) TheInsuredPersonmayavailoftheservicesandproductsspecified

withintheperiodspecifiedinoralongwiththevoucher,provided

that:

(i) The vouchers are used for only those health services and

benefitscommunicatedfromtimetotime;and

(ii) The conditions or limitations specified in the vouchers are

adheredto;and

(iii) ThePolicyiscontinuouslyrenewed.

(v) IftheoptiontoincreasetheBaseSumInsuredischosen,then:

(1) Thisoptionwillbeappliedon:

(i) TheBaseSumInsuredifthePolicyisanindividualorFamily

FloaterPolicy;

(ii) TheindividualBaseSumInsuredifthePolicyisaFamilyFirst

Policy.

(2) ForeachPolicyYear,Weoffera10%increaseontheexpiringBase

SumInsureduptoamaximumof50%oftheBaseSumInsuredof

thatPolicyYearprovidedthatthePolicy isrenewedcontinuously.

Thesub-limitsapplicabletovariousbenefitswillremainthesame

andshallnotincreaseproportionatelywiththeincreaseintotalSum

Insured.

2.12 Health Checkup

WewillcoverthecostofahealthcheckupasperYourplaneligibilityas

definedintheProductBenefitsTable.Wewillonlycoverhealthcheckups

arrangedbyUsthroughOurempanelledserviceproviders.

2.13 Consultation and Diagnostic Tests (For Platinum Policyholders only)

We will cover an Insured Persons Reasonable Charges for Medically

NecessaryconsultationwithaMedicalPractitioner,asanOPDTreatment

toassesstheInsuredPersonshealthconditionforanyIllness.Wewillalso

payforanyDiagnosticTestsprescribedbytheMedicalPractitionerand

medicinespurchasedunderandsupportedwithaMedicalPractitioners

prescriptionuptothesub-limitsshownintheProductBenefitsTable.

IfthePolicyisrenewedwithUswithoutanybreakandthereisaunutilized

amount(notusedbytheInsuredPerson)undertheapplicablesub-limit

(asspecifiedintheProductsBenefitsTable)inaPolicyYear,thenWewill

carry forward 80% of this unutilized amount to the immediately

succeeding Policy Year, provided that the total amount (including the

unutilizedamountavailableunderthisbenefit)shallatnotimeexceed2.5

timestheamountoftheentitlementinrespectofthisbenefitunderthe

planapplicabletotheInsuredPersonpertheProductBenefitsTable.

2.14 Child Care Benefits (For Platinum Policyholders only)

WewillcoverReasonableChargesforthevaccinationsshowninAnnexure

ItothisPolicyforchildrenwhoareincludedasInsuredPersonsuntilthey

havecompleted12yearsofage.Wewillalsocoverexpensestowardsone

consultationfornutritionandgrowthprovidedtothechildduringavisit

forvaccination.

2.15 Family First Benefit

This provision is applicable only to Family First Policies:

Individual cover

WithintheSumInsured,thereisanindividualinsurancecoverforeach

InsuredPersonwhichshallbeuptotheamountspecifiedintheSchedule

ofInsuranceCertificateforthatInsuredPerson.Ourmaximumliabilityfor

anyandallclaimsinrespectofanInsuredPersonunderthePolicyduring

thePolicyPeriodshallbelimitedtotheIndividualCoveramountspecified

intheScheduleofInsuranceCertificateforthatInsuredPerson.

Floater cover

Within the Sum Insured, there is a floater insurance cover up to the

amount specified in theScheduleof InsuranceCertificate. This floater

covermaybeutilizedonlyiftheIndividualCoveramountofanInsured

PersonisfullyexhaustedandthereisafurtherclaimunderthePolicy.Our

maximum,totalandcumulativeliabilityforanyandallsuchfurtherclaims

inrespectofallInsuredPersonsunderthePolicyduringthePolicyPeriod

shallbelimitedtotheFloaterCoveramountspecifiedintheScheduleof

InsuranceCertificate.

2.16 Emergency Medical Evacuation and Hospitalization (for Platinum

Policyholders only)

We will cover Emergency Medical Evacuation and Medical Expenses

incurredonHospitalization,outsideIndia,butwithinonlythoseregions

specifiedintheScheduleofInsuranceCertificate.

1. Emergency Medical Evacuation and Hospitalization

WewillprovideassistanceinMedicalEvacuationoftheInsuredPerson

and cover the Reasonable Charges for transportation of the Insured

Person (and an attending Medical Practitioner if this is Medically

Necessary) following an Emergency, to the nearest Hospital which is

preparedtoadmittheInsuredPersonprovidedthat:

i. Necessarymedical treatment cannot beprovidedat theHospital

wheretheInsuredPersonissituatedatthetimeofEmergency;

ii. The Medical Evacuation has been prescribed by a Medical

PractitionerandisMedicallyNecessary;and

iii. Our Service Provider has approved the request for Medical

Evacuation.

IftheInsuredPersonisrequiredtobeHospitalizedinanEmergencywhen

theInsuredPersonisoutsideIndia,butwithinthoseregionsspecifiedin

theScheduleofInsuranceCertificate,WewillcoverthefollowingMedical

ExpensestowardsmedicaltreatmentuntiltheInsuredPersonreachesa

MedicallyStableCondition:

(a) MedicalPractitionersfees

(b) Diagnosticsprocedures

(c) Medicines,drugsandconsumables

(d) Intravenous fluids, blood transfusion, injection administration

charges

(e) Operationtheatrecharges

(f) Thecostofprostheticsandotherdevicesorequipmentifimplanted

internallyduringaSurgicalProcedure.

(g) IntensiveCareUnitcharges

(h) ReasonableChargesforRoomRentforHospitalaccommodation

2. Specific Exclusions to Section 2.16

WeshallnotbeliableunderSection2.16foranyclaiminconnectionwith

orinrespectofthefollowing:

2.1 Anytreatmentorclaimsfallingunderanyexclusionorwaitingperiod

specifiedinSections2.7,2.17or4.

2.2 Anyclaimarisingafterthefirst180cumulativedaysoftraveloutside

IndiaduringthePolicyYear.

5. Claims Procedure applicable to all claims under Section 2.16

a) Claims for Emergency Medical Evacuation

(i) IntheeventofanEmergency,OurServiceProvidershallbe

contacted immediatelyonthehelplinenumberspecified in

theInsuredPersonshealthcard.

(ii) OurServiceProviderwillevaluatethenecessityforevacuation

of the Insured Person and if the request for Medical

Evacuation is approved, the Service Provider shall pre-

authorisethetypeoftravelthatcanbeutilizedtotransport

theInsuredPersonandprovideinformationonthenearest

Hospitalthatmaybeapproachedformedicaltreatmentofthe

InsuredPerson.

(iii) IftheServiceProviderpre-authorisestheMedicalEvacuation

oftheInsuredPersonthroughanairambulance,theService

Providershallalsoarrangeforthesametobeprovidedtothe

InsuredPersonunlessthereareanylogisticalconstraintsor

the medical condition of the Insured prevents Emergency

MedicalEvacuation.

(iv) IftheServiceProviderpre-authorisestheMedicalEvacuation

oftheInsuredPersonthroughairtravelandiftheconditionof

the InsuredPersonpermits travel by commercial airline as

certified by the treating Medical Practitioner, the Service

Providershallarrangeone-wayeconomyclassairticketsor

equivalent by the most direct route from the place of

evacuationtotheplacetowheretheInsuredPersonisbeing

evacuated.

(v) ItisagreedandunderstoodthatWeshallnotcover:

a. Anyclaimsforreimbursementofthecostsincurredinthe

evacuationortransportationoftheInsuredPersonwhile

outsideIndiaoranyclaimswhicharenotpre-authorized

byOurServiceProvider;

b. Anycostsorexpensesincurredinrelationtoanypersons

accompanyingtheInsuredPerson,evenifsuchpersons

arealsoInsuredPersons.

b) Cashless Hospitalization in Emergency at Network Hospitals:

ThehealthcardWeprovidewillenabletheInsuredPersontoaccess

medicaltreatmentatany

NetworkHospitaloutsideIndia,butwithinthoseregionsspecifiedin

theScheduleofInsuranceCertificate,onacashlessbasisonlybythe

productionofthecardtotheNetworkHospitalpriortoadmission,

subjecttothefollowing:

i. IntheeventofanEmergency,theInsuredPersonorNetwork

HospitalshallcallOurServiceProviderimmediately,,onthe

helplinenumberspecifiedintheInsuredPersonshealthcard,

requestingforapre-authorizationforthemedicaltreatment

required.

ii. Our Service Provider will evaluate the request and the

eligibilityoftheInsuredPersonunderthePolicyandcallfor

moreinformationordetails,ifrequired.

iii. OurServiceProviderwillcommunicatedirectlytotheHospital

whethertherequestforpre-authorizationhasbeenapproved

ordenied.

iv. If the pre-authorization request is approved, Our Service

ProviderwilldirectlysettletheclaimwiththeHospital. Any

additionalcostsorexpensesincurredbyoronbehalfofthe

Insured Person beyond the limits pre-authorized by the

ServiceProvidershallbebornebytheInsuredPerson.

v. Thisbenefitisavailableonlyascashlessfacilitythroughpre-authorization

byOurServiceProvider. It isagreedandunderstoodthatWeshallnot

cover:

a. Anyclaimsforreimbursementofthecostsincurredinrelationtothe

HospitalizationoftheInsuredPersonwhileinsideoroutsideIndiaor

anyclaimswhicharenotpre-authorizedbyOurServiceProvider;

b. Any costs or expenses incurred in relation any persons

accompanying the Insured Person during the period of

Hospitalization,evenifsuchpersonsarealsoInsuredPersons.

6. Itisherebyagreedandunderstoodthatinthepre-authorisationmadeby

theServiceProviderunderthisPolicyorinmakinganypaymentunderthis

Policy or in the Service Provider providing access to transportation

facilitiesorprovidinginformationonthenearestHospital,Wemakeno

representationand/orgivenoguaranteeand/orassumenoresponsibility

for the appropr iateness , qua l i ty or ef fec t iveness o f the

treatment/facilities sought or provided. The Medical Emergency

Evacuationserviceshallbeonbesteffortsbasis.

7. It is hereby agreed and understood that,Wemake no representation

and/or give no guarantee and/or assume no responsibility for the

appropriateness, quality or effectiveness of the Medical Evacuation

servicesarrangedbytheServiceProvider.InnoeventshallWebeliablefor

anyclaiminrelationtoorinrespectoftheseservices,includingwithout

limitationthefailureofperformance,error,omission,interruption,defect

ordelayinoperation,tortuousbehaviorornegligenceonthepartofthe

ServiceProvider.

2.17. Specified Illness Cover for treatment abroad (For Platinum Policyholders

only)

(1) If an Insured Person suffers a Specified Illness during the Policy

Periodandwhile thePolicy is in force,Wewill coverReasonable

Charges incurred towards treatment otherwise payable under

Sections2.1and2.2providedthat:

(a) ThesymptomsoftheSpecifiedIllnessfirstoccurormanifest

itselfduringthePolicyPeriodandaftercompletionofthe90

daywaitingperiod;

(b) TheSpecified Illness isdiagnosedbyaMedicalPractitioner

withinIndiaduringthePolicyPeriodandaftercompletionof

the90daywaitingperiod;

(c) Medical treatment for theSpecified Illness is takenoutside

India,butonlywithinthoseregionsspecifiedintheSchedule

ofInsuranceCertificate.

(2) For the purpose of this Specified Illness Cover only, Specified

Illnessmeansthefollowingillnessesorprocedures:

I. Cancer

Amalignanttumorcharacterizedbytheuncontrolledgrowthand

spreadofmalignantcellswithinvasionanddestructionofnormal

tissues.Thisdiagnosismustbesupportedbyhistologicalevidenceof

malignancy. The term cancer includes leukemia, lymphoma and

sarcoma.

SpecificExclusion:Alltumors inthepresenceofHIV infectionare

excluded.

ii. Myocardial Infarction (Heart Attack)

Thedeathofaportionoftheheartmuscleasaresultofinadequate

bloodsupplytotherelevantarea.

iii. Coronary Artery Bypass Graft (CABG)

The actual undergoing of open / keyhole chest surgery for the

correctionofoneormorecoronaryarteries,whichis/arenarrowed

orblocked.Thediagnosismustbesupportedbyrelevantdiagnostic

testsandconfirmedbyacardiologist.

iv. Major Organ Transplant

Theactualundergoingofatransplantof:

One or more of the following human organs: heart, lung, liver,

kidney,pancreas,thatresultedfromirreversibleend-stagefailureof

therelevantorgan,orhumanbonemarrowusinghaematopoietic

stemcells.

SpecificExclusions:Thefollowingareexcluded:

(a) Otherstem-celltransplants

(b) Whereonlyisletsoflangerhansaretransplanted

v. Stroke

Any cerebrovascular incident including infarction of brain tissue,

thrombosisinanintracranialvessel,hemorrhageandembolisation

from an extra cranial source, which would result in neurological

sequelae.TransientIschemicAttacks(TIA)areexcluded.Treatment

of the neurological sequelae is excluded from the cover if the

primaryconditionisnotcovered.

vi. Surgery of Aorta:

Surgeryofaortaincludinggraft,insertionofstentsorendovascular

repair.

SpecificExclusion:Whereinthesurgeryisrequiredduetounderlying

congenitalcondition.

vii. Coronary Angioplasty

Procedures done for widening a narrowed or obstructed blood

vesseloftheheartwhereinastentmayormaynotbeinsertedinto

thebloodvessel.Thesameispayableonlyiftheprocedureisdone

subsequenttoMyocardialinfarctionorAnginalattack.

viii. Primary Pulmonary Arterial Hypertension

Anabnormalelevationinpulmonaryarterypressurewithorwithout

anyknowncause.Thediseasehastobeconfirmedthroughcardiac

catheter.

ix. Brain Surgery

Anybrain(intracranial)surgeryrequiredofbrainduetotraumaticor

nontraumaticreasons.

SpecificExclusion:SurgeryfortreatingNeurocysticercosis

(3) Specific Exclusions to Section 2.17:

In addition to the specific exclusions specific for any particular

Specific Illness,Wewill not cover any treatmentor claims falling

underanyexclusionorwaitingperiodspecifiedinSections2.7or4.

(4) Claims Procedure

CashlessHospitalizationfacilityforNetworkHospitals:

i. IntheeventofthediagnosisofaSpecifiedIllness,theInsured

PersonshouldcallOurServiceProviderimmediatelyandinany

eventbeforethecommencementofthetravelfortreatment

overseasonthehelplinenumberspecifiedonintheInsured

Personshealthcard,requestingforapre-authorizationforthe

treatment;

ii. Our Service Provider will evaluate the request and the

eligibilityofthe InsuredPersonthePolicyandcall formore

informationordetails,ifrequired.

iii. OurServiceProviderwillcommunicatedirectlytotheHospital

and the Insured Person whether the request for pre-

authorizationhasbeenapprovedordenied.

iv. If the pre-authorization request is approved, Our Service

ProviderwilldirectlysettletheclaimwiththeHospital. Any

additionalcostsorexpensesincurredbyoronbehalfofthe

Insured Person beyond the limits pre-authorized by the

ServiceProvideroratanynon-NetworkHospitalshallbeborne

bytheInsuredPerson.

This benefit is available only as Cashless Facility through pre-

authorizationbyOurServiceProvider.Itisagreedandunderstood

thatWeshallnotcover:

a. Anyclaimsforreimbursementofthecostsincurredinrelation

tothetreatmentoftheSpecifiedIllnessoutsideIndiaorany

claimswhicharenotpre-authorizedbyOurServiceProvider;

b. Any costs or expenses incurred in relation to any persons

accompanying the Insured Person during any period of

treatment,evenifsuchpersonsarealsoInsuredPersons.

c. Anycostsorexpensesincurredinrelationtothetraveltoor

fromtheoverseaslocationwheretreatmentisbeingtaken.

d. Anycostsorexpensesincurredinrelationtoaccommodation

or stay or transportation in the overseas location where

treatmentisbeingtaken.

e. Any pre-Hospitalization or post-Hospitalization costs or

expensesincurredbyoronbehalfoftheInsuredPerson.

f. Anycostsorexpensesincurredinrelationtotransportationof

repatriationofthemortalremainsoftheInsuredPerson.

g. Anycostsorexpensesincurredbyanyorgandonorinrelation

toharvestingoforgans.

h. AnyOPDtreatmenttakenoutsideIndia.

3. Co-payment

Co-paymentwouldbeapplicableinaccordancewiththetableprovided

below, ifany InsuredPerson is65yearsofageoroveron thedateof

commencementofthecurrentPolicyYear,thenitisagreedthatWewill

paythepercentagespecifiedinthetablebelowoftheamountWeassess

for payment or reimbursement in respect of any claimmade by that

InsuredPersonandthebalancewillbebornebytheInsuredPerson.

Co-paymentcontributiontable:

4. Exclusions

WeshallnotbeliableunderthisPolicyforanyclaiminconnectionwithor

inrespectofthefollowing:

a. Pre-Existing Diseases

BenefitswillnotbeavailableforPre-existingDiseases:

(i) for Gold and Platinum Plans only, until 24 months of

continuouscoveragehaveelapsedsincetheinceptionofthe

firstPolicywithUs;

(ii) forSilverPlan,until48monthsofcontinuouscoveragehave

elapsedsincetheinceptionofthefirstPolicywithUs.

(iii) where the Policy is renewed for enhanced Sum Insured,

waitingperiodswouldstartafreshfortheamountofincrease

inSumInsured.

b. 90 Days Waiting Period

Wewillnotcoveranytreatmenttakenduringthefirst90dayssince

the date of commencement of the Policy, unless the treatment

neededistheresultofanAccidentorEmergency.Thiswaitingperiod

doesnotapplyforanysubsequentandcontinuousrenewalsofYour

Policy.

c. Specific Waiting Periods

ForallInsuredPersonswhoareabove60yearsofageasonthedate

of commencementof the firstPolicyPeriod the conditions listed

belowwillbesubjecttoawaitingperiodof24monthsandwillbe

coveredinthethirdPolicyYearaslongastheInsuredPersonhas

beeninsuredcontinuouslyunderthePolicywithoutanybreak:

1. Stonesintheurinarysystem(egkidney/bladder)

2. Stonesinbilliarysystem(eggallstones)

3. Cataract

4. BPH-Benignprostatichypertrophy

5. Mennoraghia, Fibromyoma, Uterine prolapse including any

conditionrequiringHysterectomy.

6. Piles(Haemorrhoids)

7. Hernia(Inguinal/umbilicalandgastric)

8. Degenerativedisordersofknee/hip

9. Chronicrenalfailureorendstagerenalfailure

10. Retinopathy

11. Diabetesandrelatedtreatments

d. Personal Waiting Periods

Conditions mentioned under Personal Waiting Period in the

ScheduleofInsuranceCertificatewillbesubjecttoawaitingperiod

of24monthsandwillbecoveredfromthecommencementofthe

third Policy Year as long as the Insured Person has been insured

continuouslyunderthePolicywithoutanybreak.

0year 80%

1yr 85%

2yr 90%

3yr 95%

4yrormore 100%(noCo-payment)

No of Policy Years of continuous renewal

at or later than the age of 65 years

Percentage of any assessed

claim amount payable by Us

e. Permanent Exclusions

We will not be liable under any circumstances, for any claim in

connectionwithorwithregardtoanyofthefollowingpermanent

exclusionsandanysuchpermanentexclusionsasmaybespecifiedin

theScheduleofInsuranceCertificate

i. Addictive conditions and disorders

Treatment related toaddictiveconditionsanddisorders,or

fromanykindofsubstanceabuseormisuse.

ii. Ageing and puberty

Treatmenttorelievesymptomscausedbyageing,puberty,or

other natural physiological cause, such asmenopause and

hearinglosscausedbymaturingorageing.

iii. Artificial life maintenance

Artificiallifemaintenance,includinglifesupportmachineused

to sustainaperson,whohasbeendeclaredbraindead,as

demonstratedby:

1. Deep coma and unresponsiveness to all forms of

stimulation;

2. Absentpupillarylightreaction;

3. Absentoculovestibularandcornealreflexes;or

4. Completeapnea.

iv. Circumcision

Circumcisionunlessnecessaryforthetreatmentofadisease

ornecessitatedbyanAccident.

v. Conflict and disaster

TreatmentforanyIllnessorinjuryresultingfromnuclearor

chemical contamination, war, riot, revolution, acts of

terrorismoranysimilarevent(otherthannaturaldisasteror

calamity),ifoneormoreofthefollowingconditionsapply:

1. TheInsuredPersonputhimselfindangerbyenteringa

known area of conflict where active fighting or

insurrectionsaretakingplace

2. TheInsuredPersonwasanactiveparticipantintheabove

mentionedactsoreventsofasimilarnature.

3. The Insured Person displayed a blatant disregard for

personalsafety

vi. Congenital conditions

TreatmentforanyCongenitalAnomaly.

vii. Convalescence and Rehabilitation

Hospitalaccommodationwhenitisusedsolelyorprimarily

foranyofthefollowingpurposes:

1. convalescence, rehabilitation, supervisionoranyother

purposeotherthanforreceivingeligibletreatmentofa

typethatnormallyrequiresastayinHospital.

2. receivinggeneralnursingcareoranyotherservicesthat

donotrequiretheInsuredPersontobeinHospitaland

couldbeprovidedinanotherestablishmentthatisnota

Hospital

3. receiving services from a therapist or complementary

medical practitioner or a practitioner of Alternative

Treatment.

viii. Cosmetic surgery

Treatment undergone purely for cosmetic or psychological

reasons to improve appearance, unless such treatment is

MedicallyNecessaryasapartoftreatmentforcancerorinjury

resultingfromAccidentsorburnsandisrequiredtorestore

functionality.

ix. Dental/oral treatment

Dental Treatment including Surgical Procedures for the

treatmentofbonediseasewhenrelatedtogumdiseaseor

damage,ortreatmentfor,ortreatmentarisingfrom,disorders

ofthetempromandibularjoint.

EXCEPTION:WewillpayforaSurgicalProcedureforwhichthe

InsuredPersonisHospitalizedandwhichistakenforInpatient

CareinaHospitalandcarriedoutbyaMedicalPractitioner

x. Drugs and dressings for OPD Treatment or take-home use

Anydrugsorsurgicaldressingsthatareprovidedorprescribed

inthecaseofOPDTreatment,orforanInsuredPersontotake

home on leaving Hospital, for any condition, except as

included inpost-hospitalizationexpensesunderSection2.4

above.

xi. Eyesight

Treatment to correct refractive errors of the eye, unless

requiredas the resultofanAccident. Wewillnotpay for

routineeyeexaminations,contactlenses,spectaclesorlaser

eyesightcorrection.

xii. Unproven/Experimental treatment

Unproven or Experimental or investigational treatment or

devicesandpharmacologicalregimens.Treatmentincluding

medication not recognized by professional medical

organizationsasconformingtoacceptedmedicalpractice;or

not approved by requisite government body. Treatment or

medicineusedinclinicaltrialsorthatneedfurtherstudy;or

are rarely used, novel, or unknownand lack authoritative

evidenceofsafetyandefficacy.

xiii. Health hydros, nature cure, wellness clinics etc.

Treatmentorservicesreceivedinhealthhydros,naturecure

clinicsoranyestablishmentthatisnotaHospital.

xiv. HIV and AIDS

Any treatment for, or treatment arising from, Human

Immunodeficiency Virus (HIV) or Acquired Immuno

DeficiencySyndrome(AIDS), includinganyconditionthat is

relatedtoHIVorAIDS.

xv. Hereditary conditions (Specified)

Anytreatmentarisingfromand/ortakenforCrohn'sDisease

,Ulcerativecolitis,Cystickidneys,Neurofibromatosis,FactorV

Leiden Thrombophilia, Familial Hypercholesterolemia,

Hemophilia, Hereditary Fructose Intolerance, Hereditary

Hemochromatosis,HereditarySpherocytosis.

xvi. Itemsofpersonalcomfortandconvenience,includingbutnot

limitedto:

1. Telephone,television,dietcharges,(unless includedin

room rent) personal attendant or barber or beauty

services,baby food, cosmetics,napkins, toiletry items,

guest services and similar incidental expenses or

services.

2. Privatenursing/attendantschargesincurredduringPre-

hospitalizationorPost-hospitalization.

3. Drugsortreatmentnotsupportedbyprescription.

4. Issue of medical certificate and examinations as to

suitability for employment or travel or anyother such

purpose.

5. Any charges incurred to procure any treatment/Illness

related documents pertaining to any period of

Hospitalization/Illness.

6. Externalandordurablemedical/nonmedicalequipment

ofanykindusedfordiagnosisandortreatmentincluding

CPAP,CAPD,Infusionpumpetc.

7. Ambulatory devices such as walkers, crutches, belts,

collars,caps,splints,slings,braces,stockingsofanykind,

diabetic foot wear, glucometer/thermometer and

similar itemsandalsoanymedicalequipmentwhich is

subsequentlyusedathome.

8. NurseshiredinadditiontotheHospitalsownstaff.

xvii. Alternative Treatment

Any Alternative Treatment; except benefits under Section

2.13 (Consultation and Diagnostic Tests (For Platinum

Policyholdersonly))shallbepayableforhomeopathicaswell

asayurvedictreatments

xviii. Psychiatric and Psychosomatic Conditions

Treatment of any mental illness or sickness or disease

including a psychiatric condition, disorganisation of

personalityormind,oremotionsorbehaviour,Parkinsonsor

Alzheimersdiseaseevenifcausedoraggravatedbyorrelated

to an Accident or Illness or general debility or exhaustion

(run-downcondition);

xix. Obesity

Treatmentforobesity.

xx. OPD Treatment

OPDTreatmentisnotcoveredexceptthoseOPDTreatment

benefitsexplicitlystatedasaneligiblebenefitforYourchosen

plan.

xxi. Reproductive medicine - Birth control & Assisted

reproduction

1. Any typeof contraception, sterilization, terminationof

pregnancy (except as provided for under Section 2.7

above)orfamilyplanning.

2. Treatment to assist reproduction, including IVF

treatment.

xxii. Self-inflicted injuries

Treatmentfor,orarisingfrom,aninjurythatisintentionally

self-inflicted,includingattemptedsuicide.

xxiii. Sexual problems and gender issues

Treatment of any sexual problem including impotence

(irrespective of the cause) and sex changes or gender

reassignmentsorerectiledysfunction.

xxiv. Sexually transmitted diseases

Treatment for any sexually transmitted disease, including

Genital Warts, Syphilis, Gonorrhoea, Genital Herpes,

Chlamydia,PubicLiceandTrichomoniasis.

xxv. Sleep disorders

Treatmentforsleepapnea,snoring,oranyothersleep-related

breathingproblem.

xxvi. Speech disorders

Treatmentforspeechdisorders,includingstammering

xxvii. Treatment for developmental problems

Treatment for, or related to developmental problems,

including:

1. learningdifficulties,suchasdyslexia;

2. behavioral problems, including attention deficit

hyperactivitydisorder(ADHD);

xxviii. Treatment received outside India

Any treatment receivedoutside Indiaexcept for treatment

undertaken under Section 2.16 (Emergency Medical

Evacuation and Hospitalization (for Platinum Policyholders

only))orSection2.17(SpecifiedIllnessCoverfortreatment

abroad (For Platinum Policyholders only)) of the Policy

Document.

xxix. Unrecognised physician or Hospital:

1. TreatmentprovidedbyaMedicalPractitionerwhoisnot

recognizedbytheMedicalCouncilofIndiaorwherethe

treatment is undertaken outside India, treatment

providedbyaMedicalPractitionerwhoisnotrecognized

by the relevant authorities in the country where the

treatmentistaken.

2. Treatmentprovidedbyanyonewiththesameresidence

asanInsuredPersonorwhoisamemberoftheInsured

Personsimmediatefamily.

3. WithrespecttoSection2.13only,treatmentprovidedby

aMedicalPractitionerwhoisnotrecognizedbyCentral

Council of Indian Medicine or by Central Council of

Homoeopathy.

xxx. Unlawful Activity

Any condition as a result of Insured Person committing or

attemptingtocommitabreachoflawwithcriminalintent.

xxxi. Genetic disorders

Anygeneticdisordersresultingfromadefectinthegenes.

xxxii Any costs or expenses specified in the List of Expenses

GenerallyExcludedatAnnexureIII.

5. Standard Terms and Conditions

a. Reasonable Care

TheInsuredPersonshalltakeallreasonablestepstosafeguardagainstany

AccidentorIllnessesthatmaygiverisetoanyclaimunderthisPolicy.

b. Observance of terms and conditions

The due observance and fulfillment of the terms, conditions and

endorsementsofthisPolicyinsofarastheyrelatetoanythingtobedone

orcompliedwithbytheInsuredPerson,shallbeaConditionPrecedentto

anyliabilitytomakepaymentunderthisPolicy.

c. Subrogation

TheInsuredPersonshalldoandconcurindoingandpermittobedoneall

suchactsandthingsasmaybenecessaryorrequiredbyUs,beforeorafter

indemnification,inenforcingorendorsinganyrightsorremedies,orof

obtainingrelieforindemnity,towhichWeareorwouldbecomeentitled

orsubrogated. NeitherYounoranyInsuredPersonshalldoanyactsor

things that prejudice these subrogation rights in any manner. Any

recoverymadebyUspursuanttothisclauseshallfirstbeappliedtothe

amounts paid or payable by Us under this Policy and the costs and

expensesincurredbyUsineffectingtherecovery,whereafterWeshallpay

thebalanceamounttoYou.

d. Contribution

ItisagreedandunderstoodthatifinadditiontothisPolicy,thereisany

otherinsurancepolicyinforceunderwhichaclaimforreimbursementof

MedicalExpensesinrespectoftheInsuredPersoncouldbemade,then

YoumaychoosetheinsurancepolicyunderwhichYouwishtheclaimtobe

settled. If, in such cases, the amount claimed (after considering the

applicabledeductiblesandco-payment)exceedsthesuminsuredundera

singlepolicy,Youmaychoosetheinsurancepoliciesunderwhichtheclaim

istobesettledandifthisPolicyischosenthenWewillsettletheclaimby

applyingtheContributionprovisions.

e. Fraudulent claims

Ifaclaimisinanywayfoundtobefraudulent,orifanyfalsestatement,or

declarationismadeorusedinsupportofsuchaclaim,orifanyfraudulent

meansordevicesareusedbytheInsuredPersonanyfalseorincorrect

DisclosuretoInformationNormsoranyoneactingonbehalfoftheInsured

PersontoobtainanybenefitunderthisPolicy,thenthisPolicyshallbevoid

andallclaimsbeingprocessedshallbeforfeitedforallInsuredPersonsand

allsumspaidunderthisPolicyshallberepaidtoUsbyallInsuredPersons

whoshallbejointlyliableforsuchrepayment.

f. Notification

YouwillinformUsimmediatelyofanychangeintheaddress,natureofjob,

stateofhealth,orofanyotherchangesaffectingYouoranyInsuredPerson

throughtheformatAnnexureA.

WeshallallowtheenhancementinSumInsuredorscopeofcoveronlyat

thetimeofRenewal,providedYouintimateUsatthetimeofRenewal,

through the format Annexure B. The decision of acceptance of

enhancementofthesuminsuredorthescopeofcoverwillbebasedon

ourunderwritingpolicyand shall be subject topaymentof applicable

premiumforsuchenhancedcover.

g. Free Look Provision

You have a period of 15 days from the date of receipt of the Policy

documenttoreviewthetermsandconditionsofthisPolicy. IfYouhave

anyobjectionstoanyofthetermsandconditions,Youmaycancelthe

Policystatingthereasons forcancellationandprovidedthatnoclaims

havebeenmadeunderthePolicy,WewillrefundthepremiumpaidbyYou

afterdeductingtheamountsspentonmedicalexaminationofanyofthe

InsuredPerson(s),stampdutychargesandproportionateriskpremiumfor

the period on cover. All rights and benefits under this Policy shall

immediatelystandextinguishedonthefreelookcancellationofthePolicy.

The free look provision is not applicable and available at the time of

RenewalofthePolicy.

Length of time Policy in force

upto30days

upto90days

upto180days

exceeding180days

Refund of premium

75%

50%

25%

0%

h. Portability

From another company to Our Policy

(i) If the proposed Insured Person was insured continuously and

withoutabreakunderanotherIndianretailhealthinsurancepolicy

withanyother IndianGeneral Insurancecompanyorstandalone

HealthInsurancecompany,itisunderstoodandagreedthat:

(1) If You wish to exercise the Portability Benefit, We should have

receivedYourapplicationandthecompletedPortabilityFormwith

completedocumentationatleast45daysbeforetheexpiryofYour

presentperiodofinsurance;

(2) Thisbenefitisavailableonlyatthetimeofrenewaloftheexisting

healthinsurancepolicy.

(3) Portability benefit is available only upto the existing cover. If the

proposedSum Insured ishigher than theSum Insuredunder the

expiringpolicy,waitingperiodswouldbeappliedontheamountof

proposed increase in Sum Insured only, in accordance with the

existing guidelinesof the InsuranceRegulatory andDevelopment

Authority.

(4) WaitingperiodcreditswouldbeextendedtoPre-existingDiseases

andtimeboundexclusions/waitingperiodsinaccordancewiththe

existing guidelinesof the InsuranceRegulatory andDevelopment

Authority.

(5) The Portability Benefit shall be applied by Us within 15 days of

receivingYourcompletedApplicationandPortabilityFormsubjectto

thefollowing

(a) You shall give Us all additional documentation and/or

informationWerequest;

(b) YoupayUstheapplicablepremiuminfull;

(c) Wemay, subject to Ourmedical underwriting, restrict the

terms uponwhichWemay offer cover, the decision as to

whichshallbeinOursoleandabsolutediscretion;

(d) ThereisnoobligationonUstoinsureallInsuredPersonsorto

insureallInsuredPersonsontheproposedterms,evenifYou

havegivenUsalldocumentation;

(e) Wehave received necessary details ofmedical history and

claimhistory fromtheprevious insurancecompany for the

InsuredPersonsprevioushealthinsurancepolicythroughthe

IRDAswebportal.

(f) No additional loading or charges shall be applied by Us

exclusivelyforportingthepolicy.

ii. From Our existing health insurance policies to this Policy

(i) IftheproposedInsuredPersonwasinsuredcontinuouslyand

withoutabreakunderanotherhealthinsurancepolicywith

Us,itisunderstoodandagreedthat:

(1) IfYouwishtoexercisethePortabilityBenefit,Weshouldhave

received Your application and completed Portability Form

beforetheexpiryofYourpresentperiodofinsurance;

(2) Thisbenefitisavailableonlyatthetimeofrenewalofexisting

healthinsurancepolicy.

(3) Portabilitybenefitisavailableonlyuptotheexistingcover.If

the proposed Sum Insured is higher than the Sum Insured

undertheexpiringpolicy,waitingperiodswouldbeappliedon

the amount of proposed increase in Sum Insured only, in

accordance with the existing guidelines of the Insurance

RegulatoryandDevelopmentAuthority.

(4) Waiting period credits would be extended to Pre-existing

Diseases and time bound exclusions/waiting periods in

accordance with the existing guidelines of the Insurance

RegulatoryandDevelopmentAuthority.

(5) ThePortabilityBenefitshallbeappliedbyUswithin15daysof

receiving Your completed Application and Portability Form

subjecttothefollowing:

(a) Youshall giveUsall additionaldocumentationand/or

informationWerequest;

(b) YoupayUstheapplicablepremiuminfull;

(c) Wemay,subjecttoOurmedicalunderwriting,restrictthe

termsuponwhichWemayoffercover,thedecisionasto

whichshallbeinOursoleandabsolutediscretion;

(d) ThereisnoobligationonUstoinsureallInsuredPersons

ortoinsureallInsuredPersonsontheproposedterms,

evenifYouhavegivenUsalldocumentation.

(e) NoadditionalloadingorchargesshallbeappliedbyUs

exclusivelyforportingthepolicy.

Wereservetherighttomodifyoramendthetermsandthe

applicabilityofthePortabilityBenefitinaccordancewiththe

provisions of the regulations and guidance issued by the

Insurance Regulatory and Development Authority as

amendedfromtimetotime.

i. Cancellation/ Termination (other than Free Look cancellation)

1. Cancellation by You.

YoumayterminatethisPolicybygiving7dayspriorwrittennoticeto

Us.WeshallcancelthePolicyandrefundthepremiumfortheperiod

asmentionedhereinbelow,providedthatnoclaimhasbeenmade

underthePolicybyoronbehalfofanyInsuredPerson:

2. Automatic Cancellation:

a. Individual Policy:

ThePolicyshallautomaticallyterminateintheeventofdeath

oftheInsuredPerson.

b. For Family Floater and Family First Policies:

ThePolicyshallautomaticallyterminate intheeventofthe

deathofalltheInsuredPersons.

c. Refund:

ArefundinaccordancewiththetableinSection5(h)(1)above

shallbepayableifthereisanautomaticcancellationofthe

PolicyprovidedthatnoclaimhasbeenmadeunderthePolicy

byoronbehalfofanyInsuredPerson.

3. Cancellation by Us:

Withoutprejudicetotheabove,WemayterminatethisPolicyduring

thePolicyPeriodby sending30dayspriorwrittennotice toYour

address shown in the Schedule of Insurance Certificate without

refundofpremiumif:

i. YouoranyInsuredPersonoranypersonactingonbehalfof

eitherhasactedinadishonestorfraudulentmannerunderor

inrelationtothisPolicy;and/or

ii. YouoranyInsuredPersonhasnotdisclosedthematerialfacts

ormisrepresentedinrelationtothePolicy;and/or

iii. YouoranyInsuredPersonhasnotcooperatedwithUs.

Foravoidanceofdoubt,itisclarifiedthatnoclaimsshallbeadmitted

and/orpaidbyUsduringthenoticeperiod.

j. Territorial Jurisdiction

AllbenefitsareavailableinIndiaonly,andallclaimsshallbepayablein

IndiainIndianRupeesonlyexceptforbenefitsandclaimsunderSections

2.16and2.17.

k. Policy Disputes

Any dispute concerning the interpretation of the terms, conditions,

limitationsand/orexclusionscontainedhereinshallbegovernedbyIndian

lawandshallbesubjecttothejurisdictionoftheIndianCourts.

l. Renewal of Policy

TheRenewalpremiumispayableonorbeforetheduedateintheamount

shownintheScheduleofInsuranceCertificateoratsuchalteredrateas

maybe reviewedandnotifiedbyUsbefore completionof the Policy

Period.TheamountofpremiumisdependentontheageoftheInsured

Personandthegeographicallocations.Thereferenceofageforcalculating

thepremium for Family Floater Policies shall be the ageof theeldest

InsuredPerson,andforFamilyFirstpoliciesitshallbetheindividualageof

eachInsuredPersonoftheFamily.

Weareundernoobligation tonotify Youof the renewaldateofYour

Policy.WewillallowaGracePeriodof30daysfromtheduedateofthe

RenewalpremiumforpaymenttoUs.

IfthePolicyisnotrenewedwithintheGracePeriodthenWemayagreeto

issueafreshPolicysubjecttoOurunderwritingcriteriaandnocontinuing

benefitsshallbeavailablefromtheexpiredPolicy.

IfanyDependentChildhascompleted21yearsatthetimeofRenewal,

thensuchInsuredPersonwillhavetotakeaseparatepolicyashe/shewill

no longer be eligible asDependent Children, however the continuity

benefitswillbepassedontotheseparatepolicytakenbysuchInsured

Person.

TherewillnotbeanyloadingatthetimeofRenewalonindividualclaims

experienceoftheInsuredPerson.RenewalofthePolicywillnotordinarily

bedeniedotherthanongroundsofmoralhazard,misrepresentationor

fraudornon-cooperationbyYou

m. Notices

Any notice, direction or instruction given under this Policy shall be in

writinganddeliveredbyhand,post,orfacsimileto

I. You/theInsuredPersonattheaddressspecifiedintheScheduleof

InsuranceCertificateoratthechangedaddressofwhichWemust

receivewrittennotice.

ii. Usatthefollowingaddress.

MaxBupaHealthInsuranceCompanyLimited

B-1/I-2,MohanCooperativeIndustrialEstate,

MathuraRoad,

NewDelhi-110044

FaxNo.:1800-3070-3333

In addition, We may send You/the Insured Person other information

throughelectronicandtelecommunicationsmeanswithrespecttoYour

Policyfromtimetotime.

n. Claims Procedure (not applicable to all claims under Sections 2.16 and

2.17)

(a) Cashless Hospitalization Facility for Network Hospitals:

(i) ThehealthcardWeprovidewillenableanInsuredPersonto

access treatment on a cashless basis only at any Network

HospitalontheproductionofthecardtotheHospitalpriorto

admission,providedthat:

(1) TheInsuredPersonhasnotifiedUsinwritingatleast72

HoursbeforeaplannedHospitalization.InanEmergency

theInsuredPersonshouldnotifyUsinwritingwithin48

hoursofHospitalization;and

(2) Wehavepre-authorizedtheInpatientCareorDayCare

Treatment

(ii) CashlessFacilitywillnotbeavailableifYoutaketreatmentin

anNon-NetworkHospital.

(iii) ForcashlessHospitalizationWewillmakethepaymentofthe

amountsassessedtobeduedirectlytotheNetworkHospital.

The treatmentmust take placewithin 15 days of the pre-

authorizationdateandpre-authorizationisonlyvalidifallthe

detailsoftheauthorizedtreatment,includingdates,Hospital

andlocations,matchwiththedetailsoftheactualtreatment

received.

(iv) Ifpre-authorisationisnotobtainedthentheCashlessFacility

willnotbeavailableandtheclaimsprocedureshallbeasper

(b)(ii)below.

(b) Non-Network Hospitals & All Other Claims for Reimbursement:

(i) InallHospitalizationswhichhavenotbeenpre-authorized,We

mustbenotifiedinwritingwithin48hoursofadmissiontothe

HospitalorbeforedischargefromtheHospital,whicheveris

earlier.TheNotificationofClaimshouldbeideallyprovidedby

the Policyholder/Insured Person. In the event Policyholder

andInsuredPersonis unwell,thentheNotificationofClaim

shouldbeprovidedbyanyimmediateadultmemberofthe

family.

(ii) ForanyIllnessorAccidentormedicalconditionthatrequires

Hospitalization, the Insured Person shall deliver to Us the

necessarydocumentslistedbelow,athisownexpense,within

30daysoftheInsuredPerson'sdischargefromHospital(when

theclaimisonlyinrespectofpost-Hospitalization,within30

daysofthecompletionofthepost-Hospitalization):

(1) Claimformdulycompletedandsignedbytheclaimant.

(2) CancelledCheque

(3) Selfattestedcopyofvalidageproof(Passport/Driving

License/PANcard/classXcertificate/Birthcertificate)

(4) Self attestedcopyof identityproof (Passport /Driving

License/PANcard/Votersidentitycard)

(5) OriginalDischargesummary

(6) Original final bill fromHospitalwith detailed break-up

andpaidreceipt

(7) Original bills ofmedicines purchased, or of any other

investigation done outside hospital with reports and

requisiteprescriptions.

(8) Invoiceofmajoraccessories in casebilledandutilized

duringtreatment(ifnotincludedinthefinalhospitalbill).

(9) For Medicolegal cases (MLC/FIR copy attested by the

concernedhospital/policestation(ifapplicable).

(10)Originalself-narrationofincidentinabsenceofMLC/FIR.

(11)Originalfirstconsultationpaper(incasediseaseisfirst

timediagnosed).

(12)OriginalLaboratoryInvestigationreports.

(13)Original X-Ray/ MRI / Ultrasound films and other

Radiologicalinvestigations

(14) Indoorcasepaper/OTnotes(ifrequired)

(15) ForanymedicaltreatmenttakenfromanNon-Network

HospitalWewillonlypayMedicalExpenseswhichare

ReasonableCharges.

(c) For Network and Non-Network Hospitals In all cases:

(i) Wereservetherighttocallfor:

(1) Anyothernecessarydocumentationorinformationthat

Webelievemayberequired;and

(2) AmedicalexaminationbyOurMedicalPractitionerorfor

an investigation as often as We believe this to be

necessary.Anyexpensesrelatedtosuchexaminationsor

investigationsshallbebornebyUs.

(ii) In the event of the Insured Person's death during

Hospitalization,writtennoticeaccompaniedbyacopyofthe

postmortemreport(ifany)shallbegiventoUswithin14days

regardlessofwhetheranyothernoticehasbeengiventoUs.

Wereservetherighttorequireanautopsy.

(iii) ForthepurposesofSection2,itisunderstoodandagreedthat

if a Hospital room as per the rent limit permitted by the

insuranceplanopted for,as shown in theProductBenefits

Table, is unavailable, thenWe will only be liable to make

paymentforaHospitalroomthatisactuallyoccupiedorasper

entitlement permitted by the plan opted for, whichever is

lower.FurtherwhereMedicalExpensesarelinkedwithroom

rates, Medical Expenses as applicable to the room that is

actuallyoccupiedorasperroomratesentitlementunderthe

planopted,whicheverislower,shallbepayable.

(d) AllclaimsaretobenotifiedtoUswithinatimelineasperClause

3(m)(b)(I). In casewhere the delay in intimation is proved to be

genuineandforreasonsbeyondthecontroloftheInsuredPersonor

NomineespecifiedintheScheduleofInsuranceCertificate,Wemay

condonesuchdelayandprocess theclaim,Wereservearight to

declinesuchrequestsforclaimprocesswherethereisnomeritfora

delayedclaim.

(e) Uponacceptanceofaclaim,thepaymentoftheamountdueshallbe

madewithin30daysfromthedateofacceptanceoftheclaim.Inthe

caseofdelayinpayment,Weshallbeliabletopayinterestatarate

whichis2%abovethebankrateprevalentatthebeginningofthe

financialyearinwhichtheclaimisreviewedbyit.

(f) It is hereby agreed and understood that in providing pre-

authorisation or accepting a claim for reimbursement under this

Policy or making a payment under this Policy, We make no

representation and/or give no guarantee and/or assume no

responsibilityfortheappropriateness,qualityoreffectivenessofthe

treatmentsoughtorprovided.

(g) Insured Person are advised to refer to the list of unrecognized

Hospitals,whichisavailableatourwebsite(www.maxbupa.com).

o. Alteration to the Policy

This Policy constitutes the complete contract of insurance. Any

changeinthePolicywillonlybeevidencedbyawrittenendorsement

signedandstampedbyUs.NooneexceptUscanchangeorvarythis

Policy.

p. Withdrawal of Product

This product may be withdrawn at Our option subject to prior

approvalofInsuranceRegulatoryandDevelopmentAuthority(IRDA)

orduetoachangeinregulations.InsuchacaseWeshallprovidean

optiontomigratetoOurothersuitableretailproductsasavailable

withUs.

q. Revision or Modification

Thisproductmayberevisedormodifiedsubjecttopriorapprovalof

theIRDA.InsuchcaseWeshallnotifyYouofanysuchchangeatleast

3monthspriortothedatefromwhichsuchrevisionormodification

shallcomeintoeffect,provideditisnototherwiseprovidedbythe

IRDA.

r. Change of Policyholder

If Youdo not renew the Policy by the duedates specified in the

Scheduleof InsuranceCertificate,anyotheradult InsuredPerson

mayapplytorenewthePolicywithin30daysoftheendofthePolicy

PeriodprovidedthatWereceiveanapplicationandthepremium

from such Insured Person and evidence satisfactory toUs of the

agreementofallotherInsuredPersonsandYou(exceptincaseof

death). If We accept such application and the premium for the

renewedPolicyispaidontime,thenthePolicyshallbetreatedas

havingbeenrenewedwithoutabreakincover.Coverageshallnotbe

availablefortheperiodforwhichpremiumhasnotbeenreceived.

If thenewproposedPolicyholderdoesnot fulfill the relationship

conditions specified in the definition of Family as stated in the

definitionofFamilyFirstPolicy,anyotheradultInsuredPersonmay

applytorenewthePolicyinaccordancewiththeaforesaidprovision

andthePolicywillcontinueasaFamilyFirstPolicyprovidedthatOur

underwritingcriteriaforFamilyFirstPoliciesissatisfied,

Insuchcases,forthepurposesofthePolicytherelationshipbetween

the Insured Persons and the Policyholder shall be governed in

relationtotheoriginalPolicyholder,notwithstandingthechangein

Policyholder and the addition of any proposed Insured Persons

under the Policy will also be subject to these proposed Insured

Personssatisfying the relationship requirementswith theoriginal

PolicyholderasspecifiedinthedefinitionofFamilyFirstPolicy.

s. Nominee

YouaremandatorilyrequiredattheinceptionofthePolicy,tomakea

nominationforthepurposeofpaymentofclaimsunderthePolicyin

theeventofdeath.

AnychangeofnominationshallbecommunicatedtoUsinwriting

andsuchchangeshallbeeffectiveonlywhenanendorsementonthe

PolicyismadebyUs.

IncaseofanyInsuredPersonotherthanYouunderthePolicy,forthe

purpose of payment of claims in the event of death, the default

nomineewouldbeYou.

t. Obligations in case of a minor

IfanInsuredPersonislessthan18yearsofage,You/adultInsured

Personshallbecompletelyresponsibleforensuringcompliancewith

allthetermsandconditionsofthisPolicyonbehalfofthatminor

InsuredPerson.

u. Customer Service and Grievances Reddressal:

i. Incaseofanyqueryorcomplaint/grievance,You/theInsured

PersonmayapproachOurofficeatthefollowingaddress:

CustomerServicesDepartment

MaxBupaHealthInsuranceCompanyLimited

B-1/I-2,MohanCooperativeIndustrialEstate,

MathuraRoad,

NewDelhi-110044

ContactNo:1800-3010-3333

FaxNo.:1800-3070-3333

EmailID:customercare@maxbupa.com

ii. In case You/the Insured Person are not satisfied with the

decision of the above office, or have not received any

response within 10 days, You may contact the following

officialforresolution:

HeadCustomerServices

MaxBupaHealthInsuranceCompanyLimited

B-1/I-2,MohanCooperative,

IndustrialEstate,MathuraRoad,

NewDelhi-110044

ContactNo:1800-3010-3333

FaxNo.:1800-3070-3333

EmailID:customercare@maxbupa.com

iii. In case You/the Insured Person are not satisfied with Our

decision/resolution, You may approach the Insurance

OmbudsmanattheaddressesgiveninAnnexureII.

iv. Thecomplaintshouldbemadeinwritingdulysignedbythe

complainantorbyhis/herlegalheirswithfulldetailsofthe

complaintandthecontactinformationofthecomplainant.

v. Asperprovision13(3)of theRedressalofPublicGrievances

Rules1998,thecomplainttotheOmbudsmancanbemade

1. onlyifthegrievancehasbeenrejectedbytheGrievance

RedressalMachineryoftheInsurer;

2. withinaperiodofoneyearfromthedateofrejectionby

theinsurer;

3. ifitisnotsimultaneouslyunderanylitigation.

6. Interpretations & Definitions

In this Policy the followingwords or phrases shall have themeanings

attributed to them wherever they appear in this Policy and for this

purposethesingularwillbedeemedtoincludetheplural,themalegender

includesthefemalewherethecontextpermits:

Def. 1. Accident or Accidental meansa sudden,unforeseenand involuntary

eventcausedbyexternal,visibleandviolentmeans.

Def. 2. Alternative Treatments areformsoftreatmentsotherthantreatment

"Allopathy"or"modernmedicine"andincludesAyurveda,Unani,Sidha

andHomeopathyintheIndiancontext.

Def. 3. Base Sum Insured meanstheamountspecifiedasSumInsuredatthe

inceptionof aPolicyYearand in theevent thePolicy isupgradedor

downgradedonanycontinuousrenewal,thentheSumInsuredforwhich

premiumispaidatthecommencementofthePolicyYearforwhichthe

prevalentupgradeordowngradeissought.

Def. 4. Cashless Facility meansafacilityextendedbytheinsurertotheinsured

wherethepayments,ofthecostsoftreatmentundergonebytheinsured

inaccordancewiththepolicytermsandconditions,aredirectlymadeto

theNetwork Provider by the insurer to the extent pre-authorization

approved.

Def. 5. Condition Precedent shall meanapolicytermorconditionuponwhich

theInsurer'sliabilityunderthepolicyisconditionalupon.

Def. 6. Congenital Anomalyreferstoacondition(s)whichispresentsincebirth,

andwhichisabnormalwithreferencetoform,structureorposition:

(i) InternalCongenitalAnomaly:CongenitalAnomalywhichisnotinthe

visibleandaccessiblepartsofthebody

(ii) ExternalCongenitalAnomaly:CongenitalAnomalywhich is in the

visibleandaccessiblepartsofthebody.

Def. 7. Contribution is essentially the right of an insurer to call uponother

insurersliabletothesameinsuredtosharethecostofanindemnity

claimonarateableproportionofSumInsured.

ThisclauseshallnotapplytoanyBenefitofferedonfixedbenefitbasis.

Def. 8. Co-payment is a cost-sharing requirement under a health insurance

policythatprovidesthatthePolicyholder/insuredwillbearaspecified

percentage of the admissible cost amount. A Co-payment does not

reducetheSumInsured.

Def. 9. Day Care Center ADayCareCentremeansanyinstitutionestablishedfor

DayCareTreatmentofIllnessand/orInjuriesoramedicalset-upwithina

Hospital andwhich has been registeredwithin the local authorities,

whereverapplicable,andisunderthesupervisionofaregisteredand

qualified Medical Practitioner AND must comply with all minimum

criteriaasunder:-hasQualifiedNursingstaffunderitsemployment;has

qualified Medical Practitioner (s) in charge; had a fully equipped

operationtheatreofitsownwheresurgicalproceduresarecarriedout;

maintainsdailyrecordsofpatientsandwillmaketheseaccessibletothe

Insurancecompanysauthorizedpersonnel.

Def. 10. Day Care Treatment refers to medical treatment, and/or surgical

procedurewhichis:(i)undertakenunderGeneralorLocalAnaesthesia

inaHospital/daycarecentreinlessthan24hrsbecauseoftechnological

advancement, and (ii) which would have otherwise required a

Hospitalizationofmorethan24hours.

TreatmentnormallytakenonanOPDbasisisnotincludedinthescopeof

thisdefinition.

Def. 11. Deductible: Deductible is a cost-sharing requirementunder ahealth

insurancepolicythatprovidesthattheInsurerwillnotbeliablefora

specifiedrupeeamountincaseofindemnitypoliciesandforaspecified

numberofdays/hoursincaseofhospitalcashpolicieswhichwillapply

beforeanybenefitsarepayablebytheinsurer.Adeductibledoesnot

reducethesuminsured.

Def. 12. Dental Treatment is treatment carried out by a dental practitioner

including examinations, fillings (where appropriate), crowns,

extract ions and surgery exc luding any form of cosmetic

surgery/implants

Def. 13. Diagnostic Tests:Investigations,suchasX-Rayorbloodtests,tofindthe

causeofyoursymptomsandmedicalcondition.

Def. 14. Disclosure to Information Norm: The Policy shall be void and all

premiumpaidhereonshallbeforfeitedtotheCompany,intheeventof

misrepresentation,mis-descriptionornon-disclosureof anymaterial

fact.

Def. 15. Domiciliary Hospitalisation: means medical treatment for an

Illness/disease/injurywhich inthenormalcoursewouldrequirecare

andtreatmentataHospitalbutisactuallytakenwhileconfinedathome

underanyofthefollowingcircumstances:

l theconditionofthepatientissuchthathe/sheisnotinaconditionto

beremovedtoahospital,or

l thepatienttakestreatmentathomeonaccountofnonavailabilityof

roominahospital.

Def. 16. EmergencymeansasevereIllnessorinjurywhichresultsinsymptoms

whichoccursuddenlyandunexpectedly,andrequiresimmediatecare

by a Medical Practitioner to prevent death or serious long term

impairmentoftheInsuredPersonshealth.

Def. 17. Emergency CaremeansmanagementforasevereIllnessorinjurywhich

results in symptoms which occur suddenly and unexpectedly, and

requiresimmediatecarebyaMedicalPractitionertopreventdeathor

seriouslongtermimpairmentoftheInsuredPersonshealth.

Def. 18. Family Floater PolicymeansaPolicy intermsofwhich,twoormore

personsofaFamilyarenamedintheScheduleofInsuranceCertificateas

Insured Persons. In a Family Floater Policy, Family means a unit

comprisingofuptosixmemberswhoarerelatedtoeachotherinthe

followingmanner:

i. Legallymarriedhusbandandwifeaslongastheycontinuestobe

married;and/or

ii. Up-tofouroftheirchildrenwhoarelessthan21yearsonthedateof

commencementoftheinitialcoverunderthePolicy

Def. 19. Family First Policy means a Policy in terms of which, two or more

persons of Your Family are named in the Schedule of Insurance

CertificateasInsuredPersons.InaFamilyFirstPolicy,FamilymeansYou

andthepersonslistedbelowwhois/arerelatedtoYouinthefollowing

manner:-

a. Legallymarriedspouseaslongasheorshecontinuestobemarried

toYou;

b. Son;

c. Daughter-in-law;

d.Daughter;

e. Son-in-law

f. Father;

g. Mother;

h. Father-in-lawaslongasYourspousecontinuestobemarriedtoYou;

i. Mother-in-lawaslongasYourspousecontinuestobemarriedtoYou;

j. Grandfather;

k. Grandmother;

l. Grandson;

m.Granddaughter.

Def. 20. Grace Period meansthespecifiedperiodoftimeimmediatelyfollowing

thepremiumduedateduringwhichapaymentcanbemadetorenewor

continueapolicy in forcewithout lossofcontinuitybenefitssuchas

waitingperiodsandcoverageofPre-existingDiseases.Coverageisnot

availablefortheperiodforwhichnopremiumisreceived.

Def. 21. Hospital (within India)meansanyinstitutionestablishedforIn-patient

careandDayCareTreatmentofillnessand/orinjuriesandwhichhas

beenregisteredasahospitalwiththelocalauthoritiesundertheClinical

Establishments (Registration andRegulation)Act, 2010orunder the

enactmentsspecifiedundertheScheduleofSection56(1)ofthesaidAct

ORcomplieswithallminimumcriteriaasunder:

a) hasatleast10inpatientbedsintownshavingapopulationofless

than10,00,000andatleast15inpatientbedsinallotherplaces;

b)hasQualifiedNursingstaffunderitsemploymentroundtheclock;

c) hasqualifiedMedicalPractitioner(s)inchargeroundtheclock;

d)has a fully equippedoperation theatre of its ownwhere surgical

proceduresarecarriedout

e)maintainsdailyrecordsofpatientsandmakestheseaccessibletothe

Insurancecompanysauthorizedpersonnel.

Hospital (outside India) means an institution (including nursing

homes) established outside India for indoor medical care and

treatmentofsicknessand injurieswhichhasbeenregisteredand

licensedassuchwiththeappropriatelocalorotherauthoritiesinthe

relevant area, wherever applicable, and is under the constant

supervisionofaMedicalPractitioner.The termHospital shallnot

includeaclinic,resthome,orconvalescenthomefortheaddicted,

detoxificationcentre,sanatorium,oldagehome.

Def. 22. Hospitalization or HospitalizedmeanstheadmissioninaHospitalfora

minimum period of 24 Inpatient Care consecutive hours except for

specifiedprocedures/treatments,wheresuchadmissioncouldbefora

periodoflessthan24consecutivehours.

Def. 23. Injury:Injurymeansaccidentalphysicalbodilyharmexcludingillnessor

diseasesolelyanddirectlycausedbyexternal,violentandvisibleand

evidentmeanswhichisverifiedandcertifiedbyaMedicalPractitioner.

Def. 24. Information Summary Sheetmeans the record and confirmation of

informationprovidedtoUsorOurrepresentativesoverthetelephone

forthepurposesofapplyingforthisPolicy.

Def. 25. Intensive Care Unit means an identified section, ward or wing of a

HospitalwhichisundertheconstantsupervisionofadedicatedMedical

Practitioner (s), and which is specially equipped for the continuous

monitoringandtreatmentofpatientswhoareinacriticalcondition,or

requirelifesupportfacilitiesandwherethelevelofcareandsupervision

isconsiderablymoresophisticatedandintensivethanintheordinary

andotherwards.

Def. 26. Illnessmeanssicknessoradiseaseorpathologicalconditionleadingto

theimpairmentofnormalphysiologicalfunctionwhichmanifestsitself

duringthePolicyPeriodandrequiresmedicaltreatment.

(i) Acute condition:Acuteconditionisadisease,IllnessorInjurythatis

likely to respond quickly to treatment which aims to return the

persontohisorherstateofhealthimmediatelybeforesufferingthe

disease/Illness/Injurywhichleadstofullrecovery.

(ii) Chronic condition: A chronic condition is defined as a disease,

illnesss, or injury that has one or more of the following

characteristics:-itneedsongoingorlong-termmonitoringthrough

consultations, examinations, check-ups, and/or tests- it needs

ongoingorlong-termcontrolorreliefofsymptomsitrequiresyour

rehabilitationorforyoutobespecificallytrainedtocopewithit-it

continuesindefinitelyitcomesbackorislikelytocomeback.

Def. 27. InpatientmeanstheInsuredPersonsadmissiontofortreatmentina

Hospitalformorethan24hoursforacoveredevent.

Def. 28. Inpatient Care meanstreatmentforwhichtheInsuredPersonhasto

stayinaHospitalformorethan24hoursforacoveredevent.

Def. 29. Insured Person means person named as insured in the Schedule of

InsuranceCertificate.

Def. 30. Maternity Expense:Maternityexpenseshallinclude:

i. Medical Treatment Expenses traceable to childbirth (including

complicated deliveries and caesarean sections incurred during

Hospitalization);

ii. Expensestowardslawfulmedicalterminationofpregnancyduring

thePolicyPeriod;

Def. 31. Medical Advise:AnyconsultationoradvicefromaMedicalPractitioner

includingtheissueofanyprescriptionorrepeatprescription.

Def. 32. Medical Expenses meansthoseexpensesthatanInsuredPersonhas

necessarilyandactuallyincurredformedicaltreatmentonaccountof

IllnessorAccidentontheadviceofaMedicalPractitioner,aslongas

thesearenomorethanwouldhavebeenpayableiftheInsuredPerson

hadnotbeeninsuredandnomorethanotherhospitalsordoctorsinthe

samelocalitywouldhavechargedforthesamemedicaltreatment.

Def. 33. Medical Evacuation means the transportation, in the event of an

Emergency,oftheInsuredPersontothenearestHospital,ifandonlyif,

thetreatmentrequiredisnotavailablelocally.

Def. 34. Medical Practitioner: AMedicalPractitioner isapersonwhoholdsa

valid registration from theMedical Council of any State or Medical

CouncilofIndiaorCouncilforIndianMedicineorforHomeopathysetup

by the Government of India or a State Government and is thereby

entitledtopracticemedicinewithinitsjurisdiction;andisactingwithin

thescopeandjurisdictionofhislicence. Onlyforthepurposesofany

claim or treatment permitted to bemade or taken outside India in

accordancewithSection2.16,MedicalPractitionershallmeanageneral

practitioner,surgeon,anesthetistorphysicianwho:

(i) holdsadegreeofarecognisedinstituteand

(ii)isregisteredbyMedicalCouncilorequivalentbodyofthecountry

wherethetreatmenthastakenplace,and

(iii)islegallyqualifiedtopracticemedicineorsurgeryinthejurisdiction

wherehepractices.

Def. 35. Medically Necessary:Medicallynecessarytreatmentisdefinedasany

treatment, tests,medication, or stay inHospital or part of a stay in

Hospitalwhich:

a) is required for the medical management of the Illness or injury

sufferedbytheinsured;

b)must not exceed the level of care necessary to provide safe,

adequate and appropriate medical care in scope, duration, or

intensity;

c) musthavebeenprescribedbyaMedicalPractitioner;

d)must conform to the professional standards widely accepted in

internationalmedicalpracticeorbythemedicalcommunityinIndia.

Def. 36. Medically Stable Condition meanstheconditionoftheInsuredPersonis

suchthatany injuriesand/orconditions/diseasessufferedhavebeen

broughtundercontrolorresistanttodeteriorationascertifiedbythe

treatingMedicalPractitioner.

Def. 37. Network Provider meansHospitalsorhealthcareprovidersenlistedby

aninsurerorbyaTPAandinsurertogethertoprovidemedicalservicesto

aninsuredonpaymentbyacashlessfacility.

Onlyforthepurposesofanyclaimortreatmentpermittedtobemadeor

takenoutsideIndiainaccorda