provides that the Company will not be liable for a specified rupee amount in case 1. Definitionsof indemnity policies, which will apply before any benefits are payable by the Company. A Deductible does not reduce the Sum Insured. For the purposes of interpretation and understanding of the product the Company has

defined, herein below some of the important words used in the product and for the 1.18 Dental Treatment is carried out by a dental practitioner including remaining language and the words the Company believes to mean the normal meaning of examinations, fillings (where appropriate), crowns, extractions and surgerythe English language as explained in the standard language dictionaries. The words and including any form of cosmetic surgery/implants.expressions defined in the Insurance Act, IRDA Act, Regulations notified by the Authority

1.19 Dependent Child means a child (natural or legally adopted), who is :and Circulars and Guidelines issued by the Authority shall carry the meanings explained therein. The judicial pronouncements of the highest courts in India will have the effect on (a) Financially dependent on the Policyholder;the definitions and the language used in this product. The terms and conditions, coverage's

(b) Does not have his independent sources of income; andand exclusions, benefits, various procedures and concepts which have been built in to the product also carry the specified meaning assigned to them in the said language. (c) Has not attained Age 25 years.The terms defined below have the meanings ascribed to them wherever they appear in this 1.20 Disclosure to Information Norm means this Policy shall be void and all Policy and, where appropriate, references to the singular include references to the plural; premium paid hereon shall be forfeited to the Company, in the event of references to the male include the female and vice versa. References to any statutory misrepresentation, mis-description or non-disclosure of any material fact.enactment include subsequent changes to the same.

1.21 Emergency means a medical condition arising out of any Illness or Injury 1.1 Accident/Accidental means a sudden, unforeseen and involuntary event contracted by the Insured Person and declared and certified by the Medical

caused by external, visible and violent means. Practitioner, attending to the Insured Person, that immediate treatment is required to save the life of the Insured Person.1.2 Acute Condition means a disease, Illness or Injury that is likely to respond

quickly to treatment which aims to return the Insured Person to his or her state of 1.22 Emergency Care means management for a severe Illness or Injury which health immediately before suffering the disease/Illness/Injury which leads to full results in symptoms which occur suddenly and unexpectedly, and requires recovery. immediate care by a Medical Practitioner to prevent death or serious long term

impairment of the Insured Person's health.1.3 Age means the completed age (in years) of the Insured Person as on his last birthday. 1.23 Geographical Scope means the countries or geographical boundaries in

which the coverage under the Policy is valid as specified in the Policy Certificate. 1.4 Ambulance means a road vehicle operated by a licensed/authorized service provider and equipped for the transport and paramedical treatment of the 1.24 Hazardous Activities means any sport or activity, which is potentially person requiring medical attention. dangerous to the Insured Person whether he is trained or not. Such sport/activity

includes stunt activities of any kind, adventure racing, base jumping, biathlon, big 1.5 Annual Multi Trip Policy means a Policy under which there can be more game hunting, black water rafting, BMX stunt/obstacle riding, bobsleighing/using than one Period of Insurance during the Policy Period, subject to the maximum skeletons, bouldering, boxing, canyoning, caving/ pot holing, cave tubing, rock trip duration, per trip, as specified on the Policy Certificate.climbing/trekking/mountaineering, cycle racing, cyclo cross, drag racing,

1.6 Any One Illness means a continuous Period of Illness and it includes relapse endurance testing, hand gliding, harness racing, hell skiing, high diving (above 5 meters), hunting, ice hockey, ice speedway, jousting, judo, karate, kendo, lugging, within 45 days from the date of last consultation with the Hospital / nursing home risky manual labor, marathon running, martial arts, micro – lighting, modern where the treatment may have been taken.pentathlon, motor cycle racing, motor rallying, parachuting, paragliding/

1.7 Assistance Service Provider means the service provider specified in the parapenting, piloting aircraft, polo, power lifting, power boat racing, quad biking, Policy Certificate appointed by the Company from time to time. river boarding, scuba diving, river bugging, rodeo, roller hockey, rugby, ski

acrobatics, ski doo, ski jumping, ski racing, sky diving, small bore target shooting, 1.8 Cashless Facility means a facility extended by the Company to the Insured speed trials/time trials, triathlon, water ski jumping, weight lifting or wrestling of Person where the payments, of the costs of treatment undergone by the Insured any type.Person in accordance with the Policy terms and conditions, are directly made to

the Network Provider by the Company to the extent pre-authorization 1.25 Hospital means any institution established for in-patient care and treatment of approved. Injury or Illness and which has been registered as a Hospital or a clinic as per law

rules and/or regulations applicable for the country where the contingency arises. 1.9 Checked-in Baggage means the baggage offered by the Insured Person and accepted for custody by a Common Carrier for international transportation in the The term Hospital shall not include a place of rest, a place for the aged, a place for same Common Carrier in which the Insured Person is travelling and for which the drug-addicts or a place for alcoholics or a hotel, health spa or massage center or Common Carrier has provided a baggage receipt, and the contents of the baggage the like.checked-in by the Insured Person so long as such contents do not violate any policy

1.26 Hospitalization means admission in a Hospital for a minimum period of 24 In-or rule restricting the nature of items that may be carried on board. This shall patient Care consecutive hours except for specified procedures/treatments, exclude all the items that are carried/ transported under a contract of where such admission could be for a period of less than 24consecutive hours.affreightment.

1.27 Identity Proof means valid Passport, Driving license, PAN card, Voter Identity 1.10 Claim means a demand made in accordance with the terms and conditions of card or any other government recognized identification document.the Policy for payment of Benefits in respect of the Insured Person.

1.28 Illness means a sickness or a disease or a pathological condition leading to the 1.11 Company means Religare Health Insurance Company Limited.impairment of normal physiological function which manifests itself during the

1.12 Common Carrier means any civilian land or water conveyance or scheduled Period of Insurance and requires medical treatment.aircraft operated under a valid license for the transportation of fare paying

1.29 Immediate Family Member means an Insured Person's lawful spouse, passengers under a valid ticket.children and parents only.

1.13 Condition Precedent shall mean a Policy term or condition upon which the 1.30 Injury means accidental physical bodily harm excluding Illness or disease solely Company's liability under the Policy is conditional upon.

and directly caused by external, violent and visible means which is verified and 1.14 Congenital Anomaly refers to a condition(s) which is present since birth, certified by a Medical Practitioner.

and which is abnormal with reference to form, structure or position.1.31 In-patient Care means treatment for which the Insured Person has to stay in

i) Internal Congenital Anomaly means Congenital Anomaly which is a Hospital for more than 24 hours for a covered event.not in the visible and accessible parts of the body.

1.32 Insured Person (Insured) means a person whose name specifically ii) External Congenital Anomaly means Congenital Anomaly which appears under Insured in the Policy Certificate and with respect to whom the

is in the visible and accessible parts of the body. premium has been received by the Company.1.15 Contribution is essentially the right of the Company to call upon other 1.33 Intensive Care Unit (ICU) means an identified section, ward or wing of a

insurers liable to the same Insured to share the cost of an indemnity claim on a Hospital which is under the constant supervision of a dedicated Medical ratable proportion of Sum Insured. Practitioner, and which is specially equipped for the continuous monitoring and

treatment of patients who are in a critical condition, or require life support 1.16 Country of Residence means the country in which the Insured Person is facilities and where the level of care and supervision is considerably more currently residing and as specified in the Policy Certificate.sophisticated and intensive than in the ordinary and other wards.

1.17 Deductible A Deductible is a cost-sharing requirement under this Policy that

Policy Terms and Conditions

1.34 Life Threatening Medical Condition means a medical condition If the Policy Period is more than 12 months, the Sum Insured shall apply on Policy suffered by the Insured Person which has the following characteristics: Year basis.

(a) Markedly unstable vital parameters (blood pressure, pulse, temperature and 1.47 Policy means these Policy Terms & Conditions, the Proposal Form, Policy respiratory rate); or Certificate and Annexures which form part of the policy contract and shall be

read together.(b) Acute impairment of one or more vital organ systems (involving brain, heart,

lungs, liver, kidneys and pancreas); or 1.48 Policy Certificate means the certificate attached to and forming part of this Policy.(c) Critical care being provided, which involves high complexity decision making to

assess, manipulate and support vital system functions to treat single or multiple 1.49 Policyholder means the person named in the Policy Certificate as the vital organ failures and requires interpretation of multiple physiological Policyholder. parameters and application of advanced technology; or

1.50 Policy Period means the period commencing from the Policy Period Start (d) Critical care being provided in critical care area such as coronary care unit, Date and ending on the Policy Period End Date as specified in the Policy

intensive care unit, respiratory care unit, or the emergency department; and Certificate.certified by the attending Medical Practitioner as a Life Threatening Medical

1.51 Policy Period End Date means the date on which the Policy expires, as Condition.specified in the Policy Certificate.

1.35 Medical Advice means any consultation or advice from a Medical Practitioner 1.52 Policy Period Start Date means the date on which the Policy commences, including the issue of any prescription or repeat prescription.

as specified in the Policy Certificate.1.36 Medical Expenses means those expenses that an Insured Person has

1.53 Pre-existing Disease means any condition, ailment or Injury or related necessarily and actually been incurred for medical treatment on account of Illness condition(s) for which the Insured Person had signs or symptoms, and/or were or Accident on the advice of the Medical Practitioner, as long as these are no more diagnosed, and/or received Medical Advice/treatment within 48 months to prior than would have been payable if the Insured Person had not been insured and no to the first policy issued by the Company. more than other Hospitals or doctors in the same locality would have charged for

the same medical treatment. 1.54 Reasonable and Customary Charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent

1.37 Medical Practitioner means a person who holds a valid registration from with the prevailing charges in the geographical area for identical or similar services, the competent authority as per law rules and/or regulations applicable for the taking into account the nature of the Illness / Injury involved.country where the contingency arises and is thereby entitled to practice medicine

within its jurisdiction; and is acting within the scope and jurisdiction of his license. 1.55 Re-pricing means the difference between

1.38 Medically Necessary means any treatment, tests, medication, or stay in (a) The amount that would be payable to the Network Provider, including amounts Hospital or part of a stay in Hospital which payable by the Company under this Policy, if no reduction was taken; and

i) Is required for the medical management of the Illness or Injury suffered by (b) The negotiated rate which the Company is able to receive after using the services the Insured Person; of a Network Provider or any other entity.

ii) Must not exceed the level of care necessary to provide safe, adequate and 1.56 Re-pricing Fees means the service fee paid to the Network Provider or any appropriate medical care in scope, duration, or intensity; other entity for the Re-pricing carried out on behalf of the Company.

iii) Must have been prescribed by a Medical Practitioner; 1.57 Room Rent means the amount charged by a Hospital for the occupancy of a bed on per day (24 hours) basis and shall include associated Medical Expenses.iv) Must conform to the professional standards widely accepted in

international medical practice or by the medical community in India. 1.58 Single Trip Policy means a Policy under which there cannot be more than one Period of Insurance during the Policy Period.

1.39 Network Provider means the Hospitals or health care providers enlisted by the Company or by its Assistant Service Provider and the Company together to 1.59 Sum Insured means the amount specified against each Insured Person in the provide medical services to the Insured on payment by a Cashless Facility. Policy Certificate which represents the Company's maximum, total and

cumulative liability for that Insured Person for any and all Claims incurred in 1.40 Nominee means the person named in the Policy Certificate who is nominated

respect of that Insured Person during the Policy Period.to receive the benefits under this Policy in accordance with the terms of the Policy, if the Policyholder is deceased. 1.60 Surgery/Surgical Procedure means manual and/or operative procedure

required for treatment of an Illness or Injury, correction of deformities and 1.41 Notification of Claim (Intimation) is the process of notifying a Claim to

defects, diagnosis and cure of diseases, relief of suffering or prolongation of life, the Company or Assistant Service Provider by specifying the timelines as well as performed in a Hospital by a Medical Practitioner.the address/telephone number to which it should be notified.

1.61 Terrorism/Terrorist Incident means any actual or threatened use of 1.42 OPD Treatment is one in which the Insured visits a clinic/hospital or

force or violence directed at or causing damage, injury, harm or disruption, or associated facility like a consultation room for diagnosis and treatment based on commission of an act dangerous to human life or property, against any the advice o f a Medical Practitioner. The Insured is not admitted as a day care or individual, property or government, with the stated or unstated objective in-patient.of pursuing economic, ethnic, nationalistic, political, racial or religious

1.43 Period of Insurance means a period within the Policy Period which interests, whether such interests are declared or not. Terrorism shall also commences when the Insured Person first boards the Common Carrier by which include any act, which is verified or recognized by the relevant Government as an it is intended that he shall finally leave the Country of Residence and expires act of terrorism.automatically on the earliest of:

1.62 Unproven/Experimental Treatment means treatment including drug (a) the actual date on which the Insured returns to the Country of Residence; or experimental therapy which is not based on established medical practice in India,

is treatment experimental or unproven.(b) Policy Period End Date; or

(c) the expiry of the “Total no. of Travel days” specified in the Policy Certificate from the commencement of the Period of Insurance if the Policy is a Single Trip Policy

2. Benefitsor the expiry of the “Maximum Trip Duration” specified in the Policy Certificate from the commencement of the Period of Insurance if the Policy is an Annual

General Conditions applicable to all Benefits:Multi Trip Policy.

(a) Any Benefit shall be available only if the same is specifically mentioned in the Policy The Policy Certificate shall specify whether the Policy is a Single Trip Policy or an Certificate.Annual Multi Trip Policy

(b) Admissibility of a Claim under Benefit 1 is a pre-condition to the admission of a 1.44 Place of Destination means the destination place where the journey of the Claim under Benefit 2, Benefit 3, Benefit 4, Benefit 5, Benefit 9 and Benefit 11

Insured Person, forming part of the Trip, is scheduled to be concluded through a (Clause 2.11.2) and the event giving rise to the Claim under the Benefit 1 shall be Common Carrier. within the Period of Insurance for the Claim for such Benefit to be accepted.

1.45 Place of Origin means the starting point/place from where the Insured (c) The maximum, total and cumulative liability of the Company for an Insured Person Person's Trip is scheduled to be undertaken through a Common Carrier by which for any and all Claims incurring under this Policy during the Policy Period for an he finally leaves the Country of Residence. insured event or occurrence that occurs during the Period of Insurance in relation

to that Insured Person shall not exceed the Sum Insured for that Insured Person. 1.46 Place of Residence means the dwelling place that the Insured Person is All Claims shall be payable subject to the terms, conditions and exclusions of the normally and presently resident in as specified as the correspondence address of Policy and subject to availability of the Sum Insured.the Policyholder in the Policy Certificate.

(d) The currency of the Sum Insured shall correspond to the currency mentioned for (ii) The total amount payable under such Claim shall not exceed the sum all the Benefits. of the Sum Insured and additional Sum Insured;

2.1 Benefit 1 : Hospitalization Expenses (iii) The additional Sum Insured shall be available only for such Insured Person for whom Claim for Hospitalization following the Accident

2.1.1. In-patient Care has been accepted under the Policy.

A. If the Insured Person is hospitalized for Emergency Care of any Illness (iv) The additional Sum Insured shall be applied only once during the Policy or Injury during the Period of Insurance, then the Company will indemnify

Period.up to the amount specified against this Benefit in the Policy Certificate the Medical Expenses incurred on Hospitalization provided that : H. Conditions For In-Patient Care (Applicable only if

opted by the Policyholder and specifically mentioned in (i) The Hospitalization is on the written advice of a Medical the Policy Certificate)

Practitioner; and(a) The Company's maximum liability under this Benefit for In-patient Care

(ii) The treatment for the Illness or Injury commences during the Period under an admissible Claim in respect of any Insured Person of Age 61 years of Insurance and immediately after the diagnosis of the Illness or or above (as on date of Policy Period Start Date) shall be limited in occurrence of the Injury; and accordance with the table below:

(iii) The amount assessed by the Company on each admitted Claim for Medical Expense Sub-limitthe Insured Person under this Benefit shall be reduced by the Deductible. The Company shall be liable to make payment under the Room Rent including boarding and lodging 1.5% of the Sum Insured subject to a Policy for any Claim in respect of the Insured Person only when the maximum of US $ 2,000 per day/€ 1,500 Deductible on that Claim is exhausted. per day

B. If a Claim is admitted under Clause 2.1.1, then the Company will ICU Charges 2% of the Sum Insured subject to a automatically extend the Period of Insurance without payment of any extra maximum of US $ 3,000 per day/€ 2,250 premium for up to 7 days from the expiry of the Period of Insurance. per dayHowever, in case the Insured Person returns to the Country of Residence Operation Theatre charges (including 10% of the Sum Insured subject to aprior to expiry of such extension, the Period of Insurance shall cease to Surgeon Charges) maximum of US $ 20,000 per Claimexist from such day. /€ 15,000 per Claim

Such extension shall be provided only if there is a delay or cancellation of Anesthesia 25% of the surgery cost payablethe departure of the Common Carrier in which the Insured Person was

Ambulance Services US $ 500 per Claim/€ 375 per Claimbooked to return to the Country of Residence and such delay was beyond the control of the Insured Person and no alternative transportation was Diagnostics and Radiology Services US $ 1,000 per Claim/€ 750 per Claimavailable to the Insured Person to return.

Medical Practitioners visit fees US $ 100 per visit/€ 75 per visit subject C. If a Claim is admitted under Clause 2.1.1, then the Company may, in its sole to maximum of 10 visits per Claim

discretion, indemnify the Medical Expenses incurred on Hospitalization of Miscellaneous Expenses US $ 1,000 per Claim/€ 750 per Claimthe Insured Person in the Country of Residence for a maximum period of

30 days from the expiry of the Period of Insurance, provided that: (b) For the purpose of application of the above limits :(i) The Hospitalization is required for the same Illness or Injury for

(i) Surgery includes operation theatre charges, surgeon fees, implant which the Claim under Clause 2.1.1 was admitted;charges and all other associated charges.

(ii) The Company shall not be liable to make any payment under this (ii) Ambulance Services include cost of transportation of the Insured Benefit after the Policy Period End Date;

Person to the nearest Hospital and paramedic services.(iii) The Company's pre-authorization for Hospitalization in the Country

of Residence as specified under this Clause has been obtained. (iii) Miscellaneous Expenses includes but not limited to the cost of medicines, pharmacy or drugs supplies, nursing charges, external D. If a Claim is admitted under Clause 2.1.1(C), then the Company will medical appliances as prescribed by a registered Medical indemnify the costs of economy airfare for the Insured Person and one Practitioner as necessary and essential as part of the treatment on accompanying attendant to return to the Country of Residence from the actuals, blood storage and processing charges and any other place of occurrence of the Illness or Injury provided that:services which are not specified above.

(i) The Company shall pay only up to the most economical airfare 2.1.2 Out-Patient Treatment available on the date of the journey; and

If an Insured Person is diagnosed with an Illness or suffers an Injury during the (ii) The Company shall indemnify the costs of the attendant's airfare only Period of Insurance that requires the Insured Person to take Out-patient if it is Medically Necessary and prescribed by the treating Medical Treatment, then the Company will indemnify up to the amount specified against Practitioner for an attendant to accompany the Insured Person;this Benefit in the Policy Certificate for the Medical Expenses incurred on that

E. In case any Claim has been made under Clause 2.1.1(D), then no Claim shall Out-patient Treatment.be made under Benefit 5.

2.1.3 Exclusions Applicable to Benefit 1F. If the Claim is made for an Emergency medical treatment rendered in case

Any Claim in respect of any Insured Person for, arising out of or directly or of a Life Threatening Medical Condition, during the Period of Insurance for indirectly due to any of the following shall not be admissible under this Benefit any sudden, unexpected, unforeseen development attributable to any Pre-unless expressly stated to the contrary elsewhere in the Policy terms and existing Disease, the claim amount shall be 10% of the Sum Insured or the conditions:actual hospitalization expenses whichever is less, the deductibles being

applied on the claim amount, provided that : (i) Medical treatment taken outside the Country of Residence if that is the sole reason or one of the reasons for the journey.(i) The approval of the Company or the Assistance Service Provider is

obtained within 24 hours of commencement of Hospitalization; and (ii) Any treatment, which could reasonably be delayed until the Insured Person's return to the Country of Residence.(ii) Any Claim under this Clause shall be admissible only till the Insured

Person becomes medically stable or is relieved from Acute pain; and (iii) Any treatment of orthopedic diseases or conditions except for fractures, dislocations and/or Injuries suffered during the Period of Insurance.(iii) All further Medical Expenses including but not limited to those

expenses related to maintaining the medically stable state or to (iv) Degenerative or oncological (Cancer) diseases.prevent the onset of Acute pain or any further treatment would not

(v) Dental Treatment.be covered by the Company.(vi) Circumcision.G. In case any Claim is made for Emergency Care of any Injury due to an

Accident during the Period of Insurance, the Company shall automatically (vii) Treatment of any Congenital Anomaly or Illness or defects or anomalies or provide an additional Sum Insured equal to the original Sum Insured for In- treatment relating to birth defects.patient Care for that Insured Person who is hospitalized, provided that:

(viii) Hormone replacement therapy.(i) The additional Sum Insured shall be utilized only after the original

(ix) Weight management services and treatment, vitamins and tonics related to Sum Insured has been completely exhausted;

weight control programs, services and supplies including treatment of case papers and prescriptions issued by the treating Medical Practitioner or obesity (including morbid obesity). Network Provider.

(x) Rest or recuperation at a spa or health resort, sanatorium, convalescence (iv) Copy of Passport with entry and exit stamp of the country of treatment.home or similar institution. (v) Original bills and receipts for:

(xi) Treatment of mental disease or Illness, stress, psychiatric or I. Charges paid towards Hospital accommodation, nursing facilities and psychological disorders.other medical services rendered.

(xii) Pregnancy and resulting childbirth, miscarriage or disease of the female II. Fees paid to the Medical Practitioner and for special nursing charges.organs of reproduction. This exclusion will not apply to ectopic pregnancy.III. Charges incurred towards any and all test and / or examinations (xiii) Routine physical tests and/or examination of any kind not consistent with or

rendered in connection with the treatment.incidental to the diagnosis and treatment of any Illness or Injury either in a Hospital or as an outpatient and any type of vaccination or inoculation if it IV. Charges incurred towards medicines or drugs purchased from a does not apply to post-bite treatment. registered pharmacy other than the Network Provider duly

supported by the prescriptions of the Medical Practitioner attending (xiv) Rehabilitation and/or physiotherapy expenses or the cost of prostheses/ to the Insured Person.prosthetics (artificial limbs) or any services provided by chiropractitioner.V. Any other document as required by the Company to assess the (xv) All non-allopathic treatment including but not limited to Naturopathy or

Claim.Yoga, Ayurvedic Medicine, Homeopathic Medicine, Unani Medicine or any unrecognized systems of medicine. (b) Only in the event that original bills, receipts, prescriptions, reports or other

documents have already been given to any other insurance company or to a (xvi) Treatment or surgery or any medical procedure (whether invasive or non-reimbursement provider the Company will accept properly verified photocopies invasive) using a robotic surgical system.of such documents attested by such other insurance company/reimbursement

2.1.4 Claim Procedure (Cashless) Applicable to Benefit 1 provider along with an original certificate of the extent of payment received from such insurance company/reimbursement provider.(a) Cashless Facility : Cashless Facility is available only at Network Providers.

The Insured Person can avail of this Cashless Facility at the time of admission into a (c) The Company will only accept bills/invoices which are made in the Insured Network Provider, by completing the following procedure: Person's name.

(i) Pre-authorization : The Policyholder or Insured Person must call the (d) The Company shall condone delay on merit for delayed Claims where delay is Company's/Assistance Service Provider's call center as specified in the proved to be for reasons beyond the control of the Policyholder or the Insured Policy Certificate and request authorization for the proposed treatment by Person.way of submission of a completed pre-authorization form at least within 24

2.2 Benefit 2 : Daily Allowancehours of admission to Hospital, if the Hospitalization is required.

(a) The Company will pay the amount specified against this Benefit in the Policy (ii) The Company will process the request for authorization after having Certificate for each continuous and completed period of 24 hours of

obtained accurate and complete information in respect of the Illness or Hospitalization of the Insured Person, provided that:Injury for which Cashless Facility is sought to be availed. The Company or the Assistance Service Provider will confirm in writing authorization or (i) The Hospitalization is only for In-patient Care; andrejection of authorization to avail Cashless Facility for the Insured Person's (ii) The Company will not be liable to make payment under this Benefit for Hospitalization. more than 5 consecutive days of Hospitalization for Any One Illness.

(iii) If the request for availing Cashless Facility is authorized by the Company or (iii) The Company will not be liable to make payment under this Benefit for first the Assistance Service Provider, then payment for the Medical Expenses 2 consecutive days of Hospitalization.incurred in respect of the Insured Person shall not have to be made to the extent that such Medical Expenses are covered under this Policy and fall 2.3 Benefit 3 : Compassionate Visitwithin the amount authorized in writing by the Company for availing (a) The Company will indemnify, up to the amount specified against this Benefit in the Cashless Facility. Payment in respect of all Deductibles and amount Policy Certificate, the reasonable expenses incurred for the actual cost of a return exceeding the sub-limits as applicable shall be made directly by the economy class air ticket or equivalent by the most direct route from the Country Policyholder or Insured Person to the Network Provider. of Residence of an Immediate Family Member to the place of Hospitalization of

(iv) If the Company or the Assistance Service Provider does not authorize the the Insured Person, provided that:Cashless Facility due to insufficient Sum Insured or insufficient information (i) The Insured Person is hospitalized for Emergency Care of any Injury or provided to the Company or the Assistance Service Provider to determine Illness suffered during the Period of Insurance; andthe admissibility of the Claim or if the treatment is not taken at a Network Provider, payment for the treatment will have to be made by the (ii) The treating Medical Practitioner advises that the attendance of an Policyholder or Insured Person to the Network Provider, following which a Immediate Family Member is necessary; andClaim for reimbursement may be made to the Company which will be (iii) The treating Medical Practitioner certifies that the Insured Person is considered by the Company subject to the terms, conditions and exclusions required to be hospitalized for at least 5 consecutive days; andunder the Policy.

(iv) The Immediate Family Member's return travel to the Country of Residence (v) It is agreed and understood that in all cases where availing of Cashless shall commence not later than the date of the Insured Person's return to

Facility has been authorized in writing by the Company or the Assistance the Country of Residence.Service Provider, all the information and documents as specified below in Clause 2.1.5. shall be submitted to the Company or the Assistance Service (b) Documents to be submitted for any Claim under this Benefit:Provider immediately and in any event before the Insured Person's It is a condition precedent to the Company's liability under this Benefit that the discharge from Network Provider. following information and documents shall be submitted to the Company or the

(b) It is agreed and understood that the Company may, in its sole discretion, modify or Assistance Service Provider immediately and in any event within 30 days of the add to the list of Network Providers or modify or restrict the extent of Cashless event giving rise to the Claim under this Benefit:Facilities that may be availed at any particular Network Provider. Before availing (i) A certificate from the Medical Practitioner recommending the presence in the Cashless Facility, Policyholder or the Insured Person is required to check the the form of special assistance to be rendered by an additional member applicable list of Network Providers for the area where he intends to avail the during the entire period of Hospitalization. The certificate shall also specify Cashless Facility through the ASP's call center number as provided in the Policy the minimum period of Hospitalization.Certificate or by visiting the ASP's website or Company's website.

(ii) Discharge summary of the Hospital furnishing details including the date of 2.1.5 Documents to be submitted for any claim under benefit 1

admission and date of discharge.(a) It is a Condition Precedent to the Company's liability under this Benefit that the

(iii) Original ticket with invoice used for the travel by the Immediate Family following information and documents shall be submitted to the Company or the Member.Assistance Service Provider immediately and in any event within 30 days of the

event giving rise to the Claim under this Benefit : (iv) Copy of passport of Immediate Family Member with entry and exit stamp.

(i) Duly filled and signed Claim form 2.4 Benefit 4 : Return of Minor Child

(ii) Duly filled and signed 'Release of Medical Information Form' (a) If the Insured Person is hospitalized for Emergency Care of any Illness or Injury during the Period of Insurance, the Company will indemnify up to the amount

(iii) Original pathological and diagnostic reports, discharge summary, indoor

specified against this Benefit in the Policy Certificate the reasonable expenses Policy Certificate, the Medical Expenses incurred for “Dental Treatment” during incurred in respect of the children, of such Insured Person, for the actual cost of an the Period of Insurance in connection with any Injury to the Insured Person's economy class air ticket or equivalent by the most direct route from the place of Sound Natural Teeth during the Period of Insurance provided that:Hospitalization of the Insured Person to the Country of Residence, provided that:

(i) The treatment is provided by a Medical Practitioner qualified in practicing (i) The Insured Person's children are less than Age 18; and dentistry or dental surgery; and

(ii) The Insured Person's children are covered under this Policy as Insured (ii) The Company's maximum and total liability per tooth shall not exceed the Person or are covered under any other travel insurance policy issued by the amount specified in the Policy Certificate; andCompany for the same Period of Insurance; and (iii) The amount assessed by the Company on each admitted Claim for the

(iii) The Insured Person's children are unattended in the place of Insured Person under this Benefit shall be reduced by the Deductible. The Hospitalization; and Company shall be liable to make payment under the Policy for any Claim in

respect of the Insured Person only when the Deductible on that Claim is (iv) The treating Medical Practitioner certifies that the Insured Person is exhausted. required to be hospitalized for at least 5 consecutive days; and(iv) For the purposes of this Benefit only:

(v) The Insured Person's children's return travel to the Country of Residence shall commence not later than 10 days from the commencement of the Sound Natural Teeth means natural teeth that are either unaltered Insured Person's Hospitalization. or are fully restored to their normal function and are disease-free, have no

decay and are not more susceptible to Injury than unaltered natural teeth;(b) Documents to be submitted for any Claim under this Benefit:(b) Clause 3(h) is superseded to the extent covered under this Benefit.

It is a condition precedent to the Company's liability under this Benefit that the following information and documents shall be submitted to the Company or the (c) Exclusions Applicable To Benefit 6Assistance Service Provider immediately and in any event within 30 days of the

Any Claim in respect of any Insured Person for, arising out of or directly or event giving rise to the Claim under this Benefit:indirectly due to any of the following shall not be admissible under this Benefit

(i) A certificate from the Medical Practitioner specifying the minimum period unless expressly stated to the contrary elsewhere in the Policy terms and of Hospitalization. conditions:

(ii) Discharge summary of the Hospital furnishing details including the date of (i) Treatment, which could reasonably be delayed until the Insured Person's admission and date of discharge. return to the Country of Residence.

(iii) Original ticket used for the return travel of the children to the Country of (d) Documents to be submitted for Claim under this BenefitResidence.

It is a condition precedent to the Company's liability under this Benefit that the (iv) Copy of passport of the children with entry and exit stamp. following information and documents shall be submitted to the Company or the

Assistance Service Provider immediately and in any event within 30 days of the 2.5 Benefit 5 : Up-gradation to Business Class

event giving rise to the Claim under this Benefit:(a) If the Insured Person is hospitalized for Emergency Care of any Illness or Injury for

(i) Original pathological or diagnostic reports and medical prescriptions issued a period of 5 consecutive days or more during the Period of Insurance, the by the treating Medical Practitioner or Hospital; Company will indemnify, up to the amount specified against this Benefit in the

Policy Certificate, the reasonable expenses incurred in respect of the Insured (ii) Original Bills and receipts for:Person's up-gradation to a business class air ticket by the most direct route from

I. Fees paid to the Medical Practitioner and special nursing charges; andthe place of Hospitalization of the Insured Person to the Country of Residence, provided that: II. Charges incurred towards any and all test and / or examinations

rendered in connection with the treatment.(i) The Insured Person's return air travel to the Country of Residence shall commence not later than 20 days from the discharge of Insured Person (iii) Charges incurred towards medicines or drugs purchased from a registered from Hospital; and pharmacy other than the Hospital duly supported by the prescriptions of

the Medical Practitioner attending to the Insured Person;(ii) If the Insured Person's air ticket can be up-graded from economy class to business class, the Company's maximum liability under this Benefit shall be (iv) Any other information or documents related to the treatment taken.limited to the difference in cost between the economy class air ticket and

2.7 Benefit 7 : Personal Accidentbusiness class air ticket; and(a) If the Insured Person suffers an Injury during the Period of Insurance solely and (iii) If the Insured Person's economy class air ticket cannot be up-graded, then

directly due to an Accident that occurs during the Period of Insurance, which the Company's maximum liability under this Benefit shall be limited to the directly results in:cost of cancellation and the difference between the cost of the new

business class ticket and the refund amount received on the economy class (i) The Insured Person's death within 12 months of the occurrence of the ticket cancelled. Injury; or

(iv) The Company shall not be liable to make any payment under this Benefit if (ii) The Insured Person's Permanent Total Disablement within 12 months of the Insured Person was originally booked to return to the Country of the occurrence of the Injury such that the Insured Person is unable to Residence on a business class air ticket. resume his normal occupation or engage in similar gainful employment due

to the Permanent Total Disability suffered.(b) In case any Claim is made under this Benefit, no Claim shall be made under Clause 2.1.1(D). The Company will pay the Sum Insured will pay in accordance with the table below :

(c) Documents to be submitted for any Claim under this Benefit: S. No. Event % of the Sum Insuredof this Benefit payableIt is a condition precedent to the Company's liability under this Benefit that the

following information and documents shall be submitted to the Company or the 1 Accidental Death 100%Assistance Service Provider immediately and in any event within 30 days of the

2 Permanent Total Disablement (PTD) meansevent giving rise to the Claim under this Benefit:

A. The total and irrecoverable loss of sight of 100%(i) A certificate from the Medical Practitioner specifying the minimum period both eyes, or actual loss by physical separation of Hospitalization.of two entire hands or two entire feet, or one

(ii) Discharge summary of the Hospital furnishing details including the date of entire hand and one entire foot, or loss of sight admission and date of discharge. of one eye and actual loss by physical separation

of one entire hand or one entire foot;(iii) Copy of the economy class air ticket issued by the Common Carrier indicating the cost the ticket and receipt for the refund of the fare of the B. Loss of sight of one eye, or actual loss by 50%Common Carrier and the cancellation charges retained. physical separation of one entire hand or one

entire foot(iv) Boarding pass and copy of business class ticket confirming the return journey and the cost of ticket.

(i) For the purpose of this Benefit only, “Physical separation of a hand or foot” 2.6 Benefit 6 : Dental Treatment means actual severance of hand at or above the wrist, and of foot at or

above the ankle. (a) The Company will indemnify, up to the amount specified against this Benefit in the

(b) Documents to be submitted for any Claim under this Benefit: It is a condition precedent to the Company's liability under this Benefit that the following information and documents shall be submitted to the Company or the It is a condition precedent to the Company's liability under this Benefit that the Assistance Service Provider immediately and in any event within 30 days of the following information and documents shall be submitted to the Company or the event giving rise to the Claim under this Benefit:Assistance Service Provider immediately and in any event within 30 days of the

event giving rise to the Claim under this Benefit: (i) Copy of the death certificate providing details of the place, date, time, and the circumstances and cause of death; (i) Medical reports giving the details of the Accident, nature of the Injury, the

extent of disability (if applicable) and the details of treatment provided. (ii) Copy of the postmortem certificate, if conducted;

(ii) Death certificate (if applicable) (iii) Documentary proof for expenses incurred towards disposal of the mortal remains;(iii) Postmortem report, if conducted

(iv) In case of transportation of the body of the deceased to the Country of (iv) Police report.Residence or Place of Residence, the receipt for expenses incurred

(v) Medical Practitioner's certificate in case of Injury stating the reasons for and towards preparation and packing of the mortal remains of the deceased the extent of the Injury and also for the transportation of the mortal remains of the deceased.

2.8 Benefit 8 : Common Carrier Accidental Death 2.11 Benefit 11 : Trip Cancellation and Interruption

2.11.1 Trip Cancellation(a) If the Insured Person dies within twelve months due to any Injury sustained solely and directly due to an Accident during the Period of Insurance whilst mounting A. If the Insured Person's outward journey as a fare paying passenger from the into or dismounting from or travelling in a Common Carrier on a valid ticket, the Country of Residence to an international Place of Destination on a Company will pay the Sum Insured as specified against this Benefit. Common Carrier is unavoidably cancelled before the commencement of

the Period of Insurance due to any of the reasons specified herein below, (b) Documents to be submitted for any Claim under this Benefit:then the Company will indemnify, up to the amount specified against this

It is a condition precedent to the Company's liability under this Benefit that the Benefit in the Policy Certificate, for those travel expenses that the following information and documents shall be submitted to the Company or the Policyholder incurred and cannot recover and for which no value can be Assistance Service Provider immediately and in any event within 30 days of the derived without knowledge of the likelihood of cancellation:event giving rise to the Claim under this Benefit:

(i) The Insured Person's Immediate Family Member dies or is (i) Medical reports giving the details of the Accident and nature of Injury. Hospitalized in an Emergency due to an unforeseen Illness or Injury

for at least 2 consecutive days provided that such Illness or Injury shall (ii) Death certificate.not first occur earlier than 10 consecutive days from the scheduled

(iii) Postmortem report, if conducted. commencement of the Period of Insurance; or

(iv) Police report. (ii) The Insured Person is Hospitalized in an Emergency due to an unforeseen Illness or Injury and such Hospitalization commences within 10 days from (v) Valid ticket or certificate from the Common Carrier establishing the the scheduled commencement of the Period of Insurance and continues Insured Person's bonafide travel in the affected Common Carrier at the for at least 2 consecutive days and the treating Medical Practitioner certifies time of the Accident.in writing that the Insured Person is not fit to undertake travel;

2.9 Benefit 9 : Medical Evacuation(iii) Earthquake, storm, flood, inundation, cyclone or tempest provided that

(a) The Company will indemnify, up to the amount specified against this Benefit in the the peril takes place prior to the commencement of the Period of Policy Certificate, for the reasonable cost incurred for the medical evacuation of Insurance at or in the vicinity of the Place of Origin of the journey, the the Insured Person in an Emergency through an Ambulance or any other ultimate scheduled Place of Destination or any intermediate place which is transportation and evacuation services, (including necessary medical care en- involved in or related to the proposed journey.route forming part of the treatment) for any Illness contracted or Injury sustained

(iv) Terrorism provided that the peril takes place prior to the commencement by the Insured Person during the Period of Insurance, provided that:of the Period of Insurance at or in the vicinity of the Place of Origin of the

(i) The treating Medical Practitioner certifies in writing that the severity or the journey, the ultimate scheduled Place of Destination or any intermediate nature of the Insured Person's Illness or Injury warrants the Insured place which is involved in or related to the proposed journey;Person's Emergency medical evacuation;

B. Any amount refunded to the Insured Person by the Common Carrier in relation (ii) These transportation expenses are limited to transporting the Insured to the cancellation shall be deducted from the amount payable to the Insured

Person from the place of contracting or sustaining such Illness or Injury to Person under this Benefit. the nearest appropriate Hospital;

2.11.2 Trip Interruption(iii) The services under this Benefit shall only be provided on a cashless basis if

A. If the Insured Person's overseas stay is unavoidably curtailed after the the costs are authorized by the Company or the Assistance Service commencement of the Period of Insurance due to any of the reasons as specified Provider in advance, unless the Insured Person has a Life Threatening herein below, then the Company will indemnify the costs of economy airfare of Medical Condition and the Policyholder or the Insured Person (or his the Insured Person to return to the Country of Residence:representatives) arrange for the Emergency medical evacuation at their

own cost and expense in which case the Company will indemnify the costs (i) The Insured Person's Immediate Family Member dies or is Hospitalized in incurred on the Emergency medical evacuation in accordance with the an Emergency due to an unforeseen Illness or Injury and such terms of this Benefit; Hospitalization continues for at least 2 consecutive days;

(b) Documents to be submitted for any Claim under this Benefit : (ii) Earthquake, storm, flood, inundation, cyclone or tempest provided that the peril takes place after the commencement of the Period of Insurance at It is a condition precedent to the Company's liability under this Benefit that the or in the vicinity of the Place of Origin of the journey, the ultimate following information and documents shall be submitted to the Company or the scheduled Place of Destination or any intermediate place which is involved Assistance Service Provider immediately and in any event within 30 days of the in or related to the proposed journey.event giving rise to the Claim under this Benefit:

(iii) Terrorism provided that the peril takes place after the commencement of (i) Medical reports and transportation details issued by the evacuation agency, the Period of Insurance at or in the vicinity of the Place of Origin of the prescriptions and medical report by the attending Medical Practitioner journey, the ultimate scheduled Place of Destination or any intermediate furnishing the name of the Insured Person and details of treatment place which is involved in or related to the proposed journey;rendered along with the statement confirming the necessity of evacuation;

B. Any amount refunded to the Insured Person by the Common Carrier in relation (ii) Documentary proof for all expenses incurred towards the Medical to the curtailment shall be deducted from the amount payable to the Insured Evacuation.Person under this Benefit.

2.10 Benefit 10 : Repatriation of Mortal RemainsC. Exclusions applicable to Benefit 11

(a) If the Insured Person dies solely and directly due to an Accident during the Period Any Claim in respect of any Insured Person for, arising out of or directly or of Insurance, the Company will indemnify, up to the amount specified against this indirectly due to any of the following shall not be admissible under this Benefit Benefit in the Policy Certificate, the costs of repatriation of the mortal remains of unless expressly stated to the contrary elsewhere in the Policy terms and the Insured Person back to the Place of Residence or, up to an equivalent amount, conditions:for a local burial or cremation at the place where death has occurred. (i) Strikes or labor disputes or slowdown;(b) Documents to be submitted for any Claim under this Benefit :

(ii) Interruption or cancellation of the journey either wholly or in partly at the the amount paid by the Company under this Benefit in full irrespective of instance of the Common Carrier (apart from the reasons listed above) whether delivery of the Baggage is taken or not; andor by the travel agent;

(iv) If a portion of the lost/undelivered Checked-In Baggage is subsequently (iii) Interruption or cancellation of the journey either wholly or in partly at the traced and offered for delivery to the Insured Person, the Insured Person

instance of the authority governing the Common Carrier or the shall refund the amount paid by the Company under this Benefit which is government; attributable to the portion of Checked-In Baggage traced in full

irrespective of whether delivery of the Baggage is taken.(iv) Any Claim under the Policy which arises out of an event which occurs prior

to Policy Period Start Date. (b) Exclusions applicable to Benefit 13

D. Documents to be submitted in support of the Claim under Any Claim in respect of any Insured Person for, arising out of or directly or Benefit 11 indirectly due to any of the following shall not be admissible under this Benefit

unless expressly stated to the contrary elsewhere in the Policy terms and It is a condition precedent to the Company's liability under this Benefit that the conditions:following information and documents (as applicable) shall be submitted to the

Company or the Assistance Service Provider immediately and in any event within (i) Any partial loss or damage of any items contained in the Checked-In 30 days of the event giving rise to the Claim under this Benefit: Baggage.

(i) Confirmation in writing of cancellation of the journey from the Common (ii) Any loss arising from any delay, detention, confiscation by customs officials Carrier detailing the circumstances of cancellation; or other public authorities.

(ii) Ticket/boarding pass issued by the Common Carrier indicating the cost of (iii) Any loss due to damage to the Checked-In Baggage.ticket and receipt for the refund of the fare of the Common Carrier

(iv) Any loss for which a Claim has already been made under Benefit 14; towards the cancelled portion of the journey indicating cancellation charges retained by the Common Carrier. (v) Any loss of Checked-In Baggage sent in advance or shipped separately.

(iii) Boarding pass in original for return journey from the place of cancellation to (c) Documents to be submitted for any Claim under Benefit 13the Country of Residence which indicates the cost of the tickets together

It is a condition precedent to the Company's liability under this Benefit that the with the receipts for the refunds obtained towards the unfulfilled portion following information and documents shall be submitted to the Company or the of the journey.Assistance Service Provider immediately and in any event within 30 days of the

(iv) A declaration from the Insured Person furnishing the circumstances that event giving rise to the Claim under this Benefit:compelled him to cancel the journey;

(i) Property irregularity report issued by the appropriate authority.(v) Medical evidence as may be required in case of the cancellation of the

(ii) Voucher of the Common Carrier for the compensation paid for the non-journey arising out of personal contingencies of the Insured Person or his delivery/short delivery of the Checked-In Baggage.Immediate Family Member;

(iii) Copies of correspondence exchanged, if any, with the Common Carrier in (vi) Receipt for the refund of the fare of the Common Carrier towards the connection with the non-delivery/short delivery of the Checked-In cancelled portion of the journey indicating the cancellation charges Baggage.retained;

2.14 Benefit 14 : Delay of Checked-In Baggage2.12 Benefit 12 : Trip Delay

(a) The Company will pay the Sum Insured as specified in the Policy Certificate if the A. The Company will pay the Sum Insured as specified in the Policy Certificate, if the delivery of the Insured Person's Checked-In Baggage which has been entrusted to departure of a Common Carrier in which the Insured Person is scheduled to the Common Carrier is delayed by more than 12 hours from the Insured Person's travel on a valid ticket during the Period of Insurance is delayed for more than 12 arrival at the Place of Destination specified on his valid ticket during the Period of consecutive hours from the later of the declared time of departure or expected Insurance. time of departure due solely and directly to any one of the following:

(b) Exclusions applicable to Benefit 14(i) Earthquake, flood, rains, storm, cyclone or tempest; orAny Claim in respect of any Insured Person for, arising out of or directly or (ii) Terrorismindirectly due to any of the following shall not be admissible under this Benefit

B. Provided that the Company or the Assistance Service Company is unless expressly stated to the contrary elsewhere in the Policy terms and conditions:(i) Given written notice of the delay immediately and in any event within

30days of the commencement of the delay; and (i) Any delay which does not exceed the time period specified in this Benefit.

(ii) Immediate alternative arrangements are made by the Insured Person for (ii) Any loss for which a Claim has already been made under Benefit 13.progressing the journey as scheduled.

(iii) Any delay in delivery of the Checked-In Baggage arising out of or resulting C. Exclusions applicable to Benefit 12 from detention or confiscation of the baggage by the Common Carrier or

customs or any government or other agencies.Any Claim in respect of any Insured Person for, arising out of or directly or indirectly due to any of the following shall not be admissible under this Benefit (iv) Any delay attributable to damage to the Checked-In Baggage warranting an unless expressly stated to the contrary elsewhere in the Policy terms and examined delivery by the Common Carrier.conditions:

(v) Self-carried or cabin baggage(i) Any contingencies other than those specifically named above;

(c) Documents to be submitted for any Claim under Benefit 14(ii) The Common Carrier is taken out of service on the instructions of the Civil

It is a condition precedent to the Company's liability under this Benefit that the Aviation Authority or any similar authority;following information and documents shall be submitted to the Company or the

2.13 Benefit 13 : Loss of Checked-In Baggage Assistance Service Provider immediately and in any event within 30 days of the event giving rise to the Claim under this Benefit:(a) The Company will pay the Sum Insured as specified in the Policy Certificate, if the

entire Checked-In Baggage is lost whilst in the custody of the Common Carrier (i) Property irregularity report issued by the appropriate authority stating the provided that: scheduled time of delivery and actual time of delivery of the Checked-In

Baggage.(i) Coverage under this Benefit shall commence only after the Checked-in Baggage is entrusted to the Common Carrier and a receipt obtained and (ii) Voucher of the Common Carrier for the compensation paid for the delay coverage under this Benefit shall terminate automatically on the Common in delivery of the Checked-In Baggage.Carrier reaching the Place of Destination specified in the ticket of the

(iii) Copies of correspondence exchanged, if any, with the Common Carrier in Insured Person during the Period of Insurance; andconnection with the delay in delivery of the Checked-In Baggage.

(ii) If more than one (1) piece of Checked-In Baggage has been checked-in 2.15 Benefit 15 : Loss of Passportunder the same ticket of the Insured Person, the Company's liability shall be

restricted to 50 % of the Sum Insured if all the pieces of Checked-In (a) If the Insured Person loses his original passport while on a foreign land on a valid Baggage are not lost; trip during the Period of Insurance, the Company will pay the amount as specified

in the Policy Certificate for obtaining a duplicate or new passport. (iii) If the lost/undelivered Checked-In Baggage is subsequently traced and offered for delivery to the Insured Person, the Insured Person shall refund (b) Documents to be submitted for any Claim under Benefit 15

It is a condition precedent to the Company's liability under this Benefit that the (xvii) Any liability arising from a contingency occurring anywhere in the Country following information and documents shall be submitted to the Company or the of Residence of the Insured Person.Assistance Service Provider immediately and in any event within 30 days of the

(xviii) Liability arising out of any breach of law or rules or any criminal liability.event giving rise to the Claim under this Benefit:(e) Terms and conditions applicable to Benefit 16(i) Copy of the police report

(i) Every notice, writ, summons or process and all documents relating to the (ii) Details of the attempts made to trace the passportClaim/event shall be forwarded to the Company immediately on receipt by

(iii) Original receipt for payment of charges to the authorities for obtaining a the Insured Person. new or duplicate passport.

(ii) No admission, offer, promise or payment shall be made or given by or on (c) Exclusions applicable to Benefit 15 behalf of the Insured Person without the prior written consent of the

Company.(i) Where the loss is not reported to the appropriate police authority within

24 hours of the discovery of the loss, and in respect of which an official (iii) Insured Person shall fully co-operate and support and act as per the advice report has not been obtained. of the Company or the Assistant Service Provider.

(ii) Where the Insured himself has failed to take reasonable steps to guard (iv) Insured Person shall fully support the Company in reaching a compromise against the loss of passport. with the aggrieved party and/ or to take such steps as may be required to

bring the Claim to an amicable settlement.2.16 Benefit 16 : Personal Liability

(v) All amounts incurred by the Company in the defense, settlement and/or (a) The Company shall indemnify, up to the amount specified against this Benefit in payment of any Claim, will correspondingly reduce the Sum Insured under the Policy Certificate, the Policyholder / the Insured Person against actual legal this benefit.liability for damages for accidental Injury or property damage to third parties

arising on account of Insured Person's negligence occurring during the Period of (vi) The Insured Person shall not settle or offer for settlement or enter into a Insurance for which civil Claim is made or suit brought against the Insured Person compromise with the claimant or any other person without the prior by the third parties not later than 60 days from the expiry of the Period of consent and the written approval of the Company or Assistance Service Insurance. Provider.

(b) The Company shall also indemnify the Insured Person towards the cost of defense (vii) The terms and exclusions of this Benefit (and any phrase or word incurred, upon the prior written consent of the Company. contained therein) shall be interpreted in accordance with Indian law.

(c) The amount assessed by the Company on each admitted Claim for the Insured (f) Documents to be submitted for any Claim under Benefit 16Person under this Benefit shall be reduced by the Deductible. The Company shall It is a condition precedent to the Company's liability under this Benefit that the be liable to make payment under the Policy for any Claim in respect of the Insured following information and documents shall be submitted to the Company or the Person only when the Deductible on that Claim is exhausted.

Assistance Service Provider immediately and in any event within 30 days of the (c) Exclusions applicable to Benefit 16 event giving rise to the Claim under this Benefit:

Any Claim in respect of any Insured Person for, arising out of or directly or (i) Statement of Claim furnishing particulars of the event leading to the liability indirectly due to any of the following shall not be admissible under this Benefit such as the court order;unless expressly stated to the contrary elsewhere in the Policy terms and (ii) Photocopy of the police report (wherever reported).conditions:

(i) Liability of the Insured Person in relation to any professional services rendered by him.

3. General Exclusions(ii) Liability for injury or damage of any kind whilst the Insured Person is

Any Claim in respect of any Insured Person for, arising out of or directly or indirectly due to engaged in his business activities or in course of business activities.any of the following shall not be admissible unless expressly stated to the contrary

(iii) Liability assumed by the Insured Person by an agreement or contract which elsewhere in the Policy terms and conditions: would not have attached in the absence of such agreement or contract.

(a) Any events occurring outside the Period of Insurance except for a Claim (iv) Liability arising out of any Acts of God including but not limited to for Trip Cancellation under Benefit 11.

earthquake, earth-tremor, volcanic eruption, flood, storm, tempest, (b) The Insured Person is :typhoon, hurricane, tornado, cyclone or other similar acts or convulsions of

nature and atmospheric disturbances. (i) Traveling against the advice of a Medical Practitioner; or(v) Fines, penalties, punitive or exemplary damages of any kind. (ii) Receiving, or is supposed to receive, medical treatment; or(vi) Liability arising from the use of any motor vehicle, aircrafts, water crafts and (iii) Having received terminal prognosis for a medical condition; or

other vehicles.(iv) Travelling for the purpose of obtaining medical treatment; or

(vii) Any liability, which is the subject matter of specific insurance elsewhere.(v) Taking part or is supposed to participate in a naval, military or air force

(viii) Any personal liability of the Insured Person towards his family, relatives or operation or war like or peace keeping operation.traveling companions, whether personal or official or commercial.

(c) An act of self-destruction or self-inflicted Injury, attempted suicide or suicide (ix) Liability resulting from transmission of an illness or disease by the Insured while sane or insane or Illness or Injury attributable to the consumption, use,

Person. misuse or abuse of tobacco, intoxicating drugs or alcohol.(x) Liability arising out of false arrest, wrongful eviction, wrongful detention, (d) Any Illness or Injury directly or indirectly resulting or arising from or occurring

defamation, libel or slander or mental trauma, anguish, or shock resulting during the commission of any breach of any law by the Insured Person with any therefrom. criminal intent.

(xi) Liability arising out of any infringement of intellectual property rights such (e) Any condition directly or indirectly caused by or associated with any sexually as copyright, patent, trademark, registered designs and trade secrets. transmitted disease, including Genital Warts, Syphilis, Gonorrhoea, Genital

Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Acquired Immuno Deficiency (xii) Liability arising from the possession of animals, birds, reptiles or insects and Syndrome (AIDS) whether or not arising out of HIV, Human T-Cell Lymphotropic their byproducts such as skin, hair, feathers, horns, fur, ivory, bones or eggs;Virus Type III (HTLV–III or IITLB-III) or Lymphadinopathy Associated Virus (LAV)

(xiii) Liability arising from the ownership or possession of vehicles, aircrafts or or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or water crafts or activities of the Insured Person involving parachuting, hang- condition of a similar kind.gliding, hot air ballooning or the use of firearms.

(f) Any treatment arising from or traceable to pregnancy (including voluntary (xiv) Liability arising from insanity, use or abuse of any intoxicant, alcohol or termination), miscarriage (unless due to an Accident), childbirth, maternity

drugs (except as medically prescribed) or drug addiction. (including caesarian section), abortion or complications of any of these. This exclusion will not apply to ectopic pregnancy.(xv) Liability arising from any supply of goods or services on the part of the

Insured Person. (g) Any treatment arising from or traceable to any fertility, infertility, sub fertility or assisted conception procedure or sterilization or procedure, birth control (xvi) Liability arising from any ownership or occupation of land or buildings procedures, hormone replacement therapy, contraceptive supplies or services other than the occupation of any temporary residence.including complications arising due to supplying services or Assisted Reproductive

Technology. (ii) Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, (h) Any dental treatment or surgery unless necessitated due to an Injury. when suitably distributed, is capable of causing any Illness, incapacitating

(i) Treatment taken from anyone who is not a Medical Practitioner or from a Medical disablement or death.Practitioner who is practicing outside the discipline for which he is licensed or any (iii) Biological attack or weapons means the emission, discharge, dispersal, kind of self-medication. release or escape of any pathogenic (disease producing) micro-organisms

(j) Personal comfort and convenience items or services including but not limited to and/or biologically produced toxins (including genetically modified T.V. (wherever specifically charged separately), charges for access to telephone organisms and chemically synthesized toxins) which are capable of causing and telephone calls (wherever specifically charged separately), foodstuffs (except any Illness, incapacitating disablement or death.patient's diet), cosmetics, hygiene articles, body or baby care products and bath In addition to the foregoing, any loss, claim or expense of whatsoever nature directly or additive, barber or beauty service, guest service as well as similar incidental indirectly arising out of, contributed to, caused by, resulting from, or in connection with any services and supplies. action taken in controlling, preventing, suppressing, minimizing or in any way relating to the

(k) Charges incurred in connection with cost of spectacles and contact lenses, above is also excluded.hearing aids, routine eye and ear examinations, laser surgery for correction of (cc) Impairment of an Insured Person's intellectual faculties by abuse of stimulants or refractory errors, dentures, artificial teeth and all other similar external appliances depressants.and or devices whether for diagnosis or treatment.

(dd) Any sporting activities in so far as they involve the training or participation in (l) Experimental, investigational or unproven treatments which are not consistent competitions of professional or semi-professional sports persons, unless declared

with or incidental to the diagnosis and treatment of the positive existence or beforehand and agreed by the Company subject to additional premium being paid presence of any Illness for which confinement is required at a Hospital. Any Illness and incorporated accordingly in the Policy.or treatment which is a result or a consequence of undergoing such experimental or unproven treatment. Any diagnosis or treatment of an Illness / Injury which (ee) Any claim relating to Hazardous Activities unless declared beforehand and agreed does not require Hospitalization. by the Company subject to additional premium being paid and incorporated

accordingly in the Policy.(m) Any expenses incurred on prosthesis, corrective devices, external durable medical equipment of any kind, like wheelchairs, walker, belts, collar, caps, splints, (ff) The Insured Person engaged in any air travel unless he is flying as a passenger on an braces, stockings of any kind, diabetic footwear, glucometer or thermometer, airline. crutches, ambulatory devices, instruments used in treatment of sleep apnea (gg) Travel by any Insured Person against whom general or special travel restrictions syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and have been imposed.oxygen concentrator for asthmatic condition, cost of cochlear implants.

(hh) Any consequential losses.(n) Weight management services and treatment, services and supplies including treatment of obesity (including morbid obesity). (ii) Any Hospitalization primarily for investigation and / or diagnosis purpose.

(o) Any treatment related to sleep disorder or sleep apnea syndrome, general debility (jj) Expenses related to any kind of RMO charges, service charge, surcharge, convalescence, cure, rest cure, health hydros, nature cure clinics, sanatorium admission fees, registration fees, night charges levied by the hospital under treatment, rehabilitation measures, private duty nursing, respite care, long-term whatever head.nursing care, custodial care or any treatment in an establishment that is not a

(kk) Any specific time-bound or lifetime exclusions specified in the Policy Certificate.Hospital.

(p) Treatment of all Congenital Anomalies or Illness or defects or anomalies or treatment relating to birth defects.

4. Claims Intimation, Assessment and Management(q) Treatment of mental illness, stress, psychiatric or psychological disorders.

Upon the occurrence of any event, Illness or Injury that may give rise to a Claim under this Policy, (r) Aesthetic treatment, cosmetic surgery and plastic surgery or related treatment of then as a Condition Precedent to the Company's liability under the Policy, the Policyholder or

any description, including any complication arising from these treatments, other Insured Person (or the Nominee or legal heir if the Policyholder / the Insured Person is deceased) than as may be necessitated due to an accident injury or burns. shall undertake all the following in addition to any specific requirements specified within the Benefit

under which the Claim is made:(s) Any treatment or surgery for change of sex or gender reassignments including any complication arising from these treatments.

4.1. Intimation(t) Circumcision unless necessary for treatment of an Illness or as may be (a) If any Illness is diagnosed or discovered or any Injury is suffered or any other contingency

necessitated due to an Accident. occurs which has resulted in a Claim or may result in a Claim under the Policy, the Policyholder or Insured Person (or the Nominee or legal heir if the Insured Person is (u) All preventive care, vaccination, including inoculation and immunizations (except deceased), shall notify the Company either at the Company's call center or the in case of post-bite treatment), vitamins & tonics.Assistance Service Provider's call center or in writing immediately and in any event

(v) Artificial life maintenance, including life support machine use, where such within the time frame (if any) specified in the Benefit under which the Claim is made.treatment will not result in recovery or restoration of the previous state of health.

(b) It is agreed and understood that the following details are to be provided to the (w) All expenses related to donor screening, treatment, including surgery to remove Company at the time of intimation of Claim:

organs from the donor, in case of transplant surgery.(i) Policy Number;

(x) Non-allopathic treatment.(ii) Name of the Policyholder;

(y) Charges incurred at a Hospital primarily for diagnostic, X-ray or laboratory (iii) Name of the Insured Person in respect of whom the Claim is made;examinations not consistent with or incidental to the diagnosis and treatment of

the positive existence or presence of any Illness or Injury, for which in-patient care (iv) Nature of the event;or a day care procedure is required.

(v) Name and address of the attending Medical Practitioner and Hospital, if (z) War (whether declared or not) and war like occurrence or invasion, acts of applicable;

foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, (vi) Date of admission to Hospital or date of loss, as applicable;military or usurped power, seizure, capture, arrest, restraints and detainment of

all kinds. (vii) Any other information, documents or details requested by the Company or the Assistant Service Provider.(aa) Stem cell implantation, harvesting, storage or any kind of treatment using stem

cells.4.2 Claims Documents

(bb) Nuclear, chemical or biological attack or weapons, contributed to, caused by, (a) The Policyholder or Insured Person (or Nominee or legal heir if the Insured Person is resulting from or from any other cause or event contributing concurrently or in deceased) shall (at his own expense) provide the following documents as specified any other sequence to the loss, claim or expense. For the purpose of this below and any additional information or documents as specified in the respective exclusion: Benefits under which the Claim is being made with the Company or the Assistance

Service Provider immediately and in any event within 30 days of the occurrence of the (i) Nuclear attack or weapons means the use of any nuclear weapon or device event. or waste or combustion of nuclear fuel or the emission, discharge,

dispersal, release or escape of fissile or fusion material emitting a level of (i) Duly completed and signed Claim form, in original;radioactivity capable of causing any Illness, incapacitating disablement or

(ii) Passport copy with entry and exit stamp;death.

(iii) Any other document as required by the Company or Assistance Service event of death of the Policyholder, the Company will pay to the nominee (as Provider; named in the Policy Certificate) and in case of no nominee to the legal heirs or

representatives of the Policyholder.(iv) Additional documents as specified under each Benefit

(x) For Claims where Re-pricing is carried out, the benefit of reduction in the Claim Note: All invoices and bills should be in Insured Person's name except for Benefit 3 amount shall be passed on to the Policyholder by reducing the Sum insured for “Compassionate Visit” where invoices and bills should be in the name of Immediate Family such Insured Person for whom the Claim is made only by the final negotiated Member of the Insured Person in respect of whom the Claim under Benefit 1 is being made. amount payable by the Company plus the Re-pricing Fees. If the sum of the (b) The Company will condone the delay in making a Claim by the Policyholder or Insured negotiated amount and Re-pricing Fees is greater than the actual billed amount

Person on merit, where delay is proved to be for reasons beyond the control of the the actual billed amount shall be reduced from the Sum Insured.Policyholder or the Insured Person. (xi) The Company shall settle any Claim within 30 days of receipt of all the necessary

4.3 Policyholder's or Insured Person's duty at the time of Claim documents/information as required for settlement of such Claim and sought by the Company. The Company shall provide the Policyholder an offer of settlement It is agreed and understood that as a condition precedent for a Claim to be considered of Claim and upon acceptance of such offer by the Policyholder the Company under this Policy: shall make payment within 7 days from the date of receipt of such acceptance. In

(a) All reasonable steps and measures must be taken to avoid or minimize the case there is delay in the payment beyond the stipulated time lines, the Company quantum of any Claim that may be made under this Policy. shall pay additional amount as interest at a rate which is 2% above the bank rate

prevalent at the beginning of the financial year in which the claim is reviewed by it.(b) The Insured Person shall follow the directions, advice or guidance provided by a Medical Practitioner and the Company shall not be obliged to make the payment that is brought about or contributed to by the Insured Person failing to follow such directions, advice or guidance. 5. General Terms and Conditions

(c) Intimation of the Claim, notification of the Claim and submission or provision of all 5.1 Disclosure to Information Norm

information and documents shall be made promptly and in any event in If any untrue or incorrect statements are made or there has been a accordance with the procedures and within the time frames specified in Clause 4 misrepresentation, mis-description or non-disclosure of any material particulars of the Policy and the specific procedures and time frames specified under the or any material information having been withheld, or if a Claim is fraudulently respective Benefits under which the Claim is being made.made or any fraudulent means or devices are used by the Policyholder or the

(d) The Insured Person will, at the request of the Company, submit himself for a Insured Person or any one acting on his / their behalf, the Company shall have no medical examination by the Company's/Assistance Service Provider's nominated liability to make payment of any Claims and the premium paid shall be forfeited to Medical Practitioner as often as the Company considers reasonable and the Company on the cancellation of the Policy.necessary. The cost of such examination will be borne by the Company.

5.2 Observance of Terms and Conditions(e) The Company's/Assistance Service Provider's Medical Practitioner and

The due observance and fulfillment of the terms and conditions of this Policy representatives shall be given access and co-operation to inspect the Insured (including the realization of premium by their respective due dates and Person's medical and hospitalization records and to investigate the facts and compliance with the specified procedure on all Claims) in so far as they relate to examine the Insured Person.anything to be done or complied with by the Policyholder or any Insured Person,

(f) The Company shall be provided with complete documents and information which shall be condition precedent to the Company's liability under the Policy.the Company has requested to establish its liability for the Claim, its

5.3 Reasonable Carecircumstances and its quantum.

Insured Persons shall take all reasonable steps to safeguard the interests against 4.4 Claim Assessmentany Illness or Injury that may give rise to a Claim.

(a) All admissible Claims under this Policy shall be assessed by the Company in the 5.4 Material Changefollowing progressive order:

It is a condition precedent to the Company's liability under the Policy that the (i) If any sub-limits on Medical Expenses are applicable in accordance with Policyholder shall immediately notify the Company in writing of any material Clause 2.1.1. (H)(a), the Company's liability to make payment shall be change in the risk on account of change in nature of occupation or business at his limited to such extent as applicable.own expense. The Company may, in its discretion, adjust the scope of cover and /

(ii) The Deductible shall then be applied. or the premium paid or payable, accordingly.4.5 Payment Terms

5.5 No Constructive Notice

(i) The Company may in its sole and absolute discretion change the Assistance Any knowledge or information of any circumstance or condition in relation to the Service Provider or utilize the service of any other Assistance Service Provider by Policyholder or Insured Person which is in possession of the Company other than giving written notification to the Policyholder. that information expressly disclosed in the Proposal Form or otherwise in writing

to the Company, shall not be held to be binding or prejudicially affect the (ii) All payments under this Policy shall be made in Indian Rupees and within India. For Company.all admissible reimbursement Claims, the exchange rate on the date of payment to

the Hospital shall be applied and for all admissible Claims where the Sum Insured is 5.6 Complete discharge on a fixed payment basis, the exchange rate on the date of loss shall be applied.

Payment made by the Company to the Policyholder or the Nominee or the legal (iii) If the Assistance Service Provider or the Company requests that bills or vouchers heir of the Policyholder, as the case may be, of any amount under the Policy shall in

in a local language or vernacular be accompanied by an appropriate translation all cases be treated as full and final and construe as an effectual discharge in favor of into English then the costs of such translation must be borne by the Policyholder / the Company.the Insured Person.

5.7 Subrogation(iv) The Sum Insured of the Insured Person shall be reduced by the amount payable or

The Policyholder and Insured Person shall at his own expense do or concur in paid under the Policy Terms and Conditions under this Policy and only the balance doing or permit to be done all such acts and things that may be necessary or amount shall be available as the Sum Insured for the unexpired Policy Period.reasonably required by the Company for the purpose of enforcing and / or

(v) The Company shall have no liability to make payment of a Claim under the Policy in securing any civil or criminal rights and remedies or obtaining relief or indemnity respect of an Insured Person, once the Sum Insured for that Insured Person is from any other party to which the Company is or would become entitled upon exhausted. the Company paying for a Claim under this Policy, whether such acts or things shall

be or become necessary or required before or after its payment. Neither the (vi) If the Policyholder or Insured Person suffers a relapse within 45 days of the date of Policyholder nor any Insured Person shall prejudice these Subrogation rights in any discharge from the Hospital for which a Claim has been made, then such relapse manner and shall at his own expense provide the Company with whatever shall be deemed to be part of the same Claim and all the limits for Any One Illness assistance or cooperation is required to enforce such rights. Any recovery the under this Policy shall be applied as if they were under a single Claim.Company makes pursuant to this clause shall first be applied to the amounts paid

(vii) The Company's maximum, total and cumulative liability under Benefit 1 towards or payable by the Company under this Policy and any costs and expenses incurred the treatment of Any One Illness in respect of any Insured Person shall not exceed by the Company of effecting a recovery, where after the Company shall pay any the sub-limits as specified in the Policy Certificate. balance remaining to the Policyholder. This clause shall not apply to any Benefit

offered on a fixed benefit basis.(viii) For Cashless Claims, the payment shall be made to the Network Provider whose discharge would be complete and final. For the purposes of this Clause, “Subrogation” means the right of the insurer to

assume the rights of the insured person to recover expenses paid out under the (ix) For Reimbursement Claims, the Company will pay to the Policyholder. In the

policy that may be recovered from any other source. extended under the then prevailing product or its nearest substitute approved by IRDA. The Company shall duly intimate the Policyholder regarding withdrawal of

5.8 Contributionthis product and the options available to the Policyholder at the time of extension

(a) In case any Insured is covered under more than one similar indemnity insurance of this policy.policies, with the Company or with other insurers, the Policyholder shall have the

(f) The Policy shall not be renewable upon expiry of the Policy Period.right to settle the Claim with any of the Company, provided that the Claim amount payable is up to Sum Insured of such Policy. 5.12 Cancellation/Termination

(b) In case the Claim amount exceeds the Sum Insured, then Policyholder shall have (a) The Company may at any time, cancel this Policy on grounds as specified in Clause the right to choose the companies with whom the Claim is to be settled. In such 5.1, by giving 15 days' notice in writing to the Policyholder at his last known cases, the settlement shall be done as under : address.

(i) If at the time when any Claim arises under this Policy, there is any other (b) At the request of the Policyholder, the Policy will be cancelled any time prior to the insurance which covers (or would have covered but for the existence of Policy Period End Date subject to the following conditions:this Policy), the same Claim (in whole or in part), then the Company shall (i) Full refund shall be made if the request for Policy cancellation is received by not be liable to pay or contribute more than its ratable proportion of any the Company within 7 days from the Policy Period Start Date or before Claim.

commencement of the first Period of Insurance, whichever is earlier, if the (c) This clause shall not apply to any Benefit offered on a fixed benefit basis. sole reason for such cancellation is denial of visa for the countries where

the Insured Person was scheduled to visit. The visa denial or cancellation 5.9 Free Look Period

letter issued by appropriate authorities shall be submitted to the Company (i) This Clause shall be applicable only for the policies which are issued for a period of along with the request for cancellation.

at least 365 days.(ii) In the event of cancellation of Policy prior to Policy Period Start Date for

(ii) The Policyholder may, within 15 days from the receipt of the Policy document, any reason whatsoever other than as specified in Clause 5.12(b)(i), the return the Policy stating reasons, if the terms and conditions are not acceptable to Company shall deduct Rs. 300/- (Rupees Three Hundred only) towards the Policyholder. cancellation charges and refund the balance amount.

(iii) If no Claim has been made under the Policy, the Company will refund the (iii) Cancellation of Policy, issued for a Single Trip Policy, at a date earlier than premium received after deducting proportionate risk premium for the period on the Policy Period End Date can be done only if the Insured Person makes cover and stamp duty charges. If only part of the risk has commenced, such request for cancellation before the Policy Period End Date. Refund of proportionate risk premium shall be calculated as commensurate with the risk premium shall only be applicable if the difference between the request covered during such period. date and the Policy Period End Date is at least 15 days. Premium refunded

will be the difference of the amount of premium paid for the original Policy 5.10 Policy Disputes

Period and the premium applicable by taking the request date as the new (a) Wherever there is a decision to be taken by the Insurer, which happens to be at Policy Period End Date. In addition a sum of Rs. 300/- (Rupees Three

variance with the Customers proposal, declarations and other such conduct an Hundred only) towards cancellation charges shall be deducted and the opportunity of natural justice shall be provided to him before a decision is taken balance amount, if any will be refunded. on the merit and circumstances of the question.

a. Formula chart for refund calculation – (b) Any and all disputes or differences under or in relation to the validity, construction,

(Original premium less revised end date Premium less Cancellation interpretation and effect to this Policy shall be determined by the Indian Courts charges)and in accordance with Indian law.Example - Mr. X has purchased a single trip policy with trip duration

5.11 Extension of the Policy Periodas 90 days for a premium of Rs. 9,000. He curtails the trip after 30

(a) Extension of the Policy Period for a Single Trip Policy days. The premium for 30 day single trip is Rs. 4,200, hence refund 9,000 less (4,200 + cancellation fees Rs. 300) = Rs. 4,500.(i) On the Policyholder's written request, the Company may at its sole

discretion extend the Policy Period provided that the total Policy Period shall not (iv) Cancellation of Policy, issued for as an Annual Multi Trip Policy, at a date exceed 365 days. If any Claim has been made under the Policy in respect of the earlier than the Policy Period End Date will be effected by the Company original Policy Period: and the Company shall retain premium on short period scales as specified

here under:I. The Insured shall be entitled to all benefits payable on fixed basis for which any claim has not been made with the company earlier under Period from Policy Period Number of Trip days Premium Retainedthe same policy. For other benefits where the payment is on Start Date utilizedindemnity basis, balance sum insured shall be available during the

Up to 1 month Less than or equal to 7 days 25% annual rateextended policy period.

Greater than 7 days & up to 21 days 50% annual rateII. Only the balance amount of the Sum Insured will be available for the Benefits which are payable on an indemnity basis. Greater than 21 days 75% annual rate

(b) Extension of the Geographical Scope of the Policy From 2 month Less than or up to 21 days 50% annual rate(i) On the Policyholder's written request, the Company may at its sole Up to 3 months Greater than 21 days and up to 35 days 75% annual rate

discretion extend Geographical Scope of the Policy specified in the Policy Greater than 35 days Full annual rateCertificate provided that the additional premium specified by the

Company is received in advance of commencement of coverage and From 4 month Up to 6 months Less than or up to 35 days 75% annual rateprovided that the Insured Person has not already entered any part of the proposed extended Geographical Scope of the Policy or made any medical Greater than 35 days Full annual raterelated Claim under the Policy. Exceeding 6 months Any Trip duration Full annual rate

(c) All requests for extensions must be made at least 1 day before the expiry of the (c) No refund of premium shall be eligible in case of cancellation of this Policy where a original Policy Period and accompanied by all the following information and Claim has been incurred under the Policy.documents:

(d) In case of demise of the Policyholder, (i) Duly completed application for extension;

(i) Where the Policy covers only the Policyholder, this Policy shall stand null and void (ii) Details of complete particulars of all Claims; from the date and time of demise of the Policy holder.(iii) A good health declaration. (ii) Where the Policy covers other Insured Members, this Policy shall continue till

(d) However, if the request to extend the Policy is received within 3 days of the Policy the end of Policy Period. Period End Date then coverage shall be reinstated, at Company's sole discretion Note: subject to underwriting, with effect from Policy Period End Date on the date of (a) The Company's liability in respect of an Insured Person shall cease upon making anyreceipt of premium by the Company. In such case Company shall not be liable for refund of premium under this Policy in accordance with the terms and conditions any Claim arising during the Policy Period End Date and date of receipt of hereof in respect of such an Insured Person and the benefit in respect of that Insured premium. Person shall forthwith terminate.

(e) This product may be withdrawn by the Company after due approval from the IRDA. In case this product is withdrawn by the Company, this Policy can be

5.13 Limitation of Liability

Any Claim under this Policy for which the notification or intimation of Claim is received 12 calendar months after the event or occurrence giving rise to the Claim shall not be admissible, unless the Policyholder proves to the Company's satisfaction that the delay in reporting of the Claim was for reasons beyond his control.

5.14 Communication

(a) Any communication meant for the Company must be in writing and be delivered to its address shown in the Policy Certificate. Any communication meant for the Policyholder will be sent by the Company to his last known address or the address as shown in the Policy Certificate.

(b) All notifications and declarations for the Company must be in writing and sent to the address specified in the Policy Certificate. Agents are not authorized to receive notices and declarations on the Company's behalf.

(c) Notice and instructions will be deemed served 10 days after posting or immediately upon receipt in the case of hand delivery, facsimile or e-mail.

5.15 Alterations in the Policy

This Policy constitutes the complete contract of insurance. No change or alteration shall be valid or effective unless approved in writing by the Company, which approval shall be evidenced by a written endorsement signed and stamped by the Company.

5.16 Cause of Action

No Claims shall be payable under this Policy unless the event or occurrence giving rise to the Claim occurs in the Geographical Scope specified in the Policy Certificate.

5.17 Overriding effect of Policy Certificate

In case of any inconsistency in the terms and conditions in this Policy vis-a-vis the information contained in the Policy Certificate, the information contained in the Policy Certificate shall prevail.

5.18 Electronic Transactions

The Policyholder and Insured Person agrees to adhere to and comply with all such terms and conditions as the Company may prescribe from time to time, and hereby agrees and confirms that all transactions effected by or through facilities for conducting remote transactions including the Internet, World Wide Web, electronic data interchange, call centers, tele-service operations (whether voice, video, data or combination thereof) or by means of electronic, computer, automated machines network or through other means of telecommunication, established by or on behalf of the Company, for and in respect of the Policy or its terms, or the Company's other products and services, shall constitute legally binding and valid transactions when done in adherence to and in compliance with the Company's terms and conditions for such facilities, as may be prescribed from time to time.

5.19 Grievances

(a) The Company has developed proper procedures and effective mechanism to address complaints, if any of the customers. The Company is committed to comply with the Regulations, standards which have been set forth in the Regulations, Circulars issued from time to time in this regard.

(b) If the Policyholder has a grievance that the Policyholder wishes the Company to redress, the Policyholder may contact the Company with the details of his grievance through:

Website : www.religarehealthinsurance.comE-mail : customerfirst@religarehealthinsurance.comContact No.: Fax :

(c) If the Policyholder is not satisfied with the Company's redressal of the Policyholder's grievance through one of the above methods, the Policyholder may contact the Company's Head of Customer Service at:

The Grievance Cell,Religare Health Insurance Company LimitedA3, A4, A5 GYS Global,Sector -125, Noida - 201301

d. If the Policyholder is not satisfied with the Company's redressal of the Policyholder's grievance through one of the above methods, the Policyholder may approach the nearest Insurance Ombudsman for resolution of the grievance. The contact details of Ombudsman offices are mentioned on the next page-

1800-200-44881800-200-6677

Post/Courier : Any branch office or the correspondence address, during normal business hours.

Office of the Ombudsmen Name of the Ombudsmen Contact Details Area of Jurisdiction

AHMEDABAD Shri P. Ramamoorthy Insurance Ombudsman, Gujarat , UT of Dadra & Nagar Haveli,Office of the Insurance Ombudsman, 2nd Floor, Ambica House, Daman and Diu Nr. C.U. Shah College, Ashram Road, AHMEDABAD - 380 014.Tel : 079-27546840, Fax : 079-27546142E-mail : ins.omb@rediffmail.com

BHOPAL Insurance Ombudsman, Madhya Pradesh & ChhattisgarhOffice of the Insurance Ombudsman, Janak Vihar Complex,2nd Floor, 6, Malviya Nagar, Opp. Airtel, Near New Market,BHOPAL(M.P.) - 462 023.Tel : 0755-2569201, Fax : 0755-2769203E-mail : bimalokpalbhopal@airtelmail.in

BHUBANESHWAR Shri B. P. Parija Insurance Ombudsman, OrissaOffice of the Insurance Ombudsman, 62, Forest Park, BHUBANESHWAR - 751 009.Tel : 0674-2596455, Fax : 0674-2596429 E-mail : ioobbsr@dataone.in

CHANDIGARH Shri. Manik Sonawane Insurance Ombudsman, Punjab , Haryana, Himachal Pradesh, Office of the Insurance Ombudsman, S.C.O. No.101-103, Jammu & Kashmir , UT of Chandigarh2nd Floor, Batra Building, Sector 17-D, CHANDIGARH - 160 017.Tel : 0172-2706468, Fax : 0172-2708274 E-mail : ombchd@yahoo.co.in

CHENNAI Shri. V. Ramasaamy Insurance Ombudsman, Tamil Nadu, UT - Pondicherry Town Office of the Insurance Ombudsman, Fathima Akhtar Court, and Karaikal (which are part of UT of 4th Floor, 453 (old 312), Anna Salai, Teynampet, CHENNAI - 600 018. Pondicherry) Tel : 044-24333668/5284, Fax : 044-24333664 E-mail : chennaiinsuranceombudsman@gmail.com

NEW DELHI Shri Surendra Pal Singh Insurance Ombudsman, Delhi & RajasthanOffice of the Insurance Ombudsman, 2/2 A, Universal Insurance Bldg.,Asaf Ali Road, NEW DELHI - 110 002.Tel : 011-23239633, Fax : 011-23230858E-mail : iobdelraj@rediffmail.com

GUWAHATI Shri D. C. Choudhury Insurance Ombudsman, Assam , Meghalaya, Manipur, Mizoram,Office of the Insurance Ombudsman, “Jeevan Nivesh”, 5th Floor, Arunachal Pradesh, NagalandNear Panbazar Overbridge, S.S. Road, GUWAHATI - 781 001 (ASSAM). and TripuraTel : 0361-2132204/5, Fax : 0361-2732937E-mail : ombudsmanghy@rediffmail.com

HYDERABAD Shri K. Chandrahas Insurance Ombudsman, Andhra Pradesh, Karnataka andOffice of the Insurance Ombudsman, 6-2-46, 1st Floor, Moin Court, UT of Yanam - a part of the UTA.C. Guards, Lakdi-Ka-Pool, HYDERABAD - 500 004. of PondicherryTel : 040-65504123, Fax : 040-23376599E-mail : insombudhyd@gmail.com

KOCHI Shri R. Jyothindranathan Insurance Ombudsman, Kerala, UT of (a) Lakshadweep,Office of the Insurance Ombudsman, 2nd Floor, CC 27/2603, (b) Mahe - a part of UT Pulinat Bldg., Opp. Cochin Shipyard, M.G. Road, ERNAKULAM - 682 015. of PondicherryTel : 0484-2358759, Fax : 0484-2359336E-mail : iokochi@asianetindia.com

KOLKATA Ms. Manika Datta Insurance Ombudsman, West Bengal, Bihar, Jharkhand andOffice of the Insurance Ombudsman, 4th Floor, UT of Andeman & Nicobar Islands,Hindusthan Bldg. Annexe, 4, C.R.Avenue, KOLKATA - 700 072. SikkimTel : 033-22124346/(40), Fax : 033-22124341E-mail : iombsbpa@bsnl.in

LUCKNOW Shri G. B. Pande Insurance Ombudsman, Uttar Pradesh and UttaranchalOffice of the Insurance Ombudsman, Jeevan Bhawan, Phase-2,6th Floor, Nawal Kishore Road, Hazaratganj, LUCKNOW - 226 001.Tel : 0522-2231331, Fax : 0522-2231310E-mail : insombudsman@rediffmail.com

MUMBAI Shri S. Viswanathan Insurance Ombudsman, Maharashtra, Goa Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe,S.V. Road, Santacruz(W), MUMBAI - 400 054.Tel : 022-26106928, Fax : 022-26106052E-mail : ombudsmanmumbai@gmail.com

The details of Insurance Ombudsman are available on IRDA website : www.irda.gov.in, on the website of General Insurance Council : www.generalinsurancecouncil.org.in, the Company's website www.religarehealthinsurance.com or from any of the Company's offices.

Address and contact number of Governing Body of Insurance Council -

Shri M.V.V. Chalam, Secretary General The Secretary3rd Floor, Jeevan Seva Annexe, 3rd Floor, Jeevan Seva Annexe,S.V. Road, Santacruz(W), S.V. Road, Santacruz (W),MUMBAI - 400 021 MUMBAI - 400 021Tel : 022-26106245 Tel : 022 26106980 Fax : 022-26106949 Fax : 022-26106949E-mail : inscoun@gmail.com