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Royal Sundaram General Insurance Co. Limited IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 1 of 13 Health Forever Prospectus HEALTH FOREVER PROSPECTUS Health Forever Health is Wealth. Your Health is your biggest investment. What will happen to your family in case you have a medical emergency? Health Forever helps you to get quick and effective treatment in hospitals for yourself and your family without drawing on your savings or borrowing money from friends and relatives. Presenting “Health Forever” from Royal Sundaram General Insurance Company Ltd., which is a Health Insurance Plan offered for one to two years term. Who is providing coverage under Health Forever? Your Coverage under Health Forever is offered by Royal Sundaram General Insurance Company Limited (first private non-life Insurance Company licensed to operate in India). What is the coverage provided under Health Forever? This policy is specially designed to offer complete protection to you and your Dependents who bear any legal relation to you. Hospitalization Cover: Any expenses incurred towards Inpatient Hospitalization for a period of more than 24 hours, for the illnesses / diseases contracted or injury sustained by the insured person during the period of Insurance. However this time limit is not applicable to the following specific “Day Care treatments: Cataract, Tonsilectomy, Eye Surgery, Lithotripsy (Kidney Stone removal) and D & C. 1. Room, Boarding Expenses as provided by the Hospital/Nursing Home subject to a limit of 1.5% of the Sum Insured per day and for Intensive Care Unit 3% of Sum Insured per day. 2. Nursing Expenses incurred during In-Patient hospitalization. 3. Surgeon, Anaesthetist, Medical Practitioner, Consultants & Specialist Fees. 4. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy Radiotherapy, Donors medical expenses towards Organ transplant, Cost of Pacemaker, Artificial Limbs, Cost of Organs. 5. Pre-Hospitalization expenses upto to 30 days before the date of admission and Post- Hospitalization expenses upto 60 from the date of discharge when the claim for hospitalization is admitted under the policy excluding nursing / attendant expenses. The Claim amount payable towards the treatment of following disease, illness, medical condition or injury is subject to a limit of: Treatment Limit per claim Cataract Rs.7,500/- per annum. What is the age at entry and other eligibility conditions?

Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

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Page 1: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 1 of 13 Health Forever Prospectus

HEALTH FOREVER – PROSPECTUS Health Forever Health is Wealth. Your Health is your biggest investment. What will happen to your family in case you have a medical emergency? Health Forever helps you to get quick and effective treatment in hospitals for yourself and your family without drawing on your savings or borrowing money from friends and relatives. Presenting “Health Forever” from Royal Sundaram General Insurance Company Ltd., which is a Health Insurance Plan offered for one to two years term. Who is providing coverage under Health Forever? Your Coverage under Health Forever is offered by Royal Sundaram General Insurance Company Limited (first private non-life Insurance Company licensed to operate in India). What is the coverage provided under Health Forever? This policy is specially designed to offer complete protection to you and your Dependents who bear any legal relation to you. Hospitalization Cover: Any expenses incurred towards Inpatient Hospitalization for a period of more than 24 hours, for the illnesses / diseases contracted or injury sustained by the insured person during the period of Insurance. However this time limit is not applicable to the following specific “Day Care treatments: Cataract, Tonsilectomy, Eye Surgery, Lithotripsy (Kidney Stone removal) and D & C.

1. Room, Boarding Expenses as provided by the Hospital/Nursing Home subject to a limit of 1.5% of the Sum Insured per day and for Intensive Care Unit 3% of Sum Insured per day.

2. Nursing Expenses incurred during In-Patient hospitalization.

3. Surgeon, Anaesthetist, Medical Practitioner, Consultants & Specialist Fees.

4. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy Radiotherapy, Donors medical expenses towards Organ transplant, Cost of Pacemaker, Artificial Limbs, Cost of Organs.

5. Pre-Hospitalization expenses upto to 30 days before the date of admission and Post-Hospitalization expenses upto 60 from the date of discharge when the claim for hospitalization is admitted under the policy excluding nursing / attendant expenses.

The Claim amount payable towards the treatment of following disease, illness, medical condition or injury is subject to a limit of:

Treatment Limit per claim

Cataract Rs.7,500/- per annum.

What is the age at entry and other eligibility conditions?

Page 2: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 2 of 13 Health Forever Prospectus

The policy is issued to individual for covering their family. The insurance is available to persons between the age of 91 days and 75 years at the Policy Start

Date. The Proposer should be minimum 18 years (completed age) on Policy Start Date.

This policy covers Self, Spouse and dependants who bear legal relation to the proposer. Underwriter’s are free to define the scope of relations who can be covered as a family member, out of eligible family member.

There is no Exit age in the policy. Policy can be renewed continuously subject to payment of premium within Grace Period.

Persons holding existing health policy either with Royal Sundaram or any other Insurers can port in to this Policy subject to the guidelines issued by Authority & subject to underwriting guidelines.

What additional benefits do I get? Along with the above benefits, you are also entitled to avail of the following benefits:-

Cashless Hospitalization: Health Forever also provides the benefit of a cashless cover for more than 4000 network hospitals.

Cumulative Bonus: Sum Insured under the policy for hospitalization benefit shall be increased by slabs of 15% for every claim free year, subject to a maximum of 4 slabs. In case of a claim under the policy, the earned bonus will be reduced by 1 slab.

Tax Benefit: Premium eligible tax benefits under Section 80D of the Income Tax Act, up to Rs.15,000/- for premium paid for Self, Spouse and Dependent Children. For Dependent Parents the additional tax rebate up to Rs.15,000/-. For premium paid for Senior Citizen parents additional tax benefit of Rs.20,000/-.

Pre-existing disease: Coverage of pre existing disease would be applicable after four continuous years of insurance under this policy.

Hospital Cash Benefits - The Insured Person is eligible for benefit to the extent of Rs.150/- per completed day of hospitalisation subject to a maximum of 10 days.

ICU Benefit If the period of hospitalization exceeds 7 days in an ICU at a Hospital / Nursing Home with a minimum of 300 beds, a lump sum recovery benefit of Rs.10,000/- is payable.

Critical Illness Benefit - A lump sum benefit of Rs.15, 000/- is payable if the person is diagnosed and treated for Cancer or Stroke or undergoes CABG (Coronary Artery Bypass Graft) or organ Transplant. This benefit is payable from the second year and is payable once during the lifetime of the Insured Person per illness.

Convalescence Benefit - If the period of hospitalization exceeds consecutive 15 days, a lump sum Convalescence benefit of Rs.15,000/- is payable.

What is the coverage amount under Health Forever? You and your family would be covered under the following Sum Insured, on Individual basis as opted.

Page 3: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 3 of 13 Health Forever Prospectus

Health Forever

Plans Sum Insured

Plan 1 1,00,000/-

Plan 2 2,00,000/-

Plan 3 3,00,000/-

Plan 4 4,00,000/-

Plan 5 5,00,000/-

The limits specified above are in Indian Rupees and is applicable for the stipulated policy period for policy with One year duration. In respect policy of 2 / 3 year tenures, the Sum Insured shall be available per annum. Who is eligible for the coverage? You must satisfy the following conditions:

Parameter Eligibility

Age at entry 91 days - 75 years

Coverage Term 1 year /2 years /3 years

Health Condition You need to be in good health, have understood and signed the health declaration form.

What are the geographical limits? This policy is valid for treatment taken within India only. What do I need to pay?

Payment of premium : Single payment only irrespective of tenure. Indicative premium for single life for coverage of stipulated Sum Insured is shown in the table below. Premium table One year table (excluding applicable Service Tax & cess)

Sum Insured

91 days - 18 Yrs

19 - 45 Yrs

46 - 60 Yrs

61 - 76 Yrs

76 - 80 Yrs

81 - 85 Yrs

86 - 90 Yrs

91 - 95 Yrs

96 and above

100000 1,215 1,858 2,852 3,872 4,337 5,030 5,835 6,769 7,852

200000 1,895 3,212 5,064 7,262 8,135 9,437 10,947 12,698 14,730

300000 2,587 4,369 7,109 10,377 11,622 13,481 15,638 18,140 21,042

400000 3,402 5,782 9,433 13,811 15,467 17,942 20,812 24,142 28,005

500000 4,221 7,195 11,753 17,242 19,308 22,398 25,981 30,138 34,961

Two year table (excluding applicable Service Tax & cess)

Page 4: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 4 of 13 Health Forever Prospectus

Sum Insured

91 days - 18 Yrs

19 - 45 Yrs

46 - 60 Yrs

61 - 76 Yrs

76 - 80 Yrs

81 - 85 Yrs

86 - 90 Yrs

91 - 95 Yrs

96 and above

100000 2,189 3,348 5,133 6,971 7,807 9,056 10,505 12,186 14,136

200000 3,415 5,781 9,114 13,073 14,642 16,985 19,703 22,855 26,512

300000 4,655 7,863 12,795 18,678 20,917 24,264 28,146 32,649 37,873

400000 6,124 10,409 16,977 24,859 27,842 32,296 37,464 43,458 50,411

500000 7,596 12,951 21,157 31,032 34,757 40,318 46,769 54,252 62,932

Three year table (excluding applicable Service Tax & cess)

Sum Insured

91 days - 18 Yrs

19 - 45 Yrs

46 - 60 Yrs

61 - 75 Yrs

76 - 80 Yrs*

81 - 85 Yrs**

86 - 90 Yrs**

91 - 95 Yrs**

96 and above**

100000 3,281 5,016 7,700 10,455

11,709

13,582

15,755

18,276

21,200

200000 5,117 8,674 13,673

19,607

21,965

25,480

29,556

34,285

39,771

300000 6,986 11,795

19,194

28,018

31,379

36,399

42,222

48,978

56,815

400000 9,185 15,611

25,468

37,289

41,760

48,443

56,193

65,184

75,613

500000 11,396

19,425

31,732

46,553

52,132

60,474

70,150

81,374

94,394

How do I pay my Premium? You will get the choice of easy payment option as follows:

If you prefer, you can choose to pay the premium in full by a cheque or demand draft in favour of “Royal Sundaram General Insurance Company Limited”

In case you wish to continue the policy after the stipulated period of one year, you have the option of making the premium payment by providing an ECS mandate against your bank account or by issuing a cheque in favour of Royal Sundaram General Insurance Company Ltd.

You can also pay your premium through your credit card.

What are the specific circumstances under which the premium could be loaded or a discount provided could be withdrawn and the extent to which it will be done?

Family Discount of 10% is allowed for covering 3 or more members. Discount will be withdrawn in renewal if the no.of members covered is less than 3

Page 5: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 5 of 13 Health Forever Prospectus

How do I Enroll? Quick and easy enrolment process. Medical examination is required for persons above 60 years . All you need to do is to complete the enrolment cum health declaration form. Kindly ensure all details are captured accurately and completely filled in before signing. When does the coverage start? Coverage in respect of all customers starts from the date of receipt of premium. How can my coverage end? The coverage shall end on occurrence of any one of the instances as mentioned in the table below.

Event Parameter

End of coverage term After 1/2/3 years of policy inception (Depends on the tenure chosen) unless renewed

If you cancel the coverage Premium would be refunded as per the grid short period scales

Non receipt of renewal premium

If the renewal premium is not paid within the due date and within the Grace Period of 30 days.

Fraudulent event/non-cooperation

The policy when not renewed on grounds of fraud, moral hazard or misrepresentation or non-cooperation by you.

What are the medical examinations to be done before taking Health Forever? The following pre-Policy check-up at our network may be required for insured persons above 60 years.

ECG with Report, Blood Sugar – both fasting and post prandial & Urine Sugar both fasting and post prandial.

Company reserves the rights to prescribe further tests based on the Medical Reports of the Individuals. The medical reports are valid for a period of 90 days from the date of Pre-Policy Checkup. Company may prescribe the list of network centres which the customer has to access to do the medical tests or may allow the customer to choose any diagnostic centres of his choice. For accepted proposals, the cost of medicals undertaken shall be borne / reimbursed by the Company @ 100% for policies with more than 1 year tenure and @ 50% for policies with tenure of 1 year tenure and less. Is there a Free Look provision under Health Forever? At the inception of your Health Forever policy you will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the Policy and return the same, if not acceptable. You shall be entitled to the following provided there is no claim settled during the Free Look-in period:

Page 6: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 6 of 13 Health Forever Prospectus

a) A refund of the premium paid less any expenses incurred by us on medical examination of the

insured person/s and the stamp duty charges or;

b) where the risk has already commenced and the option of return of the policy is exercised, a

deduction towards the proportionate risk premium for period on cover or;

c) Where only a part of the risk has commenced, such proportionate risk premium

commensurate with the risk covered during such period

If notice of cancellation is received after Free look-in, the Company shall from the date of receipt of the cancellation notice by the insured, cancel the Policy and retain the premium for the period your Policy has been in force at the Company’s short period scale as mentioned below provided that no claim has been made under the Policy by or on behalf of the insured. What document will I get as a proof of Insurance? A Certificate of Insurance (COI)/ Policy Copy issued to you by the company can be used as a proof of payment of premium to claim a benefit under the prevailing taxation laws. You would also get the Health Cards and the policy terms and conditions towards the insurance policy along with the Health Kit. What is the claim process? For admission in network hospital The Insured shall call the TPA helpline and furnish Membership Number, Policy Number and the Name of the Patient within 72 hours before admission to hospital for planned hospitalization and not later than 48 hours of admission in case of emergency hospitalization. The insured shall also provide to the TPA by fax or e-mail, the details of hospitalization like diagnosis, name of hospital, duration of stay in hospital, estimated expenses of hospitalization etc in the prescribed form available with the Insurance help desk at the Hospital, duly signed by the attending doctor and the insured person. The Insured shall also provide any additional information or medical record as may be required by the medical panel of the TPA. After establishing the admissibility of the claim under the policy, the TPA shall provide a pre-authorisation to the hospital guaranteeing payment of the hospitalization expenses subject to the sum insured, terms conditions and limitations of the policy. For admission in non-network hospital or into network hospital if cashless facility is not availed

Notice of claim: Preliminary notice of claim with particulars relating to Policy number, Name of the Insured Person in respect of whom claim is made, nature of illness/injury and name and address of the hospital, should be given to the Insurer by email or phone within 72 hours before admission in case of planned hospitalization and not later than 48 hours in case of emergency hospitalization.

Submission of claim: The insured shall submit the claim form along with attending physician’s certificate duly filled and signed in all respects with the following claim documents not later than 30 days from the date of discharge.

Mandatory documents

1. Test reports and prescriptions relating to First / Previous consultations for the same or related illness

2. Case history / Admission-discharge summary describing the nature of the complaints and its duration, treatment given, advice on discharge etc issued by the Hospital

Page 7: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 7 of 13 Health Forever Prospectus

3. Death summary in case of death of the insured person at the hospital 4. Hospital Receipts / bills / cash memos in Original (including advance and final hospital

settlement receipts) 5. All test reports for X-rays, ECG, Scan, MRI, Pathology etc., including doctor’s prescription

advising such tests/investigations (CDs of angiogram, surgery etc need not be sent unless specifically sought)

6. Doctor’s prescriptions with cash bills for medicines purchased from outside the hospital 7. F.I.R/MLC. in the case of accidental injury and english translation of the same, if in any other

language 8. Detailed self-description stating the date, time, circumstances and nature of injury/accident in

case of claims arising out of injury 9. Legal heir certificate in the absence of nomination under the policy, in case of death of the

proposer. In the absence of legal heir certificate, evidence establishing legal heirship may be provided as required by Us

10. For a) Cataract claims - IOL sticker b) PTCA claims - Stent sticker 11. Copies of health insurance policies held with any other insurer covering the insured persons 12. If a claim is partially settled by any other insurer, a certificate from the other insurer

confirming the final claim amount settled by them and that Original claim documents are retained at their end.

Documents to be submitted if specifically sought

1. Copy of indoor case records (including nurse's notes, OT notes and anesthetists' notes, vitals chart)

2. Copy of extract of Inpatient Register 3. Attendance records of employer/educational institution 4. Complete medical records (including indoor case records and OP records) of past

hospitalization/treatment if any 5. Attending Physician’s certificate clarifying

reason for hospitalization and duration of hospitalization

history of any self-inflicted injury

history of alcoholism, smoking

history of associated medical conditions, if any 6. Previous master health check-up records/pre-employment medical records if any 7. Any other document necessary in support of the claim on case to case basis.

Waiver: The above time limit for claim intimation and claim submission may be waived by the insurer in exceptional circumstances on a case to case basis subject to satisfactory reasons. This waiver cannot be claimed by the insured as a matter of right.

The claim documents should be sent to:

Health Claims Department

M/s Royal Sundaram General Insurance co. Limited

(Formerly known as Royal Sundaram Alliance Insurance Company Limited)

Vishranthi Melaram Towers No 2/319 Rajiv Gandhi Salai (OMR) Karapakkam, Chennai 600097

Insured /Insured Person must give Us at his expense, all the information We ask for about the claim and he must help Us to take legal action against anyone if required.

Page 8: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 8 of 13 Health Forever Prospectus

If required, the Insured / Insured Person must give consent to obtain Medical opinion from any Medical Practitioner at Our expense.

If required the Insured or Insured Person must agree to be examined by a Medical Practitioner of Our choice at Our expense.

However, if the documents submitted along with the claim are not in order or not complying with the requirements of the insurer, the claim could get rejected. Claims can also be rejected in case the declaration signed at the time of enrollment is proved to be false.

Under Network hospitals cashless can be availed only for Hospitalization expenses.

Under Non-network hospitals customer will get as reimbursement from the Company under

all sections. Can I renew my policy after the stipulated period of one year? Yes, for subsequent renewals post the expiry of your policy period, you have the following options:

Provide ECS (Electronic Clearing System) instructions against your bank account.

Provide a cheque in favor of Royal Sundaram General Insurance Company Limited.

Provide your credit card no with expiry date.

In addition to the above Royal Sundaram would also send you a renewal notice for your policy which would have the confirmation of the payment details. What are the benefits of renewing the policy next year? You become eligible to claim for ailments, which have a waiting period. For example, you may claim expenses for ailments Cataract, Sinusitis, etc. (First Year Exclusions) after the first renewal of the policy. Similarly, even pre-existing ailments become claimable after 4 years of continuous coverage. You also become eligible for cumulative bonus provided if you have not made any claim during the policy period. What are the exclusions? The Company shall not be liable under this Policy for any claim in connection with or in respect of: 1. Pre-Existing Conditions and its complication which shall however be covered after 4 years of

continuous insurance from the commencement date of the first policy issued by Us or any Indian Insurer subject to Portability guidelines.

This exclusion will also apply to any complications arising from pre-existing condition. For example, if a person is suffering from pre existing diabetes or hypertension or both, then the policy would be subject to the following exclusions:

Diabetes Hypertension or Diabetes

Diabetic Retinopathy Coronary Artery Disease

Diabetic Nephropathy Cerebro Vascular Accident

Page 9: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 9 of 13 Health Forever Prospectus

Diabetic Foot / wound Hypertensive Nephropathy

Diabetic Angiopathy Internal Bleeding/Haemorrhages

Diabetic Neuropathy

Hyper / Hypoglycaemic shocks

2. 30 Days Waiting Period: Any claim during the first 30 days from the Commencement Date of the First Policy with us shall not be payable unless caused by an Accident. 3. First Year Exclusions: During the first year of the policy any expenses incurred towards the following disease / surgical procedures are not covered unless caused by accident. Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Anomaly, Fistula in Anus, Piles, Sinusitis. 4. Treatment arising from or traceable to pregnancy / childbirth including voluntary termination of pregnancy. This exclusion shall however not apply in case of ectopic pregnancy. 5. The cost of spectacles, contact lenses and hearing aids. Injections for Age related Macular Degeneration / Choroidal Neovascularization membrane. and related disorders, Yag Laser / Argon Laser and such other treatments. 6. Dental treatment. 7. a. Convalescence, general debility, `Run-down’ condition or rest cure, Congenital external disease or defects or anomalies, Sterilization, Tubectomy, Vasectomy, Venereal disease, Intentional self injury or attempted suicide. b. Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident.

8. All expenses arising out of any condition directly or indirectly caused by or associated with Human T-Cell Lymphotropic Virus Type III (HTLB-III) or Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or variations Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS. 9. Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home. 10. Hospitalisation for evaluation/ diagnostic purpose. 11. Expenses on vitamins and tonics unless forming part of treatment for injury or disease 12. Claims directly or indirectly caused by or arising from or attributable to: a. War, Invasion, Act of Foreign Enemy, Warlike Operations (whether war be declared or not) b. Nuclear weapons/materials or Radioactive Contamination.

c. Ionising radiation or contamination by any Nuclear fuel or from any Nuclear waste from burning Nuclear fuel or

Page 10: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 10 of 13 Health Forever Prospectus

d. Radioactive, toxic, explosive or other dangerous properties of any explosive nuclear machinery or part of it. e. Biological, Nuclear or chemical terrorism

13. Any routine or preventative examinations, vaccinations, inoculation or screening, unless forming part of treatment for animal bite requiring hospitalization and any Out-patient (OPD) treatment charges. 14. Sex change or treatment which results from, or is in any way related to, sex change. 15. Hormone replacement therapy (including hormone replacement treatment following any disease / surgery) Cytotron Therapy, Oxymed Therapy, Arterial Clearance Therapy and similar such therapies. 16. Treatment of obesity (including morbid obesity) and any other weight control programs, services or supplies. 17. The treatment of psychiatric and psychosomatic disorders and mental or nervous conditions, insanity. 18. Any cosmetic, plastic surgery, aesthetic or related treatment of any description, corrective surgery for refractive error and including any complication arising from these treatments, whether or not for psychological reasons, unless medically necessary as a result of cancer, accidents and burns. 19.. Expenses incurred towards treatment of illness/disease/injury/condition arising out of use / misuse or abuse of alcohol, solvents, substance or drugs (whether prescribed or not). 20. Any stay or extended stay in Hospital for any domestic reason or where there is no active regular treatment by a Medical Practitioner. Any hospitalization which is not Medically Necessary. 21. . Any treatment received outside India. 22. . Any other Alternative Treatments except Allopathy (Modern Medicine). 23. Complication of any surgery, therapy or treatment administered on the Insured Person which is not prescribed or required by a Registered Medical Practitioner/Registered Medical Institution in their professional capacity. 24. Any fertility, sub-fertility or assisted conception operation. 25. Participation in Hazardous sports / activities of any kind. 26. Treatment provided by a Medical Practitioner which is outside of his discipline for which he is licensed. 27. Any claim in respect of stem cell implantation/ surgery and storage except Bone Marrow Transplantation which is otherwise covered by policy.

Page 11: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 11 of 13 Health Forever Prospectus

28. Insured’s / Proposer’s involvement in any activities resulting in any breach of law with criminal intent. 29. Any claim respect of Unproven / Experimental treatment. 30. Excluded Expenses as per Annexure 1. 31. Treatment taken at excluded hospitals as per Annexure 3. Note: For updated list of Excluded Hospitals please visit our website www.royalsundaram.in 32. Cost of Donors screening or treatment including surgery to remove organs in the event of the insured acting as a Donor. What are the Cancellation/Termination provisions available under the policy? The Company may at any time cancel this Policy on the grounds of mis-representation, fraud, non-disclosure of material facts on the Proposal Form or non-cooperation by You, by giving fourteen (14) days notice in writing by courier / registered post / acknowledgement due post to the Insured at address recorded / updated in the policy. In the event of such cancellation on the grounds of mis representation or fraud or non disclosure of material facts, the policy shall be void, no refund of premium shall be made and no claim shall be payable under the policy. In the event of cancellation on the grounds of non cooperation, the company shall be liable to repay on demand a rateable proportion of the premium for the unexpired term from the date of cancellation.

The insured may also cancel this Policy by giving fifteen (15) days notice in writing to the Company, for the cancellation of this Policy, in which case the Company shall from the date of receipt of the notice cancel the Policy and retain the premium for the period his Policy has been in force at the Company’s short period scale as mentioned below provided that no refund of premium shall be made if any claim has been made under the Policy by or on behalf of the insured.

Short period scales of rates:

Period on Risk Rate of Premium to

be retained Rate of Premium

to be retained Rate of Premium to be

retained

Tenure of the Policy 1 Year 2 Year 3 Year

Up to 1 month 25% of Premium 10% of premium 10% of premium

Up to 3 months 50% of Premium 25% of premium 20% of premium

Up to 6 months 75% of Premium 40% of premium 25% of premium

Up to 12 months Full Premium 50% of premium 30% of premium

Up to 13 months 60% of premium 40% of premium

Up to 15 months 75% of premium 50% of premium

Up to 18 months 90% of premium 60% of premium

Up to 24 months Full Premium 70% of premium

Up to 25 months 75% of premium

Up to 27 months 80% of premium

Up to 30 months 90% of premium

Exceeding 30 months Full Premium

Page 12: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 12 of 13 Health Forever Prospectus

From the amount thus arrived the cost of medical expenses (if any) incurred by the company shall be deducted and the balance shall be refunded. Will the policy be withdrawn by the insurer at any point of time? If so, what are the options available? The product / plan may be withdrawn at any time, by giving a notice of 3 months to the Proposer at the address recorded / updated in the policy. When the policy is withdrawn, the product / plan shall not be available for renewal at the due date. However, the cover under such policy shall continue till the expiry date shown in the Schedule of the policy. In the event of withdrawal of a product, Company shall offer similar alternative product from its currently marketed product suites. What are the conditions associated with renewal of my policy? Premium will be charged based on the age band in the premium table and any further increase is subject to IRDA’s approval. The Sum Insured can be enhanced at the time of renewal upto a maximum of 100% of the expiring sum insured if there are no claims lodged / paid during all years of insurance and the age of the insured person is under 45 years. Such increase sum insured shall however not be applicable for treatment of diseases contracted prior to such increase and also in respect of any pre-existing diseases at the time of enrolment under this policy. However the quantum of increase shall be at the discretion of the company. There will be a 30 day grace period available to you from the expiry date to renew your policy. However there will be no coverage during the period of break in insurance. Any change in the terms of cover including premium during renewal shall be subject to IRDA’s approval and a notice of 3 months before expiry of the policy shall be given. This product can be ported to another company before the renewal date. In case you wish to port, to ensure continuous coverage of the policy without any break in insurance, please get in touch with the other insurance company 45 days before the renewal date to initiate the necessary porting formalities there.

Is my Health Forever policy portable? Your Health Forever Policy is portable. If you desire to port to this policy, application in the appropriate form should be made before 45 days from the date of renewal. The company shall underwrite proposals falling under portability as per the company’s underwriting guidelines. In the event of acceptance of proposal under portability the commencement date for the purpose of applying time bound exclusions and Pre-existing Disease(s) shall be deemed from the first inception date of any Indemnity Health Insurance Policy and such rights shall be limited to the extent of the sum insured including Cumulative Bonus in each of the year, provided the Policy has been continuously renewed without any break. Portability rights do not apply to Maternity Benefits Disclaimer:

Page 13: Royal Sundaram General Insurance Co. Limited · The insurance is available to persons between the age of 91 days and 75 years at the Policy Start Date. The Proposer should be minimum

Royal Sundaram General Insurance Co. Limited

IRDA Regn No. 102 IRDA/NL-HLT/RSAI/P-H/V.II/211/13-14 Page 13 of 13 Health Forever Prospectus

Health Forever: Insurance is the subject matter of solicitation. The Health Forever policy is issued by Royal Sundaram General Insurance Company Limited. Claims will be settled by Royal Sundaram General Insurance Company Limited as per the terms and conditions of the policy. This brochure is not a contract of Insurance. Please refer policy document for exact terms and conditions and specific details applicable to this Insurance. This plan is underwritten by Royal Sundaram General Insurance Company Limited. Your participation in this insurance product is purely on a voluntary basis. Prohibition of rebates: Section 41 of the Insurance Act 1938 No person shall allow or offer to allow, directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published Prospectuses or table of the insurer. Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees. For any Complaint / Grievance / Refund / Cancellation / Claim, please contact: Royal Sundaram General Insurance Co. Limited (Formerly known as Royal Sundaram Alliance Insurance Company Limited) Vishranthi Melaram Towers No 2/319 Rajiv Gandhi Salai (OMR) Karapakkam, Chennai 600097 Email: [email protected] Toll No.: 1860 425 0000 Visit us at www.royalsundaram.in