IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
THE NEW INDIA ASSURANCE CO. LTD
Regd. & Head Office: 87, M.G. Road, Fort, Mumbai – 400001
NEW INDIA FLEXI FLOATER GROUP MEDICLAIM POLICY
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
1.0 Whereas Insured designated in the Schedule hereto has by a proposal and declaration dated as
stated in the Schedule which shall be the basis of this Contract and is deemed to be
incorporated herein, has applied to THE NEW INDIA ASSURANCE CO. LTD. (hereinafter
called the COMPANY) for the insurance herein after set forth in respect of
Employees/Members (including their eligible Family Members) named in the Schedule
hereto (herein after called the INSURED PERSON) and has paid premium as consideration
for such insurance.
2.0 NOW THIS POLICY WITNESSES that subject to the terms, conditions, exclusions and
definitions contained herein or endorsed or otherwise expressed here on the Company
undertakes that if during the period stated in the Schedule or during the continuance of this
policy by renewal any Insured Person shall contract any Illness (herein defined) or sustain
any Injury (herein defined) and if such Injury shall require any such Insured Person, upon
the advice of a duly qualified Medical practitioner (herein defined) or a surgeon to incur
Medical Expenses/Surgery at any Hospital / Day Care Center (herein defined) in India as an
Inpatient, the Company will pay to the Insured Person the amount of such expenses as would
fall under different heads mentioned below, and as are Reasonably and Customarily, and
Medically Necessarily incurred thereof by or on behalf of such Insured Person.
2.1 Room rent, Boarding, DMO / RMO / CMO / RMP Charges, Nursing (Including Injection / Drugs
and Intra venous fluid administration expenses), not exceeding 1.5% of Sum Insured per day
2.2 Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU), Intensivist charges, Monitor
and Pulse Oxymeter expenses, not exceeding 3% of the sum insured per day
2.3 Associate Medical Expenses; such as Professional fees of Surgeon, Anaesthetist, Consultant,
Specialist; Anaesthesia, Blood, Oxygen, Operating Theatre Charges and Procedure Charges
such as Dialysis, Chemotherapy, Radiotherapy & similar medical expenses related to the
treatment
2.4 Cost of Pharmacy and Consumables, Cost of Implants and Medical Devices and Cost of
Diagnostics.
2.5 Pre-hospitalization medical charges up to 30 days period.
2.6 Post-hospitalization medical charges up to 60 days period.
NOTE: SUB-LIMIT CLAUSE
1. Proportionate Deduction: Proportionate Deduction is applicable on the Associate Medical
Expenses, if the Insured Person opts for a higher Room than his eligible category. It shall be
effected in the same proportion as the eligible rate per day
bears to the actual rate per day of Room Rent. However, it is not applicable on
1. Cost of Pharmacy and Consumables
2. Cost of Implants and Medical Devices
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
3. Cost of Diagnostics.
Proportionate Deduction shall also not be applied in respect of Hospitals which do not follow
differential billing or for those expenses in which differential billing is not adopted based on
the room category, as evidenced by the Hospital’s schedule of charges / tariff.
2. No payment shall be made under 2.3 other than as part of the hospitalization bill.
3. However, the bills raised by Surgeon, Anesthetist directly and not included in the
hospitalization bill may be reimbursed in the following manner:
a) The reasonable, customary and Medically Necessary Surgeon fee and Anesthetist fee
would be reimbursed, limited to the maximum of Rs. Twenty Thousand. The payment
shall be reimbursed provided the insured pays such fee(s) through cheque and the
Surgeon / Anesthetist provides a numbered bill. Bills given on letter-head of the
Surgeon, Anesthetist would not be entertained.
b) Fees paid in cash will be reimbursed up to a limit of Rs. 10,000/- only, provided the
Surgeon/Anesthetist provides a numbered bill.
(N.B: Company’s Liability in respect of all claims admitted during the Policy Period shall not exceed
the Sum Insured per person mentioned in the schedule. In case of Floater basis, the limit shall apply
to the Floater Sum Insured and not to per person.)
2.7 The Company will pay Hospital Cash at the rate of 0.1% of the Sum Insured, for each day of
Hospitalization, admissible under the Policy. The payment under this Clause for Any One
Illness shall not exceed 1% of the Sum Insured. The payment under this Clause is applicable
only where the period of Hospitalization exceeds twenty four hours.
2.8 AYUSH: Expenses incurred for Ayurvedic / Homeopathic / Unani Treatment are admissible
up to 25% of the sum insured provided the treatment for Illness and accidental injuries, is
taken in AYUSH Hospital.
2.9 Ambulances services – 1.0 % of the sum insured or actual, whichever is less, subject to
maximum of Rs. 2,500/- in case patient has to be shifted from residence to hospital for
admission in Emergency Ward or ICU or from one Hospital to another Hospital by fully
equipped ambulance for better medical facilities.
2.10 Hospitalization expenses (excluding cost of organ) incurred on the donor during the course
of organ transplant to the insured person. The Company’s liability towards expenses incurred
on the donor and the insured recipient shall not exceed the sum insured of the insured person
receiving the organ.
2.11 Subject to the terms and Conditions of the Policy,
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
Zone I – Anywhere in India
Zone II – Anywhere in India (Except Mumbai and Greater Mumbai)
Zone III – Anywhere in India (Except Mumbai, Greater Mumbai, Delhi and NCR and
Bangalore)
2.12 LIMIT ON PAYMENT FOR CATARACT: Company’s liability for payment of any claim relating to
Cataract, for each eye, shall not exceed 10% of the Sum Insured subject to a maximum of Rs.
50,000.
2.13 SPECIFIC COVERAGES:
a) Impairment of Persons’ intellectual faculties by usage of drugs, stimulants or depressants as
prescribed by a medical practitioner is covered up to 5% of Sum Insured, maximum up to
Rs. 25,000 per policy period subject to it arising during treatment of covered illness for an
admissible claim. This amount shall be part of the Sum Insured.
b) Artificial life maintenance, including life support machine use, where such treatment will
not result in recovery or restoration of the previous state of Health under any
circumstances unless in a vegetative state as certified by the treating medical practitioner,
is covered up to 10% of Sum Insured and for a maximum of 15 days per policy period
following admission for a covered illness. (Explanation: Expenses up to the date of
confirmation by the treating doctor that the patient is in vegetative state shall be covered
as per the terms and conditions of the policy contract). Such expenses shall be payable if
required in conjunction to an admissible claim and shall be within the Sum insured
c) Puberty and Menopause related Disorders: Treatment for any symptoms, Illness,
complications arising due to physiological conditions associated with Puberty,
Menopause such as menopausal bleeding or flushing is covered only as Inpatient
procedure after 24 months of continuous coverage. This cover will have a sub-limit of
up to 25% of Sum Insured per policy period.
d) Age Related Macular Degeneration (ARMD) is covered after 48 months of continuous
coverage only for Intravitreal Injections and anti – VEGF medication. This cover will have a
sub-limit of 10% of Sum Insured, maximum upto Rs. 75,000 per policy period. This limit
shallbe within the Sum Insured and does not increase the overall Sum Insured.
(a) Persons paying Zone I premium can avail treatment in any Zone.
(b) Persons paying Zone II premium
i) Can avail treatment in Zone II and Zone III,
ii) Availing treatment in Zone I, will have to bear 10% of each claim.
(c) Persons paying Zone III premium
i) Can avail treatment in Zone III
ii) Availing treatment in Zone II, will have to bear 10% of each claim.
iii) Availing treatment in Zone I, will have to bear 20% of each claim.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
e) Behavioural and Neuro developmental Disorders: Disorders of adult personality and
Disorders of speech and language including stammering, dyslexia; are covered as Inpatient
procedure after 24 months of continuous coverage. This cover will have a sub-limit of 25%
of Sum Insured per policy period. This limit shall be within the Sum Insured and does not
increase the overall Sum Insured.
f) Genetic diseases or disorders are covered with a sub-limit of 25% of Sum Insured per policy
period with 48 months waiting periods. This limit shall be within the Sum Insured and does
not increase the overall Sum Insured.
Note: For the coverages defined in 2.13(a) to(f), waiting period’s, if any, shall be
applicable afresh i.e. for both New and Existing Policyholders w.e.f 1
st
October 2020
or date of inception of first policy, whichever is later. Coverage for such illness or
procedures shall only be available after completion of the said waiting periods.
g) Treatment of mental illness, stress or psychological disorders and neurodegenerative
disorders The Company shall indemnify the Hospital or the Insured the Medical Expenses
related to following and they are covered after a waiting period of 48 months with a sub-
limit up to 25% of Sum Insured per policy period.
The below covers are subject to the patient exhibiting any of the following traits and
requiring Hospitalisation as per the treating Psychiatrist’s advice
1. Major Depressive Disorder- when the patient is aggressive or violent.
2. Acute psychotic conditions- aggressive/violent behavior or hallucinations,
incoherent talking or agitation.
3. Schizophrenia- esp. Psychotic episodes.
4. Bipolar disorder- manic phase.
Treatment of any Injury due to exhibiting Suicidality shall not be covered.
Condition
Treatment shall be undertaken at a hospital categorized as Mental health Establishment
Or at a Hospital with a specific department for Mental Illness, under a Medical
Practitioner qualified as Mental Health Professional.
Exclusion
Any kind of Psychological counselling,cognitive/family/group/behavior/palliative therapy
or other kinds of psychotherapy for which Hospitalization is not necessary shall not be
covered.
Note: For the coverages defined in 2.13(g) , waiting period shall be applicable for both New
and Existing Policyholders w.e.f 16
th
August 2018 or date of inception of first policy,
whichever is later. This coverage shall only be available after completion of the said waiting
period.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
2.14 COVERAGE FOR MODERN TREATMENTS or PROCEDURES:
The following procedures will be covered (wherever medically indicated) either as in
patient or as part of day care treatment in a hospital up to the limit specified against each
procedure during the policy period.
Sl.No
Treatment or Procedure
Limit (Per Policy Period)
2.14.1
Uterine Artery Embolization and HIFU
(High
intensity focused ultrasound)
Upto 20% of Sum Insured
subject
to a Maximum upto Rs. 2 Lakh
2.14.2
Balloon Sinuplasty.
Upto 20% of Sum Insured
subject
to a Maximum upto Rs. 2 Lakh
2.14.3
Deep Brain stimulation
Upto 50% of Sum Insured
subject
to a maximum upto Rs. 5 Lakh
2.14.4
Oral chemotherapy
Upto 10% of Sum Insured
subject
to Maximum upto Rs. 1 Lakh.
2.14.5
Immunotherapy- Monoclonal Antibody to
be
given as injection
Upto 25% of Sum Insured
subject
to a Maximum of Rs 2 Lakh
2.14.6
Intravitreal injections
Upto 10% of Sum Insured
subject
to a Maximum of Rs.75,000
2.14.7
Robotic surgeries
Upto 50% of Sum Insured
subject
to Maximum of Rs. 5 Lakh
2.14.8
Stereotactic radio surgeries
Upto 50% of Sum Insured
subject
to Maximum Rs. 3 Lakh
2.14.9
Bronchial Thermoplasty
Upto 50% of Sum Insured
subject
to Maximum of Rs. 2.5 Lakh
2.14.10
Vaporisation of the prostrate (Green laser
treatment or holmium laser treatment)
Upto 50% of Sum Insured
subject
to Maximum of Rs. 2.5 Lakh
2.14.11
IONM - (Intra Operative Neuro
Monitoring)
Upto 10% of Sum Insured
subject
to Maximum of Rs. 50,000
2.14.12
Stem cell therapy: Hematopoietic stem
cells for bone marrow transplant for
haematological
conditions to be covered.
Upto 50% of Sum Insured
subject to Maximum of Rs.
2.5 Lakh.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
3.0 DEFINITIONS:
3.1 ACCIDENT: An accident is a sudden, unforeseen and involuntary event caused by external,
visible and violent means.
3.2 AGE means age of the Insured person on last birthday as on date of commencement of the
Policy.
3.3 ANY ONE ILLNESS means continuous Period of illness and it includes relapse within 45 days
from the date of last consultation with the Hospital/Nursing Home where treatment may
have been taken.
3.4 AYUSH TREATMENT refers to Hospitalisation treatments given under Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homeopathy systems.
3.5 AYUSH HOSPITAL is a Healthcare facility wherein medical / surgical / para-surgical
treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s)
comprising of any of the following:
a) Central or State Government AYUSH Hospital or
b) Teaching hospital attached to AYUSH College recognized by the Central Government
/ Central Council of Indian Medicine / Central Council for Homeopathy; or
c) AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any
recognized system of medicine, registered with the local authorities, wherever
applicable, and is under the supervision of a qualified registered AYUSH Medical
Practitioner and must comply with all the following criterion:
i) Having at least 5 in-patient beds;
ii) Having qualified AYUSH Medical Practitioner in charge round the
clock;
iii) Having dedicated AYUSH therapy sections as required and/or has
equipped operation theatre where surgical procedures are to be
carried out;
iv) Maintaining daily records of the patients and making them
accessible to the insurance company’s authorized representative
3.6 AYUSH DAY CARE CENTRE means and includes Community Health Centre (CHC), Primary
Health Centre (PHC), Dispensary, Clinic, Polyclinic or any such health centre which is
registered with the local authorities, wherever applicable and having facilities for carrying
out treatment procedures and medical or surgical/para-surgical interventions or both under
the supervision of registered AYUSH Medical Practitioner(s) on day care basis without in-
patient services and must comply with all the following criterion:
i. Having qualified registered AYUSH Medical Practitioner(s) in charge;
ii. Having dedicated AYUSH therapy sections as required and/or has equipped operation
theatre where surgical procedures are to be carried out;
iii. Maintaining daily records of the patients and making them accessible to the insurance
company’s authorized representative.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
3.7 BREAK IN POLICY means the period of gap that occurs at the end of the existing policy term,
when the premium due for renewal on a given policy is not paid on or before the premium
renewal date or within 30 days thereof.
3.8 CASHLESS FACILITY means a facility extended by the insurer to the Insured where the
payments, of the costs of treatment undergone by the Insured in accordance with the policy
terms and conditions, are directly made to the network provider by the Company to the
extent pre-authorization approved.
3.9 CONDITION PRECEDENT: Condition Precedent shall mean a policy term or condition upon
which the Insurer's liability under the policy is conditional upon.
3.10 CONGENITAL ANOMALY: refers to a condition(s) which is present since birth, and which is
abnormal with reference to form, structure or position.
i. CONGENITAL INTERNAL ANOMALY means a Congenital Anomaly which is not in the
visible and accessible parts of the body.
ii. CONGENITAL EXTERNAL ANOMALY means a Congenital Anomaly which is in the visible
and accessible parts of the body
3.11 DAY CARE CENTRE: A day care centre means any institution established for day care
treatment of illness and/or injuries or a medical setup within a hospital and which has been
registered with the local authorities, wherever applicable, and is under supervision of a
registered and qualified Medical Practitioner AND must comply with all minimum criteria
as under:
- Has qualified nursing staff under its employment;
- Has qualified medical practitioner/s in charge;
- Has a fully equipped operation theatre of its own where surgical procedures
are carried out;
- Maintains daily records of patients and will make these accessible to the
insurance company’s authorized personnel.
3.12 DAY CARE TREATMENT refers to medical treatment or Surgery which are:
- Undertaken under General or Local Anesthesia in a Hospital/Day Care Centre in less than
24 hours because of technological advancement, and
- Which would have otherwise required a hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this
definition.
3.13 DENTAL TREATMENT is treatment carried out by a dental practitioner including
examinations, fillings (where appropriate), crowns, extractions and surgery excluding any
form of cosmetic surgery / implants
3.14 DISCLOSURE TO INFORMATION NORM: The policy shall be void and all premium paid thereon
shall be forfeited to Us in the event of misrepresentation, mis-description or non-disclosure
of any material fact.
3.15 EMERGENCY CARE means management for an Illness or Injury which results in symptoms
which occur suddenly and unexpectedly, and requires immediate care by a medical
practitioner to prevent death or serious long-term impairment of the Insured Person’s health.
3.16 FLOATER BENEFIT means the sum insured as specified for a particular insured and the
members of his/her family as covered under the policy and is available for any or all the
members of his/her family for one more claims during the tenure of the policy.
3.17 GRACE PERIOD means specified period of time immediately following the premium due date
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
during which a payment can be made to renew or continue the Policy in force without loss
of continuity benefits such as waiting period and coverage of pre-existing diseases. Coverage
is not available for the period for which no premium is received.
3.18 HOSPITAL means any institution established for Inpatient Care and Day Care treatment of
Illness and / or Injuries and which has been registered as a Hospital with the local
authorities under the Clinical Establishment (Registration and Regulation) Act, 2010 or
under the enactments specified under the schedule of Section 56(1) of the said act OR
complies with all minimum criteria as under:
- has at least 10 inpatient beds, in those towns having a population of less than 10,00,000
and at least 15 inpatient beds in all other places;
- has qualified nursing staff under its employment round the clock;
- has qualified medical practitioner (s) in charge round the clock;
- has a fully equipped operation theatre of its own where surgical procedures are carried out
- maintains daily records of patients and will make these accessible to the Insurance
company’s authorized personnel.
The term ‘Hospital’ shall not include an establishment which is a place of rest, a place for the
aged, a place for drug-addicts or place for alcoholics, a hotel or a similar place.
3.19 HOSPITALISATION means admission in a Hospital for a minimum period of 24 in patient
Care consecutive hours except for specified procedures/ treatments, where such admission
could be for a period of less than 24 consecutive hours.
Hysterectomy
Inguinal/Ventral/Umbilical/Femoral
Hernia
Lithotripsy (Kidney Stone Removal)
Parenteral Chemotherapy
Piles / Fistula
Prostate
Radiotherapy
Sinusitis
Stone in Gall Bladder, Pancreas, and Bile
Duct
Tonsillectomy,
Urinary Tract System
OR any other Surgeries / Procedures agreed by TPA/Company which require less than 24
hours hospitalization due to advancement in Medical Technology
.
3.20 ILLNESS means a sickness or a disease or pathological condition leading to the impairment
of normal physiological function which manifests itself during the Policy Period and requires
medical treatment.
3.21 INJURY means accidental physical bodily harm excluding illness or disease solely and
directly caused by external, violent and visible and evident means which is verified and
certified by a Medical Practitioner.
i. Acute Condition means a disease, Illness or Injury that is likely to respond quickly to
treatment which aims to return the person to his or her state of health immediately
before suffering the disease / Illness / Injury which leads to full recovery.
ii. Chronic Condition means a disease, Illness, or Injury that has one or more of the following
characteristics
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
a. it needs ongoing or long-term monitoring through consultations, examinations,
check- ups, and / or tests
b. it needs ongoing or long-term control or relief of symptoms
c. it requires rehabilitation for the patient or for the patient to be special trained to
cope with it
d. it continues indefinitely
e. it recurs or is likely to recur
3.22 INPATIENT CARE means treatment for which the Insured Person has to stay in a Hospital for
more than 24 hours for a covered event.
3.23 INSURED PERSON means person(s) named in the schedule of the Policy.
3.24 INTENSIVE CARE UNIT (ICU) means an identified section, ward or wing of a Hospital which
is under the constant supervision of a dedicated Medical Practitioner, and which is specially
equipped for the continuous monitoring and treatment of patients who are in a critical
condition, or require life support facilities and where the level of care and supervision is
considerably more sophisticated and intensive than in the ordinary and other wards.
3.25 ICU (INTENSIVE CARE UNIT) CHARGES means the amount charged by a Hospital towards
ICU expenses on a per day basis which shall include the expenses for ICU bed, general
medical support services provided to any ICU patient including monitoring devices, critical
care nursing and intensivist charges.
3.26 MEDICAL ADVICE means Any consultation or advice from a Medical Practitioner including
the issue of any prescription or repeat prescription
3.27 MEDICAL EXPENSES means those expenses that an Insured Person has necessarily and
actually incurred for medical treatment on account of Illness or Injury on the advice of a
Medical Practitioner, as long as these are no more than would have been payable if the
Insured Person had not been insured and no more than other Hospitals or doctors in the
same locality would have charged for the same medical treatment.
3.28 MEDICALLY NECESSARY treatment is defined as any treatment, tests, medication, or stay in
Hospital or part of a stay in Hospital which
- is required for the medical management of the Illness or Injury suffered by the insured;
- must not exceed the level of care necessary to provide safe, adequate and appropriate
medical care in scope, duration, or intensity;
- must have been prescribed by a Medical Practitioner;
- must confirm to the professional standards widely accepted in international medical
practice or by the medical community in India.
3.29 MEDICAL PRACTITIONER is a person who holds a valid registration from the Medical Council
of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy
set up by the Government of India or a State Government and is thereby entitled to practice
medicine within its jurisdiction; and is acting within the scope and jurisdiction of his license.
Note: The Medical Practitioner should not be the insured or close family members.
3.30 NETWORK HOSPITAL means Hospitals enlisted by the Company, TPA or jointly by the
Company and TPA to provide medical services to an Insured by a cashless facility.
3.31 NON-NETWORK HOSPITAL means any Hospital that is not part of the network.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
3.32 NOTIFICATION OF CLAIM means the process of intimating a claim to the Company or TPA
through any of the recognized modes of communication.
3.33 PRE-EXISTING DISEASE (PED) means any condition, ailment, Injury or Illness
a) That is/are diagnosed by a physician within 48 months prior to the effective date of the
Policy issued by Us and its reinstatement or
b) For which medical advice or treatment was recommended by, or received from, a
physician within 48 months prior to the effective date of the Policy or its reinstatement.
3.34 PRE-HOSPITALISATION MEDICAL EXPENSES mean Medical Expenses incurred during the
period preceding the Insured Person is Hospitalised, provided that:
i.
Such Medical Expenses are incurred for the same condition for which the Insured Person’s
Hospitalization was required, and
ii.
The Inpatient Hospitalization claim for such Hospitalization is admissible by the
Insurance Company.
3.35 POST-HOSPITALISATION MEDICAL EXPENSES mean Medical Expenses incurred during the
period immediately after the Insured Person is discharged from the hospital provided that:
i.
Such Medical Expenses are incurred for the same condition for which the Insured Person’s
Hospitalisation was required, and
ii.
The Inpatient Hospitalisation claim for such Hospitalisation is admissible by the
Insurance Company.
3.36 POLICY means these Policy wordings, the Policy Schedule and any applicable endorsements
or extensions attaching to or forming part thereof. The Policy contains details of the extent
of cover available to the Insured person, what is excluded from the cover and the terms &
conditions on which the Policy is issued to The Insured person.
3.37 POLICY PERIOD means period of one policy year as mentioned in the schedule for which the
Policy is issued.
3.38 POLICY SCHEDULE means the Policy Schedule attached to and forming part of Policy.
3.39 POLICY YEAR means a period of twelve months beginning from the date of commencement
of the policy period and ending on the last day of such twelve-month period. For the purpose
of subsequent years, policy year shall mean a period of twelve months commencing from the
end of the previous policy year and lapsing on the last day of such twelve-month period, till
the policy period, as mentioned in the schedule
3.40 PREFERRED PROVIDER NETWORK (PPN) means network providers in specific cities which
have agreed to a cashless packaged pricing for specified planned procedures for Our
policyholders. The list of planned procedures is available with Us / TPA and subject to
amendment from time to time. Reimbursement of expenses incurred in PPN for the
procedures (as listed under PPN package) shall be subject to the rates applicable to PPN
package pricing.
3.41 QUALIFIED NURSE Qualified nurse is a person who holds a valid registration from the
Nursing Council of India or the Nursing Council of any state in India.
3.42 REASONABLE AND CUSTOMARY CHARGES mean the charges for services or supplies, which
are the standard charges for the specific provider and consistent with the prevailing charges
in the geographical area for identical or similar services, taking into account the nature of
the Illness / Injury involved.
3.43 RENEWAL means the terms on which the contract of insurance can be renewed on mutual
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
consent with a provision of grace period for treating the renewal continuous for the purpose
of all waiting periods.
3.44 ROOM RENT means the amount charged by a Hospital for the occupancy of a bed per day (24
hours) basis and shall include associated medical expenses.
3.45 SUB-LIMIT means a cost sharing requirement under this policy in which We would not be
liable to pay any amount in excess of the pre-defined limit.
3.46 SUM INSURED is the maximum amount of coverage opted for each Insured Person and
shown in the Schedule.
3.47 SURGERY OR SURGICAL PROCEDURE means manual and / or operative procedure (s)
required for treatment of an Illness or Injury, correction of deformities and defects,
diagnosis and cure of diseases, relief of suffering or prolongation of life, performed in a
Hospital or Day Care Centre by a Medical Practitioner.
3.48 THIRD PARTY ADMINISTRATORS (TPA) means a Company registered with the Authority,
and engaged by an Insurer, for a fee or by whatever name called and as may be mentioned
in the health services agreement, for providing health services.
3.49 WAITING PERIOD means a period from the inception of this Policy during which specified
diseases / treatments are not covered. On completion of the period, diseases / treatments
shall be covered provided the Policy has been continuously renewed without any break.
3.50 ASSOCIATE MEDICAL EXPENSES means medical expenses such as Professional fees of
Surgeon, Anaesthetist, Consultant, Specialist; Anaesthesia, Blood, Oxygen, Operating Theatre
Charges and Procedure Charges such as Dialysis, Chemotherapy, Radiotherapy & similar
medical expenses related to the treatment
4.0 EXCLUSIONS
The Company shall not be liable to make any payment under this policy in respect of:
4.1 PRE-EXISTING DISEASES (Code- Excl01)
a) Treatment of any Pre existing Condition/Disease, until Thirty Six months of Continuous
Coverage of such Insured Person have elapsed. For Continuous coverage of less than
Thirty Six months, the amount payable shall be restricted to a specified % of the
admissible claim amount SUBJECT TO A MAXIMUM OF % OF THE SUM INSURED, as
per Table below
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
AMOUNT PAYABLE IS % OF ADMISSIBLE CLAIM AMOUNT SUBJECT TO A MAXIMUM OF %
OF THE SUM
INSURED, FOR CONTINUOUS COVERAGE
OF LESS THAN TWELVE MONTHS
25%
EXCEEDING TWELVE MONTHS BUT LESS
THAN
TWENTY-FOUR MONTHS
50%
EXCEEDING TWENTY FOUR MONTHS BUT
LESS THAN THIRTY SIX MONTHS
75%
b) In case of enhancement of Sum Insured the waiting period shall apply afresh to the extent
of Sum Insured increase.
c) If the Insured Person is continuously covered without any break as defined under the
portability norms of the extant IRDAI (Health Insurance) Regulations then waiting
period
for the same would be reduced to the extent of prior coverage.
d) Coverage under the policy for any pre-existing disease is subject to the same being
declared at the time of application and accepted by us.
4.2 Waiting period for specified diseases/ailments/conditions:
a) For those Insured Persons with less than twenty-four months of Continuous
Coverage, the policy will cover the following diseases/ailments/conditions only
up to the limits specified below.
CONTINUOUS COVERARE
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
Sr.
No.
Name of Disease / Ailment / Surgery
OF LESS
THAN
TWELVE
MONTHS
EXCEEDING
TWELVE
MONTHS BUT
LESS THAN
TWENTY FOUR
MONTHS
1
Any Skin disorder
25%
50%
2
All internal & external
benigntumors, cysts, polyps of any
kind, including benign breast
lumps
25%
50%
3
Benign Ear, Nose, Throat disorders
25%
50%
4
Benign Prostate Hypertrophy
25%
50%
5
Cataract & age related eyeailments
25%
50%
6
Diabetes melitus
25%
50%
7
Gastric/ Duodenal Ulcer
25%
50%
8
Gout & Rheumatism
25%
50%
9
Hernia of all types
25%
50%
10
Hydrocele
25%
50%
11
Hypertension
25%
50%
12
Hysterectomy for
Menorrhagia/Fibromyoma,
Myomectomy and Prolapse of
uterus
25%
50%
13
Non Infective Arthritis
25%
50%
14
Piles, Fissure and Fistula in Anus
25%
50%
15
Pilonidal Sinus, Sinusitis and related
disorders
25%
50%
16
Prolapse Inter Vertebral Disc unless
arising
from accident
25%
50%
17
Stone in Gall Bladder & Bile duct
25%
50%
18
Stones in Urinary Systems
25%
50%
19
Unknown Congenital internal
disease/defects
25%
50%
20
Varicose Veins and Varicose Ulcers
25%
50%
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
b) For those Insured Persons with less than thirty-six months of Continuous
Coverage, the policy will cover the following diseases/ailments/conditions
only up to the limits specified below.
Sr.
No
Name of
Disease/Ailment/Surgery
CONTINUOUS COVERAGE
OF LESS
THAN
TWELVE
MONTHS
EXCEEDING
TWELVE
MONTHS BUT
LESS THAN
TWENTY-FOUR
MONTHS
EXCEEDING
TWENTY-
FOUR
MONTHS
BUT
LESS THAN
THIRTY-SIX
MONTHS
1.
Age related Osteoarthritis &
Osteoporosis
25%
50%
75%
2.
Joint Replacements due to
Degenerative Condition
25%
50%
75%
AMOUNT PAYABLE IS % OF ADMISSIBLE CLAIM AMOUNT SUBJECT TO A MAXIMUM OF
% OF THE SUM INSURED, AS SPECIFIED AT (A) AND (B) ABOVE
c) In case of enhancement of sum insured the waiting period shall apply afresh to the
extent of sum insured increase.
d) If any of the specified disease/procedure falls under the waiting period specified
for preexisting diseases, then the longer of the two waiting periods shall apply.
e) The waiting period for listed conditions shall apply even if contracted after the
policy or declared and accepted without a specific exclusion.
f) If the Insured Person is continuously covered without any break as defined under
the
applicable norms on portability stipulated by IRDAI, then waiting period for the
same
would be reduced to the extent of prior coverage.
4.3 FIRST THIRTY DAYS WAITING PERIOD (Code- Excl03)
a. Expenses related to the treatment of any illness within 30 days from the first
policy commencement date shall be excluded except claims arising due to an
accident, provided the same are covered.
b. This exclusion shall not, however, apply if the Insured Person has Continuous
Coverage for more than twelve months.
c. The within referred waiting period is made applicable to the enhanced sum
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
insured in the event of granting higher sum insured subsequently.
4.4 PERMANENT EXCLUSIONS: Any medical expenses incurred for or arising out of:
4.4.1 INVESTIGATION & EVALUATION (Code- Excl04)
a. Expenses related to any admission primarily for diagnostics and evaluation
purposes.
b. Any diagnostic expenses which are not related or not incidental to the current
diagnosis and treatment
However, Treatment for any symptoms, Illness, complications arising due to
physiological conditions for which aetiology is unknown is not excluded. It is covered
with a Sub-Limit of upto 10% of Sum Insured per policy period.
4.4.2 REST CURE, REHABILITATION AND RESPITE CARE (Code- Excl05)
Expenses related to any admission primarily for enforced bed rest and not for
receiving treatment. This also includes:
a. Custodial care either at home or in a nursing facility for personal care such as
help with activities of daily living such as bathing, dressing, moving around either
by skilled nurses or assistant or non-skilled persons.
b. Any services for people who are terminally ill to address physical, social,
emotional and spiritual needs.
However, Expenses related to any admission primarily for enteral feedings is not
excluded, if the Oral intake is absent for a period of at-least 5 days. It will be covered
for a Maximum period of 14 days in a Policy Period
4.4.3 OBESITY/ WEIGHT CONTROL (Code- Excl06)
Expenses related to the surgical treatment of obesity that does not fulfil all the below
conditions:
a. Surgery to be conducted is upon the advice of the Doctor
b. The surgery/Procedure conducted should be supported by clinical protocols
c. The member has to be 18 years of age or older and
d. Body Mass Index (BMI);
1. greater than or equal to 40 or
2. greater than or equal to 35 in conjunction with any of the following severe
co- morbidities following failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes
4.4.4 CHANGE-OF-GENDER TREATMENTS (Code- Excl07)
Expenses related to any treatment, including surgical management, to change
characteristics of the body to those of the opposite sex.
4.4.5 COSMETIC OR PLASTIC SURGERY (Code- Excl08)
Expenses for cosmetic or plastic surgery or any treatment to change appearance
unless for reconstruction following an Accident, Burn(s) or Cancer or as part of
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
medically necessary treatment to remove a direct and immediate health risk to the
insured. For this to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
4.4.6 HAZARDOUS OR ADVENTURE SPORTS (Code- Excl09)
Expenses related to any treatment necessitated due to participation as a professional
in hazardous or adventure sports, including but not limited to, para-jumping, rock
climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand
gliding, sky diving, deep-sea diving.
However, Treatment related to Injury or Illness associated with Hazardous activities
related to particular line of employment or occupation (not for recreational purpose)
is not excluded.
4.4.7 BREACH OF LAW (Code- Excl10)
Expenses for treatment directly arising from or consequent upon any Insured Person
committing or attempting to commit a breach of law with criminal intent.
4.4.8 EXCLUDED PROVIDERS (Code-Excl11)
Expenses incurred towards treatment in any hospital or by any Medical Practitioner
or any other provider specifically excluded by the Insurer and disclosed in its website
/ notified to the policyholders are not admissible. However, in case of life-
threatening situations or following an accident, expenses up to the stage of
stabilization are payable but not the complete claim
4.4.9 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and
consequences thereof. (Code- Excl12)
4.4.10 Treatments received in health hydros, nature cure clinics, spas or similar
establishments or private beds registered as a nursing home attached to such
establishments or where admission is arranged wholly or partly for domestic
reasons. (Code- Excl13)
4.4.11 Dietary supplements and substances that can be purchased without prescription,
including but not limited to Vitamins, minerals and organic substances unless
prescribed by a medical practitioner as part of hospitalization claim or day care
procedure. (Code- Excl14)
4.4.12 REFRACTIVE ERROR (Code- Excl15)
Expenses related to the treatment for correction of eye sight due to refractive error
less than 7.5 dioptres.
4.4.13 UNPROVEN TREATMENTS (Code- Excl16)
Expenses related to any unproven treatment, services and supplies for or in
connection with any treatment. Unproven treatments are treatments, procedures
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
or supplies that lack significant medical documentation to support their
effectiveness.
4.4.14 STERILITY AND INFERTILITY (Code- Excl17)
Expenses related to sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproduction services including artificial insemination and
advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
4.4.15 MATERNITY EXPENSES (Code - Excl18)
a. Medical treatment expenses traceable to childbirth (including complicated
deliveries and caesarean sections incurred during hospitalization) except ectopic
pregnancy;
b. Expenses towards miscarriage (unless due to an accident) and lawful medical
termination of pregnancy during the policy period.
4.4.16 War (whether declared or not) and war like occurrence or invasion, acts of foreign
enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military
or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
4.4.17 Nuclear, chemical or biological attack or weapons, contributed to, caused by,
resulting from or from any other cause or event contributing concurrently or in any
other sequence to the loss, claim or expense. For the purpose of this exclusion:
a. Nuclear attack or weapons means the use of any nuclear weapon or device or
waste or combustion of nuclear fuel or the emission, discharge, dispersal, release
or escape of fissile/ fusion material emitting a level of radioactivity capable of
causing any Illness, incapacitating disablement or death.
b. Chemical attack or weapons means the emission, discharge, dispersal, release or
escape of any solid, liquid or gaseous chemical compound which, when suitably
distributed, is capable of causing any Illness, incapacitating disablement or death.
c. Biological attack or weapons means the emission, discharge, dispersal, release or
escape of any pathogenic (disease producing) micro-organisms and/or
biologically produced toxins (including genetically modified organisms and
chemically synthesized toxins) which are capable of causing any Illness,
incapacitating disablement or death.
4.4.18 Circumcision unless required to treat Injury or Illness.
4.4.19 Vaccination & Inoculation.
4.4.20 Cost of braces, equipment or external prosthetic devices, non-durable implants,
eyeglasses, Cost of spectacles and contact lenses, hearing aids including cochlear
implants, durable medical equipment.
4.4.21 All types of Dental treatments except arising out of an accident.
4.4.22 Convalescence, general debility.
4.4.23 Bodily injury or sickness due to willful or deliberate exposure to danger (except in
an attempt to save human life), intentional self-inflicted injury, attempted suicide.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
However, Failure to seek or follow medical advice or failure to follow treatment is
not excluded. It is covered with a sub-limit of 10% of Sum Insured per policy
period.
4.4.24 Treatment of any bodily injury sustained whilst or as a result of participating in any
criminal act.
4.4.25 Naturopathy Treatment.
4.4.26 Instrument used in treatment of Sleep Apnea Syndrome (C.P.A.P.) and continuous
Peritoneal Ambulatory dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial
Asthmatic condition.
4.4.27 Stem cell implantation / surgery for other than those treatments mentioned in clause
2.14.12.
4.4.28 Domiciliary Hospitalization.
4.4.29 Treatment taken outside India.
4.4.30 Change of treatment from one system to another unless recommended by the
consultant / hospital under whom the treatment is taken.
4.4.31 Any kind of Service charges, Surcharges, Luxury Tax and similar charges levied by
the Hospital.
4.4.32 Treatment such as Rotational Field Quantum Magnetic Resonance (RFQMR),
External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP),
Hyperbaric Oxygen Therapy.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
5.0 CONDITIONS:
5.1 COMMUNICATION: Every notice or communication to be given or made under this
policy shall be delivered in writing at the address as shown in the Schedule.
5.2 PREMIUM PAYMENT: The premium payable under this policy shall be paid in advance.
No receipt for Premium shall be valid except on the official form of the Company. The
due payment of premium and the observance and fulfillment of the terms, provisions,
conditions and endorsements of this policy by the Insured Person in so far as they relate
to anything to be done or complied with by the Insured Person shall be condition
precedent to any liability of the Company to make any payment under this policy. No
waiver of any terms, provisions, conditions and endorsements of this policy shall be
valid, unless made in writing and signed by an authorized official of the Company.
5.3 NOTICE OF CLAIM: Preliminary notice of claim with particulars relating to Policy
Number, name of insured person in respect of whom claim is to be made, nature of
illness/injury and Name and Address of the attending Medical
Practitioner/Hospital/Nursing Home should be given to the Company/TPA within 7
days from the date of hospitalization in respect of reimbursement claims.
Final claim along with hospital receipted original Bills/Cash memos, claim form and
documents as listed in the claim form below should be submitted to the Policy issuing
Office/TPA not later than 30 days of discharge from the hospital. The insured may also
be required to give the Company/TPA such additional information and assistance as
the Company/TPA may require in dealing with the claim.
a. Bill, Receipt and Discharge certificate / card from the Hospital.
b. Cash Memos from the Hospitals(s) / Chemists(s), supported by proper prescriptions.
c. Receipt and Pathological test reports from Pathologist supported by the note from
the attending Medical Practitioner / Surgeon recommending such Pathological tests
/ pathological.
d. Surgeon's certificate stating nature of operation performed and Surgeons’ bill and
receipt.
e. Attending Doctor's/ Consultant's/ Specialist's / Anesthetist’s bill and receipt, and
certificate regarding diagnosis.
f. Certificate from attending Medical Practitioner / Surgeon that the patient is fully
cured.
Waiver: Waiver of period of intimation may be considered in extreme cases of
hardships where it is proved to the satisfaction of the Company/TPA that under the
circumstances in which the insured was placed it was not possible for him or any other
person to give such notice or file claim within the prescribed time limit. This waiver
cannot be claimed as a matter of right.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
5.4 PHYSICAL EXAMINATION: Any medical practitioner authorized by the Company shall
be allowed to examine the Insured Person in case of any alleged injury or Disease
requiring Hospitalization when and as often as the same may reasonably be required
on behalf of the Company.
5.5 The Company shall not be liable to make any payment under this policy in respect of
any claim if such claim be in any manner fraudulent or supported by any fraudulent
means or device whether by the Insured Person or by any other person acting on his
behalf.
5.6 MULTIPLE POLICIES:
1. In case of multiple policies taken by Insured Person during a period from the
Company or one or more Insurers to indemnify treatment costs, Insured Person
shall have the right to require a settlement of Insured Person’s claim in terms of any
of his/her policies. In all such cases the Company, if chosen by Insured Person, shall
be obliged to settle the claim as long as the claim is within the limits of and
according to the terms of this Policy
2. Insured having multiple policies shall also have the right to prefer claims under
this policy for the amounts disallowed under any other policy / policies, even if the
Sum Insured is not exhausted. Then We shall independently settle the claim subject
to the terms and conditions of this Policy.
3. If the amount to be claimed exceeds the Sum Insured under a single policy after,
Insured Person shall have the right to choose Insurers from whom You wants to
claim the balance amount.
4. Where an Insured has policies from more than one Insurer to cover the same risk
on indemnity basis, the Insured shall only be indemnified the Hospitalisation costs
in accordance with the terms and conditions of the chosen policy.
Note: The Insured Person must disclose such other insurance at the time of making a
claim under this Policy.
5.7 CANCELLATION CLAUSE: The policy may be renewed by mutual consent. The company
shall not however be bound to give notice that it is due for renewal and the Company
may at any time cancel this Policy by sending the insured 30 days’ notice by registered
letter at the Insured’s last known address and in such event the Company shall refund to
the Insured a pro-rata premium for unexpired Period of Insurance. The Company shall,
however, remain liable for any claim which arose prior to the date of cancellation.
The Insured may at any time cancel this policy and in such event the Company shall
allow refund of premium at Company’s short period rate only (table given here below)
provided no claim has occurred up to the date of cancellation.
PERIOD OF RISK
RATE OF PREMIUM TO BE
CHARGED
Up to one month
1/4
th
of the annual rate
Up to three months
½ of the annual rate
Up to six months
3/4
th
of the annual rate
Exceeding six
months
Full annual rate
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
5.8 DISCLAIMER OF CLAIM: If the Company shall disclaim liability to the Insured for any
claim hereunder and if the Insured shall not within 12 calendar months from the date
of receipt of the notice of such disclaimer notify the Company in writing that he does
not accept such disclaimer and intends to recover his claim from the Company then
the claim shall for all purposes be deemed to have been abandoned and shall not
thereafter be recoverable hereunder
5.9 All medical/surgical treatment under this policy shall have to be taken in India and
admissible claims thereof shall be payable in Indian currency
6.0 CASHLESS SERVICE THROUGH TPAS: Claims in respect of Cashless access services will be
through the agreed list of network of hospital and is subject to pre-admission
authorization. The TPA shall, upon getting the related medical information from the
insured person /network provider, verify that the person is eligible to claim under the
policy and after satisfying itself will issue a pre-authorization letter / guarantee of
payment letter to the hospital mentioning the sum guaranteed as payable also the
ailment for which the person is seeking to be admitted as a patient. The TPA reserves
the right to deny pre-authorization in case the insured person is unable to provide the
relevant medical details as required by the TPA. The TPA will make it clear to the
insured person that denial of Cashless Access is in no way construed to be denial of
treatment. The insured person may obtain the treatment as per his /her treating
Medical Practitioners medical advice and later on submit the full claim papers to the
TPA for reimbursement.
7.0 FRAUD, MISREPRESENTATION, CONCEALMENT: The policy shall be null and void and no
benefits shall be payable in the event of misrepresentation, misdescription or
nondisclosure of any material fact/particulars if such claim be in any manner
fraudulent or supported by any fraudulent means or device whether by the Insured
Person or by any other person acting on his/her behalf.
8.0 FREE LOOK PERIOD:
The free look period shall be applicable at the inception of the first policy.
You will be allowed a period of fifteen days from the date of receipt of the policy to
review the terms and conditions of the policy and to return the same if not
acceptable.
If You have not made any claim during the free look period, You shall be entitled to:
i. A refund of the premium paid less any expenses incurred by Us on medical
examination and the stamp duty charges or;
ii. where the risk has already commenced and the option of return of the policy is
exercised by You, a deduction towards the proportionate risk premium for
period on cover or;
iii. Where only a part of the risk has commenced, such proportionate risk premium
commensurate with the risk covered during such period.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
9.0 RENEWAL CLAUSE: The Company sends renewal notice as a matter of courtesy. If the
insured does not receive the renewal notice it will not amount to any deficiency of
service.
The Company shall not be responsible or liable for non-renewal of the policy due to
non- receipt /delayed receipt of renewal notice or due to any other reason whatsoever.
We shall be entitled to decline renewal if:
a) Any fraud, moral hazard/misrepresentation or suppression by You or any one
acting on Your behalf is found either in obtaining insurance or subsequently in
relation thereto, or non-cooperation of the Insured Person, or
b) We have discontinued issue of the Policy, in which event You shall however have the
option for renewal under any similar Policy being issued by Us; provided however,
benefits payable shall be subject to the terms contained in such other Policy, or
c) You fail to remit Premium for renewal before expiry of the Period of Insurance. We
may accept renewal of the Policy if it is effected within thirty days (grace period) of
the expiry of the Period of Insurance. On such acceptance of renewal, we, however
shall not be liable for any claim arising out of Illness contracted or Injury sustained
or Hospitalization commencing in the interim period after expiry of the earlier
Policy and prior to date of commencement of subsequent Policy.
ENHANCEMENT OF SUM INSURED: If the policy is to be renewed for enhanced sum
insured then the restrictions i.e. 4.1, 4.2 and 4.3 will apply to additional sum insured as
if it is a new policy.
NO CLAIM DISCOUNT: Discount of 5% on the premium on renewal in respect of each
Claim free year, subject to maximum of 15% shall be allowed, provided the policy is
renewed under the scheme with the Company without any break. In case, any claim is
admitted under the policy, the entire no claim discount earned shall be forfeited on
renewal of the said policy. However, the No Claim Discount shall continue to accrue
afresh from the next claim free year.
DISCOUNT IN PREMIUM IN LIEU OF CUMULATIVE BONUS: The discount in premium in
lieu of cumulative bonus at the time of inception of this policy is offered as a onetime
measure, in lieu of Cumulative Bonus offered by the previous insurer. This discount in
premium in lieu of cumulative bonus would continue to be extended as long as no claim
is reported under the policy.
If there is a claim during the current year, next year, there will be no discount in
premium in lieu of cumulative bonus and whatever discount is allowed would stand
withdrawn at the time of renewal. Even if the claim is for a smaller amount and for only
one person in the family, the Discount in premium in lieu of cumulative bonus will be
withdrawn in the next year.
10.0 COMPANY’S LIABILITY: The company’s aggregate liability in respect of all claims admitted
during the period of insurance in respect of all persons insured under the policy shall
not exceed the Sum Insured stated in the Schedule
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
11.0 MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS: If the claim event falls
within two policy periods, the claim shall be paid taking into consideration the available sum
insured for the expiring policy only. Sum Insured of the renewed Policy will not be available
for the
Hospitalisation (including Pre & Post Hospitalisation Expenses), which has commenced in the
expiring Policy. Claim shall be settled on per event basis.
12.0 REPUDIATION OF CLAIM: A claim, which is not covered under the Policy conditions, can
be rejected. All the documents submitted to TPA shall be electronically collected by Us
for settlement and denial of the claims by the appropriate authority.
With Our prior approval Communication of repudiation shall be sent to You, explicitly
mentioning the grounds for repudiation, through Our TPA.
13.0 PROTECTION OF POLICY HOLDERS’ INTEREST: This policy is subject to IRDA
(Protection of Policyholders’ Interest) Regulation, 2002
14.0 GRIEVANCE REDRESSAL: In the event of Insured has any grievance relating to the
insurance, Insured Person may contact any of the Grievance Cells at Regional Offices of
the Company or Office of the Insurance Ombudsman under the jurisdiction of which the
Policy Issuing Office falls. The contact details of the office of the Insurance Ombudsman
are provided in the Annexure II.
15.0 PAYMENT OF CLAIM:
i. The Company shall settle or reject a claim, as may be the case, within thirty days of the
receipt of the last ‘necessary’ document.
ii. While efforts will be made by the Company to not call for any document not listed in
Clause5.3, where any additional document or clarification is necessary to take a decision
on the claim, such additional documents will be called for.
iii. All necessary claim documents pertaining to Hospitalisation should be furnished by
the
Insured Person in original to the TPA (as mentioned in the Schedule), within thirty days
from
the date of discharge from the Hospital. However, claims filed even beyond such period
will
be considered if there are valid reasons for delay in submission.
a. In case of any deficiency in submission of documents, the TPA shall issue a
deficiency request.
b. In case of non-submission of documents requested in the deficiency request
within seven days from the date of receipt of the deficiency request, three
reminders shall be sent by the TPA at an interval of seven days each.
c. The claim shall stand repudiated if the documents, mandatory for taking the
decision of admissibility of the Claim, are not submitted within seven days of the
third reminder. If the required documents are such that it does not affect the
admissibility of the claim and is limited to payment of certain expenditure only,
the Claim will be paid after reducing such amount from the admissible amount.
In case of any delay, such claims shall be paid by Us with a penal interest as per
Regulation 9(6) of IRDA (Protection of Policyholders’ Interests) Regulations, 2017 as
modified from time to time.
All admissible claims shall be payable in Indian Currency.
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
16.0 ARBITRATION: If we admit liability for any claim but any difference or dispute arises as
to the amount payable for any claim the same shall be decided by reference to
Arbitration.
The Arbitrator shall be appointed in accordance with the provisions of the Arbitration
and Conciliation Act, 1996.
No reference to Arbitration shall be made unless We have Admitted our liability for a
claim in writing.
If a claim is declined and within 12 calendar months from such disclaimer any suit or
proceeding is not filed then the claim shall for all purposes be deemed to have been
abandoned and shall not thereafter be recoverable hereunder.
17.0 PORTABILITY AND MIGRATION:
You will have the option to migrate the policy to other Health Insurance
products/plans offered by the company by applying for migration of the policy at-
least 30 days before the policy renewal date as per IRDAI guidelines on Migration. If
You are presently covered and has been continuously covered without any lapses
under any Health Insurance product/plan offered by the Company, then You will get
the accrued continuity benefits in waiting periods as per IRDAI guidelines on
Migration. For detailed guidelines on Migration. Kindly refer the link
https://www.irdai.gov.in/ADMINCMS/cms/frmGeneral_NoYearList.aspx?DF=RL&m
id=4.2
PORTABILITY:
You will have the option to port the policy to other Insurers by applying to such
Insurer to port the entire policy along with all the members of the family, if any, at-
least 45 days before, but not earlier than 60 days from the policy renewal date as per
IRDAI guidelines related to portability. If such person is presently covered and has
been continuously covered without any lapses under any Health Insurance policy
with an Indian General/Health Insurer, the proposed Insured person will get the
accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.
For detailed guidelines on Portability. Kindly refer the link
https://www.irdai.gov.in/ADMINCMS/cms/frmGeneral_NoYearList.aspx?DF=RL&m
id=4.2
ANNEXURE I: LIST OF EXPENSES EXCLUDED ("NON-MEDICAL")
SNO
LIST OF EXPENSES EXCLUDED ("NON-MEDICAL")
SUGGESTIONS
TOILETRIES/COSMETICS/ PERSONAL COMFORT OR CONVENIENCE ITEMS
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
1
HAIR REMOVAL CREAM
Not Payable
2
BABY CHARGES (UNLESS SPECIFIED/INDICATED)
Not Payable
3
BABY FOOD
Not Payable
4
BABY UTILITES CHARGES
Not Payable
5
BABY SET
Not Payable
6
BABY BOTTLES
Not Payable
7
BRUSH
Not Payable
8
COSY TOWEL
Not Payable
9
HAND WASH
Not Payable
10
M01STUR1SER PASTE BRUSH
Not Payable
11
POWDER
Not Payable
12
RAZOR
Payable
13
SHOE COVER
Not Payable
14
BEAUTY SERVICES
Not Payable
15
BELTS/ BRACES
Essential and may be paid
specifically for cases who
have undergone surgery of
thoracic or
lumbar spine.
16
BUDS
Not Payable
17
BARBER CHARGES
Not Payable
18
CAPS
Not Payable
19
COLD PACK/HOT PACK
Not Payable
20
CARRY BAGS
Not Payable
21
CRADLE CHARGES
Not Payable
22
COMB
Not Payable
23
DISPOSABLES RAZORS CHARGES ( for site
preparations)
Payable
24
EAU-DE-COLOGNE / ROOM FRESHNERS
Not Payable
25
EYE PAD
Not Payable
26
EYE SHEILD
Not Payable
27
EMAIL / INTERNET CHARGES
Not Payable
28
FOOD CHARGES (OTHER THAN PATIENT'S DIET
PROVIDED
BY HOSPITAL)
Not Payable
29
FOOT COVER
Not Payable
30
GOWN
Not Payable
31
LEGGINGS
Essential in bariatric and
varicose vein surgery and
should be considered for
these conditions
where surgery itself is
payable.
32
LAUNDRY CHARGES
Not Payable
33
MINERAL WATER
Not Payable
34
OIL CHARGES
Not Payable
35
SANITARY PAD
Not Payable
36
SLIPPERS
Not Payable
37
TELEPHONE CHARGES
Not Payable
38
TISSUE PAPER
Not Payable
39
TOOTH PASTE
Not Pavable
40
TOOTH BRUSH
Not Payable
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
41
GUEST SERVICES
Not Payable
42
BED PAN
Not Payable
43
BED UNDER PAD CHARGES
Not Payable
44
CAMERA COVER
Not Payable
45
CLINIPLAST
Not Payable
46
CREPE BANDAGE
Not Payable/ Payable by the
patient
47
CURAPORE
Not Payable
48
DIAPER OF ANY TYPE
Not Payable
49
DVD, CD CHARGES
Not Payable ( However if
CD is specifically sought
by In
surer/TPA then payable)
50
EYELET COLLAR
Not Payable
51
FACE MASK
Not Payable
52
FLEXI MASK
Not Payable
53
GAUSE SOFT
Not Payable
54
GAUZE
Not Payable
55
HAND HOLDER
Not Payable
56
HANSAPLAST/ADHESIVE BANDAGES
Not Payable
57
INFANT FOOD
Not Payable
58
SLINGS
Reasonable costs for one
sling in case of upper arm
fractures
should be considered
ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES
59
WEIGHT CONTROL PROGRAMS/ SUPPLIES/
SERVICES
Not Payable
60
COST OF SPECTACLES/ CONTACT LENSES/
HEARING AIDS
ETC.,
Not Payable
61
DENTAL TREATMENT EXPENSES THAT DO NOT
REQUIRE
HOSPITALISATION
Not Payable
62
HORMONE REPLACEMENT THERAPY
Not Payable
63
HOME VISIT CHARGES
Not Payable
64
INFERTILITY/ SUBFERTILITY/ ASSISTED
CONCEPTION
PROCEDURE
Not Payable
65
OBESITY (INCLUDING MORBID OBESITY)
TREATMENT IF
EXCLUDED IN POLICY
Not Payable
66
PSYCHIATRIC & PSYCHOSOMATIC DISORDERS
Not Payable
67
CORRECTIVE SURGERY FOR REFRACTIVE ERROR
Not Payable
68
TREATMENT OF SEXUALLY TRANSMITTED
DISEASES
Not Payable
69
DONOR SCREENING CHARGES
Not Payable
70
ADMISSION/REGISTRATION CHARGES
Not Payable
71
HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC
PURPOSE
Not Payable
72
EXPENSES FOR INVESTIGATION/ TREATMENT
IRRELEVANT
TO THE DISEASE FOR WHICH ADMITTED OR
Not Payable
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
DIAGNOSED
73
ANY EXPENSES WHEN THE PATIENT IS
DIAGNOSED WITH RETRO VIRUS + OR
SUFFERING FROM /HIV/ AIDS ETC IS
DETECTED/ DIRECTLY OR INDIRECTLY
Not Payable
74
STEM CELL IMPLANTATION/ SURGERY and storage
Not Payable
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE SEPARATE CONSUMABLES
ARE NOT PAYABLE BUT THE SERVICE IS
75
WARD AND THEATRE BOOKING CHARGES
Payable under OT Charges,
not
separately
76
ARTHROSCOPY & ENDOSCOPY INSTRUMENTS
Rental charged by the Hospital
77
MICROSCOPE COVER
Payable under OT Charges,
not separately
78
SURGICAL BLADES, HARMONIC SCALPEL, SHAVER
Payable under OT Charges,
not separately
79
SURGICAL DRILL
Payable under OT Charges,
not separately
80
EYE KIT
Payable under OT Charges,
not
separately
81
EYE DRAPE
Payable under OT Charges,
not
separately
82
X-RAY FILM
Payable under Radiology
Charges,
not as consumable
83
SPUTUM CUP
Payable under
Investigation Charges,
not as consumable
84
BOYLES APPARATUS CHARGES
Part of OT Charges,
not separately
85
BLOOD GROUPING AND CROSS MATCHING OF
DONORS SAMPLES
Part of Cost of Blood, not
payable
86
Antisepticordisinfectant lotions
Not Payable - Part of
Dressing Charges
87
BAND AIDS, BANDAGES, STERLILE INJECTIONS,
NEEDLES, SYRINGES
Not Payable - Part of
Dressing charges
88
COTTON
Not Payable -Part of
Dressing Charges
89
COTTON BANDAGE
Not Payable- Part of
Dressing Charges
90
MICROPORE/ SURGICAL TAPE
Not Payable – Part of
Dressing Charges
91
BLADE
Not Payable
92
APRON
Not Payable
93
TORNIQUET
Not Payable
94
ORTHOBUNDLE, GYNAEC BUNDLE
Not Payable, Part of
Dressing Charges
95
URINE CONTAINER
Not Payable
ELEMENTS OF ROOM CHARGE
96
LUXURY TAX
Actual tax levied by
government is payable. Part
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
of room charge
for sub limits
97
HVAC
Part of room charge, Not
Payable separately
98
HOUSE KEEPING CHARGES
Part of room charge, Not
Payable separately
99
SERVICE CHARGES WHERE NURSING
CHARGE ALSO CHARGED
Part of room charge, Not
Payable separately
100
TELEVISION & AIR CONDITIONER CHARGES
Part of room charge, Not
Payable separately
101
SURCHARGES
Part of room charge, Not
Payable separately
102
ATTENDANT CHARGES
Part of room charge, Not
Payable separately
103
IM IV INJECTION CHARGES
Part of nursing charge, Not
Payable separately
104
CLEAN SHEET
Part of Laundry /
Housekeeping, Not Payable
separately
105
EXTRA DIET OF PATIENT (OTHER THAN
THAT WHICH FORMS PART OF BED
CHARGE)
Patient Diet provided by
Hospital is payable
106
BLANKET/WARMER BLANKET
Part of room charge, Not
Payable separately
ADMINISTRATIVE OR NON - MEDICAL CHARGES
107
ADMISSION KIT
Not Payable
108
BIRTH CERTIFICATE
Not Payable
109
BLOOD RESERVATION CHARGES AND
ANTE NATAL BOOKING CHARGES
Not Payable
110
CERTIFICATE CHARGES
Not Payable
111
COURIER CHARGES
Not Payable
112
CONVENYANCE CHARGES
Not Payable
113
DIABETIC CHART CHARGES
Not Payable
114
DOCUMENTATION CHARGES / ADMINISTRATIVE
EXPENSES
Not Payable
115
DISCHARGE PROCEDURE CHARGES
Not Payable
116
DAILY CHART CHARGES
Not Payable
117
ENTRANCE PASS / VISITORS PASS CHARGES
Not Payable
118
EXPENSES RELATED TO PRESCRIPTION ON
DISCHARGE
Payable under Post-
Hospitalisation where
admissible
119
FILE OPENING CHARGES
Not Payable
120
INCIDENTAL EXPENSES / MISC. CHARGES (NOT
EXPLAINED)
Not Payable
121
MEDICAL CERTIFICATE
Not Payable
122
MAINTENANCE CHARGES
Not Payable
123
MEDICAL RECORDS
Not Payable
124
PREPARATION CHARGES
Not Payable
125
PHOTOCOPIES CHARGES
Not Payable
126
PATIENT IDENTIFICATION BAND / NAME TAG
Not Payable
127
WASHING CHARGES
Not Payable
128
MEDICINE BOX
Not Payable
129
MORTUARY CHARGES
Payable up to 24 hrs,
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
shifting charges not
payable
130
MEDICO LEGAL CASE CHARGES (MLC CHARGES)
Not Payable
EXTERNAL DURABLE DEVICES
131
WALKING AIDS CHARGES
Not Payable
132
BIPAP MACHINE
Not Payable
133
COMMODE
Not Payable
134
CPAP/ CAPD EQUIPMENTS
Device not payable
135
INFUSION PUMP – COST
Device not payable
136
OXYGEN CYLINDER (FOR USAGE OUTSIDE THE
HOSPITAL)
Not Payable
137
PULSEOXYMETER CHARGES
Device not payable
138
SPACER
Not Payable
139
SPIROMETRE
Device not payable
140
SP02 PROBE
Not Payable
141
NEBULIZER KIT
Not Payable
142
STEAM INHALER
Not Payable
143
ARMSLING
Not Payable
144
THERMOMETER
Not Payable
145
CERVICAL COLLAR
Not Payable
146
SPLINT
Not Payable
147
DIABETIC FOOT WEAR
Not Payable
148
KNEE BRACES ( LONG/ SHORT/ HINGED)
Not Payable
149
KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
Not Payable
150
LUMBOSACRAL BELT
Payable for surgery of
lumbar spine.
151
NIMBUS BED OR WATER OR AIR BED CHARGES
Payable for any ICU patient
requiring more than 3 days
in ICU, all patients with
paraplegia
/quadriplegia for any
reason and at reasonable
cost of
approximately Rs 200/day
152
AMBULANCE COLLAR
Not Payable
153
AMBULANCE EQUIPMENT
Not Payable
154
MICROSHEILD
Not Payable
155
ABDOMINAL BINDER
Essential and should be paid
in post-surgery patients of
major abdominal surgery
including TAH, LSCS,
incisional hernia repair,
exploratory laparotomy for
intestinal obstruction,
liver transplant etc.
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
156
BETADINE / HYDROGEN PEROXIDE /
SPIRIT / DISINFECTANTS ETC
Not Payable
157
PRIVATE NURSES CHARGES - SPECIAL NURSING
CHARGES
Post hospitalization nursing charges
Not Payable
158
NUTRITION PLANNING CHARGES - DIETICIAN
CHARGESDIET CHARGES
Patient Diet provided by
hospital is payable
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
159
SUGAR FREE Tablets
Payable -Sugar free variants of
admissible medicines are
not excluded
160
CREAMS POWDERS LOTIONS
Payable when prescribed
(Toiletries are not payable,
only
prescribed medical
pharmaceuticals
payable)
161
Digestion gels
Payable when prescribed
162
ECG ELECTRODES
One set every second day is
Payable.
163
GLOVES Sterilized
Gloves payable / unsterilized
gloves not payable
164
HIV KIT
payable Pre-operative
screening
165
LISTERINE/ ANTISEPTIC MOUTHWASH
Payable when prescribed
166
LOZENGES
Payable when prescribed
167
MOUTH PAINT
Payable when prescribed
168
NEBULISATION KIT
If used during
Hospitalisation is Payable
reasonably
169
NOVARAPID
Payable when prescribed
170
VOLINI GEL/ ANALGESIC GEL
Payable when prescribed
171
ZYTEE GEL
Payable when prescribed
172
VACCINATION CHARGES
Routine Vaccination not
Payable / Post Bite
Vaccination Payable
PART OF HOSPITAL'S OWN COSTS AND NOT PAYABLE
173
AHD
Not Payable - Part of
Hospital's internal Cost
174
ALCOHOL SWABES
Not Payable - Part of
Hospital's internal Cost
175
SCRUB SOLUTION/STERILLIUM
Not Payable - Part of
Hospital's internal Cost
OTHERS
176
VACCINE CHARGES FOR BABY
Not Payable
177
AESTHETIC TREATMENT / SURGERY
Not Payable
178
TPA CHARGES
Not Payable
179
VISCO BELT CHARGES
Not Payable
180
ANY KIT WITH NO DETAILS MENTIONED
[DELIVERY KIT, ORTHOKIT, RECOVERY KIT,
ETC]
Not Payable
181
EXAMINATION GLOVES
Not payable
182
KIDNEY TRAY
Not Payable
183
MASK
Not Payable
184
OUNCE GLASS
Not Payable
185
OUTSTATION CONSULTANT'S/ SURGEON'S FEES
Not payable
186
OXYGEN MASK
Not Payable
187
PAPER GLOVES
Not Payable
188
PELVIC TRACTION BELT
Payable in case of PIVD
requiring traction
189
REFERAL DOCTOR'S FEES
Not Payable
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
190
ACCU CHECK (Glucometery/ Strips)
Not payable pre
Hospitalisation or post
Hospitalisation / Reports
and Charts required /
Device not payable
191
PAN CAN
Not Payable
192
SOFNET
Not Payable
193
TROLLY COVER
Not Payable
194
UROMETER, URINE JUG
Not Payable
195
AMBULANCE
Payable
196
TEGADERM / VASOFIX SAFETY
Payable - maximum of 3 in 48
hrs
and then 1 in 24 hrs
197
URINE BAG
Payable where Medically
Necessary - maximum 1
per 24 hrs
198
SOFTOVAC
Not Payable
199
STOCKINGS
Payable for case like CABG etc.
ANNEXURE II: CONTACT DETAILS OF INSURANCE OMBUDSMEN
AHMEDABAD - Shri
Kuldip Singh Office of
the Insurance
Ombudsman, Jeevan
Prakash Building, 6th
floor,
BHOPAL - Shri Guru
Saran Shrivastava Office
of the Insurance
Ombudsman,
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
Tilak Marg, Relief Road,
Ahmedabad – 380 001. Tel.:
079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@ecoi.co.in
Office, Near New Market, Bhopal –
462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@ecoi.co.in
BHUBANESHWAR - Shri
Suresh Chandra Panda Office
of the Insurance Ombudsman,
62, Forest park, Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@ecoi.co.in
CHANDIGARH - Dr.
Dinesh Kumar Verma
Office of the Insurance
Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017. Tel.: 0172 -
2706196 / 2706468
Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@ecoi.co.in
CHENNAI - Shri M.
Vasantha Krishna Office
of the Insurance
Ombudsman, Fatima
Akhtar Court, 4th Floor,
453,
Anna Salai, Teynampet,
CHENNAI – 600 018. Tel.:
044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@ecoi.co.in
DELHI - Shri Sudhir Krishna
Office of the Insurance
Ombudsman, 2/2 A, Universal
Insurance Building,
Asaf Ali Road, New
Delhi – 110 002. Tel.:
011 -
23232481/23213504
Email: bimalokpal.delhi@ecoi.co.in
GUWAHATI - Shri Kiriti
.B. Saha Office of the
Insurance Ombudsman,
Jeevan Nivesh, 5th
Floor,
Nr. Panbazar over bridge, S.S.
Road, Guwahati –
781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
Email: bimalokpal.guwahati@ecoi.co.in
HYDERABAD - Shri I.
Suresh Babu Office of
the Insurance
Ombudsman, 6-2-46,
1st floor, "Moin Court",
Lane Opp. Saleem Function Palace, A. C.
Guards, Lakdi-Ka-Pool, Hyderabad - 500
004.
Tel.: 040 - 67504123 / 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@ecoi.co.in
ERNAKULAM - Ms.
Poonam Bodra Office of
the Insurance
Ombudsman,
2nd Floor, Pulinat Bldg., Opp. Cochin
Shipyard, M. G. Road, Ernakulam - 682
015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@ecoi.co.in
KOLKATA - Shri P. K. Rath
Office of the Insurance
Ombudsman, Hindustan Bldg.
Annexe, 4th Floor, 4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@ecoi.co.in
LUCKNOW -Shri Justice Anil
Kumar Srivastava Office of
the Insurance Ombudsman,
6th Floor, Jeevan Bhawan, Phase-II,
Nawal Kishore Road, Hazratganj,
Lucknow - 226 001. Tel.: 0522 -
2231330 / 2231331
MUMBAI - Shri Milind A.
Kharat Office of the
Insurance Ombudsman,
3rd Floor, Jeevan Seva
Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054. Tel.: 022 -
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14
Fax: 0522 - 2231310
Email: bimalokpal.lucknow@ecoi.co.in
26106552 / 26106960
Fax: 022 - 26106052
Email: bimalokpal.mumbai@ecoi.co.in
JAIPUR - Smt. Sandhya Baliga
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg, Jaipur - 302
005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@ecoi.co.in
PUNE - Shri Vinay Sah
Office of the Insurance
Ombudsman, Jeevan
Darshan Bldg., 3rd
Floor,
C.T.S. No.s. 195 to 198, N.C. Kelkar Road,
Narayan Peth, Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@ecoi.co.in
BENGALURU - Smt.
Neerja Shah Office of
the Insurance
Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-
19 Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru – 560 078. Tel.:
080 - 26652048 /
26652049
Email: bimalokpal.bengaluru@ecoi.co.in
NOIDA - Shri Chandra
Shekhar Prasad Office of
the Insurance
Ombudsman,
Bhagwan Sahai Palace, 4th Floor, Main
Road, Naya Bans, Sector 15, Distt: Gautam
Buddh Nagar, U.P-201301.
Tel.: 0120-2514250 / 2514252 / 2514253
Email: bimalokpal.noida@ecoi.co.in
PATNA - Shri N. K. Singh
Office of the Insurance
Ombudsman, 1st
Floor,Kalpana Arcade
Building,,
Bazar Samiti Road,
Bahadurpur, Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@ecoi.co.in
IRDA/NL-HLT/NIA/P-H/V.I/340/13-14