1

UNITED INDIA INSURANCE COMPANY LIMITED REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014 TOP UP MEDICARE POLICY 1. WHEREAS the 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 !"#$E% #"%#A #"S!RA"CE C&'(A") (hereinafter called the C&'(A") for the insurance hereinafter set forth in respect of person(s named in the Schedule hereto (hereinafter called the #"S!RE% (ERS&" and has paid premium as consideration for such insurance. "&W $H#S (&*#C) W#$"ESSES that sub+ect to the terms, conditions, e-clusions and definitions contained herein or endorsed, or otherwise e-pressed hereon the Company underta.es that if during the period stated in the Schedule or during the continuance of this policy by renewal, any insured person contracts any disease or suffers from any illness (hereinafter called %#SEASE or sustains any bodily in+ury through accident (hereinafter called #"/!R) and if such disease or in+ury re0uires any such insured (erson, upon the ad1ice of a duly 0ualified (hysician2'edical Specialist2'edical practitioner (hereinafter called 'E%#CA* (RAC$#$#&"ER or of a duly 0ualified Surgeon (hereinafter called S!R3E&" to incur hospitalisation e-penses for medical2surgical treatment at any "ursing Home2Hospital2%ay Care Centre in #ndia as herein defined (hereinafter called H&S(#$A* as an inpatient, the Company will pa !"#$%&" T"'#( Pa#! A()'*'+!#a!$# (hereinafter called $(A to the Hospital 2 "ursing Home or the #nsured (erson the amount of such e-penses specified under Co1ered E-penses, as are reasonably and necessarily incurred in respect thereof by or on behalf of such #nsured P,#+$* +%-.,/! !$ 0a+'+ $1 Pa ),*! C2a%+, but not e-ceeding the Sum #nsured in aggregate in any one period of insurance stated in the schedule hereto. 0a+'+ $1 Pa ),*! 1 A* /2a') %*(,# !"'+ p$2'/ +"a22 -, pa a-2, - !", C$)pa* $*2 '1 a3 '! '+ '* #,+p,/! $1 C$4,#,( E5p,*+,+ +p,/'1',( '* !"'+ p$2'/ a*( -3 !", C$4,#,( E5p,*+,+ ,5/,,( !", T"#,+"$2( 2,4,2 a*( /3 a22 2')'!+ $1 #,')-%#+,),*! %*(,# a* $!",# H,a2!" I*+%#a*/, P$2'/ 6R,')-%#+,),*! S/",), a4a'2a-2, !$ !", '*+%#,( p,#+$* "a4, -,,* ,5"a%+!,(3 2 T", /2a') pa a-2, %*(,# !"'+ P$2'/ 7'22 -, !", a)$%*! - 7"'/" +%/" C$4,#,( E5p,*+,+ '* #,+p,/! $1 a* "$+p'!a2'+a!'$* ,5/,,(+ !", "'&",# $1 !", 1$22$7'*& : '3 !", T"#,+"$2( L,4,2 $p!,( 1$# !", '*+%#,( p,#+$*61a)'2 a+ app2'/a-2, a*( +!a!,( '* !", +/",(%2, $# ''3 !", a)$%*! #,/,'4,(6#,/,'4a-2, %*(,# a* 6a22 $!",# H,a2!" I*+%#a*/, P$2'/',+ 87",!",# $# *$! '++%,( - !", C$)pa* 96 R,')-%#+,),*! S/",), /$4,#'*& !", I*+%#,( p,#+$*61a)'2 a+ app2'/a-2, 1$# +%/" C$4,#,( E5p,*+,+3 : 4 Ea/" /2a'), '1 )$#, !"a* $*,, (%#'*& !", p,#'$( $1 !"'+ p$2'/ +"a22 -, +,pa#a!,2 +%-.,/! !$ !", a-$4, 0a+'+ $1 Pa ),*!3 I* *$ /a+, +"a22 !", C$)pa* -, 2'a-2, !$ pa a* +%) '* ,5/,++ $1 !", S%) I*+%#,( '* a&&#,&a!, $1 a22 /2a')+ (%#'*& !", p,#'$( $1 !"'+ P$2'/ 3

1.1

132

CO;ERED E<PENSES #n the e1ent of any claim(s becoming admissible under this (olicy, the company will pay the following e-penses through $(A to the Hospital2"ursing or the insured person A. Room, 4oarding E-penses as pro1ided by the Hospital2"ursing Home. $his also includes "ursing care2e-penses, R'& charges, #5 6luids24lood $ransfusion2#n+ection administration charges and the li.e. 4. Surgeon, Anaesthetist, 'edical (ractitioner, Consultants, Specialists 6ees C. Anaesthetics, 4lood, &-ygen, &peration $heatre Charges, surgical appliances, 'edicines 7 %rugs, %iagnostic 'aterials and 89ray, %ialysis, Chemotherapy, Radiotherapy, Artificial *imbs, cost of prosthetic de1ices implanted during surgical procedure li.e (acema.er, rele1ant laboratory diagnostic tests 7 similar e-penses. %. All Hospitalisation E-penses (e-cluding cost of organ, if any incurred for donor in respect of &rgan transplant. E. (re and (ost9Hospitalisation e-penses. 6. Ambulance charges by road not e-ceeding Rs.:;<<29 per hospitalisation, incurred to shift the insured person from Residence2accident site to Hospitals in emergency cases and from one Hospital2"ursing Home to another Hospital2"ursing Home2%iagnostic centre for better care2diagnosis.

23 DEFINITIONS: :.1 H&S(#$A* 2 "!RS#"3 H&'E means any institution in #ndia established for indoor care and treatment of sic.ness and in+uries and which Either (a has been registered as a Hospital or "ursing Home with the local authorities and is under the super1ision of a registered and 0ualified 'edical (ractitioner. &r (b Complies with minimum criteria as under=9 i #t should ha1e at least 1; inpatient beds. ii 6ully e0uipped operation theatre of its own where1er surgical operations are carried out. iii 6ully 0ualified "ursing Staff under its employment round the cloc.. i1 6ully 0ualified %octor (s should be in9charge round the cloc.. >C> towns condition :.1 b(i in respect of number of beds be reduced

".4= #n class to 1<.

:.1.1 $he term > Hospital 2 "ursing Home > shall not include an establishment which is a place of rest, a place for the aged, a place for drug9addicts or place for alcoholics, a hotel or a similar place. :.: >Surgical &peration> means manual and 2 or operati1e procedures for correction of deformities and defects, repair of in+uries, diagnosis and cure of diseases, relief of suffering and prolongation of life. E-penses on Hospitalisation for minimum period of :@ hours are admissible. Howe1er, this time limit is not applied to specific treatments, i.e, %ialysis, Chemotherapy, RadiotherapyA Eye Surgery, %ental Surgery, *ithotripsy (Bidney Stone remo1al , % 7 C, $onsillectomy ta.en in the Hospital 2 "ursing Home and the #nsured is discharged on the same day, the treatment will be considered to be ta.en under hospitalisation 4enefit. $his condition will also not apply in case of stay in hospital of less than :@ hours pro1ided 9

:.?

a $he treatment is such that it necessitates hospitalisation and the procedure in1ol1es specialised infrastructural facilities a1ailable in hospitals. b %ue to technological ad1ances hospitalisation is re0uired for less than :@ hours only. c $hey are carried out in %ay Care Centre networ.ed by $(As where re0uirement of minimum number of beds is o1erloo.ed but ha1ing (i fully e0uipped &peration $heatre, (ii fully 0ualified %ay Care Staff (c fully 0ualified Surgeons2(ost9&perati1e attending %octors. "ote= (rocedures2treatments usually done in out patient department are not payable under the policy e1en if con1erted as an in9patient in the hospital for more than :@ hours or carried out in %ay Care Centres. Reasonable and "ecessary E-penses shall mean the cost of surgical 2 medical treatment that is necessary, customary and reasonable for treating the condition for which insured person was hospitalised to the e-tent relatable to such condition.

:.@

:30 ANY ONE ILLNESS: Any one illness will be deemed to mean continuous period of illness and it includes relapse within 4= days from the date of discharge from the Hospital 2 "ursing Home where treatment has been ta.en. &ccurrence of the same illness after a lapse of 4= days as stated abo1e will be considered as fresh illness for the purpose of this policy. :31 PRE - HOSPITALISATION:Rele1ant medical e-penses incurred during period up to ?< days prior to Hospitalisation on disease 2 illness 2 in+ury sustained will be considered as part of claim as mentioned under item 1.: abo1e :32 POST HOSPITALISATION: Rele1ant medical e-penses incurred upto a ma-imum period of C< days from the date of discharge will be considered as part of claim as mentioned under item 1.: abo1e. Howe1er, in case of relapse and readmission to hospital before C< days, the period for consideration of (ost9Hospitalisation e-penses will end on the day before readmission. ?.?'E%#CA* (RAC$#$#&"ER means a person who holds a degree 2 diploma of a recognised institution and is registered with 'edical Council of respecti1e State of #ndia. $he term 'edical (ractitioner would include (hysician, Specialist and Surgeon. ?.@D!A*#6#E% "!RSE means a person who holds a certificate of a recognised "ursing Council and who is employed on recommendation of the attending 'edical (ractitioner. ?.;$(A means a $hird (arty Administrator who holds a 1alid *icense from #nsurance Regulatory and %e1elopment Authority to act as a $H#R% (AR$) A%'#"#S$RA$&R and is empanelled by the Company for the pro1ision of health ser1ices as specified in the agreement between the Company and $(A. 43 E<CLUSIONS:$he company shall not be liable to ma.e any payment under this policy in respect of any e-penses whatsoe1er incurred by any #nsured (erson in connection with or in respect of=

4 @.1 Any pre9e-isting condition(s as defined in the policy, until @E months of continuous co1erage of such insured person ha1e elapsed, since inception of his2her $&( !( 'E%#CARE (olicy with the Company. (re9E-isting Condition2%isease definition F Any condition, ailment or in+ury or related condition(s for which insured person had signs or symptoms, and2or were diagnosed, and2or recei1ed medical ad1ice2treatment, within @E months prior to his2her $&( !( 'E%#CARE policy with the Company. ".4.= #n case of persons ha1ing any other Health #nsurance (olicy from any Company with a Sum #nsured abo1e $hreshold *e1el at the time of ta.ing this policy, the e-clusion period of @E months for (re9e-isting %isease2Condition will be rec.oned from the date of inception of the policy for such portion of Sum #nsured, including Cumulati1e 4onus earned if any, abo1e the $hreshold *e1el. #f e-piring policy sum insured has increased o1er the years, the @E months of continuous co1erage has to be completed for the incremental sum insured. @.:#n+ury 2 disease directly or indirectly caused by or arising from or attributable to in1asion, Act of 6oreign enemy, War li.e operations (whether war be declared or not 4.3 a. Circumcision unless necessary for treatment of a disease not e-cluded hereunder or as may be necessitated due to an accident b. 1accination or inoculation or change of life or cosmetic or aesthetic treatment of any description c. plastic surgery other than as may be necessitated due to an accident or as a part of any illness. 4.4 4.5 4.6 Cost of spectacles, contact lenses and hearing aids. %ental treatment or surgery of any .ind unless re0uiring hospitalisation. Con1alescence, general debilityA run9down condition or rest cure, Congenital e-ternal disease or defects or anomalies, Sterility, 5enereal disease, intentional self in+ury and use of into-ication drugs 2 alcohol All e-penses arising out of any condition directly or indirectly caused to or associated with Human $9Cell *ymphotropic 5irus $ype ### (H$*4 9 ### or lymphadinopathy Associated 5irus (*A5 or the 'utants %eri1ati1e or 5ariation %eficiency Syndrome or any syndrome or condition of a similar .ind commonly referred to as A#%S. Charges incurred at Hospital or "ursing Home primarily for diagnosis, -9ray or *aboratory e-aminations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positi1e e-istence or presence of any ailment, sic.ness or in+ury, for which confinement is re0uired at a Hospital 2 "ursing Home E-penses on 1itamins and tonics unless forming part of treatment for in+ury or diseases as certified by the attending physician

4.7

4.8

4.9

@.1<#n+ury or %isease directly or indirectly caused by or contributed to by nuclear weapon 2 materials @.11$reatment arising from or traceable to pregnancy (including 1oluntary $ermination of pregnancy and childbirth (including caesarean section . @.1:"aturopathy $reatment, acupressure, acupuncture, magnetic and such other therapies.

5 @.1?E-ternal and or durable 'edical 2 "on9medical e0uipment of any .ind used for diagnosis and2or treatment and2or monitoring and2or maintenance and2or support including C(A(, CA(%, #nfusion pump, &-ygen concentrator etc., Ambulatory de1ices i.e., wal.er, crutches, 4elts, Collars, Caps, Splints, Slings, 4races, Stoc.ings, etc., of any .ind, %iabetic foot wear, 3lucometer2$hermometer and similar related items and also any medical e0uipment, which are subse0uently used at home. @.1@ @.1; =3 Any .ind of Ser1ice charges, Surcharges, Admission 6ees2Registration Charges le1ied by the hospital. All non9'edical e-penses of any .ind whatsoe1er. CONDITIONS:

$he (roposal form, (rospectus, (re9acceptance Health chec.9up and the (olicy issued shall constitute complete Contract of #nsurance. ;.1 E1ery notice or communication regarding hospitalisation or claim under this policy shall be deli1ered in writing at the address of the $(A office as shown in the Schedule. &ther matters with regard to the policy may be communicated to the (olicy #ssuing &ffice and the $(A. ;.: $he premium payable under this (olicy shall be paid in ad1ance. "o receipt for (remium shall be 1alid e-cept on the official form of the company signed by a duly authorised official of the company. $he due payment of premium and the obser1ance and fulfilment of the terms, pro1isions, conditions and endorsements of this (olicy by the #nsured (erson in so far as they relate to anything to be done or complied with by the #nsured (erson shall be a condition precedent to any liability of the Company to ma.e any payment under this (olicy. "o wai1er of any terms, pro1isions, conditions and endorsements of this policy shall be 1alid unless made in writing and signed by an authorised official of the Company. ;.? !pon the happening of any e1ent which may gi1e rise to a claim under this (olicy notice with full particulars shall be sent to the $(A named in the schedule immediately and in case of emergency Hospitalisation, within :@ hours from the time of Hospitalisation. In the case of a covered hospitalisation, the costs of which were not initially estimated to exceed the Threshold Level but were subsequently found likely to exceed the Threshold Level, the intimation to the named TPA should be submitted along with a copy of intimation made to the Primary ealth Policy TPA!"eimbursement Provider immediately on knowing that the Threshold Level is likely to be exceeded# ;.@ $he #nsured (erson shall obtain and furnish to the $(A with all original bills, receipts, prescriptions, reports and other documents upon which a claim is based and shall also gi1e the $(A 2 Company such additional information and assistance as the $(A 2 Company may re0uire in dealing with the claim. $hen original bills, receipts, prescriptions, reports and other documents are given to Primary insurer or to the "eimbursement Provider, verified photocopies attested by such other %rganisation have to be submitted# ;.; $he #nsured2#nsured (erson shall be bound to disclose particulars of all other (olicies of #nsurance2Reimbursement Schemes under which he2she is co1ered for E-penses as are co1ered under this (olicy. 5.6 All supporting documents relating to the claim must be filed with $(A within 1; days from the date of discharge from the hospital. #n case of post9

6 hospitalisation, treatment (limited to C< days , all claim documents should be submitted within &' days after completion of such treatment. "ote= Wai1er of this Condition may be considered in e-treme cases of hardship where it is pro1ed to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to gi1e such notice or file claim within the prescribed time9 limit. 5.7 Any medical practitioner authorised by the $(A 2 Company shall be allowed to e-amine the #nsured (erson in case of any alleged in+ury or disease leading to Hospitalisation as may be reasonably required, at the cost of the insurer# ;.E $he Company shall not be liable to ma.e any payment under this policy in respect of any claim if such claim is found to be fraudulent or supported by any fraudulent means or de1ice whether by the #nsured (erson or by any other person acting on his behalf. ;.G Renewal Clause = $he (olicy may be renewed by mutual consent and in such e1ent the renewal premium shall be paid to the Company on or before the date of e-piry of the (olicy or of the subse0uent renewal thereof and in any case not later than 1; days from the date of e-piry of the current policy. #f, howe1er, during the grace period of 1; days, any insured person incurs any hospitalisation e-penses, he shall not be entitled for any claim. $he Company shall not be bound to gi1e notice that such renewal premium is due, pro1ided howe1er that if the insured applies for renewal and remits the re0uisite premium before the e-piry of this policy, renewal shall not normally be refused, unless the Company has reasonable +ustification to do so. A policy that is sought to be renewed after the grace period of 1; days will be underwritten as a 6resh (olicy. Cancellation Clause = $he Company may at any time cancel the (olicy on grounds of misrepresentation, fraud, non9disclosure of material fact or non9cooperation by the insured by sending se1en days notice in writing by Registered A2% to the insured at his last .nown address in which case the Company shall return to the insured a proportion of the premium corresponding to the une-pired period of insurance if no claim has been paid2admitted under the policy. $he insured may at any time cancel this policy and in such e1ent the Company shall allow refund of premium at CompanyHs short period rate table gi1en below pro1ided no claim has occurred upto the date of cancellation. (ER#&% &" R#SB RA$E &6 (RE'#!' $& 4E CHAR3E%. !pto one month 12@ th of the annual rate !pto three months 12: of the annual rate !pto si- months ?2@th of the annual rate E-ceeding si- months 6ull annual rate. ;.1< #f any dispute or difference shall arise as to the 0uantum to be paid under the policy (liability being otherwise admitted such difference shall independently of all other 0uestions be referred to the decision of a sole arbitrator to be appointed in writing by the parties or if they cannot agree upon a single arbitrator within ?< days of any party in1o.ing arbitration, the same shall be referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute2difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the pro1isions of the Arbitration and Conciliation Act, 1GGC.

7 #t is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before pro1ided, if the Company has disputed or not accepted liability under or in respect of this (olicy. #t is hereby e-pressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy that award by such arbitrator2arbitrators of the amount of the loss or damage shall be first obtained. ;.11 #f the Company, as per terms and conditions of the policy, disclaims liability to the #nsured for any claim hereunder and if the #nsured does not within 1: calendar months from the date or receipt of the notice of such disclaimer notify the Company in writing that he does not accept such disclaimer and intends to reco1er his claim from the Company then the claim shall for all purposes be deemed to ha1e been abandoned and shall not thereafter be reco1erable hereunder. 63 PAYMENT OF CLAIM All claims under this policy shall be payable in #ndian currency. All medical2surgical treatments for the purpose of this insurance will ha1e to be ta.en in #ndia only. (ayment of claim shall be made through $(A to the Hospital2"ursing Home or the #nsured (erson as the case may be. I #R%A RE3!*A$#&"S = $his policy is sub+ect to Regulations of #R%A ((rotection of (olicyholdersH #nterest Regulations, :<<: as amended from time to time.

E 3R#E5A"CE RE%RESSA* = #n the e1ent of the policyholder ha1ing any grie1ance relating to the insurance, he2she may contact any of the 3rie1ance Cells at Regional &ffices of the Company or &ffice of the #nsurance &mbudsman under the +urisdiction of which the (olicy #ssuing &ffice falls. JJ J JJJJJJJJ

UNITED INDIA INSURANCE COMPANY LIMITED REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014 TOP UP MEDICARE POLICY9 SCHEDULE > INDI;IDUAL POLICY 1. :. ?. @. ;. C. (olicy "o. Annual (remium "ame of the #nsured %ate of 4irth Address of the #nsured %etails of the #nsured (ersons = of Age2 SeRelationshi &ccupat p with the ion (roposer %ate of E-cluded commenc diseases ement of first policy Sum #nsured opted $hreshold *e1el = = Agency Code= = Rs. %e1.&fficer code=

"ame #nsured person

I. E.

(eriod of #nsurance

= 6rom

$o

%etails of other Health #nsurance (olicies F (current and pre1ious Sum #nsured (eriod of #nsured #nsured #nsurance person91 person9:

Name of Health Insurer (olicy no.

(erson9?

(erson9@

(erson9;

$(A

"otice or communication to be gi1en in respect of a claim or for any other reason to $(A G "ame and Address of $(A "ame2s of the contact person2s= $elephone "umber2s= Call centre $elephone number= 1<. (roposal and %eclaration %ated #" W#$"ESS WHERE&6, the undersigned being duly authorised has hereunto set his2her hand at 999999999999999999999 this 9999999999999 day of 999999999999999 :< #ssuing office 6or !nited #ndia #nsurance Co. *td. 999999999999999999999999999999 999999999999999999999999999999 999999999999999999999999999999

%uly Constituted Attorney.

UNITED INDIA INSURANCE COMPANY LIMITED REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014 TOP UP MEDICARE POLICY SCHEDULE > FAMILY POLICY 1. :. ?. @. ;. C. (olicy "o. Annual (remium "ame of the (roposer %ate of 4irth Address of the (roposer = %etails of the #nsured (ersons = Age2 SeRelationship with the (roposer &ccupation %ate of commencement of first policy E-cluded diseases Agency Code= = Rs. = %e1.&fficer code=

"ame of #nsured person

I. E, G.

Sum #nsured $hreshold *e1el (eriod of #nsurance

Rs. 9 Rs. = 6rom $o

1<. %etails of other Health #nsurance (olicies (current and pre1ious Name of Health Insurer (olicy no. Sum #nsured (eriod of #nsured #nsured #nsurance person91 person9:

(erson9?

(erson9@

(erson9;

$(A

"otice or communication to be gi1en in respect of a claim or for any other reason to $(A 11 "ame and Address of $(A "ame2s of the contact person2s= $elephone "umber2s= Call centre $elephone number= 1:. (roposal and %eclaration %ated #" W#$"ESS WHERE&6, the undersigned being duly authorised has hereunto set his2her hand at 999999999999999999999 this 9999999999999 day of 999999999999999 :< #ssuing office 6or !nited #ndia #nsurance Co. *td. 999999999999999999999999999999 999999999999999999999999999999 999999999999999999999999999999

%uly Constituted Attorney.