Yes. You can cover the entire family under a Single Sum Insured. The members of the family who could be covered under the Policy are:

a) Proposer

b) Proposer’s Spouse

c) Proposer’s Dependent Children

d) Proposer’s Parents (parents less than equal to 60 years of age will be covered only if they are dependent on the proposer) Minimum two members are required in this policy. This policy cannot be given to a single person. Maximum six members can be covered in a single policy.

Yes. You can cover the entire family under a Single Sum Insured. The members of the family who could be covered under the Policy are:

a) Proposer

b) Proposer’s Spouse

c) Proposer’s Dependent Children

d) Proposer’s Parents (parents less than equal to 60 years of age will be covered only if they are dependent on the proposer)

Minimum two members are required in this policy. This policy cannot be given to a single person. Maximum six members can be covered in a single policy.

A New Born Baby to an insured mother, who has 24 months of Continuous Coverage, is covered for any Illness or Injury from the date of birth till the expiry of the Policy, within the terms of the Policy, without any additional Premium. Any expenses incurred towards post natal care, pre-term or pre-mature care or any such expense incurred for delivery of the New Born Baby would not be covered. Congenital External Anomaly of the New Born Baby is also not covered under the policy.

No coverage for the New Born Baby would be available during subsequent renewals until the child is declared for insurance and covered as an Insured Person.

This Policy is designed to give You and Your family, protection against unforeseen Hospitalisation expenses.

Policy covers following Hospitalisation Expenses:

A. Room Rent / Boarding/ Nursing Expenses and other expenses as specified in policy up to 1% of sum insured per day. This also includes Nursing Care, RMO Charges, IV Fluids / Blood Transfusion / Injection administration charges and the like, but does not include cost of materials.

B. ICU up to 2% of Sum Insured per day.

C. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees

D. Anesthetist, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, relevant laboratory diagnostic tests, etc. & similar expenses.

E. All Hospitalisation Expenses (excluding cost of organ, if any) incurred for donor in respect of Organ transplant.

F. For cataract claims, the liability of the company will be restricted to 10% of Sum Insured or Rs. 50000 whichever less, for each eye.

Note: Procedures / treatments usually done in outpatient department are not payable under the policy even if converted as an in-patient in the hospital for more than 24 hours or carried out in Day Care Centers.

This policy provides for payment of Hospital Cash at the rate of 0.1% of Sum Insured per day of Hospitalisation. This benefit will be given in every case of admissible claim and for each member. This benefit is applicable only where Hospitalisation exceeds twenty four consecutive hours.

The total payment for Any One Illness shall not exceed 1% of the Sum Insured. This benefit shall be directly given by TPA / underwriting office, as the case may be.

If during the Period of Insurance any Insured Person discovers that he/she is suffering from any Critical Illness as listed below, we will pay flat 10% of Sum Insured as additional benefit i.e. other than the admissible claim:

1. Cancer

2. First Heart attack of specified severity

3. Open chest CABG

4. Open Heart replacement or repair of Heart valves

5. Coma of specified severity

6. Kidney failure requiring regular dialysis

7. Stroke resulting in permanent symptoms

8. Major organ / bone marrow transplant

9. Permanent paralysis of limbs 10. Motor neurone disease with permanent symptoms 11. Multiple sclerosis with persisting symptoms

This will be paid only if the Hospitalisation is more than 24 hours. Any payment under this clause would be in addition to the Sum Insured and shall not deplete the Sum Insured. This benefit will be paid once in lifetime of any Insured Person. This benefit is not applicable for those Insured Persons for whom it is a pre-existing disease.

Pre-acceptance test is required for all the members entering after the age of 50 for the first time. A person also needs to undergo this pre-acceptance medical check-up if he has an adverse medical history. The cost of this check-up will be borne by the proposer. But if the proposal is accepted, then 50% of the cost of this check-up will be reimbursed to the proposer.

No. This Policy does NOT cover ALL cases of Hospitalisation.

The exclusions under the policies are:

1 Treatment of any Pre-existing Condition/Disease, until 48 months of Continuous Coverage of such Insured Person have elapsed, from the Date of inception of his/her first Policy with Us as mentioned in the Schedule.

2 Any Illness contracted by the Insured person during the first 30 days of the commencement date of this Policy. This exclusion shall not however, apply if the Insured person has Continuous Coverage for more than twelve months.

3.1 Unless the Insured Person has Continuous Coverage in excess of twenty four months with Us, expenses on treatment of the following Illnesses are not payable:

1. Cataract and age related eye ailments

2. Benign prostate hypertrophy

3. Benign ear, nose, throat disorders

4. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus

5. Hernia of all types

6. Piles, Fissures and Fistula in anus

7. Stones in Urinary system

8. All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps

9. Gastric/ Duodenal Ulcer

10. Hydrocele

11. Stone in Gall Bladder and Bile duct, excluding malignancy

12. Pilonidal sinus, Sinusitis and related disorders

13. Non Infective Arthritis

14. Gout and Rheumatism

15. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident

16. Skin Disorders

17. Varicose Veins and Varicose Ulcers

18. Hypertension

19. Diabetes Mellitus

Note: Even after twenty four months of Continuous Coverage, the above illnesses will not be covered if they arise from a Pre-existing Condition, until 48 months of Continuous Coverage have elapsed since inception of the first Policy with the Company.

3.2 Unless the Insured Person has Continuous Coverage in excess of forty eight months with Us, the expenses related to treatment of

1. Joint Replacement due to Degenerative Condition, and

2. Age-related Osteoarthritis & Osteoporosis are not payable

4.1 Injury / Illness directly or indirectly caused by or arising from or attributable to War, invasion, Act of Foreign enemy, War like operations (whether war be declared or not), nuclear weapon/ ionising radiation, contamination by Radioactive material, nuclear fuel or nuclear waste or from the combustion of nuclear fuel.

4.2 a. Circumcision unless necessary for treatment of a Illness not excluded hereunder or as may be necessitated due to an accident b. Change of life or cosmetic or aesthetic treatment of any description such as correction of eyesight, etc. c. Plastic Surgery other than as may be necessitated due to an accident or as a part of any Illness.

4.3 Vaccination and/or inoculation

4.4 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.

4.5 Dental treatment or Surgery of any kind unless necessitated by accident and requiring Hospitalisation.

4.6.1 Convalescence, general debility, 'Run-down' condition or rest cure, obesity treatment and its complications, treatment relating to all psychiatric and psychosomatic disorders, infertility, sterility, Venereal disease, intentional self-injury and Illness or Injury caused by the use of intoxicating drugs/alcohol.

4.6.2 Congenital Internal and External Disease or Defects or anomalies

However, the exclusion for Congenital Internal Disease or Defects or anomalies shall not apply after twenty four months of Continuous Coverage, if it was unknown to You or to the Insured Person at the commencement of such Continuous Coverage. Exclusion for Congenital Internal Disease or Defects or Anomalies would not apply to a New Born Baby during the year of Birth and also subsequent renewals, if Premium is paid for such New Born Baby and the renewals are effected before or within thirty days of expiry of the Policy. The exclusion for Congenital External Disease or Defects or anomalies shall not apply after forty eight months of Continuous Coverage, but such cover for Congenital External Disease or Defects or anomalies shall be limited to 10% of the average Sum Insured in the preceding four years.

4.7 Bodily Injury or Illness due to willful or deliberate exposure to danger (except in an attempt to save human life), intentional self-inflicted Injury, attempted suicide, arising out of nonadherence to medical advice.

4.8 Treatment of any Bodily Injury or Illness sustained whilst or as a result of active participation in any hazardous sports of any kind.

4.9 Treatment of any Injury or Illness sustained whilst or as a result of participating in any criminal act.

4.10 Sexually Transmitted Diseases, any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB - III) or lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.

4.11 Charges incurred at Hospital primarily for diagnosis, x-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any Illness or Injury for which confinement is required at a Hospital.

4.12 Expenses on vitamins and tonics unless forming part of treatment for Injury or Illness as certified by the attending physician.

4.13 Maternity Expenses, treatment arising from or traceable to pregnancy, miscarriage, abortion or complications; except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved by submission of Ultra Sonographic Report and Certification by Gynaecologist that it is life threatening one if left untreated.

4.14 Naturopathy Treatment.

4.15 External and or durable Medical / Non-medical equipment of any kind used for diagnosis and or treatment including CPAP (Continuous Positive Airway Pressure), Sleep Apnea Syndrome , CPAD (Continuous Peritoneal Ambulatory Dialysis), Oxygen Concentrator for Bronchial Asthmatic condition, Infusion pump etc. Ambulatory devices i.e., walker, crutches, Belts, Collars, Caps, Splints, Slings, Stockings, elastocrepe bandages, external orthopaedic pads, sub cutaneous insulin pump, Diabetic foot wear, Glucometer / Thermometer, alpha / water bed and similar related items etc., and also any medical equipment, which is subsequently used at home .

4.16 Genetic disorders and stem cell implantation/Surgery.

4.17 Domiciliary Hospitalisation

4.18 Acupressure, acupuncture, magnetic therapies

4.19 Experimental or unproven treatments/ therapies

4.20 Change of treatment from one system of medicine to another unless recommended by the consultant/ Hospital under whom the treatment is taken.

4.21 Any expenses relating to cost of items detailed in Annexure I of Policy Document.

4.22 Any kind of Service charges, Surcharges, Luxury Tax and similar charges levied by the Hospital.

4.23 Treatment for Age Related Macular Degeneration (ARMD) , treatments such as Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy

The term Pre-existing condition / disease is defined in the Policy. It is defined as:

"Any condition, ailment or Injury or related condition(s) for which the Insured Person had:

a) Signs or symptoms, or

b) Been diagnosed or received Medical Advice, or

c) Been Treated for any condition or disease,

Within forty eight months prior to the commencement of the first policy.”

Such a condition or disease shall be considered as Pre-existing. Any Hospitalisation arising out of such pre-existing disease or condition is not covered under the Policy.

Yes. Unless the Insured Person is Hospitalised for a condition warranting Hospitalisation, no claim is payable under the Policy. The Policy does not cover outpatient treatments.

The Policy pays only where the Hospitalisation is for more than twenty four hours. But for certain treatments specified in the Policy, period of stay at the Hospital could be less than twenty four hours. The 24 hours treatments are according to the table given in Point 13 below.

Following are the day-care treatments covered under this policy (treatments done within 24 hours).

1 Adenoidectomy 2 Appendectomy

3 Anti-Rabies Vaccination

4 Coronary angiography

5 Coronary angioplasty

6 Dilatation & Curettage

7 ERCP (Endoscopic Retrograde Cholangiopancreatography)

8 ESWL ( Extracorporeal Shock Wave Lithotripsy)

9 Excision of Cyst/granuloma/lump

10 FOLLOWING EYE SURGERIES:

A Cataract Surgery (Extra Capsular Cataract Excision or Phacoemulsification + Intra Ocular Lens

B Corrective surgery for blepharoptosis when not congenital/cosmetic

C Corrective Surgery for entropion / ectropion

D Dacryocystorhinostomy [DCR]

E Excision involving one-fourth or more of lid margin, full-thickness

F Excision of lacrimal sac and passage

G Excision of major lesion of eyelid, full-thickness

H Manipulation of lacrimal passage

I Operations for pterygium

J Operations of canthus and epicanthus when done for adhesions due to chronic Infections

K Removal of a deeply embedded foreign body from the conjunctiva with incision

L Removal of a deeply embedded foreign body from the cornea with incision

M Removal of a foreign body from the lens of the eye

N Removal of a foreign body from the posterior chamber of the eye

O Repair of canaliculus and punctum

P Repair of corneal laceration or wound with conjunctival flap

Q Repair of post-operative wound dehiscence of cornea

R Penetrating or Non-Penetrating Surgery for treatment of Glaucoma

11 Pacemaker insertion

12 Turbinectomy/turbinoplasty

13 Excision of pilonidal sinus

14 Therapeutic endoscopic surgeries 15 Conisation of the uterine cervix

16 Medically necessary Circumcision

17 Excision or other destruction of Bartholin's gland (cyst)

18 Nephrotomy

19 Oopherectomy

20 Urethrotomy

21 PCNL(percutaneous nephrolithotomy)

22 Reduction of dislocation under General Anaesthesia

23 Transcatherter Placement of Intravascular Shunts

24 Incision Of The Breast, lump excision

25 Vitrectomy

26 Thyriodectomy

27 Vocal cord surgery

28 Stapedotomy

29 Tympanoplasty & revision tympanoplasty

30 Arthroscopic Knee Aspiration if Proved Therapeutic

31 Perianal abscess Incision & Drainage

32 DJ stent insertion

33 FESS (Functional Endoscopic Sinus Surgery)

34 Fissurectomy / Fistulectomy

35 Fracture/dislocation excluding hairline fracture

36 Haemo dialysis

37 Hydrocelectomy

38 Hysterectomy

39 Inguinal/ventral/ umbilical/femoral hernia repair

40 Laparoscopic Cholecystectomy

41 Lithotripsy

42 Liver aspiration

43 Mastoidectomy

44 Parenteral chemotherapy

45 Haemorrhoidectomy

46 Polypectomy

47 FOLLOWING PROSTATE SURGERIES A TUMT(Transurethral Microwave Thermotherapy) B TUNA(Transurethral Needle Ablation) C Laser Prostatectomy D TURP( transurethral Resection of Prostate) E Transurethral Electro-Vaporization of the Prostate(TUEVAP)

48 Radiotherapy

49 Sclerotherapy

50 Septoplasty

51 Surgery for Sinusitis

52 Varicose Vein Ligation

53 Tonsillectomy

54 Surgical treatment of a varicocele and a hydrocele of the spermatic cord 55 Retinal Surgeries

56 Ossiculoplasty

57 Ascitic/pleural therapeutic tapping

58 therapeutic Arthroscopy

59 Mastectomy

60 Surgery for Carpal Tunnel Syndrome

61 Cystoscopic removal of urinary stones / DJ stents

62 AV Malformations (Non cosmetic only)

63 Orchidectomy

64 Cystoscopic fulguration of tumour

65 Amputation of penis 66 Creation of Lumbar Subarachnoid Shunt

67 Radical Prostatectomy

68 Lasik surgery (non-cosmetic)

69 Orchidopexy (non-congenital)

70 Nephrectomy

71 Palatal surgery

72 Stapedectomy & revision of stapedectomy

73 Myringotomy

74 Or any other surgeries / procedures agreed by the TPA and the Company which require less than 24 hours Hospitalisation and for which prior approval from TPA is mandatory.

Upon the happening of any event which may give rise to a claim under the policy, please immediately intimate the TPA or underwriting office or nearest office of “The New India Assurance Co. Ltd.”, whichever is applicable, named in the schedule with all the details such as name of the Hospital, details of treatment, patient name, policy number etc.

In case of emergency Hospitalisation, this information needs to be given to the TPA or underwriting office, whichever applicable, within 24 hours from the time of Hospitalisation.

This is an important condition that you need to comply with.

Company will pay ambulance charges up to 1% of SI or actual whichever is less. These charges are available in case of emergency extraction from anywhere to Hospital or Hospital to Hospital.

The liability of the company in case of Ayurvedic / Homoeopathic / Unani treatment will be 25% of the Sum Insured provided the treatment is taken in a government Hospital or in any institute recognized by government or accredited by Quality Council Of India or National Accreditation Board on Health, excluding centers for spas, massage and health rejuvenation procedures..

Yes. Medical Expenses incurred immediately before, but not exceeding thirty days, the Insured Person is Hospitalised will be paid, provided that:

i. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required, and

ii. The In-patient Hospitalisation claim for such Hospitalisation is admissible by Us.

Yes. Medical Expenses incurred immediately after, but not exceeding thirty days, the Insured Person is discharged from the Hospital will be paid, provided that:

i. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required, and

ii. The In-patient Hospitalisation claim for such Hospitalisation is admissible by Us.

Yes. We will pay Hospitalisation expenses up to a limit, known as Sum Insured. In cases where the Insured Person was Hospitalised more than once, the total of all amounts paid

a) for all cases of Hospitalisation,

b) expenses paid for medical expenses prior to Hospitalisation, and

c) expenses paid for medical expenses after discharge from Hospital

Shall not exceed the Sum Insured.

The Sum Insured under the policy is available for any or all the members covered for one or more claims during the tenure of the policy.

The Policy covers treatment only in India.

Cashless Hospitalisation is service provided by the TPA on Our behalf whereby you are not required to settle the Hospitalisation expenses at the time of discharge from Hospital. The settlement is done directly by the TPA on Our behalf.However those expenses which are not admissible under the Policy would not be paid and you would have to pay such inadmissible expenses to the Hospital. Cashless facility is available only in Networked Hospitals. Prior approval is required from the TPA before the patient is admitted into the Networked Hospital. The list of Networked Hospitals can also be obtained from the TPA or from their website. You will have full freedom to choose the hospitals from the Networked Hospitals and avail Cashless facility on production of proof of Insurance and Your identity, subject to the claim being admissible. The TPA might not agree to provide Cashless facility ata Hospital which is not a Network Hospital. In such cases you may avail treatment at any Hospital of Your choice and seek reimbursement of the claim subject to the terms and conditions of the Policy. In cases where the admissibility of the claim could not be determined with the available documents, even if the treatment is at a Network Hospital, the TPA may refuse to provide Cashless facility. Such refusal may not necessarily mean denial of the claim. You may seek reimbursement of the expenses incurred by producing all relevant documents and the TPA may pay the claim, if it is admissible under the terms and conditions of the Policy. Note: This facility is available only for Mediclaim purposes.

In case of treatment in a non-Network Hospital, you must ensure that the Hospital where treatment is taken fulfills the conditions of definition of Hospital in the Policy. Within twenty four hours of Hospitalisation the TPA should be intimated. The following documents in original should be submitted to the TPA within seven days from the date of Discharge from the Hospital:

• Claim Form duly filled and signed by the claimant.

• Discharge Certificate from the hospital.

• All documents pertaining to the illness starting from the date it was first detected i.e. Doctor's consultation reports/history.

• Bills, Receipts, Cash Memos from hospital supported by proper prescription.

• Receipt and diagnostic test report supported by a note from the attending medical practitioner/surgeon justifying such diagnostics.

• Surgeon's certificate stating the nature of the operation performed and surgeon's bill and receipt.

• Attending doctor’s / consultant’s / specialist’s / anesthetist's bill and receipt, andcertificate regarding diagnosis.

• Details of previous policies, if the details are not already with TPA or any other information needed by the TPA for considering the claim.

The Policy allows reimbursement of medical expenses incurred before and after admissible Hospitalisationup to a certain number of days. For reimbursement, send all bills in original with supporting documents along with a copy of the discharge summary and a copy of the authorization letter to his/her TPA/underwriting office, whichever applicable. The bills must be sent to the TPA/underwriting office within 7 days from the date of completion of treatment. You must also provide the TPA/underwriting office with additional information and assistance as may be required by the Company/TPA in dealing with the claim.