Group Health Insurance – Terms & Conditions

Summary of Key Terms

This summary of key terms under the Group Health Insurance Terms & Conditions (“Policy”) is
offered by Religare Health Insurance Company Limited (“Religare”) to Zipcash Card Services
Private Limited (“Zipcash”). Covers under the Policy can be availed by registered users/ customers
on the Zipcash mobile application or any other online platform, owned and/or operated by Zipcash,
(hereinafter referred to as “Ola Money App”) by selecting the option of health insurance which is
accepted by Religare.

The insurance cover under the Policy will apply only to Zipcash customers who have purchased the
health insurance on the Ola Money App. Insurance cover starts from the date mentioned in the
certificate of insurance received from Religare and shall be valid till such time as mentioned in the
certificate of insurance.

Key Benefits:

Key benefits available under the Policy:

Plan A Plan B Plan C

Coverage up to Coverage up to Coverage up to

Particulars INR 3,00,000 INR 5,00,000 INR 10,00,000

Hospital Daily Allowance INR 3,000 INR 5,000 INR 10,000

(maximum 100 days)

18 Years

Minimum Entry Age Minor: 91 days with proposer of 18 years or above.

65 Years

Maximum Entry Age 24 Years: For Child in Family Plan

Wait Periods:

• Non-Accidental Claims 30 days

• Named Ailments 12 months

 • Pre-existing diseases 12 months

Tenure 1 Year and renewable

Deductible options NIL Deductible (claims paid from 1st day onwards)

Underwriting Process No Medical Tests, health declaration based insurance

Premium Payment option Annually/Monthly

Premium Chart

Annual Premium Monthly Premium

(in INR without GST) (in INR without GST)
Daily
Amount(INR) Age 1A 2A 2A+2C 1A 2A 2A+2C

Up to 40 720 1,368 1,500 60 114 125

41-60 1,080 2,052 2,280 90 171 190
3,000 61-65 1543 2,932 3257 129 245 271
Up to 40 1,188 2,257 2,388 99 188 199

41-60 1,788 3,397 3,900 149 283 325

5,000 61-65 2554 4,853 5571 213 405 464
Up to 40 2,376 4,514 4,776 198 376 398
41-60 3,576 6,794 7,800 298 566 650

10,000 61-65 5109 9705 11150 426 808 929

General Conditions:

1. Wait Periods and Exclusions

• 30 Days Waiting Period: Religare shall not be responsible for any medical expenses towards
any hospitalization that began within 30 days of the commencement of the Policy, except for
those hospitalizations incurred due to an injury or accident.
• 12 Months Waiting Period: Religare shall not be liable to pay daily limit of sum insured for
hospitalization for treatment of the following illnesses/ surgeries for the first 12 months from
the policy commencement:
Ø Surgical treatments for Benign ear, nose and throat (ENT) disorders and surgeries
(example: Nasal Septum Deviation, Sinusitis and related disorders);
Ø Surgery of Genito-urinary system unless necessitated by malignancy (example:
Benign Prostatic Hypertrophy, Myomectomy for fibroids, Hysterectomy for
 menorrhagia or Fibromyoma or prolapse of uterus unless necessitated by
malignancy);
Ø Stones (Kidney Stone / Ureteric Stone / Gall Bladder Stone);
Ø Fissure / Fistula in anus, Hemorrhoids / Piles, Pilonidal Sinus, Gastric and Duodenal
Ulcers;
Ø All types of Hernia & Hydrocele;
Ø Internal tumors, skin tumors, cysts, nodules, polyps including breast lumps (each of
any kind) unless malignant.
• Religare shall not be liable to pay daily limit of sum insured during hospitalization for a
diagnosis/ treatment of any pre-existing diseases till the time as defined in the Policy but not
exceeding 12 months of continuous coverage, since the cover start date under the first policy
with Religare.
• Permanent Exclusions: Any claim in respect of any insured member for, arising out of or
directly or indirectly due to any of the following shall not be admissible, unless expressly
stated to the contrary elsewhere in the Policy.
Ø Any treatment arising from or traceable to pregnancy (including voluntary
termination), miscarriage (unless due to an Accident), childbirth, maternity (including
caesarian section), abortion or complications of any of these.
Ø Any treatment arising from or traceable to any fertility or sterilization, birth control
procedures, contraceptive supplies or services including complications arising due to
supplying services or Assisted Reproductive Technology.
Ø Any condition directly or indirectly caused by or associated with any sexually
transmitted disease, including Genital Warts, Syphilis, Gonorrhea, Genital Herpes,
Chlamydia, Pubic Lice and Trichomoniasis, Acquired Immuno Deficiency Syndrome
(AIDS) whether or not arising out of HIV, Human T-Cell Lymphotropic Virus Type
III (HTLV–III or IITLB-III) or Lymphadinopathy Associated Virus (LAV) or the
Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or
condition of a similar kind.
Ø Treatment taken from anyone who is not a Medical Practitioner or from a Medical
Practitioner who is practicing outside the discipline for which he is licensed or any
kind of self -medication.
Ø Unproven/Experimental Treatment or investigational treatment.
Ø Any diagnosis or treatment of an Illness or Injury, which does not require
Hospitalization.
Ø Any hospitalization done specifically for the purpose of prosthesis, corrective
devices, external durable medical equipment of any kind, like wheelchairs, walkers,
belts, collars, caps, splints, braces, stockings of any kind, diabetic footwear,
glucometer/thermometer, crutches, ambulatory devices, instruments used in treatment
of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis
(C.A.P.D.) and oxygen concentrator for asthmatic condition or cochlear implants
Ø Any treatment related to sleep disorder or sleep apnea syndrome, general debility
convalescence, cure, rest cure, health hydros, nature cure clinics, sanatorium
treatment, Rehabilitation measures, private duty nursing, respite care, long-term
nursing care, custodial care or any treatment in an establishment that is not a
Hospital.
Ø Treatment of all external & internal Congenital Anomaly or Illness or defects or
anomalies or treatments relating to birth defects.
Ø Treatment of mental illness, stress or psychological disorders.
Ø Aesthetic treatment, Cosmetic Surgery and plastic surgery or related treatment of any
description, including any complication arising from these treatments, other than as
may be necessitated due to an Injury, cancer or burns
Ø Any treatment or surgery for change of sex or gender reassignments including any
complication arising from these treatments.
Ø Circumcision unless necessary for treatment of an Illness or as may be necessitated
due to an Accident.
 Ø Any hospitalization specifically done for any preventive care, vaccination, including
inoculation and immunizations (except in case of post-bite treatment), vitamins and
tonics
Ø Artificial life maintenance, including life support machine use, where such treatment
will not result in recovery or restoration of the previous state of health (xvi) Non-
allopathic treatment.
Ø Any hospitalization incurred outside India. (xviii) Domiciliary Hospitalization or
treatment.
Ø 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.
Ø Any hospitalization (because of Illness or Injury) directly or indirectly resulting or
arising from or occurring during commission of any breach of any law by the Insured
Member with any criminal intent.
Ø Any hospitalization because of act of self-destruction or self-inflicted Injury,
attempted suicide or suicide while sane or insane or Illness or Injury attributable to
consumption, use, misuse or abuse of tobacco, intoxicating drugs and alcohol.
Ø 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:
o 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.
o 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.
o 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.
In addition to the foregoing, any loss, claim or expense of whatsoever nature
directly or indirectly arising out of, contributed to, caused by, resulting from,
or in connection with any action taken in controlling, preventing,
suppressing, minimizing or in any way relating to the above shall also be
excluded.
Ø Any hospitalization because of Impairment of an Insured Member’s intellectual
faculties by abuse of stimulants or depressants.
Ø Any hospitalization pertaining to Alopecia wigs and/or toupee and all hair or hair fall
treatment and products.
Ø Any medical or physical condition or treatment or service, which is specifically
excluded under the Policy Certificate.
Ø Any treatment taken in a clinic, rest home, convalescent home for the addicted,
detoxification Centre, sanatorium, home for the aged, mentally disturbed, remodeling
clinic or similar institutions, unless specifically provided for.

2. Claims Process
• Upon hospitalization, the customer shall intimate Religare at the earliest and within 15 days
of discharge from the hospital, such intimation can be done through Religare website.
• Religare may ask for additional documentation including claim form, copy of discharge
summary, ID proof, cancelled cheque and such other documents for the purpose of
adjudication of claim.
• Once documents are received Religare will intimate the decision to the customer and credit
the claim amount into the customer’s bank account.

3. Renewal Terms
• The policy will terminate on the Policy period end date. All renewal applications and requisite
approvals shall be given/ paid to Religare on or before the Policy period end date.
• Grace Period: Grace period shall mean a 30 day’s immediately following the Policy period
end date during which a payment can be made to renew the Policy without loss of continuity
benefits such as waiting periods and coverage of pre-existing diseases. Coverage shall not be
available for the period for which premium is not received by Religare and Religare shall not
be liable for any Claims incurred during such period. The provisions of Section 64VB of the
Insurance Act shall be applicable.
• Religare shall not refuse to renew the Policy except on grounds of fraud, moral hazard or
misrepresentation.
• The general underwriting conditions, where the underwriters review the Proposal Form or any
other parameter described above, shall prevail and need be adhered to at the renewal also.
• Renewal premium is subject to change with prior approval from IRDA.
• Any Policy which is due for renewal, and where the customer has requested for one or more
of the following alterations in the expiring Policy, may be subjected to a review by Religare
• Increase in Sum Insured
• Change in terms & conditions
• The policyholder/ customer has an option to seek a change of TPA at time of renewal of
policy The policyholder shall give Religare written notice for such change 30 days before the
renewal.
• In the event Religare withdraws the product after due approval from the IRDA, in case if the
product is withdrawn the Policy can be renewed under the then prevailing Health insurance
product or its nearest substitute approved by IRDA. Religare shall intimate the policyholder
regarding the withdrawal of the product and the options available to the policyholder at the
time of renewal of the policy.

4. Cancellation/ Termination
• The customer may give 15 days’ notice in writing to Religare for the cancellation of the
policy. Religare shall from the date of receipt of the notice cancel the policy and refund the
premium for the unexpired period of the policy as detailed below:

Cancellation period up to (x months) Refund%*

from the policy period start date

1 month 75

3 months 50
6 months 25
Beyond 6 months 0

*No refund shall be made for those insured member who has incurred claim under the policy.
*Refund % to be applied on total premium amount received as on the date of receipt of the
cancellation request.

5. Grievance Redressal
In case of any grievance the customer can contact Religare with the details provided below:
Website: www.religarehealthinsurance.com
E-mail: customerfirst@religarehealthinsurance.com
Telephone: 1800-400-4488
Post/Courier: Any branch or the correspondence address, during normal business hours

In the event the customer is dissatisfied with the redressal provided then they may write to
Religare at Resolve1@religarehealthinsurance.com or send written complaint to:
Director - Services, Vipul Tech Square, Tower C, 3rd Floor, Sector – 43, Golf Course Road,
Gurgaon - 122009

The customer may approach the nearest Insurance Ombudsman for resolution of the
grievance. The contact details of Ombudsman s are available on Religare website.