Individual Health Insurance Renewal

( DUPLICATE )
UNITED INDIA INSURANCE COMPANY LIMITED

DIVISIONAL OFFICE III - 082500, 118/90, GUMTI PLAZA, KAUSHALPURI,, , KANPUR URBAN-208012 UTTAR PRADESH
PH: (512) 2224681 Fax: (512) 2218677 EMAIL:
INDIVIDUAL HEALTH INSURANCE POLICY

UIN NO. IRDA/NL-HLT/UII/P-H/V.I/228/13-14
POLICY NO.: 0825002817P113288533
PERIOD OF INSURANCE
FROM 00:00hrs of 20/12/2017
To MIDNIGHT on 19/12/2018
Insured
MR. RAJ K NOTANI
641-RATAN LAL NAGAR,KANPUR DIST. : KANPUR URBAN, UTTAR PRADESH
KANPUR URBAN
UTTAR PRADESH-208023
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.
Agent Name : MANOJ KUMAR ANSHWANI

Agent Code : AGI0019783
9415487562
Mobile/Landline Number/Email :
UIICanshwani@gmail.com
The genuineness of the policy can be verified through "Verify Your Policy" link at www.uiic.co.in.
For any Information, Service Requests and Grievances please write to 082500@uiic.co.in
For ID Cards & Claim Intimations Please contact the TPA mentioned in the Policy document.
Regd Office: 24 Whites Road, Chennai-600014,Head Office: No.19,Lane IV,Nungambakkam High Road, Chennai-600034.
Website: http://www.uiic.co.in
Printed By : JAY28894 @ 26/02/2020 5:02:36 PM
POLICY NO.: 0825002817P113288533
INDIVIDUAL HEALTH INSURANCE POLICY

SCHEDULE
Policy Number 0825002817P113288533 Previous Policy No. 0825002816P112098587
Name/ID MR. RAJ K NOTANI /1395488934
Tel.(O) Tel.(R) Fax
Insured Detail
EMail Mobile 9451543456
Business/Occupation None
Period Of Insurance From 00:00hrs of 20/12/2017 To Midnight on 19/12/2018
Coinsurance UIIC 082500 : 100%
Details of the Persons Covered

Sl Name Of Insured Nominee Pre-Existing illnesses/diseases
Gender Relation Occupn. Nominee
No Person Relationship declared *
JAYA
1 MR. RAJ K NOTANI Male Self Salaried Spouse
NOTANI
RAJ K
2 SMT.JAYA NOTANI Female Spouse Unemployed Spouse
NOTANI
Son - RAJ K
3 JAYANT NOTANI Male Unemployed Father
Studying NOTANI
Sl Name of insured Sum Dom.Hosp Amb Hospital Daily Premium( Inception date of Last Claimed
Age Plan
No person Insured ( ) Limit( ) Charge( ) Cash( ) ) first policy Date
MR. RAJ K
1 55 Gold 400000 50000 0 0 8129 20/12/2007
NOTANI
2 SMT.JAYA NOTANI 52 Gold 400000 50000 0 0 8129 20/12/2007
3 JAYANT NOTANI 25 Platinum 100000 20000 0 0 1200 20/12/2007
Total Basic Premium : 17458 Family Discount : 698.32 Premium : 13,268.00

No Claim Disc : 3491.6 CGST(9%) : 1,194.00
PAN Number : SGST(9%) : 1,194.00
Staff Discount : 0 Stamp duty 1.00
:
Net Premium : 13,268.00 Total : 15,656.00
Receipt Number 10108250017113517691
Assignee's Name:
Receipt Date 18/12/2017
Agent/Broker Code: : AGI0019783
MANOJ KUMAR ANSHWANI
Direct Business: :
Development Officer Code: : 26156
Anoop Kumar Mota
Notice or communication in respect of claim or for any others reason to be given to TPA within 24 hrs from the date of admission and
documents to be submitted to TPA within 15 days from the date of Discharge.
This Schedule and the attached policy shall be read together as one contract and any word or expression to which a specific meaning has
been attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear.
*Terms, conditions and clauses attached as per the respective individual plans
POLICY NO.: 0825002817P113288533
Customer GST/UIN No.: Office GST No.: 09AAACU5552C1ZH

SAC Code: 9971 Invoice No. & Date: 2817I113288533 & 18/12/2017
Amount Subject to Reverse Charges-NIL
Anti Money Laundering Clause:-In the event of a claim under the policy exceeding 1 lakh or a claim for refund of premium exceeding
1 lakh, the insured will comply with the provisions of AML policy of the company. The AML policy is available in all our operating offices as
well as Company's web site.
LET US JOIN THE FIGHT AGAINST CORRUPTION. PLEASE TAKE THE PLEDGE AT https://pledge.cvc.nic.in.
Date of Proposal and Declaration: 20/12/2017

IN WITNESS WHEREOF, the undersigned being duly authorised has hereunto set his/her hand at
DO 3 KANPUR on this 13th day of December ,2017.
For and On behalf of

United India Insurance Co. Ltd.
Affix
Policy
Stamp
Here
Authorised Signatory.
Underwritten By - ARU20133 ( DO UNDERWRITER )
POLICY NO.: 0825002817P113288533
Details of TPA
Please contact the following TPA for Issue of Identity Cards, Cashless Approvals & Claims Settlement.
Name of TPA M/s Raksha TPA Pvt. Ltd.

Address 15/5, Mathura Road, Faridabad, Pin Code : 121003, Fax No :
Toll Free number 18001801444
Contact Details For General Enquiries For Cashless approval For Claim intimation For Grievances
Telephone Numbers 0129-4289999 0129-4289999 0129-4289999 0129-4289999
Email IDs crcm@rakshatpa.com cashless@rakshatpa.com claimintimation@rakshatpa.com crcm@rakshatpa.com
POLICY NO.: 0825002817P113288533

REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014
HEALTH INSURANCE POLICY - GOLD

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 UNITED INDIA INSURANCE COMPANY
(hereinafter called the COMPANY) for the insurance hereinafter set forth in respect of person(s)named in the Schedule hereto
(hereinafter called the INSURED PERSON) and has paid premium as consideration for such insurance.
1.1 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 during the period stated in the Schedule, if any insured person(s)
c o n t r a c t s a n y d i s e a s e o r s u f f e r s f r o m a n y i l l n e s s (hereinafter called DISEASE) or sustains any bodily injury through accident
(hereinafter called INJURY) and if such disease or injury requires such insured Person, upon the advice of a duly qualified
Physician/Medical Specialist/Medical practitioner (hereinafter called MEDICAL PRACTITIONER) or o f a d u l y q u a l i f i e d S u r g e o n
(hereinafter called SURGEON) to incur hospitalisation/domiciliary hospitalisation expenses for medical/surgical treatment at any
Nursing Home/Hospital in India as herein defined (hereinafter called HOSPITAL) as an inpatient, the Company will pay through TPA
to the Hospital / Nursing Home or the Insured Person the amount of such expenses as are reasonably and necessarily incurred in
respect thereof by or on behalf of such Insured Person but not exceeding the Sum Insured in aggregate in any one period of
insurance stated in the schedule hereto.
COVERAGE
1.2 In the event of any claim(s) becoming admissible under this scheme, the company will pay through TPA to the Hospital / Nursing
H o m e o r t h e i n s u r e d p e r s o n t h e amount of such expenses as would fall under different heads mentioned below, a n d a s a r e
reasonably and necessarily incurred thereof by or on behalf of such Insured Person, but not exceeding the Sum Insured in
aggregate mentioned in the schedule hereto.
A. R o o m , Boarding and Nursing Expenses as provided by the Hospital/Nursing Home upto 1% o f S u m I n s u r e d p e r d a y . T h i s a l s o
includes Nursing Care, RMO charges, IV Fluids/Blood Transfusion/Injection administration charges and similar expenses.
B. If admitted in IC Unit, the Company will pay upto 2% of Sum Insured per day or actual amount whichever is less.
C. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
D. Anaesthetist, Blood, O x y g e n , O p e r a t i o n T h e a t r e C h a r g e s , s u r g i c a l a p p l i a n c e s , M e d i c i n e s & D r u g s , Dialysis, Chemotherapy,
Radiotherapy, cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic
implants, infra cardiac valve replacements, vascular stents, relevant laboratory diagnostic tests, X-ray and such similar expenses
that are medically necessary.
E. All Hospitalisation Expenses (excluding cost of organ, if any) incurred for donor in respect of Organ transplant to the insured.
Note 1: The amount payable under 1.2C& D above shall be at the rate applicable to the entitled room category. In case the insured
person opts for a room with rent higher than the entitled category as in 1.2A above, the charges payable under 1.2C & D shall be
limited to the charges applicable to the entitled category. This will not be applicable in respect of Medicines & Drugs and implants.
Note 2 : No payment shall be made under 1.2C other than as part of the hospitalisation bill.
1.2.1 Expenses in respect of the following specified illnesses will be restricted as detailed below:
Hospitalisation Benefits LIMITS per surgery RESTRICTED TO
a. Cataract, Hernia,Hysterectomy a. Actual expenses incurred or 25% of the sum insured whichever is less
b. Major surgeries* b. Actual expenses incurred or 70% of the Sum Insured whichever is less
POLICY NO.: 0825002817P113288533
Major surgeries include cardiac surgeries, brain tumour surgeries, pace maker implantation for sick sinus syndrome, cancer
surgeries, hip, knee, joint replacement surgery, Organ Transplant.
The above limits specified are applicable per hospitalisation / surgery.
1.2.2 P r e & P o s t H o s p i t a l i s a t i o n i n r e s p e c t o f e a c h--- Actual expenses incurred subject to m a x i m u m o f 1 0 % o f S u m I n s u r e d

hospitalisation whichever is less.
1.3 Company's Liability for all claims admitted in respect of any/all insured person/s during the period of insurance shall not exceed
the Sum Insured stated in the schedule.
2.1 Expenses on Hospitalisation for minimum period of 24 hours are admissible. However, this time limit is not applied to specific
treatments, such as
1. Adenoidectomy 13. Radiotherapy 24. Inguinal/ventral/ Umbilical/femoral hernia
2. Appendectomy 14. Lithotripsy 25. Parenteral chemotherapy
3. Ascitic/Pleural tapping 15.Incision and drainage of abcess 26. Polypectomy
4. Auroplasty 16. Varicocelectomy 27. Septoplasty
5. Coronary angiography 17. Wound suturing 28. Piles/fistula
6. Coronary angioplasty 18. FESS 29. Prostate
7. Dental surgery 19. Haemo dialysis 30. Sinusitis
8. D & C 20. Fissurectomy/Fistulectomy 31. Tonsillectomy
9. Endoscopies 21. Mastoidectomy 32. Liver aspiration
10. Excision of Cyst/granuloma /Lump 22. Hydrocele 33. Sclerotherapy
11. Eye surgery 23. Hysterectomy 34. Varicose Vein Ligation
12. Fracture/dislocation exclu-ding
hairline fracture
This condition will also not apply in case of stay in hospital of less than 24 hours provided-
a) The treatment is undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hours because of
technological advancement and
b) Which would have otherwise required a hospitalisation of more than 24 hours.
Procedures/treatments usually done on out patient basis 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 Centres.
2.2 Domiciliary Hospitalisation means medical treatment for a period exceeding three days for such an illness/disease/injury which in
the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the
following circumstances :
a. The condition of the patient is such that he/she is not in a condition to be removed to a hospital or
b. The patient takes treatment at home on account of non-availability of room in a hospital.
Subject however that domiciliary hospitalisation benefits shall not cover:
i) Expenses incurred for pre and post hospital treatment and

ii) Expenses incurred for treatment for any of the following diseases:-
a. Asthma
b. Bronchitis
c. Chronic Nephritis and Nephritic Syndrome
d. Diarrhoea and all type of Dysenteries including Gastroenteritis
e. Diabetes Mellitus and Insipidus
f. Epilepsy
g. Hypertension
h. Influenza, Cough and Cold
i. All Psychiatric or Psychosomatic Disorders
j. Pyrexia of unknown Origin for less than 10 days
k. Tonsillitis and Upper Respiratory Tract infection including Laryngitis and pharangitis
l. Arthritis, Gout and Rheumatism
POLICY NO.: 0825002817P113288533
Liability of the company under this clause is restricted as stated in the Schedule attached hereto
2.3 For AYUSH Treatment, hospitalisation expenses are admissible only when the treatment has been undergone in a Government
Hospital or in any Institute recognised by the Government and/or accredited by Quality Council of India/National Accreditation Board
on Health.
MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS
If the claim event falls within two policy periods, the claims shall be paid taking into consideration the available sum insured in the
two policy periods, including the deductibles for each policy period. Such eligible claim amount to be payable to the insured shall be
reduced to the extent of premium to be received for the renewal/due date of premium of health insurance policy, if not received
earlier.
3. DEFINITIONS:
3.1 ACCIDENT
Accident-An accident is a sudden, unforeseen and involuntary event caused by external and visible and violent means
3.2 A. "Acute condition"-Acute condition is 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 l e a d s t o f u l l
recovery.
B. "Chronic c o n d i t i o n " - A c h r o n i c c o n d i t i o n i s d e f i n e d a s a d i s e a s e , i l l n e s s , o r i n j u r y t h a t h a s o n e o r m o r e o f t h e f o l l o w i n g
characteristics-
i. it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests-
ii. it needs ongoing or long-term control or relief of symptoms
iii. it requires your rehabilitation or for you to be specially trained to cope with it
iv. it continues indefinitely
v. it comes back or is likely to come back.
3.3 ALTERNATIVE TREATMENT

Alternative treatments are forms of treatments other than treatment "Allopathy" or "modern medicine" and includes Ayurveda,
Unani, Siddha and Homeopathy in the Indian context.
3.4 ANY ONE ILLNESS
Any one illness will be deemed to mean continuous period of illness and it includes relapse within 45 days from the date of last
consultation with the Hospital / Nursing Home where treatment has been taken.
3.5 CASHLESS FACILITY
Cashless facility means a facility extended by the insurer/TPA 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
insurer/TPA to the extent pre-authorisation approved.
3.6 CONGENITAL ANOMALY
Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form, structure or
position.
a . Internal Congenital Anomaly
Which is not in the visible and accessible parts of the body.
b . External Congenital Anomaly
Which is in the visible and accessible parts of the body.
3.7 CONDITION PRECEDENT

Condition Precedent shall mean a policy term or condition upon which the Insurer's liability under the policy is conditional upon.
3.8 CONTRIBUTION
Contribution is essentially the right of an insurer to call upon other insurers liable to the same insured to share the cost of an
indemnity claim on a rateable proportion.
POLICY NO.: 0825002817P113288533
3.9 DAY CARE CENTRE
Day Care centre means any institution established for day care treatment of illness and/or injuries or a medical set-up within a
hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered
and qualified medical practitioner AND must comply with all minimum criteria as under :
a. Has qualified nursing staff under its employment
b. Has qualified Medical Practitioner(s) in charge
c. Has a fully equipped operation theatre of its own where surgical procedures are carried out-
d. Maintains daily records of patients and will make these accessible to the Insurance Company's authorized personnel..
3.10 DAY CARE TREATMENT -Day Care treatment means the medical treatment and/or surgical procedure which is-(i)Undertaken under
General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of technological and (ii) which would have
otherwise required a hospitalisation of more than 24 hours. Treatment normally taken on an out-patient basis is not included in the
scope of this definition.
3.11 DEDUCTIBLE
Deductible is a cost sharing requirement under a Health Insurance Policy that provides that the Insurer will not be liable for a
specified rupee amount in case of Indemnity policies and for a specified number of days/hours in case of hospital cash policies
which will apply before any benefits are payable by the insurer. A deductible does not reduce the sum insured.
3.12 DOMICILIARY HOSPITALISATION
Domiciliary Hospitalisation means medical treatment for an illness/disease/injury which in the normal course would require care and
treatment at a hospital but is actually taken while confined at home under any of the following circumstances :
c. The condition of the patient is such that he/she is not in a condition to be removed to a hospital or
d. The patient takes treatment at home on account of non-availability of room in a hospital.
3.13 GRACE PERIOD
Grace Period means the specified period of time immediately following the premium due date during which a payment can be made
to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage of pre-existing
diseases. Coverage is not available for the period for which no premium is received.
3.14 HOSPITAL/NURSING HOME
A Hospital means any institution established for in-patient 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 establishments (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 qualified nursing staff under its employment round the clock.
- H a s a t least 10 in-patient beds in towns having a population of less than 10 lacs and at least 15 in-patient beds in all other
places;
- 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 makes these accessible to the insurance company's authorized personnel.
3.15 HOSPITALISATION
Means admission in a Hospital/Nursing Home 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.
3.16 ID CARD
ID card means the identity card issued to the insured person by the TPA to avail cashless facility in network hospitals.
3.17 ILLNESS
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 required medical treatment.
3.18 INJURY Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent a n d
visible and evident means which is verified and certified by a Medical Practitioner.
POLICY NO.: 0825002817P113288533
3.19 IN-PATIENT CARE

In-patient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.
3.20 INTENSIVE CARE UNIT
The term "Intensive Care" unit means an identified section, ward or wing of a hospital which is under the constant supervision of a
dedicated Medical Practitioner(s), 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.
3.21 MEDICAL ADVISE
Medical Advise-Any consultation or advice from a Medical Practitioner including the issue of a any prescription or repeat prescription.
3.22 MEDICAL EXPENSES
Medical e x p e n s e s - M e d i c a l E x p e n s e s m e a n s t h o s e e x p e n s e s t h a t a n I n s u r e d p e r s o n h a s necessarily and actually incurred for
medical treatment on account of illness or Accident 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.
3.23 MEDICALLY NECESSARY
Medically Necessary treatment is defined as any treatment, tests, medication, or stay in hospital or part of a stay in hospital which
a. Is required for the medical management of the illness or injury suffered by the insured;
b. Must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration or intensity;
c. Must have been prescribed by a Medical Practitioner;
d. Must conform to the professional standards widely accepted in international medical practice or by the medical community in India.
3.24 MEDICAL PRACTITIONER
A Medical Practitioner is a person who holds a valid registration from the Medical Council of any State of India or Medical Council of
India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Goverment and is thereby
entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of licence.
T h e t e r m Medical Practitioner would include Physician, Specialist and Surgeon. (The Registered Practitioner should not be the
insured or close family members such as parents, in-laws, spouse and children).
3.25 NETWORK PROVIDER
Network Provider means the hospital/nursing home or health care providers enlisted by an insurer or by a TPA and insurer together
to provide medical services to an insured on payment by a cashless facility. The list of Network Hospitals is maintained by and
available with the TPA and the same is subject to amendment from time to time.
Preferred Provider Network means a network of hospitals which have agreed to a cashless packaged pricing for certain procedures
for the insured person. The list is available with the company/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.
3.26 NON-NETWORK HOSPITALS
Non-Network-Any hospital, day care centre or other provider that is not part of the network.
3.27 NOTIFICATION OF CLAIM
Notification of claim is the process of notifying a claim to the insurer or TPA by specifying the timelines as well as the
address/telephone number to which it should be notified.
3.28 PORTABILITY
Portability means transfer by an Individual Health Insurance Policyholder (including family cover) of the credit gained for pre-
existing conditions and time-bound exclusions if he/she chooses to switch from one insurer to another.
POLICY NO.: 0825002817P113288533
3.29 PRE-EXISTING DISEASE

Any condition, ailment or injury or relation condition(s) for which you had signs or symptoms, and/or were diagnosed, and/or
received medical advice/treatment within 48 months to prior to the first policy issued by the insurer.
3.30 PRE-HOSPITALISATION MEDICAL EXPENSES
Relevant medical expenses incurred immediately 30 days before the Insured person is hospitalised provided that ;
a. Such Medical expenses are incurred for the same condition for which the Insured Person's Hospitalisation was required; and
b. T h e In-patient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company
3.31 POST-HOSPITALISATION MEDICAL EXPENSES
Relevant medical expenses incurred immediately 60 days after the Insured person is discharged from the hospital provided
that ;
b. T h e In-patient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company.
3.32 QUALIFIED NURSE
QUALIFIED NURSE means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any
State in India and who is employed on recommendation of the attending Medical Practitioner.
3.33 REASONABLE AND CUSTOMARY CHARGES
Reasonable and Customary charges means 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 illness/injury involved.
3.34 RENEWAL
Renewal defines the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for
treating the renewal continuous for the purpose of all waiting periods.
3.35 R O O M RENT
Room rent shall mean the amount charged by a hospital for the Occupancy of a bed on per day (24 hours) basis and shall include
associated medical expenses.
3.36 SUBROGATION
Subrogation shall mean the right of the insurer to assume the rights of the insured person to recover expenses paid out under the
policy that may be recovered from any other source.
3.37 SURGERY OR SURGICAL PROCEDURE''
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.
3.38 "THIRD PARTY ADMINISTRATOR"
TPA means a Third Party Administrator who holds a valid License from Insurance Regulatory and Development Authority to act as a
THIRD PARTY ADMINISTRATOR and is engaged by the Company for the provision of health services as specified in the agreement
between the Company and TPA.
3.39 UNPROVEN/EXPERIMENTAL TREATMENT
Treatment i n c l u d i n g d r u g e x p e r i m e n t a l t h e r a p y w h i c h i s n o t b a s e d o n e s t a b l i s h e d m e d i c a l p r a c t i c e i n I n d i a , i s t r e a t m e n t
experimental or unproven.
4. Exclusions
The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any
Insured Person in connection with or in respect of:
4.1 Any pre-existing condition(s) as defined in the policy, until 48 months of continuous coverage of such insured person have elapsed,
since inception of his/her first Policy with the Company.
POLICY NO.: 0825002817P113288533
4.2 Any disease other than those stated in clause 4.3, contracted by the Insured person during the first 30 days from the
commencement date of the policy. This condition 4.2 shall not however, apply in case of the Insured person having been covered
under an Insurance Scheme with our Company for a continuous period of preceding 12 months without any break.
4.3 During the first two years of the operation of the policy, the expenses on treatment of diseases such as Cataract, Benign Prostatic
Hyperthrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, piles,
Sinusitis and related disorders, Gall Bladder Stone removal, Gout & Rheumatism, Calculus Diseases are not payable.
4.4 During the f i r s t f o u r y e a r s o f t h e o p e r a t i o n o f t h e p o l i c y , t h e e x p e n s e s r e l a t e d t o t r e a t m e n t o f J o i n t R e p l a c e m e n t d u e t o
Degenerative Condition and age-related Osteoarthiritis & Osteoporosis are not payable. If these diseases mentioned in Exclusion
no.4.3 an 4.4 (other than congenital internal disease) are pre-existing at the time of proposal they will not be covered even during
subsequent period of renewal subject to the pre-existing disease exclusion clause. If the insured is aware of the existence of
Congenital internal exclusion clause. If the insured is aware of the existence of Congenital internal disease before inception of the
policy, the same will be treated as pre-existing.
4.5 Injury / disease 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)
4.6 a . Circumcision unless necessary for treatment of a disease not excluded h e r e u n d e r o r a s m a y b e n e c e s s i t a t e d d u e t o a n
accident.
b. vaccination or inoculation or 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.
4.7 Cost of spectacles, contact lenses and hearing aids.

4.8 Dental treatment or surgery of any kind unless necessitated by accident and requiring hospitalisation.
4.9 Convalescence, general debility; run-down condition or rest cure, obesity treatment and its complications including morbid obesity,
Congenital external disease or defects or anomalies, treatment relating to all psychiatric and and psychomatic disorders. Infertility,
Sterility, Venereal disease, intentional self injury and use of intoxication drugs / alcohol
4.10 All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III
(HTLB - III) or lymphadinopathy 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 or Nursing Home 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 ailment, sickness or injury,
for which confinement is required at a Hospital / Nursing Home
4.12 Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician
4.13 Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials
4.14 Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these including
caesarean section, except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy) which is proved by submission of
Ultra Sonographic report and Certificate of Gynaecologist that it is life threatening one if left untreated.
4.15 Naturopathy T r e a t m e n t , a c u p r e s s u r e , a c u p u n c t u r e , m a g n e t i c t h e r a p i e s , e x p e r i m e n t a l a n d unproven treatments/therapies.
Treatment including drug experimental therapy w h i c h i s n o t b a s e d o n e s t a b l i s h e d m e d i c a l p r a c t i c e i n I n d i a , i s t r e a t m e n t
4.16 External and or durable Medical / Non-medical equipment of any kind used for diagnosis and/or treatment and/or monitoring
and/or maintenance and/or support including CPAP, CAPD, Infusion pump, Oxygen concentrator etc., Ambulatory devices i.e.,
walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, elastrocepe 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 are subsequently used at home.
POLICY NO.: 0825002817P113288533
4.17 Genetic disorders and stem cell implantation/surgery.
4.18 Change of treatment from one system of medicine to another unless recommended by the consultant/hospital under whom the
treatment is taken.
4.19 Treatment for Age Related Mascular Degeneration (ARMD), treatment such as Rotational Field Quantum Magnetic Resonance
(RFQMR), Enhanced External Counter Pulsation (EECP), etc.
4.20 All non-medical expenses including convenience items for personal comfort such as charges for telephone, television, ayah, private
nursing/barber or beauty services, diet charges, baby food, cosmetic, tissue paper, diapers, sanitary pads, toiletry items and similar
incidental expenses. Detailed list is available on our website www.uiic.co.in.
4.21 A n y k i n d o f Service charges, Surcharges, Admission Fees/Registration Charges, Luxury tax a n d s i m i l a r c h a r g e s l e v i e d b y t h e

hospital.
5. CONDITIONS:
T h e Proposal form, Prospectus, Pre-acceptance Health check-up and the Policy issued shall constitute complete Contract of
Insurance.
5.1 Every notice or communication regarding hospitalisation or claim under this policy shall be delivered in writing at the address of the
TPA office as shown in the Schedule. Other matters with regard to the policy may be communicated to the Police Issuing Office. The
insured should immediately bring to our notice any change in the address or contact details.
5.2 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 signed by a duly authorised official of the company. The due payment of premium and the observance and fulfilment
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 a 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 authorised official of the Company.
5.3 Notice of claim - Upon the happening of any event which may give rise to a claim under this Policy notice with full particulars shall
be sent to the TPA named in the schedule immediately and in case of emergency Hospitalisation, within 24 hours from the time of
Hospitalisation.
5.4 All supporting documents relating to the claim must be filed with TPA within 15 days from the date of discharge from the hospital.
I n c a s e o f post-hospitalisation, treatment (limited to 60 days), all claim documents should be submitted within 7 days after
completion of such treatment.
Note: Waiver of this Condition may be considered in extreme cases of hardship where i t i s p r o v e d t o t h e s a t i s f a c t i o n o f t h e
Company 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.
5.5 The Insured Person shall obtain and furnish to the TPA with all original bills, receipts and other documents upon which a claim is
based and shall also give the TPA / Company such additional information and assistance as the TPA / Company may require in
dealing with the claim.
5.6 Any medical practitioner authorised by the TPA / Company shall be allowed to examine the Insured Person in case of any alleged
injury or disease requiring H o s p i t a l i s a t i o n w h e n a n d s o o f t e n a s t h e s a m e m a y r e a s o n a b l y b e r e q u i r e d o n b e h a l f o f t h e
TPA/Company.
5.7 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.
5.8 T h e Policy shall be void and all premium paid hereon shall be forfeited to the Company, in the event of misrepresentation, mis-
description or non-disclosure of any material fact.
5.9 Refund of premium for Overseas Mediclaim Policy (OMP)-If during the policy period the insured person is also covered under an
Overseas Mediclaim Policy (OMP) of any non-life insurance company, the policy will be inoperative in respect of the insured persons
for the number of days the OMP is in force and proportionate premium for the number of days the OMP was in force shall be
refunded. The insured person must inform the company in writing before leaving and may submit an application, in respect of the
refund to the Company, stating the details of visit(s) abroad, along with copies of the OMP, within 30 days of expiry of the policy
POLICY NO.: 0825002817P113288533
5.10 If at the time when any claim arises under this Policy, there is in existence any other insurance (other than Cancer Insurance Policy
in collaboration with Indian Cancer Society), whether it be effected by or on behalf of any Insured Person in respect of whom the
claim may have arisen covering the same loss, liability, compensation, costs or expenses, the Company shall not be liable to pay
or contribute more than its rateable proportion of any loss, liability, compensation costs or expenses. The benefits under this Policy
shall be in excess of the benefits available under Cancer Insurance Policy.
Note : The insured person must disclose such other insurance at the time of making the claim under this policy
5.11 Renewal Clause :
1. The Company shall renew this policy if the insured shall remit the requisite premium to the Company prior to expiry o the period of
insurance stated in the schedule.
2. The Company shall be entitled to decline renewal if;
a. Any fraud, misrepresentation or suppression by the insured or on his behalf is found either in obtaining insurance or subsequently
in relation thereto or,
b. The Company has discontinued issue of the policy, in which event the insured shall however have the option for renewal under any
similar policy being issued by the company, provided however benefits payable shall be subject to the terms contained in such
other policy.
3. I f t h e i n s u r e d f a i l s t o r e m i t p r e m i u m f o r r e n e w a l b e f o r e e x p i r y o f t h e p e r i o d o f insurance, but within 30 days thereafter,
admissibility of any claim during t h e p e r i o d o f s u b s e q u e n t p o l i c y s h a l l b e c o n s i d e r e d i n t h e s a m e m a n n e r a s under a Policy
renewed without break. The Company however shall not be liable for any claim arising out of ailment suffered or hospitalisation
commencing in the interim period after expiry of the earlier policy and prior to date of commencement of subsequent policy.
5.12 ENHANCEMENT OF SUM INSURED

The insured may seek enhancement of Sum Insured in writing at or before payment of premium for renewal, which may be granted
at the discretion of the Company. However, notwithstanding enhancement, for claims arising in respect of ailment, disease or injury
contracted or suffered during a preceding policy period, liability of the company shall be only to the extent of the Sum Insured
under the policy i n f o r c e a t t h e t i m e w h e n i t w a s c o n t r a c t e d o r s u f f e r e d d u r i n g t h e c u r r e n c y o f such renewed policy or any
subsequent renewal thereof.
Any such request for enhancement must be accompanied by a declaration that the insured or any other insured person in respect of
whom such enhancement is sought is not aware of any symptoms or other indications that may give rise to a claim under the policy.
The Company require such insured persons' to undergo a M e d i c a l e x a m i n a t i o n t o e n a b l e t h e c o m p a n y t o t a k e a d e c i s i o n o n
accepting the request for enhancement in the Sum Insured.
5.13 Cancellation Clause :
The Company may at any time cancel the Policy on grounds of misrepresentation, fraud, non-disclosure of material fact or non-
cooperation by the insured by sending fifteen days notice in writing by Registered A/D to the insured at his last known address in
which case the Company shall return to the insured a proportion of the last premium corresponding to the unexpired period of
i n s u r a n c e i f n o c l a i m h a s b e e n p a i d u n d e r t h e p o l i c y . T h e i n s u r e d m a y a t a n y time cancel this policy and in such event the
Company shall allow refund of premium at Company's short period rate table given below provided no claim has occurred upto the
date of cancellation.
RATE OF PREMIUM TO BE
PERIOD ON RISK
CHARGED.
Upto one month 1/4 th of the annual rate
Upto three months 1/2 of the annual rate
Upto six months 3/4 th of the annual rate
Exceeding six months Full annual rate.
5.14 I f a n y dispute or difference shall arise as to the quantum to be paid under the policy (liability being otherwise admitted) such
difference shall independently of all other questions 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 30 days of any party invoking 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 dispute/difference
and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the
provisions of the Arbitration and Conciliation Act, 1996.
POLICY NO.: 0825002817P113288533
It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the
Company has disputed or not accepted liability under or in respect of this Policy.
It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy
that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.
5.15 I f t h e Company, as per terms and conditions of the policy or 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 or receipt of the notice of such disclaimer notify the
TPA/ Company in writing that he does not accept such disclaimer and intends to recover his claim from the TPA/Company then the
claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.
5.16 All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in
Indian Currency.
6 PAYMENT OF CLAIM
All claims under this policy shall be payable in Indian currency. All medical/surgical treatments for the purpose of this insurance will
have to be taken in India only. Payment of claim shall be made through TPA to the Hospital/Nursing Home or the Insured Person
as the case may be.
Upon acceptance of an offer of settlement, the payment of amount due shall be made within 7 days from the date of acceptance of
offer by the Insured. In the cases of delay in the payment, the insurer shall be liable to pay interest at a rate which is 2% above
the bank rate prevalent at the beginning of the financial year in which the claim is reviewed by it.
7 Free Look Period - The policy shall have a free look period which shall be applicable at the inception of the policy and;
i The insured will be allowed a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of
the policy and to return the same if nor acceptable.
ii If the insured has not made any claim during the free look period, the insured shall be entitled to -
a. A refund of the premium paid less any expenses incurred by the insurer on medical examination of the insured persons and the
stamp duty charges or
b. W h e r e t h e r i s k h a s already commenced and the opinion of return of the policy is excercised by the policybolder, a deduction
towards the proportionate risk premium for period on cover or;
c. Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such
period
8. COST OF HEALTH CHECK UP
The insured s h a l l b e e n t i t l e d f o r a r e i m b u r s e m e n t o f t h e c o s t o f M e d i c a l c h e c k - u p o n c e a t t h e e n d o f b l o c k o f e v e r y t h r e e
underwriting years provided there are no claims reported during the block and subject to the policy being renewed without break.
The amount of such reimbursement shall be limited to 1% of the average sum insured for the preceding three policy periods.
9. IRDA REGULATIONS : This policy is subject to Regulations of IRDA (Protection of Policyholders' Interest) Regulations 2002 as
amended from time to time.
10. GRIEVANCE REDRESSAL : In the event of the policyholder having any grievance relating to the insurance, the insured person may
submit in writing to the Policy Issuing Office or Grievance cells at Regional Office of the Company for redressal. If the grievance
remains unaddressed, the insured person may contact the Officer, Uni-Customer Care Department, Head Office.
11. OMBUDSMAN
The Insured person can also approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance.
The updated list of Office of Insurance Ombudsman are available on IRDA website www.irda.gov.in and on the website of General
Insurance Council www.gicouncil.in
12. IMPORTANT NOTICE
1 The Company may revise any of the terms, conditions and exceptions of this insurance including the premium payable on renewal in
accordance with the guidelines/rules framed by the Insurance Regulatory and Development Authority (IRDA). We shall notify you of such
changes at least three months before the revision are to take effect.
2 The Company may also withdraw the insurance as offered hereunder after following the due process as laid down by the IRDA and we
shall offer to cover you under such revised/new covers for which we shall have obtained from the Authority at such terms, conditions,
exceptions and premium that the IRDA may have approved.
*************
POLICY NO.: 0825002817P113288533

HEAD OFFICE
CUSTOMER INFORMATION SHEET

Description is illustrative and not exhaustive
S.No. TITLE DESCRIPTION REFER TO POLICY
CLAUSE NO.
1 Product Name Individual Health Insurance Policy - Gold
2 What am I covered a. In Patient Hospitalisation - Expenses for hospitalization more than 24 hours
for subject to following limits -
i. R o o m , Boarding and Nursing Expenses including RMO charges, IV 1.2A

fluids/Blood Transfusion/Injection administration charges - 1% of
Sum Insured per day or actual expenses whichever is less.
ii. ICU - 2% of SI per day or actual expenses whichever is less. 1.2B
iii. Surgeon fees, Anesthetist, Medical Practitioners, Consultants, 1.2C

Specialist's fees, etc.
iv Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical

appliances, Medicines & drugs, Dialysis, Chemotherapy,
Radiotherapy, cost of Artificial limbs, cost of prosthetic devices
1.2D
implanted during surgical procedure viz. Pacemaker, Orthopaedic
implants, infra cardiac valve replacements, vascular stents,
relevant diagnostic tests.
b. Day care Procedures - Listed in the policy which require less than 24 hours 2.1
hospitalization.
c. Pre and Post Hospitalisation - Related medical expenses incurred 30 days 1.2.2
prior to hospitalization and within 60 days from the date of discharge - actual
expenses or 10% of the Sum insured whichever is less.
d. Ayurvedic Treatment is covered only if taken in Government Hospital or any 2.3

institution recognized by Government/accreditated by QCI/National
Accreditation Board on Health
Add-on covers
e. Ambulance charges upto maximum of Rs.2500/- per policy period on

payment of additional premium of Rs.100/-
f. Hospital daily cash benefit of Rs.250/500 per day subject to max. o f

2500/5000 per hospitalization on payment of additional premium o f
Rs.150/300.
POLICY NO.: 0825002817P113288533
3 What are the a . Domiciliary treatment, treatment outside India 4.5
major exclusions
in the policy b . War and warlike operations 4.6
c. Circumcision, vaccination and plastic surgery unless forming part of treatment and 4.7
requires hospitalization.
d . Spectacles, contact lens and hearing aids 4.8
e . Dental treatment unless arising due to an accident 4.8
f. HIV, AIDS and sexually transmitted diseases 4.10
g . Any hospitalization primarily for investigation/diagnostic purposes. 4.11
h . Vitamins, tonics unless necessitated for treatment 4.12
i. Pregnancy and related disorders 4.14
j. Naturopathy and Experimental treatment 4.15

k . External Medical equipments 4.16
l. Treatment for Genetic disorders and stem cell therapy. 4.17
m .Change of system of treatment or medicine 4.18
n ARMD, RFQMR and EECP treatment 4019
o Non-Medical e x p e n s e s 4.20
p Any kind of service charges, admission fees/registration charges 4.21
(Note : the above is a partial listing of the policy exclusions. Please refer to the policy
clauses for the full listing)
4 Waiting period a . Initial waiting period – 30 days for all illness (not applicable on renewal or for accident 4.2
cases)
b . Waiting period of 48 months for Pre-existing disease. 4.1
c. Some specified diseases have a waiting period of 24 or 48 months. 4.3 & 4.4
Two years waiting period
Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or 4.3

Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, Piles,
Sinusitis and related disorders, Gall Bladder Stone Removal, Gout & Rheumatism,
Calculus Diseases
Four years waiting period
Joint replacement due to degenerative condition, age related Osteoarthritis or 4.4

Osteophorosis
5 Payment basis a . Reimbursement of covered expenses up to specified limits
b . Cashless payment of covered expenses upto specified limits in Network Hospitals.
c. In cities where PPN Network is available, cashless will be restricted to PPN and claim
payments as per agreed tariff.
POLICY NO.: 0825002817P113288533
6 Cost sharing In case of a claim, this policy requires you to share the following costs :
a. Expenses exceeding the following Sub-limits
i. Room /ICU charges beyond 1% of Sum Insured per day or beyond 2% 1.2 A & B
of Sum Insured per day for ICU charges.
ii. All other expenses shall be at the rate applicable to the entitled room
category
iii. Other sub-limits 1.2.1

Catarct, Hernia & Hysterectomy - Actual expenses or 25% of Si whichever
is less. Major surgeries- Actual expenses or 70% of the SI whichever is
less.
7 Renewal condition The policy can be renewed annually throughout the lifetime of the insured. 5.11
In the event of break in the policy a grace period of 30 days is allowed. 5.11.3
Enhancement of sum Insured at renewal will be considered at the discretion of 5.12

the Company.
8 Renewal benefits Expenses of Health check-up will be reimbursed once at the end of every three 8
continuous years of insurance provided no claims are reported during the block
upto 1% of average sum insured of previous three policies
9 Cancellation The policy would be cancelled and no claim or refund would be due to you if : 5.13
a . you have not correctly disclosed details about your current and past health status
or
b. have otherwise encouraged or participated in any fraudulent claim under the

policy.
10 Special condition At least 15 days from the issuance of first policy would be given as free-look 7
and special benefit period to the insured to review the terms and conditions
LEGAL DISCLAIMER
The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the
Customer Information sheet and policy document the terms and conditions mentioned in the policy document shall prevail.
For details, please refer to policy clauses for full details.

POLICY NO.: 0825002817P113288533

REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014
HEALTH INSURANCE POLICY - PLATINUM
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 UNITED INDIA INSURANCE COMPANY
(hereinafter called the COMPANY) for the insurance hereinafter set forth in respect of person(s)named in the Schedule hereto
(hereinafter called the INSURED PERSON) and has paid premium as consideration for such insurance.
1.1 NOW THIS POLICY WITNESSES that subject to the terms, conditions, exclusions and definitions contained herein or endorsed, or
otherwise expressed hereon the Company undertakes that during the period stated in the Schedule, any insured person(s) contracts
any disease or suffers from any illness (hereinafter called DISEASE) or sustains any bodily injury through accident (hereinafter called
INJURY) and if such disease or injury requires such insured Person, upon the advice of a duly qualified Physician/Medical
Specialist/Medical practitioner (hereinafter called MEDICAL PRACTITIONER) or of a duly qualified Surgeon (hereinafter called
SURGEON) to incur hospitalisation/domiciliary hospitalisation expenses for medical/surgical treatment at any Nursing Home/Hospital
in India as herein defined (hereinafter called HOSPITAL) as an inpatient, the Company will pay through TPA to the Hospital / Nursing
Home or the Insured Person the amount of such expenses as are reasonably and necessarily incurred in respect thereof by or on
behalf of such Insured Person b u t n o t e x c e e d i n g t h e S u m I n s u r e d i n a g g r e g a t e i n a n y o n e p e r i o d o f i n s u r a n c e s t a t e d i n t h e
schedule hereto.
1.2 In the event of any claim(s) becoming admissible under this scheme, the company will pay through TPA to the Hospital / Nursing
Home or the insured person the amount of such expenses falling under different heads mentioned below, as are reasonably and
medically Necessary incurred thereof by or on behalf of such Insured Person, but not exceeding the Sum Insured in aggregate
mentioned in the schedule hereto.
A. R o o m , Boarding and Nursing Expenses as provided by the Hospital/Nursing Home upto 1% o f S u m I n s u r e d p e r d a y . T h i s a l s o
includes Nursing Care, RMO charges, IV Fluids/Blood Transfusion/Injection administration charges and similar expenses.
B. Intensive Care Unit(ICU) expenses not exceeding 2% of the sum insured per day or actual amount whichever is less.
C. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
D. Anaesthetist, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Dialysis, Chemotherapy,
Radiotherapy, cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic
implants, infra cardiac valve replacements, vascular stents, relevant laboratory diagnostic tests, X-ray and such similar expenses
that are medically necessary
E. All Hospitalisation Expenses (excluding cost of organ, if any) incurred for donor in respect of Organ transplant to the insured.
Note: 1.The amount payable under 1.2C& D above shall be at the rate applicable to the entitled room category. In case the insured person
opts for a room with rent higher than the entitled category as in 1.2A above, the charges payable under 1.2C & D shall be limited to
the charges applicable to the entitled category. This will not be applicable in respect of Medicines & Drugs and implants.
Note: 2.No payment shall be made under 1.2C other than as part of the hospitalisation bill.
(N.B: Company's Liability in respect of all claims admitted during the period of insurance shall not exceed the Sum Insured per person as
mentioned in the schedule)
POLICY NO.: 0825002817P113288533
2.1E x p e n s e s o n Hospitalisation for minimum period of 24 hours are admissible. However, t h i s t i m e l i m i t i s n o t a p p l i e d t o s p e c i f i c
treatments, such as
1. Adenoidectomy 13. Radiotherapy 24. Inguinal/ventral/ Umbilical/femoral hernia

2. Appendectomy 14. Lithotripsy 25. Parenteral chemotherapy
3. Ascitic/Pleural tapping 15.Incision and drainage of abcess 26. Polypectomy
4. Auroplasty 16. Varicocelectomy 27. Septoplasty
5. Coronary angiography 17. Wound suturing 28. Piles/fistula
6. Coronary angioplasty 18. FESS 29. Prostate
7. Dental surgery 19. Haemo dialysis 30. Sinusitis
8. D & C 20. Fissurectomy/Fistulectomy 31. Tonsillectomy
9. Endoscopies 21. Mastoidectomy 32. Liver aspiration
10. Excision of Cyst/granuloma /Lump 22. Hydrocele 33. Sclerotherapy
11. Eye surgery 23. Hysterectomy 34. Varicose Vein Ligation
12. Fracture/dislocation exclu-ding hairline
fracture
This condition will also not apply in case of stay in hospital of less than 24 hours provided -
The treatment is undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hours because of
a.
technological advancement and
b. Which would have otherwise required a hospitalisation of more than 24 hours.
Procedures/treatments usually done on out patient basis 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 Centres.
2.2 Domiciliary Hospitalisation means medical treatment for a period exceeding three days for such an illness/disease/injury which in the
normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the following
circumstances :
- The condition of the patient is such that he/she is not in a condition to be removed to a hospital or
- The patient takes treatment at home on account of non-availability of room in a hospital.
Subject however that domiciliary hospitalisation benefits shall not cover:
i) Expenses incurred for pre and post hospital treatment and
ii) Expenses incurred for treatment for any of the following diseases:-
1. Asthma
2. Bronchitis
3. Chronic Nephritis and Nephritic Syndrome
4. Diarrhoea and all type of Dysenteries including Gastroenteritis
5. Diabetes Mellitus and Insipidus
6. Epilepsy
7. Hypertension
8. Influenza, Cough and Cold
9. All Psychiatric or Psychosomatic Disorders
10. Pyrexia of unknown Origin for less than 10 days
11. Tonsillitis and Upper Respiratory Tract infection including Laryngitis and pharangitis
12. Arthritis, Gout and Rheumatism
Liability of the company under this clause is restricted as stated in the Schedule attached hereto
2.3 For Ayurvedic Treatment, hospitalisation expenses are admissible only when the treatment has been undergone in a Government
Hospital or in any Institute recognised by the Government and/or accredited by Quality Council of India/National Accreditation Board
on Health.
MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS

If the claim event falls within two policy periods, the claims shall be paid taking into consideration the available sum insured in the two
policy periods, including the deductibles for each policy period. Such eligible claim amount to be payable to the insured shall be reduced to
the extent of premium to be received for the renewal/due date of premium of health insurance policy, if not received earlier.
3. DEFINITIONS:
3.1 ACCIDENT
Accident-An accident is a sudden, unforeseen and involuntary event caused by external and visible and violent means
POLICY NO.: 0825002817P113288533
3.2 A. "Acute condition"-Acute condition is 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.
B. "Chronic condition"-A chronic condition is defined as a disease, illness, or injury that has one or more of the following
characteristics-
i. it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests-
ii. it needs ongoing or long-term control or relief of symptoms
iii. it requires your rehabilitation or for you to be specially trained to cope with it
iv. it continues indefinitely
v. it comes back or is likely to come back.
3.3 ALTERNATIVE TREATMENT

Alternative treatments are forms of treatments other than treatment "Allopathy" or "modern medicine" and includes Ayurveda,
Unani, Siddha and Homeopathy in the Indian context.
3.4 ANY ONE ILLNESS
Any one illness will be deemed to mean continuous period of illness and it includes relapse within 45 days from the date of last
consultation with the Hospital / Nursing Home where treatment has been taken. Occurrence of the same illness after a lapse of 45
days as stated above will be considered as fresh illness for the purpose of this policy.
3.5 CASHLESS FACILITY
Cashless facility means a facility extended by the insurer/TPA to the i n s u r e d w h e r e t h e p a y m e n t s , o f t h e c o s t s o f t r e a t m e n t
undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the
insurer/TPA to the extent pre-authorisation approved.
3.6 CONGENITAL ANOMALY
Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form, structure or
position.
a. Internal Congenital Anomaly
Which is not in the visible and accessible parts of the body.
b. External Congenital Anomaly
Which is in the visible and accessible parts of the body.
3.7 CONDITION PRECEDENT
Condition Precedent shall mean a policy term or condition upon which the Insurer's liability under the policy is conditional upon.
3.8 CONTRIBUTION
Contribution is essentially the right of an insurer to call upon other insurers liable to the same insured to share the cost of an
indemnity claim on a rateable proportion.
3.9 DAY CARE CENTRE
`Day Care centre means any institution established for day care treatment of illness and/or injuries or a medical set-up within a
hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered
and qualified medical practitioner AND must comply with all minimum criteria as under :
a. Has qualified nursing staff under its employment
b. Has qualified Medical Practitioner(s) in charge
c. Has a fully equipped operation theatre of its own where surgical procedures are carried out-
d. Maintains daily records of patients and will make these accessible to the Insurance Company's authorized personnel.
3.10 DAY CARE TREATMENT -Day Care treatment means the medical treatment and/or surgical procedure which is -(i)Undertaken under
General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of technological and (ii) which would have
otherwise required a hospitalisation of more than 24 hours. Treatment normally taken on an out-patient basis is not included in the
scope of this definition.
3.11 DEDUCTIBLE
Deductible is a cost sharing requirement under a Health Insurance Policy that provides that the Insurer will not be liable for a
specified rupee amount in case of Indemnity policies and for a specified number of days/hours in case of hospital cash policies
which will apply before any benefits are payable by the insurer. A deductible does not reduce the sum insured.
POLICY NO.: 0825002817P113288533
3.12 DOMICILIARY HOSPITALISATION
Domiciliary Hospitalisation means medical treatment for an illness/disease/injury which in the normal course would require care and
treatment at a hospital but is actually taken while confined at home under any of the following circumstances :
a . The condition of the patient is such that he/she is not in a condition to be removed to a hospital or
b . The patient takes treatment at home on account of non-availability of room in a hospital.
3.13 GRACE PERIOD
Grace Period means the specified period of time immediately following the premium due date during which a payment can be made
to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage of pre-existing
diseases. Coverage is not available for the period for which no premium is received.
3.14 HOSPITAL/NURSING HOME
A Hospital means any institution established for in-patient 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 establishments (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 qualified nursing staff under its employment round the clock.
- H a s a t least 10 in-patient beds in towns having a population of less than 10 lacs and at least 15 in-patient beds in all other
places;
- 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 makes these accessible to the insurance company's authorized personnel.
3.15 HOSPITALISATION
Means admission in a Hospital/Nursing Home 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.
3.16 ID CARD
ID card means the identity card issued to the insured person by the TPA to avail cashless facility in network hospitals.
3.17 ILLNESS
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 required medical treatment.
3.18 INJURY 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.
3.19 IN-PATIENT CARE
In-patient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.
3.20 INTENSIVE CARE UNIT
The term "Intensive Care" unit means an identified section, ward or wing of a hospital which is under the constant supervision of a
dedicated Medical Practitioner(s), 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.
3.21 MEDICAL ADVISE
Medical Advise-Any consultation or advice from a Medical Practitioner including the issue of a any prescription or repeat prescription.
3.22 MEDICAL EXPENSES
M e d i c a l e x p e n s e s - M e d i c a l E x p e n s e s m e a n s t h o s e e x p e n s e s t h a t a n I n s u r e d person has necessarily and actually incurred for
medical treatment on account of illness or Accident 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.
POLICY NO.: 0825002817P113288533
3.23 MEDICALLY NECESSARY
Medically Necessary treatment is defined as any treatment, tests, medication, or stay in hospital or part of a stay in hospital which
a. Is required for the medical management of the illness or injury suffered by the insured;
b. Must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration or
intensity;
c. Must have been prescribed by a Medical Practitioner;
d. Must conform to the professional standards widely accepted in international medical practice or by the medical community in
India.
3.24 MEDICAL PRACTITIONER
A Medical Practitioner is a person who holds a valid registration from the Medical Council of any State of India or Medical Council of
India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Goverment and is thereby
entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of licence.
The term Medical Practitioner would include Physician, Specialist and Surgeon. (The Registered Practitioner should not be the
insured or close family members such as parents, in-laws, spouse and children).
3.25 NETWORK PROVIDER
Network Provider means the hospital/nursing home or health care providers enlisted by an insurer or by a TPA and insurer together
to provide medical services to an insured on payment by a cashless facility. The list of Network Hospitals is maintained by and
available with the TPA and the same is subject to amendment from time to time.
Preferred Provider Network means a network of hospitals which have agreed to a cashless packaged pricing for certain procedures
for the insured person. The list is available with the company/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.
3.26 NON-NETWORK HOSPITALS
Non-Network-Any hospital, day care centre or other provider that is not part of the network.
3.27 NOTIFICATION OF CLAIM
Notification of claim is the process of notifying a claim to the insurer or TPA by specifying the timelines as well as the
address/telephone number to which it should be notified.
3.28 PORTABILITY
Portability means transfer by an Individual Health Insurance Policyholder (including family cover) of the credit gained for pre-
existing conditions and time-bound exclusions if he/she chooses to switch from one insurer to another.
3.29 PRE-EXISTING DISEASE
Any condition, ailment or injury or relation condition(s) for which you had signs or symptoms, and/or were diagnosed, and/or
received medical advice/treatment within 48 months to prior to the first policy issued by the insurer.
3.30 PRE-HOSPITALISATION MEDICAL EXPENSES
Relevant medical expenses incurred immediately 30 days before the Insured person is hospitalised provided that ;
b. T h e In-patient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company
3.31 POST HOSPITALISATION MEDICAL EXPENSES
Relevant medical expenses incurred immediately 60 days after the Insured person is discharged from the hospital provided that ;
b. T h e In-patient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company.
3.32 QUALIFIED NURSE
QUALIFIED NURSE means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any
State in India and who is employed on recommendation of the attending Medical Practitioner.
POLICY NO.: 0825002817P113288533
3.33REASONABLE AND CUSTOMARY CHARGES
Reasonable and Customary charges means 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 illness/injury involved.
3.34RENEWAL
Renewal defines the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for
treating the renewal continuous for the purpose of all waiting periods.
3.35R O O M RENT
Room rent shall mean the amount charged by a hospital for the Occupancy of a bed on per day (24 hours) basis and shall include
associated medical expenses.
3.36SUBROGATION
Subrogation shall mean the right of the insurer to assume the rights of the insured person to recover expenses paid out under the
policy that may be recovered from any other source.
3.37SURGERY OR SURGICAL PROCEDURE
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.
3.38THIRD PARTY ADMINISTRATOR
TPA means a Third Party Administrator who holds a valid License from Insurance Regulatory and Development Authority to act as a
THIRD PARTY ADMINISTRATOR and is engaged by the Company for the provision of health services as specified in the agreement
between the Company and TPA.
3.39UNPROVEN/EXPERIMENTAL TREATMENT
Treatment including drug experimental therapy which is not based on established medical practice in India, is treatment experimental
or unproven.
4. Exclusions
The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured
Person in connection with or in respect of:
4.1 Congenital Diseases (Internal and External)
4.2 Injury / disease 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)
4.3 a . Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident.
b . vaccination or inoculation or 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.
4.4 Cost of spectacles, contact lenses and hearing aids.
4.5 Dental treatment or surgery of any kind unless necessitated by accident and requiring hospitalisation.
4.6 Convalescence, general debility; run-down condition or rest cure, obesity treatment and its complications including morbid obesity,
Congenital external disease or defects or anomalies, treatment relating to all psychiatric and and psychomatic disorders. Infertility,
Sterility, Venereal disease, intentional self injury and use of intoxication drugs / alcohol
4.7 All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III
(HTLB - III) or lymphadinopathy 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.
4.8 Charges incurred at Hospital or Nursing Home 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 ailment, sickness or injury, for
which confinement is required at a Hospital / Nursing Home
4.9 Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician
4.10Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials
POLICY NO.: 0825002817P113288533
4.11 Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these including
caesarean section, except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy) which is proved by submission of
Ultra Sonographic report and Certificate of Gynaecologist that it is life threatening one if left untreated.
4.12 Naturopathy T r e a t m e n t , a c u p r e s s u r e , a c u p u n c t u r e , m a g n e t i c t h e r a p i e s , e x p e r i m e n t a l a n d unproven treatments/therapies.
Treatment including drug experimental therapy w h i c h i s n o t b a s e d o n e s t a b l i s h e d m e d i c a l p r a c t i c e i n I n d i a , i s t r e a t m e n t
4.13 External and or durable Medical / Non-medical equipment of any kind used for diagnosis and/or treatment and/or monitoring
and/or maintenance and/or support including CPAP, CAPD, Infusion pump, Oxygen concentrator etc., Ambulatory devices i.e.,
walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, elastrocepe 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 are subsequently used at home.
4.14 Genetic disorders and stem cell implantation/surgery.
4.15 Change of treatment from one system of medicine to another unless recommended by the consultant/hospital under whom the
treatment is taken.
4.16 Treatment for Age Related Mascular Degeneration (ARMD), treatment such as Rotational Field Quantum Magnetic Resonance
(RFQMR), Enhanced External Counter Pulsation (EECP), etc.
4.17 All non-medical expenses including convenience items for personal comfort such as charges for telephone, television, ayah, private
nursing/barber or beauty services, diet charges, baby food, cosmetic, tissue paper, diapers, sanitary pads, toiletry items and similar
incidental expenses. For detailed list of non-payable expenses, please log on to our website www.uiic.co.in.
4.18 A n y k i n d o f Service charges, Surcharges, Admission Fees/Registration Charges, Luxury tax a n d s i m i l a r c h a r g e s l e v i e d b y t h e
hospital.
5. CONDITIONS:
T h e Proposal form, Prospectus, Pre-acceptance Health check-up and the Policy issued shall constitute complete Contract of Insurance.
5.1 Every notice or communication regarding hospitalisation or claim under this policy shall be delivered in writing at the address of the
TPA office as shown in the Schedule. Other matters with regard to the policy may be communicated to the Police Issuing Office. The
insured should immediately bring to our notice any change in the address or contact details.
5.2 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 signed by a duly authorised official of the company. The due payment of premium and the observance and fulfilment
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 a 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 authorised official of the Company.
5.3 Notice of claim - Upon the happening of any event which may give rise to a claim under this Policy notice with full particulars shall
be sent to the TPA named in the schedule immediately and in case of emergency Hospitalisation, within 24 hours from the time of
Hospitalisation.
5.4 All supporting documents relating to the claim must be filed with TPA within 15 days from the date of discharge from the hospital.
I n c a s e o f post-hospitalisation, treatment (limited to 60 days), all claim documents should be submitted within 7 days after
completion of such treatment.
Note: Waiver of this Condition may be considered in extreme cases of hardship where it is proved 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 give such notice or file claim
within the prescribed time-limit.
5.5 The Insured Person shall obtain and furnish to the TPA with all original bills, receipts and other documents upon which a claim is
based and shall also give the TPA / Company such additional information and assistance as the TPA / Company may require in
dealing with the claim.
5.6 Any medical practitioner authorised by the TPA / Company shall be allowed to examine the Insured Person in case of any alleged
injury or disease requiring H o s p i t a l i s a t i o n w h e n a n d s o o f t e n a s t h e s a m e m a y r e a s o n a b l y b e r e q u i r e d o n b e h a l f o f t h e
TPA/Company.
POLICY NO.: 0825002817P113288533
5.7 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.
5.8 T h e Policy shall be void and all premium paid hereon shall be forfeited to the Company, in the event of misrepresentation, mis-
description or non-disclosure of any material fact.
5.9 Refund of premium for Overseas Mediclaim Policy (OMP)-If during the policy period the insured person is also covered under an
Overseas Mediclaim Policy (OMP) of any non-life insurance company, the policy will be inoperative in respect of the insured persons
for the number of days the OMP is in force and proportionate p r e m i u m f o r t h e n u m b e r o f d a y s t h e O M P w a s i n f o r c e s h a l l b e
refunded. The insured person must inform the company in writing before leaving and may submit an application, in respect of the
refund to the Company, stating the details of visit(s) abroad, along with copies of the OMP, within 30 days of expiry of the policy
5.10 If at the time when any claim arises under this Policy, there is in existence any other insurance (other than Cancer Insurance Policy
in collaboration with Indian Cancer Society), whether it be effected by or on behalf of any Insured Person in respect of whom the
claim may have arisen covering the same loss, liability, compensation, costs or expenses, the Company shall not be liable to pay or
contribute more than its rateable proportion of any loss, liability, compensation costs or expenses. The benefits under this Policy
shall be in excess of the benefits available under Cancer Insurance Policy.
5.12 Renewal Clause :
1. T h e C o m p a n y shall renew this policy if the insured shall remit the requisite premium to the Company prior to expiry o the
period of insurance stated in the schedule.
2. The Company shall be entitled to decline renewal if;
a . Any fraud, misrepresentation or suppression by the insured or on his behalf is found either in obtaining insurance or
subsequently in relation thereto or,
b . The Company has discontinued issue of the policy, in which event the insured shall however have the option for renewal
under any similar policy being issued by the company, provided however benefits payable shall be subject to the terms
contained in such other policy.
3. I f t h e insured fails to remit premium for renewal before expiry of the period of insurance, but within 30 days thereafter,
admissibility of any claim during the period of subsequent policy shall be considered in the same manner as under a Policy
renewed without break. The Company however shall not be liable for any claim arising out of ailment suffered or hospitalisation
commencing in the interim period after expiry of the earlier policy and prior to date of commencement of subsequent policy.
5.13 ENHANCEMENT OF SUM INSURED
The insured may seek enhancement of Sum Insured in writing at or before payment of premium for renewal, which may be granted
at the discretion of the Company. However, notwithstanding enhancement, for claims arising in respect of ailment, disease or injury
contracted or suffered during a preceding policy period, liability of the company shall be only to the extent of the Sum Insured under
the policy in force at the time when it was contracted or suffered during the currency of such renewed policy or any subsequent
renewal thereof.
Any such request for enhancement must be accompanied by a declaration that the insured or any other insured person in respect of
whom such enhancement is sought is not aware of any symptoms or other indications that may give rise to a claim under the policy.
The Company may require such insured person/s to undergo a Medical examination to enable the company to take a decision on
accepting the request for enhancement in the Sum Insured. 50% of the cost of the Medical examination will be reimbursed to the
insured person on acceptance of the request for enhancement of sum insured.
5.14 Cancellation Clause :
The Company may at any time cancel the Policy on grounds of misrepresentation, fraud, non-disclosure of material fact or non-
cooperation by the insured by sending fifteen days notice in writing by Registered A/D to the insured at his last known address in
which case the Company shall return to the insured a proportion of the last premium corresponding to the unexpired period of
i n s u r a n c e i f n o c l a i m h a s b e e n p a i d u n d e r t h e p o l i c y . T h e i n s u r e d m a y a t a n y time cancel this policy and in such event the
Company shall allow refund of premium at Company's short period rate table given below provided no claim has occurred upto the
date of cancellation.
PERIOD ON RISK RATE OF PREMIUM TO BE CHARGED.
Upto one month 1/4 th of the annual rate
Upto three months 1/2 of the annual rate
Upto six months 3/4 th of the annual rate
Exceeding six months Full annual rate.
POLICY NO.: 0825002817P113288533
5.15 I f a n y dispute or difference shall arise as to the quantum to be paid under the policy (liability being otherwise admitted) such
difference shall independently of all other questions 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 30 days of any party invoking 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 dispute/difference
and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the
provisions of the Arbitration and Conciliation Act, 1996.
It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the
Company has disputed or not accepted liability under or in respect of this Policy.
It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy
that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.
5.16 I f t h e Company, as per terms and conditions of the policy or 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 or receipt of the notice of such disclaimer notify the
TPA/ Company in writing that he does not accept such disclaimer and intends to recover his claim from the TPA/Company then the
claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.
5.17 All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in
Indian Currency.
6 PAYMENT OF CLAIM
All claims under this policy shall be payable in Indian currency. All medical/surgical treatments for the purpose of this insurance will have to
be taken in India only. Payment of claim shall be made through TPA to the Hospital/Nursing Home or the Insured Person as the case may
be.
Upon acceptance of an offer of settlement, the payment of amount due shall be made within 7 days from the date of acceptance of offer
by the Insured. In the cases of delay in the payment, the insurer shall be liable to pay interest at a rate which is 2% above the bank rate
prevalent at the beginning of the financial year in which the claim is reviewed by it.
7 Free Look Period - The policy have a free look period which shall be applicable at the inception of the policy and;
i The insured will be allowed a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of
the policy and to return the same if nor acceptable.
ii If the insured has not made any claim during the free look period, the insured shall be entitled to -
a. A refund of the premium paid less any expenses incurred by the insurer on medical examination of the insured persons and the
stamp duty charges or
b. W h e r e t h e r i s k h a s already commenced and the opinion of return of the policy is excercised by the policybolder, a deduction
towards the proportionate risk premium for period on cover or;
c. Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such
period
8. COST OF HEALTH CHECK UP
The insured s h a l l b e e n t i t l e d f o r a r e i m b u r s e m e n t o f t h e c o s t o f M e d i c a l c h e c k - u p o n c e a t t h e e n d o f b l o c k o f e v e r y t h r e e
underwriting years provided there are no claims reported during the block and subject to the policy being renewed without break.
The amount of such reimbursement shall be limited to 1% of the average sum insured for the preceding three policy periods.
9. IRDA REGULATIONS : This policy is subject to Regulations of IRDA (Protection of Policyholders'Interest) Regulations 2002 as
amended from time to time.
10. GRIEVANCE REDRESSAL : In the event of the policyholder having any grievance relating to the insurance, the insured person
may submit in writing to the Policy Issuing Office or Grievance cells at Regional Office of the Company for redressal. If the
grievance remains unaddressed, the insured person may contact the Officer, Uni-Customer Care Department, Head Office.
11. OMBUDSMAN
The Insured person can also approach the office of Insurance Ombudsman of the respective area/region for redressal of
grievance.The updated list of Office of Insurance Ombudsman are available on IRDA website www.irda.gov.in a n d o n t h e
website of General Insurance Council www.gicouncil.in
POLICY NO.: 0825002817P113288533
12. IMPORTANT NOTICE
1 The Company may revise any of the terms, conditions and exceptions of this insurance including the premium payable on renewal in
accordance with the guidelines/rules framed by the Insurance Regulatory and Development Authority (IRDA) and after obtaining prior approval
from the Authority. We shall notify you of such changes at least three months before the revision are to take effect.
2 The Company may also withdraw the insurance as offered hereunder after following the due process as laid down by the IRDA and after
obtaining prior approval of the IRDA and we shall offer to cover you under such revised/new terms, conditions, exceptions and premium for
which we shall have obtained prior approval from the Authority.
*************
POLICY NO.: 0825002817P113288533

HEAD OFFICE
CUSTOMER INFORMATION SHEET

Description is illustrative and not exhaustive
S.No. TITLE DESCRIPTION REFER TO POLICY
CLAUSE NO.
1 Product Individual Health Insurance Policy - Platinum
Name
2 What am I a. In Patient Hospitalisation - Expenses for hospitalization more than 24 hours

covered for subject to following limits -
i. R o o m , Boarding and Nursing Expenses including RMO charges, 1.2A

IV fluids/Blood Transfusion/Injection administration charges -
1 % o f S u m I n s u r e d p e r day or actual expenses whichever is
less.
ii. ICU - 2% of SI per day or actual expenses whichever is less. 1.2B
iii. Surgeon fees, Anesthetist, Medical Practitioners, Consultants, 1.2C

Specialist's fees, etc.
iv Anaesthesia, Blood, Oxygen, Operation Theatre Charges,

Surgical appliances, Medicines & drugs, Dialysis, Chemotherapy,
Radiotherapy, cost of Artificial limbs, cost of prosthetic devices
1.2D
implanted during surgical procedure viz. Pacemaker, Orthopaedic
implants, infra cardiac valve replacements, vascular stents,
relevant diagnostic tests.
b. Day care Procedures - Listed in the policy which require less than 24 hours 2.2
hospitalization.
c. Ayurvedic Treatment is covered only if taken in Government Hospital or any 2.3

institution recognized by Government/accreditated by QCI/National
Accreditation Board on Health
Add-on covers
d. Ambulance charges upto maximum of Rs.2500/- per policy period on

payment of additional premium of Rs.100/-
e. Hospital daily cash benefit of Rs.250/500 per day subject to max. o f

2500/5000 per hospitalization on payment of additional premium o f
Rs.150/300.
3 What are the a. Congenital diseases (Internal and External) 4.1

major
exclusions in b. Domiciliary treatment, treatment outside India 4.2
the policy
c. War and warlike operations 4.3
d. Circumcision, vaccination and plastic surgery unless forming part of 4.4

treatment and requires hospitalization.
e. Spectacles, contact lens and hearing aids 4.5
f. Dental treatment unless arising due to an accident 4.7

POLICY NO.: 0825002817P113288533
g. HIV, AIDS and sexually transmitted diseases 4.8
h. Any hospitalization primarily for investigation/diagnostic purposes. 4.9
i. Vitamins, tonics unless necessitated for treatment 4.11
j. Pregnancy and related disorders 4.12
k. Naturopathy and Experimental treatment 4.13
l. External Medical equipments 4.14
m. Treatment for Genetic disorders and stem cell therapy. 4.15
n. Change of system of treatment or medicine 4.16
o. ARMD, RFQMR and EECP treatment 4.17
p. Non-Medical e x p e n s e s 4.18
q. Any kind of service charges, admission fees/registration charges
(Note : the above is a partial listing of the policy exclusions. Please refer to the policy
clauses for the full listing)
4 Waiting Nil
period
5 Payment a. Reimbursement of covered expenses up to specified limits

basis
b. Cashless payment of covered expenses upto specified limits in Network

Hospitals.
c. In cities where PPN Network is available, cashless will be restricted to PPN and
claim payments as per agreed tariff.
6 Cost sharing In case of a claim, this policy requires you to share the following costs :
a. Expenses exceeding the following Sub-limits
i. Room /ICU charges beyond 1% of Sum Insured per day or beyond 1.2 A & B
2% of Sum Insured per day for ICU charges.
7 Renewal The policy can be renewed annually throughout the lifetime of the insured. 5.12
condition
In the event of break in the policy a grace period of 30 days is allowed. 5.12.3
Enhancement of sum Insured at renewal will be considered at the discretion of the 5.13
Company.
8 Renewal Expenses of Health check-up will be reimbursed once at the end of every three 8
benefits continuous years of insurance provided no claims are reported during the block upto 1%
of average sum insured of previous three policies
9 Cancellation The policy would be cancelled and no claim or refund would be due to you if : 5.14
a .you have not correctly disclosed details about your current and past health
status or
b .have otherwise encouraged or participated in any fraudulent claim under the
policy.
10 Special At least 15 days from the issuance of first policy would be given as free-look period to 7
condition and the insured to review the terms and conditions
special
benefit
POLICY NO.: 0825002817P113288533
LEGAL DISCLAIMER
The information must be read in conjunction with the product brochure and policy document. In case of any conflict between
the Customer Information sheet and policy document the terms and conditions mentioned in the policy document shall
prevail.
For details, please refer to policy clauses for full details.

POLICY NO.: 0825002817P113288533
UIN NO. IRDA/NL-HLT/UII/P-H/V.I/228/13-14.

DIVISIONAL OFFICE III - 082500, 118/90, GUMTI PLAZA, KAUSHALPURI,, ,
KANPUR URBAN - 208012 UTTAR PRADESH
PH: (512) 2224681 FAX: (512) 2218677 EMAIL:
Premium Certificate for the purpose of deduction under Section 80-D of Income Tax (Amendment) Act, 1986.
This is to certify that MR. RAJ K NOTANI has paid 13,268.00 ( Thirteen thousand two hundred sixty-eight rupees only) towards Premium
for INDIVIDUAL HEALTH POLICY for the period from 00:00 hrs On 20/12/2017 To Midnight of 19/12/2018
Policy No: 0825002817P113288533
For and On behalf of

United IndiaInsurance Co. Ltd.
Place: DO 3 KANPUR 082500
Date:26/02/2020 5:02:36 PM Authorised Signatory
NOTE: This Certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation of the policy
or any alteration in the Insurance affecting the premium.
REGD. & HEAD OFFICE, 24, WHITES ROAD, CHENNAI - 600014

Website: http://www.uiic.co.in, Email - info@uiic.co.in

Individual Health Insurance Renewal

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Individual Health Insurance Renewal

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( DUPLICATE )

UNITED INDIA INSURANCE COMPANY LIMITED

INDIVIDUAL HEALTH INSURANCE POLICY

Agent Name : MANOJ KUMAR ANSHWANI

INDIVIDUAL HEALTH INSURANCE POLICY

Coinsurance UIIC 082500 : 100%

Details of the Persons Covered

Total Basic Premium : 17458 Family Discount : 698.32 Premium : 13,268.00

Customer GST/UIN No.: Office GST No.: 09AAACU5552C1ZH

Date of Proposal and Declaration: 20/12/2017

For and On behalf of

Name of TPA M/s Raksha TPA Pvt. Ltd.

UNITED INDIA INSURANCE COMPANY LIMITED

UIN NO. IRDA/NL-HLT/UII/P-H/V.I/228/13-14

HEALTH INSURANCE POLICY - GOLD

The above limits specified are applicable per hospitalisation / surgery.

1.2.2 P r e & P o s t H o s p i t a l i s a t i o n i n r e s p e c t o f e a c h--- Actual expenses incurred subject to m a x i m u m o f 1 0 % o f S u m I n s u r e d

i) Expenses incurred for pre and post hospital treatment and

MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS

3.3 ALTERNATIVE TREATMENT

3.7 CONDITION PRECEDENT

3.19 IN-PATIENT CARE

3.29 PRE-EXISTING DISEASE

4.7 Cost of spectacles, contact lenses and hearing aids.

4.21 A n y k i n d o f Service charges, Surcharges, Admission Fees/Registration Charges, Luxury tax a n d s i m i l a r c h a r g e s l e v i e d b y t h e

5.12 ENHANCEMENT OF SUM INSURED

UNITED INDIA INSURANCE COMPANY LIMITED

CUSTOMER INFORMATION SHEET

i. R o o m , Boarding and Nursing Expenses including RMO charges, IV 1.2A

ii. ICU - 2% of SI per day or actual expenses whichever is less. 1.2B

iii. Surgeon fees, Anesthetist, Medical Practitioners, Consultants, 1.2C

iv Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical

d. Ayurvedic Treatment is covered only if taken in Government Hospital or any 2.3

e. Ambulance charges upto maximum of Rs.2500/- per policy period on

f. Hospital daily cash benefit of Rs.250/500 per day subject to max. o f

d . Spectacles, contact lens and hearing aids 4.8

e . Dental treatment unless arising due to an accident 4.8

f. HIV, AIDS and sexually transmitted diseases 4.10

g . Any hospitalization primarily for investigation/diagnostic purposes. 4.11

h . Vitamins, tonics unless necessitated for treatment 4.12

i. Pregnancy and related disorders 4.14

j. Naturopathy and Experimental treatment 4.15

l. Treatment for Genetic disorders and stem cell therapy. 4.17

m .Change of system of treatment or medicine 4.18

n ARMD, RFQMR and EECP treatment 4019

p Any kind of service charges, admission fees/registration charges 4.21

b . Waiting period of 48 months for Pre-existing disease. 4.1

Two years waiting period

Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or 4.3

Four years waiting period

Joint replacement due to degenerative condition, age related Osteoarthritis or 4.4

5 Payment basis a . Reimbursement of covered expenses up to specified limits

b . Cashless payment of covered expenses upto specified limits in Network Hospitals.

a. Expenses exceeding the following Sub-limits

iii. Other sub-limits 1.2.1

Enhancement of sum Insured at renewal will be considered at the discretion of 5.12

b. have otherwise encouraged or participated in any fraudulent claim under the

For details, please refer to policy clauses for full details.

UNITED INDIA INSURANCE COMPANY LIMITED

UIN NO. IRDA/NL-HLT/UII/P-H/V.I/228/13-14

HEALTH INSURANCE POLICY - PLATINUM

1. Adenoidectomy 13. Radiotherapy 24. Inguinal/ventral/ Umbilical/femoral hernia

MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS