UNITED INDIA INSURANCE COMPANY LIMITED

REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
Health Department
Head Office,
19, IVth Lane, Nungambakkam High Road
All ROs /LCBs /DOs / BOs / MOs
Chennai – 600 034

Phone: +91 44 28575401

HO: HEALTH: CIR: 13:2021-22 16th February 2022

SUPER TOP-UP MEDICARE POLICY- REVISED

UIN: UIIHLIP22187V032122

Underwriting Guidelines and Administrative Instructions

1. Eligibility
The Policy provides cover on an Individual or Family Floater basis. A separate Sum Insured for each Insured
Person is provided under Individual basis while under Family Floater basis, the Sum Insured limit is shared
by the whole family of the Insured as specified in the Policy Schedule and our total liability for the family
cannot exceed the Sum Insured in a Policy period.
Any person aged between 18 years and 65 years can take this insurance for himself and his/her family
consisting all or either of :
i. Self, Spouse, dependent children, Parents and Parents-in-law on Individual Sum Insured basis; or
ii. Self, Spouse and dependent children on floater basis.
Beyond 65 years, only renewals are allowed.
Dependent children between the age of 91 days and 18 years shall be covered provided either or both
parents are covered concurrently. Children above 18 years will continue to be covered along with parents
till the age of 26 years, provided they are unmarried/unemployed and dependent. The upper age limit will
not apply to mentally challenged children. In the event of children becoming independent, employed,
getting married, or attaining age above 26 years, a separate policy can be taken on expiry of the current
policy for which continuity benefits will be provided.
Midterm inclusion of family members is allowed at pro-rata premium only in case of:
i. Newly married spouse within 60 (sixty) days of marriage.
ii. New born baby, between the ages of 91 days to 180 days, born to mother, insured under the policy
or the adopted child between the ages of 91 days to 18 years within 60 (sixty) days of date of
adoption.
Please note the following for clear understanding:
A. Super Top-Up Medicare Policy (STUMP) proposals can be accepted, subject to these guidelines, even
if :
a. there is no base policy (the normal health policy without any threshold/deductible).
b. there is a base policy with Sum Insured lesser or higher than the threshold limit opted for
STUMP.
c. the base policy is a group health policy or a bancassurance policy
d. there is base policy (retail/ group/ bancassurance) with another insurer.
e. There is another Super Top-Up/ deductible based policy taken by the proposer.

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 UNITED INDIA INSURANCE COMPANY LIMITED
REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
B. STUMP proposals can be accepted on floater basis even if the base policy is on non-
floater/Individual Sum Insured basis. Similarly, they can be accepted on non-floater basis even if the
base policy is on floater basis.
C. The annual policy period need not necessarily be the same for STUMP as compared to the policy
period for the Base Policy e.g. the STUMP can be issued for a period from 01.03.2022 to 28.02.2023
even if the base policy is running for a period from 01.10.2021 to 30.09.2022.
However, it will be administratively convenient, both for underwriting as well as for claims, if the
policy period coincides.

2. Date of Introduction:
a. Date of Introduction of the revised Super Top-Up Medicare Policy (STUMP) is 1st March 2022;
b. All Fresh policies to be underwritten under the revised Product with effect from (w.e.f.) 1st March
2022. In case of Renewals, they may be underwritten under the revised product w.e.f. 1st March
2022, if opted by policyholder and w.e.f. 30th May 2022 compulsorily.
c. There will be a notice period of 90 (ninety) days from the date of launch i.e. from 1st March 2022 to
29th May 2022, during which the existing customers will have the option to either continue with the
existing premium rates and policy conditions or opt for new premium rates and new policy
conditions.
d. After this notice period is over on 29th May 2022, all the customers opting for Super Top-Up
Medicare Policy will be automatically covered with the new policy conditions at revised premium
w.e.f. 30th May 2022.

3. Underwriting Acceptance Limit:

All operating offices except Micro Offices: Up to Maximum Sum Insured.
Micro Offices shall be allowed to accept fresh proposals, including those for renewals with enhancement in
Sum Insured, as per the following combination of Threshold limit and Sum Insured:
THRESHOLD LIMIT SUM INSURED
5 Lacs 5 Lacs, 10 Lacs
10 Lacs 10 Lacs, 15 Lacs
15 Lacs 15 Lacs

Any proposals including any renewal where enhancement of Sum Insured is sought beyond above shall be
escalated to the In-charge of controlling Divisional Office for underwriting decision. However, they may
renew all existing policies without an enhancement in Sum Insured irrespective of the existing threshold/
Sum Insured.

4. TPA Option:
All policies to be serviced by TPAs only. The customer should be provided with the choice of TPA from
amongst the TPAs mapped with the underwriting office. TPA change request can be considered only at the
time of renewal.
As far as possible, for administrative convenience, the TPA for STUMP should be the same as for the base
policy, if it is issued by us.
TPA charges payable will be at the rate of 1.5% of the net premium.

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REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
5. Threshold and Sum Insured:
a. Various options for Threshold and Sum Insured combination are available for fresh policies as under:
THRESHOLD LIMIT SUM INSURED
5 Lacs 5 Lacs, 10 Lacs, 15 Lacs, 20 Lacs, 45 Lacs, 70 Lacs, 95 Lacs
10 Lacs 10 Lacs, 15 Lacs, 20 Lacs, 40 Lacs, 65 Lacs, 90 Lacs
15 Lacs 15 Lacs, 35 Lacs, 60 Lacs, 85 Lacs
20 Lacs 20 Lacs, 30 Lacs, 55 Lacs, 80 Lacs
25 Lacs 25 Lacs, 50 Lacs, 75 Lacs

b. The following Threshold and Sum Insured Combination are not available anymore for fresh proposals:
THRESHOLD LIMIT SUM INSURED
2 Lacs 2 Lacs, 3 Lacs
3 Lacs 3 Lacs, 5 Lacs, 7 Lacs
However, the renewal of such combinations will be allowed.
c. Existing policyholders with Threshold and Sum Insured Combination of erstwhile policy shall be allowed
to renew the policies for the same Threshold and Sum Insured Combination. However, if they choose to
change their Sum Insured, then they can move to new Threshold and Sum Insured Combination options
only.
d. In case of policies issued on Individual Sum Insured basis, different Sum Insureds can be opted for
different members of the family provided that the Sum Insured for other family members should be
equal to or less than the Sum Insured of Proposer cum Primary Insured Person. In case the Proposer is
not insured under the policy, the Sum Insured for other family members should be equal to or less than
the Sum Insured of the Insured Person with the highest age.

6. Change in Cover Type:

a. The cover type can be changed at the Proposer’s request at the time of renewal only from Individual
Sum Insured basis to Family Floater basis as per the new threshold/ Sum Insured combinations only.
b. However, no change will be allowed for conversion from the policy on family floater basis to that on
individual Sum Insured basis except:
i. when only one person remains in the floater policy at the time of renewal or
ii. when a child becomes independent or married and can no more be covered under the same
family floater policy with his/her parents.
Illustration for Conversion of Family Floater Policy type to Individual SI Basis policy type :
Previous Year’s Sum Event New Policy Sum Insured
Family Composition Insured
Self + Spouse Rs. 5 Lacs Death of Spouse Rs. 5 Lacs for Self
Self + Child Rs. 10 Lacs Child attaining Rs. 10 Lacs for Self; Rs. 10 Lacs for Child
age of 27
Self + Spouse+ Child Rs. 7 Lacs Child aged 23 got Rs. 7 Lacs for Child alone.
employed Self + Spouse will continue under Family Floater Policy type
with SI Rs. 7 Lacs

c. The Sum Insured can be enhanced also during such conversions in policy type at the time of renewal,
subject to guidelines in section 12 ‘Change in Sum Insured’ below. For any increase in Sum Insured,
the waiting period shall start afresh only for the enhanced portion of the sum insured.

7. Premium rates:
a. Premium payable annually– As per Premium Table attached.

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REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
b. Premium can be paid online for both, new policy and renewals.
c. In case of policies issued on Individual Sum Insured Basis, 5% family discount will be allowed if more
than one persons of a family are covered.
d. Online Discount: A discount of 10% will be applicable for fresh policies purchased online through the
Company’s website. For renewals, the same discount of 10% shall be offered provided the original policy
was purchased either directly from our office without any intermediary or online through the
Company’s website and all subsequent renewals are only made through the Company’s website.
e. Staff Discount: A Discount of 15% is applicable for fresh and renewal policies purchased directly from
office without any intermediary for all the employees and retired employees of United India Insurance
Co. Ltd.

8. Underwriting Loading for Pre-existing Conditions-

This policy now comes with the provision for loading for pre-existing conditions.
A risk loading on the premium payable (excluding statutory levies & taxes) based on Insured Person’s health
status shall be applied, if the proposal is accepted at the time of underwriting. Loadings shall be applied
from Inception Date of the first Policy including subsequent renewal(s).
The loadings are applicable on individual ailments only. In case of loading on two or more ailments, the
loadings shall apply in conjunction on additive basis. In case of floater policies, where more than one
individual have applicable loading for pre-existing condition, the highest of the total loading of the
individuals irrespective of age, shall be applied.
Details of applicable loadings by ailments/ condition are listed as under:
S.No. List of Acceptable Conditions Applicable
(subject to other co-existing conditions) Underwriting
Loading (%)
1 Haemolytic Anaemia 10
2 Asthma 10
3 Renal Stones 10
4 Diabetes Mellitus 20
5 Hypertension 20

Note:
1. The application of loading does not mean that the illness/ condition, for which loading has been applied,
would be covered from inception. Any waiting period as mentioned in the policy shall be applied on
illness/condition, as applicable.
2. For existing customers of Super Top-Up Medicare Policy as on 28th February 2022, these loadings need
not be applied even if they are affected with these conditions and even if Sum Insured enhancement is
also considered.

8.1 Illustration of PED Loadings:

Fresh Business (Individual SI basis): Loading as % of Premium
Relationship Haemolytic Asthma Renal Stones Diabetes Hyper- Total for
Anaemia mellitus tension Individual
Self 10 No such PED 10 20 20 60
Spouse 10 No such PED 10 No such PED No such PED 20
Child 1 No such PED 10 No such PED No such PED No such PED 10
Child 2 10 No such PED No such PED No such PED No such PED 10

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 UNITED INDIA INSURANCE COMPANY LIMITED
REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
Fresh Business (Floater basis):
Relationship Haemolytic Asthma Renal Stones Diabetes Hyper- Total
Anaemia mellitus tension
Self No such PED No such PED No such PED 20 20 40
Spouse 10 No such PED 10 No such PED No such PED 20
Child 1 No such PED 10 No such PED No such PED No such PED 10
Child 2 10 No such PED No such PED No such PED No such PED 10

9. Proposal Form:
The revised STUMP proposal form only has to be used for all fresh proposals. The underwriter shall ensure
that the proposal form is complete in all respects including photographs and contact details and then
carefully scrutinize it along with the pre-acceptance check-up reports, if any, and use the information
provided therein to decide about acceptance of risk.

The proposal form with all attachments as mentioned above must be preserved carefully till completion of
five years after the last renewal of policy with us. A scanned copy of the same should also be shared with
the TPA servicing the policy. We are arranging for solution for streamlining this process. Till that happens,
the policy issuing office shall do so physically.

The mobile phone number and email address facilitate faster and effective communication at low cost and
hence all efforts should be made to accurately capture these. Similarly, an effort towards capturing proof of
address and other identification details help in checking possible cases of impersonation at the time of claim.

The underwriter shall process the proposals with speed and efficiency and the decision on the proposal
thereof, shall be communicated in writing to the proposer within a reasonable period but not exceeding 15
days from the date of receipt of proposals or any requirements called for.

Age proof must be obtained for the Proposer and all Insured Persons as age is one of the primary
underwriting criteria and has impact on premium also. Aadhaar Card serves the dual purpose of age-proof
as well as address-proof and hence need to be emphasised upon. PAN details must be submitted by the
Proposer.

10. Pre-Acceptance Medical Check–up:

i. A person may need to undergo pre-acceptance medical check-up as specified in 10.iii below, if he has
an adverse medical history as revealed from the proposal form or from the claims record in case of our
own renewals.
ii. Adverse Medical History for a person means:
 more than two Hospitalisation occurred in the previous two years except for hospitalisations for
vector-borne, air-borne and water-borne diseases with hospitalisations less than 5 days,
 he/she is suffering from Critical Illness, Recurring Illness or Chronic Illness.
 he/she is suffering from Hypertension, Diabetes, Chest Pain or Coronary Insufficiency or Myocardial
Infarction.
 he/she is not in good health and is not free from Physical and mental diseases or infirmity or medical
complaints.
iii. The pre-acceptance health check-up reports as detailed below have to be submitted in the following
cases with adverse medical history:
a. Fresh Entrants less than 55 years with a proposed threshold limit of less than Rs. 10 Lacs

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REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
b. Fresh Entrants => 55 years with a proposed threshold limit of less than Rs. 15 Lacs
c. Renewals seeking enhancement of Sum Insured: Persons less than 55 years with Combined present
Sum Insured under base policy and Super Top-Up Policy less than Rs. 10 Lacs
d. Renewals seeking enhancement of Sum Insured: Persons less than 55 years with proposed threshold
limit of less than Rs. 10 Lacs
e. Renewals seeking enhancement of Sum Insured: Persons => 55 years of age, with Combined present
Sum Insured under base policy and Super Top-Up Policy less than Rs. 15 Lacs
f. Renewals seeking enhancement of Sum Insured: Persons => 55 years of age with proposed threshold
limit less than Rs. 15 Lacs
Note: If the medical check-up requirement is coming as ‘No’ based on any of the sub-clauses above, no
pre-acceptance health check-up is required even if it is ‘Yes’ according to another sub-clause.
Illustration for c, d, e & f:
Age of insured Existing Existing Sum Proposed Proposed Sum Whether Medical
person Threshold Limit Insured Threshold Limit Insured Check-up required

50 2 Lacs 3 Lacs 5 Lacs 5 Lacs Yes

50 3 Lacs 5 Lacs 5 Lacs 5 Lacs No
50 3 Lacs 5 Lacs 10 Lacs Any SI Option No
50 3 Lacs 7 Lacs 5 Lacs Any SI Option No
55 3 Lacs 5 Lacs 10 Lacs Any SI Option Yes
55 3 Lacs 7 Lacs 15 Lacs Any SI Option No

Required Health Check-up Reports:

Wherever the underwriting decision, as per the guidance provided under Annexure 1, rests at the Policy
Underwriting Office, following tests are required:

Physical examination (report to be signed by the Doctor

Serum Creatinine
with minimum MD/MS qualification)
CBC SGOT & SGPT
Urine Routine & Microscopic ECG
HbA1c (Glycosylated Haemoglobin) Stress Test if necessitated.
Lipid Profile Any other investigation required by the company

In case the proposal needs to be referred to RO as per Annexure 1, the relevant further information and/ or
the required investigation reports shall be as advised by the Health Department of the concerned R.O.

The date of medical reports should not exceed thirty (30) days prior to the date of the proposal.

The cost of this check–up will be borne by the proposer. But if the proposal is accepted, then 50% of the
cost of this check–up will be reimbursed to the proposer. Pre–acceptance medical check–up shall be
conducted at designated centres authorized by Us.

11. Proposal Evaluation:

For every proposer, the detailed proposal form is sought to collect all possible information necessary to
evaluate the risk.

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REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
The guidelines in Annexure 1 shall be used to decide about acceptance or rejection of the proposal.

The Underwriter may accept or reject the proposal based on these guidelines. In case a proposal is escalated
to R.O. Health Department, the same should be evaluated by Company Doctor posted at/ mapped with the
R.O. and the decision regarding acceptance or rejection must be conveyed over mail within 3 days of receipt
of such proposal at R.O. We shall provide additional guidelines to RO Health Underwriters/ Doctors for
helping with the underwriting decision.

Please note that the information elicited from the proposer (in the proposal form and any additional
information provided) forms the basis of risk acceptance. Any wrong answer / lack of answer / incorrect
answer shall have the impact of misrepresentation thus invalidating the policy (if accepted based on such
misrepresentation). Where, in case of a risk which has been accepted, it is subsequently ascertained that
the proposer has divulged incorrect information or has refrained from divulging correct / adequate
information, this policy shall not be binding on the insurer.

In health insurance, the underwriting is done at the inception of policy only and thus all care should be
taken while accepting the proposals and underwriter should refrain from issuing policies to persons
suffering with adverse conditions as mentioned in these guidelines. Proposals for persons suffering with
pre-existing disease/ conditions, if accepted after due application of mind by the underwriter after pre-
acceptance medical check-up with applicable loading, must carry a brief acceptance note with reference to
Annexure 1.

12. Change in Sum Insured:

The Insured member can apply for change (Increase/ Decrease) of Sum Insured at the time of renewal by
submitting a fresh proposal form to the company. The request shall be processed by the Underwriter as per
these underwriting guidelines as amended from time to time. Any such request for increase of Sum Insured
must be accompanied by a health declaration for the Policyholder or other Insured Persons giving their
respective complete current health status. 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.

All waiting periods as defined in the Policy shall apply for the incremental portion of the Sum Insured from
the effective date of enhancement of such Sum Insured considering such Policy Period as the first Policy
with the Company.

Enhancement of Sum Insured shall not be considered for:

a. Any proposal which is liable to be rejected for fresh acceptance as per these guidelines.
Example:
A proposal form for renewal with enhancement in Sum Insured is received with a history of ‘Hepatitis
B or C’:
Underwriting Decision: The request for enhancement in Sum Insured shall be rejected as the guidance
provided in Annexure 1 prescribes straight decline of any fresh proposal with a history of ‘Hepatitis B
or C’.
Wherever, the fresh acceptance is required to be escalated to the RO Underwriter/ Doctor for
underwriting decision, the request for enhancement in Sum Insured shall also be escalated.

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b. More than three Hospitalisation in the preceding two years except for treatment of vector-borne,
air-borne and water-borne diseases with hospitalisations less than 5 days.
In cases where enhancement is considered after taking into account parameters as in 12.a and 12.b above ,
enhancement may be allowed by Underwriter after checking the claim history under our Super Top-Up
Medicare policy (STUMP) as per the rules laid down in the following table:

Enhancement Permitted:
All figures Rs. in Lacs
Current On Renewal
Threshold Sum Insured Claim Status under STUMP in Threshold Sum Insured
Limit previous two years Limit
2 2,3 No claim 5 Upto 95
2 2,3 Claim due to a disease other than 5 Upto 95
those as per Straight Decline list
in Part A- Annexure 1
3 3,5,7 No claim 5 Upto 95
3 3,5,7 Claim due to a disease other than 5 Upto 95
those as per Straight Decline list
in Part A- Annexure 1
5 5,10,15,20, No claim Equal to or Upto the maximum SI available for that
more than 5 combination
45,70
5 5,10 Claim due to a disease other than Equal to or Upto the maximum SI available for that
those as per Straight Decline list more than 5 combination
in Part A- Annexure 1
5 or above Above 10 No claim Equal to or Upto the maximum SI available for that
more than 5 combination
5 or above Above 10 Claims due to a disease other than Equal to or Upto the maximum SI available for that
those as per Straight Decline list in more than 5 combination
Part A- Annexure 1

13. Grace Period:

A grace period of 30 days is allowed for renewals of the policy. However, any claim occurring during the
grace period/break cannot be considered. Policies renewed within the grace period shall be treated as
“Continuous” renewal. Policies renewed after the grace period will be treated as fresh.
In case of requests for extension of grace period beyond 30 days, please refer to the instructions issued vide
Circular no. HO/ Cir/ Health/ UW/ 24/ 2020-21 dated 10th February, 2021 or any subsequent amendments
thereof.

14. Renewal:
The policy can ordinarily be renewed annually throughout the lifetime of the Insured Person by mutual
consent. All care should be taken to send the renewal notice well in time though the Company is not rule-
bound to do so.
Renewal should not be rejected arbitrarily on grounds other than any non-cooperation, fraud,
misrepresentation or suppression by the insured or on his behalf either in obtaining insurance or
subsequently in relation thereto. Renewal shall not be denied on the ground that the Insured had made a
claim or claims in the preceding policy years.

15. Migration & Portability:

The Insured Person will have the option to port the policy to other Insurers as per IRDAI guidelines related
to portability. If a person is presently covered and has been continuously covered without any lapses under

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any Top-up (Polices issued with deductible) health insurance policy with an Indian General/Health Insurer,
he may apply for portability to STUMP and in that case, if accepted, the Insured Person will get the accrued
continuity benefits in waiting periods as per IRDAI guidelines on portability to Our Company. In all such
cases, the proposal form must be collected with Annexure C duly filled in. All such portability applications
are subject to Underwriting as per these guidelines.
All port-in requests should be approved by RO Health underwriter after ensuring acceptability of the
proposal based on these guidelines.
The Insured Person will have the option to migrate the policy to other health insurance products/plans with
deductible (Top-Up) offered by the company by applying for migration of the policy at least 30 days before
the policy renewal date as per IRDAI guidelines on Migration. lf such person is presently covered and has
been continuously covered without any lapse under any such Top-Up health insurance product/plan offered
by the Company, the Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI
guidelines on migration to STUMP as per IRDAI guidelines. For Detailed Guidelines on migration, kindly refer
the link:
https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1

16. Nomination:
The Proposer/Primary Insured is mandatorily required at the inception of the policy to make a nomination
for the purpose of payment of claims under the policy in the event of death of the insured. Any change of
nomination shall be communicated to the company in writing and such change shall be effective only when
an endorsement on the policy is made.

17. Free-Look Period:

The Free Look Period shall be applicable on new Super Top-Up Medicare policies and not on renewals or at
the time of porting/migrating the policy. The Insured Person shall be allowed free look period of fifteen days
from date of receipt of the policy document to review the terms and conditions of the policy, and to return
the same if not acceptable. lf the insured has not made any claim during the Free Look Period, the insured
shall be entitled to refund as per Policy Terms.

18. Rejection:
Insurance is a subject matter of solicitation. While any person may seek insurance under any policy, the
insurer may decide to accept or reject the proposal based on objective criteria. The underwriting office may
call for the medical tests before making the decision for underwriting.
Further, in accordance with the IRDAI Health Regulations, 2016, a denial of a proposal shall be
communicated to the prospect in writing, by recording the reasons for denial.

19. Agency Commission/ Intermediary Charges – 15% of premium

(Sanjay Joshi)
Deputy General Manager

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Annexure 1
Part A:
Straight Decline List
System Diseases
Heart failure
Rheumatic Heart Disease/ Ischemic Heart Disease
Cardiovascular Valvular Heart Disease : Mitral Regurgitation / Aortic Regurgitation /
Pulmonary Regurgitation
Atrial Septal Defect/ Ventricular Septal Defect/ Patent Ductus Arteriosus
Arrhythmias, Heart Block
Pericarditis / Myocarditis/ Endocarditis
Cardiomyopathy
Leukemia
Cancer Lymphoma
Sarcoma
Cerebro – Vascular Stroke
Encephalopathy
Brain abscess
Neuropathy/ Any neurological disease
Respiratory Pulmonary fibrosis
Interstitial lung disease (ILD)
COPD/ Chronic Bronchitis / Bronchiectasis
Pulmonary Hypertension
Emphysema
ARDS/Hyaline membrane Disease
Gastro Intestinal Hepatitis B or C
Portal Hypertension / Ascites
Chronic liver disease
Crohn's disease
Ulcerative colitis
Post Bariatric surgeries
Pancreatitis
Multiple Myeloma
Genito – Urinary Cervical Erosion
Dysplasia Cervix
Chronic Kidney Disease
Post Renal Transplant
Nephropathy: Nephritic Syndrome / Nephrotic Syndrome / Glomerulonephritis
Single Kidney / Contracted Kidney/Poly cystic Kidney Disease
Endocrinal Adrenal Disorders
Pituitary Disorders
Hydrocephaly
Neuropsychiatric Parkinson's Disease
Alzheimer’s Disease
Myasthenia gravis
Cerebral Palsy
Paralysis
Multiple Sclerosis
Musculo –Skeletal Kyphosis
Scoliosis
Oral Sub-mucosal fibrosis
Spina Bifida
Spinal Muscular Atrophy

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Musculo –Skeletal Degenerative Disorders
Eye Retinopathy
Vestibular Schwanoma
Others Major organ failure (Kidney, Liver, Heart, Lungs etc.)

Part B:
Medical Underwriting Parameters for New Proposals in Operating Offices
Question in Proposal Form
Height & Weight
Consume Tobacco (Smoking or
Chewing)
Last claim details
Answer
The information to be used to
calculate BMI (Body Mass Index)=
Weight(Kg)/Height(M2); (You may
use any online BMI Calculator)
Yes
Porting from Other Company/
Migrating from UIIC-other
deductible-based Health Product
with No Claim History
Porting from Other Company/
Migrating from UIIC- deductible-
based Health Product with Claim
History except for diseases/
conditions as per this Annexure in
previous two years
Underwriting Decision at
Operating Office
BMI:
 If <18 or >35: REJECT
 >32 upto 35,
Without any co-morbidity : Accept
With co-morbidity : REJECT
 Combined with diabetes/
hypertension or related condition:
REJECT
 Otherwise: Refer to RO
ACCEPT
ACCEPT

Porting from Other Company/ REJECT

Migrating from UIIC- deductible-
based Health Product with Claim
History for diseases as per Annexure
-
Porting from Other Company/ REJECT
Migrating from UIIC- deductible-
based Health Product with Claim
History- >2 Hospitalisation for same
ailment occurred in previous two
years
Good Health Declaration No Ask for details; Co-relate with detailed
Medical History
Psychiatric disorder Yes Refer to RO
Genetic Disorders Yes Refer to RO
Diabetes Mellitus Type 1 Refer to RO

Type 2- Non Insulin Dependent HbA1c 6-7: Accept with 20% Loading
HbA1c >7: REJECT
Type 2- Insulin Dependent REJECT

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Range Diastolic <65 and >100 REJECT
Hypertension Range Diastolic 65 and upto 90 ACCEPT
Range Diastolic >90 and upto 100 Accept with 20% Loading
Range Systolic upto 120 ACCEPT
Range Systolic > 120 upto 160 Accept with 20% Loading
Range Systolic > 160 REJECT
 Haemolytic Anaemia: Accept with
Blood Disorders Yes 10% loading
 Others: Refer to R.O.
Yes
Diseases of Cardiovascular
Refer to RO
system, Heart diseases
Yes  If Cancer- REJECT
Disease of Prostrate  Other than Cancer- ACCEPT
Disease of Fistula, Piles, Hernia, Yes ACCEPT
Varicose veins
Disease of bones/ joint Yes  If Cancer- REJECT
including rheumatic, slipped  Other than Cancer- ACCEPT
disc, injury to Ligaments
Paralysis /Spinal disorder REJECT
Yes  If Cancer- Refer to RO
Diseases of breast  Other than Cancer- Accept
Yes  Asthma Cases:
Accept with 10% loading
Respiratory or allergic disease  Other Cases:
If Cancer: REJECT
Other than Cancer: Refer to RO
Any disorder/ disease of the Yes  Renal Stones: Accept
stomach, Intestine, Liver, Gall If Cancer: REJECT
bladder, Pancreas, kidney,  Others: Refer to RO
Urinary Bladder, urinary Tract
Cancer, Pre-cancerous Lesion, Yes  If Cancer- REJECT,
boil, cyst or wound etc. of any  Others- Refer to RO
location other than specified
elsewhere in this annexure,
which does not heal or improve
despite treatment
Yes  Cataract &/or Glaucoma -
Cataract and other diseases of Accept
the eye  Others- Refer to RO
Yes  Tonsillitis/Sinusitis : ACCEPT
ENT diseases  If Cancer: REJECT
 Others : Refer to RO
Gynaecological disorder such as Yes  Caesarean delivery/
DUB, Fibroid Uterus, Ovarian Hysterectomy- ACCEPT
cyst - or have undergone  Others: Refer to RO
caesarean / Hysterectomy
Any other illness, disease, Yes Refer to RO
accident or surgery/ operation
sustained?
Any complaint that may Yes Refer to RO
necessitate treatment in the
future?
Epilepsy Accept with 10% Loading
Autism/ Down’s Syndrome Refer to RO

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 UNITED INDIA INSURANCE COMPANY LIMITED
REGISTERED OFFICE: 24 Whites Road, Chennai – 600014

CIRCULAR
Any adverse comments on health Decide in light of comments vis a vis
Physical examination guidelines provided here for that
condition; if in doubt, Refer to RO
Urine routine and microscopic Proteins/Occult Blood/Sugar +++ REJECT
examination Sugar ++, If HbA1c 6-8 Accept with 20% Loading, with PED
Clause
Sugar ++, If HbA1c >8 REJECT
Sugar + , HbA1c upto 6 Accept without loading
Serum Creatinine Above 1.5 mg/dl REJECT
ECG Report Abnormal REJECT
SGPT >300 Units per litre REJECT
CBC RBC/WBC/Platelets abnormal range Refer to RO
Explanatory Notes:
1. If under any of the above criteria, the suggested action is ‘ Reject’, the proposal shall be rejected
even if under another criteria, the suggested action is ‘Accept’.
2. If under any of the above criteria, the suggested action is ‘Refer to RO’, then the proposal shall
be escalated to RO Underwriter/ Doctor for Underwriting decision even if under another criteria,
the suggested action is ‘Accept’.

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