Policy Version-3

CignaTTK ProHealth Insurance
Policy Terms and Conditions
I PREAMBLE & OPERATING CLAUSE
This is a legal contract between You and Us subject to the receipt of full premium, Disclosure to
Information Norm including the information provided by You in the Proposal Form and the terms,
conditions and exclusions of this Policy.
If any Claim arising as a result of a Disease/Illness or Injury that occurred during the Policy Period
becomes payable, then We shall pay the Benefits in accordance with terms, conditions and
exclusions of the Policy subject to availability of Sum Insured and Cumulative Bonus (if any). All limits
mentioned in the Policy Schedule are applicable for each Policy Year of coverage.
BENEFITS UNDER THE POLICY
II BASIC COVERS
II.1. Inpatient Hospitalization:

We will cover Medical Expenses of an Insured Person in case of Medically Necessary Hospitalization
arising from a Disease/ Illness or Injury provided such Medically Necessary Hospitalization is for more
than 24 consecutive hours provided that the admission date of the Hospitalisation due to Illness or
Injury is within the Policy Year. We will pay Medical Expenses as shown in the Schedule for:
a. Reasonable and Customary Charges for Room Rent for accommodation in Hospital room up
to Category as per Plan opted and specified in the Schedule to this Policy.
b. Intensive Care Unit charges for accommodation in ICU ,
c. Operation theatre charges,
d. Fees of Medical Practitioner/ Surgeon ,
e. Anaesthetist,
f. Qualified Nurses,
g. Specialists,
h. Cost of diagnostic tests,
i. Medicines,
j. Drugs and consumables, blood, oxygen, surgical appliances and prosthetic devices
recommended by the attending Medical Practitioner and that are used intra operatively during
a Surgical Procedure.
Room category coverage for Sum Insured under each plan will be up to limit specified in the Policy
Schedule.
If the Insured Person is admitted in a room category that is higher than the one that is specified in the
Schedule to this Policy then the Policyholder/Insured Person shall bear a ratable proportion of the
total Associated Medical Expenses (including surcharge or taxes thereon) in the proportion of the
difference between the room rent of the entitled room category to the room rent actually incurred.
All Claims under this benefit can be made as per the process defined under Section VII 4 & 5.
II.2. Pre - hospitalization:
We will, on a reimbursement basis cover Medical Expenses of an Insured Person which are incurred
due to a Disease/ Illness or Injury that occurs during the Policy Year immediately prior to the Insured
Person’s date of Hospitalisation up to limits specified in the Schedule, provided that a Claim has been
admitted under In-patient Benefit under Section II.1 and is related to the same illness/condition.
CignaTTK ProHealth Insurance_Terms & Conditions Page 1

[UIN: CTTHLIP18045V031819]
All Claims under this benefit can be made as per the process defined under Section VII 5.
II.3. Post - hospitalization:

We will, on a reimbursement basis cover Medical Expenses of an Insured Person which are incurred
due to a Disease/ Illness or Injury that occurs during the Policy Year immediately post discharge of
the Insured Person from the Hospital up to limits specified in the Schedule, provided that a Claim has
been admitted under In-patient Benefit under Section II.1 and is related to the same illness/condition.
.
All Claims under this benefit can be made as per the process defined under Sec tion VII 5.
II.4. Day Care Treatment:

We will cover payment of Medical Expenses of an Insured Person in case of Medically Necessary
Day Care Treatment or Surgery that requires less than 24 hours Hospitalization due to advancement
in technology and which is undertaken in a Hospital / nursing home/Day Care Centre on the
recommendation of a Medical Practitioner. Any treatment in an outpatient department/OPD is not
covered. For list of Day Care Treatments refer Annexure II of the Policy.
Coverage will also include pre-post hospitalisation expenses as available under the Plan opted.
II.5. Domiciliary Treatment:

We will cover Medical Expenses of an Insured Person which are towards a Disease/Illness or Injury
which in the normal course would otherwise have been covered for Hospitalisation under the policy
but is taken at home on the advice of the attending Medical Practitioner, under the following
circumstances:
i. The condition of the Insured Person does not allow a Hospital transfer; or
ii. A Hospital bed was unavailable;
Provided that, the treatment of the Insured Person continues for at least 3 days, in which case the
reasonable cost of any Medically Necessary treatment for the entire period shall be payable.
a. We will pay for Pre-hospitalisation, Post-hospitalisation Medical Expenses up to 30 days

each.
b. We shall not be liable under this Policy for any Claim in connection with or in respect of the
following:
i. Asthma, bronchitis, tonsillitis and upper respiratory tract infection including laryngitis and
pharyngitis, cough and cold, influenza,
ii. Arthritis, gout and rheumatism,
iii. Chronic nephritis and nephritic syndrome,
iv. Diarrhoea and all type of dysenteries, including gastroenteritis,
v. Diabetes mellitus and Insipidus,
vi. Epilepsy,
vii. Hypertension,
viii. Psychiatric or psychosomatic disorders of all kinds,
ix. Pyrexia of unknown origin.
All Claims under this benefit can be made as per the process defined under Section VII 5.
II.6. Ambulance Cover:

a. We will provide for reimbursement of Reasonable and Customary expenses up to limits specified in
the Schedule that are incurred towards transportation of an Insured Person by a registered healthcare
or Ambulance service provider to a Hospital for treatment of an Illness or Injury covered under the

Policy in case of an Emergency, necessitating the Insured Person’s admission to the Hospital. The
necessity of use of an Ambulance must be certified by the treating Medical Practitioner.
b. Reasonable and Customary expenses shall include:

(i) Costs towards transferring the Insured Person from one Hospital to another Hospital or diagnostic
centre for advanced diagnostic treatment where such facility is not available at the existing Hospital;
or
(ii) When the Insured Person requires to be moved to a better Hospital facility due to lack of super
speciality treatment in the existing Hospital.
II.7. Donor Expenses:

a. We will cover In-patient Hospitalisation Medical Expenses towards the donor for harvesting the
organ up to the limits of the Sum Insured, provided that: The organ donor is any person in accordance
with the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and rules,
provided that -
b. The organ donated is for the use of the Insured Person who has been asked to undergo an organ
transplant on Medical Advise.
c. We have admitted a claim under Section II.1 – towards In-patient Hospitalization
d. We will not cover expenses towards the Donor in respect of:
i. Any Pre or Post - hospitalization Medical Expenses,
ii. Cost towards donor screening,
iii. Cost directly or indirectly associated to the acquisition of the organ,
iv. Any other medical treatment or complication in respect of the donor, consequent to
harvesting.
II.8. Worldwide Emergency Cover:

We will cover Medical Expenses incurred during the Policy Year, for Emergency Treatments of the
Insured Person incurred outside India, up to limits specified in the Schedule, provided that:
(a) The treatment is Medically Necessary and has been certified as an Emergency by a Medical
Practitioner, where such treatment cannot be postponed until the Insured Person has returned to
India and is payable under Section II.1 of the Policy.
(b)The Medical Expenses payable shall be limited to Inpatient Hospitalization only.
(c) Any payment under this Benefit will only be made in India, in Indian rupees on a re-imbursement
basis and subject to Sum Insured. Insured Person can contact Us at the numbers provided on the
Health Card for any claim assistance In case where Cumulative Bonus accumulated is used for
payment of claim under this benefit, the maximum liability under a single Policy year shall not exceed
the Opted Sum Insured including Cumulative Bonus or Cumulative Bonus Booster as applicable.
(d) The payment of any claim under this Benefit will be based on the rate of exchange as on the date
of payment to the Hospital published by Reserve Bank of India (RBI) and shall be used for conversion
of foreign currency into Indian rupees for payment of claim. You further understand and agree that
where on the date of discharge, if RBI rates are not published, the exchange rate next published by
RBI shall be considered for conversion.

(e) You have given Us, intimation of such hospitalisation within 48 hours of admission.
(f) Any claim made under this Benefit will be as per the claims procedure provided under Clause VII.5
of this Policy.
(g) Exclusion VI.21 does not apply to this benefit.
II.9. Restoration of Sum Insured:

We will provide for a 100% restoration of the Sum Insured for any number of times in a Policy Year ,
provided that:
a. The Sum Insured inclusive of earned Cumulative Bonus (if any) or Cumulative Bonus Booster (if
opted & earned) is insufficient as a result of previous claims in that Policy Year.
b. The Restored Sum Insured shall not be available for claims towards an Illness/ disease/ Injury
(including its complications) for which a claim has been paid in the current Policy Year for the
same Insured Person.
c. The Restored Sum Insured will be available only for claims made by Insured Persons in respect
of future claims that become payable under Section II of the Policy and shall not apply to the first
claim in the Policy Year. No Restoration of the Sum Insured will be provided for coverage under
Section II. 8. Worldwide Emergency Cover, Section II.12, Maternity Expenses, New Born Baby
Expenses Section II.13 and First Year Vaccinations Section II.14.
d. The Restored Sum Insured will not be considered while calculating the Cumulative Bonus/
Cumulative Bonus Booster.
e. Such restoration of Sum Insured will be available for any number of times, during a Policy Year to
each insured in case of an individual Policy and can be utilised by Insured Persons who stand
covered under the Policy before the Sum Insured was exhausted.
f. If the Policy is issued on a floater basis, the Restored Sum Insured will also be available on a
floater basis.
g. If the Restored Sum Insured is not utilised in a Policy Year, it shall not be carried forward to
subsequent Policy Year.
For any single claim during a Policy Year the maximum Claim amount payable shall be sum of:
i. The Sum Insured

ii. Cumulative Bonus (if earned) or Cumulative Bonus Booster (if opted & earned)
h. During a Policy Year, the aggregate claim amount payable, subject to admissibility of the claim,
shall not exceed the sum of:
i. The Sum Insured
ii. Cumulative Bonus (if earned) or Cumulative Bonus Booster (if opted & earned)
iii. Restored Sum Insured
II.10. AYUSH Cover
We will pay the Medical Expenses incurred during the Policy Year, up to the limits specified in the
Policy Schedule of an Insured Person in case of Medically Necessary Treatment taken during In-
patient Hospitalisation for AYUSH Treatment for an Illness or Injury that occurs during the Policy
Year, provided that:
i) i. The Insured Person has undergone AYUSH Treatment in a government Hospital or in any
institute recognised by government and/or accredited by Quality Council of India/ National
Accreditation Board on Health.
ii) Teaching hospitals of AYUSH Colleges recognized by Central Council of Indian Medicine (CCIM)
and Central Council of Homeopathy (CCH)
iii) AYUSH Hospitals having registration with a Government authority under appropriate Act in the
state/ UT and complies with the following as minimum criteria:
a) Has at least fifteen in-patient beds
b) Has minimum five qualified and registered AYUSH doctors

c) Has qualified paramedical staff under its employment round the clock
i. The following exclusions will be applicable in addition to the other Policy exclusions:
Facilities and services availed for pleasure or rejuvenation or as a preventive aid, like beauty
treatments, Panchakarma, purification, detoxification and rejuvenation etc.
All claims under this Benefit can be made as per the process defined under Sections VII 4 & 5.
II.11. Health Maintenance Benefit:

We will cover, up to limits specific in the Schedule, by way of reimbursement of the Reasonable and
Customary Charges incurred by the Insured Person for Medically Necessary charges incurred during
the Policy Year on:
i. an Out Patient basis for Protect, Plus, Preferred and Premier Plans
ii. an Out Patient and In-patient basis for Accumulate Plan.
. Coverage and validity for HMB under Protect, Plus, Preferred, Premier and Accumulate will be as
per below table:
Plan Name Coverage Validity
i) Diagnostic tests, i. Fresh limits will be available as per

preventive tests, drugs, the Plan under the new Policy Year
Protect, Plus, Preferred & prosthetics, medical aids
Premier (spectacles and contact ii. Any unutilised Health Maintenance
lenses, hearing aids, Benefit limit shall lapse at the end of
crutches, wheel chair, the Policy Year
walker, walking stick,
lumbo-sacral belt),
prescribed by the
specialist Medical
Practitioner up to the
limits specified in the
Schedule.
ii) Towards Dental
Treatments and AYUSH
Forms of Medicines
wherever prescribed by
a Medical Practitioner.
i. Diagnostic i. Fresh limits will be available as per

tests, preventive the Plan under the new Policy Year
Accumulate tests, drugs, Non-
Medical expenses as
defined under ii. Any unutilised Health Maintenance
Annexure IV of the Benefit limit shall not lapse at the end
policy), prosthetics, of the Policy Year and can continue
medical aids to be carried forward each year as
(spectacles and long as the Policy is renewed with Us
contact lenses, in accordance with the Renewal
hearing aids, Terms under the Policy.
crutches, wheel chair,
walker, walking stick,

lumbo-sacral belt), iii. In case of expiry of the policy any
crutches and wheel unutilized Health Maintenance
chair prescribed by Benefit limit shall be available for a
the specialist Medical claim up to a period of 12 months
Practitioner up to the from the date of expiry of the Policy.
limits specified in the
Schedule.
ii. Towards Dental iv. In case of utilisation of Health
Treatments and Maintenance Benefit post expiry of
AYUSH Forms of the policy year, the cumulative bonus
Medicines wherever shall be suitably adjusted basis
prescribed by a revised Health Maintenance Benefit
Medical Practitioner balance for the previous policy year.
as an Out-Patient.
iii. Towards payment of

the deductible/ co-
pay/ Non- Medical
expenses (as defined
under Annexure IV of
the policy), of a claim
wherever opted and
applicable including
any cashless facility
in case of a
Hospitalization or Day
Care Claim.
iv. Towards
payment of renewal
premium (inclusive of
taxes): Up to 50 % of
the accumulated
Health Maintenance
Benefit can be utilised
for payment against
premium from first
renewal of the policy.
Subject to renewal of
the policy in
Accumulate Plan.
Insured can use Our application or contact Us for scheduling an appointment for availing services
covered under this benefit at our Network provider.
All Waiting Periods and Permanent Exclusions including Co-pay’s applicable on the Policy under
Section V and VI shall not apply to this section.
All Claims under this benefit can be made as per the process defined under Section VII.13 . Further,
all claims under this benefit will be subject to the any one claim limits specified under Section VII.15 of
the Policy.
II.12. Maternity Expenses:

We will cover Maternity Expenses up to limits for Maternity Sum insured specified in the Schedule for
the delivery of a child and/ or Maternity Expenses incurred during the Policy Year, related to a
Medically Necessary and lawful termination of pregnancy up to maximum 2 deliveries or terminations
during the lifetime of an Insured Person between the ages of 18 years to 45 years.
You understand and agree that:

(a) Our maximum liability per delivery or termination is subject to the limits specified in the Schedule.
(b) The Insured Person should have been continuously covered under this Policy for at least 48
months before availing this Benefit, except in case of opting for ‘Reduction in maternity waiting’ where
the limit will be relaxed to 24 months of waiting.
(c) The cover under this Benefit shall be restricted to two live children only.
(d) The payment towards any admitted claim under this Benefit for any complication arising out of or
as a consequence of maternity or child birth will be restricted to limits specified in the Schedule
however any restored amount will not be available for coverage under this section.
(e) Pre or post natal Maternity Expenses will be covered within the Maternity Sum Insured under this
Benefit however; any Pre or Post – hospitalisation Expenses paid under Section II.2 and II.3, above
will not be covered under this Benefit.
(f) Maternity Sum Insured available under Maternity Expenses will be in addition to Sum Insured.
(g) Applicable Deductible or Co-pay under the applicable plan shall also apply to this benefit.
(h) We will not cover the following expenses under Maternity Benefit:
i) Medical Expenses in respect of the harvesting and storage of stem cells when carried out as a
preventive measure against possible future Illnesses.
ii) Medical Expenses for ectopic pregnancy. However, these expenses will be covered under the In-
patient Hospitalisation under Section II.1.
II.13. New Born Baby Expenses:

Subject to a claim being admitted under Maternity Expenses Cover under Section II.12, We will cover.
(a) Medical Expenses towards treatment of the New Born Baby while the Insured Person is
Hospitalised as an In-patient for delivery.
(b) The Reasonable and Customary Charges incurred on the New Born Baby during and post birth up
to 90 days from the date of delivery, within the limits specified in the Schedule under Maternity
Expenses without payment of any additional premium.
(c) Subject to the terms and conditions of the Policy, We will cover the New Born Baby beyond 90
days on payment of requisite premium for the New Born Baby into the Policy by way of an
endorsement or at the next Renewal, whichever is earlier.
Applicable Deductible or Co-pay under the applicable plan shall also apply to this benefit.
II.14. First Year Vaccinations

We will cover Reasonable and Customary charges for vaccination expenses for the New Born Baby
as per National Immunization Scheme (India) listed below, till the baby completes 1 year (12 months)
upto the limits specified in the Schedule. Any restored Sum Insured will not be available for coverage
under this section.
We will continue to provide Reasonable and Customary charges for vaccination of the New Born
Baby until it completes 12 months, if the Policy ends before the New Born Baby has completed one
year subject however to the Policy being renewed in the subsequent year.
Time Interval Vaccinations to be done (Age) Frequency

BCG (Birth to 2 weeks) 1
0 – 3months OPV (0‚6‚10 weeks) OR OPV +
3 OR 4
IPV1 (6,10 weeks)

DPT (6 & 10 week) 2
Hepatitis-B (0 & 6 week) 2
Hib (6 & 10 week) 2
OPV (14 week) OR OPV + IPV2 1 or 2
DPT (14 week) 1
3 – 6 months
Hepatitis-B (14 week) 1
Hib (14 week) 1
9 months Measles (+9 months) 1
12 months Chicken Pox (12 months) 1
All Claims under this benefit can be made as per the process defined under Section VII. 5.
III. VALUE ADDED COVERS:
III.1. Health Check Up:

(a) If the Insured Person has completed 18 years of Age, the Insured Person may avail a
comprehensive health check-up with Our Network Provider as per the eligibility details mentioned in
the table below. All Insured members above the age of 18 years will be eligible for a Health Check
Up. Health Check Ups will be and arranged by Us and conducted at Our Network Providers.
rd
For Protect & Accumulate Plan – Available once every 3 Policy year
For Plus, Preferred and Premier Plan – Available once each year excluding the first policy year.
(b) Original Copies of all reports will be provided to You.
Sum Insured Age List of tests
Protect Plus & >18 years Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC,
Accumulate Plan SGPT
Sum Insured
₹2.5 Lacs,
₹3.5 Lacs,
₹4.5 Lacs,
₹5.5 Lacs,
Protect Plus & 18 to 40 Vitals, ECG, FBS, Sr. Creatinine,, SGPT, CBC-ESR, Lipid
Accumulate Plan years Profile, SGOT, GGT
Sum Insured > 40 years Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid
₹7.5 Lacs, (For Profile, SGOT, GGT, TSH
₹10 Lacs Females
Only)
> 40 years Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid
(For Males Profile, SGOT, GGT
Only)
Protect Plus & 18 to 40 Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid
Accumulate Plan years Profile, SGOT, GGT, TSH
(For
Sum Insured Females
Only)

₹15 Lacs, 18 to 40 Vitals, ECG, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR,
₹20 Lacs, years Lipid Profile, SGOT, GGT
₹25 Lacs, (For Males
₹30 Lacs, Only)
₹50 Lacs, > 40 years Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile,
₹100 Lacs SGOT, GGT, TSH, TMT
(For
Females
only)
> 40 years Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile,
(For Males SGOT, GGT, TMT
only)
Preferred & 18 to 40 Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid
Premier Plan years Profile, SGOT, GGT, TSH, Pap smear, Mammogram
Sum Insured
₹15 Lacs and (For
Above Females
Only)
18 to 40 Vitals, ECG, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid
years Profile, SGOT, GGT, PSA
(For Males
Only)
SGOT, GGT, TSH, TMT, Pap smear, Mammogram, Uric acid,
USG Abdomen & Pelvis
(For
Females
only)
(For Males SGOT, GGT, TMT, PSA, Uric acid, USG Abdomen & Pelvis
only)
Full explanation of Tests is provided here: Vitals- Height, Weight, Blood Pressure, Pulse, BMI,
Chest Circumference & Abdominal Girth FBS – Fasting Blood Sugar, GGT – Gamma-Glutamyl
Transpeptidase, ECG – Electrocardiogram, CBC-ESR – Complete Blood Count-Erythrocyte
Sedimentation Rate, SGPT – Test Serum Glutamic Pyruvate Transaminase, SGOT – Serum Glutamic
Oxaloacetic Transaminase, TSH – Thyroid Stimulating Hormone, TMT – Tread Mill Test, USG –
Ultrasound Sonography, PSA – Prostate Specific Antigen, Pap smear - Papanicolaou test
(c) Coverage under this value added cover will not be available on reimbursement basis. All Claims
under this benefit can be made as per the process defined under Section VII. 15
III.2. Expert opinion on Critical Illness:

You may choose to secure a second opinion from Our Network of Medical Practitioners, if an Insured
Person is diagnosed with the covered Critical Illness during the Policy Year. The expert opinion would
be directly sent to the Insured Person.
You understand and agree that You can exercise the option to secure an expert opinion, provided:

(a) We have received a request from You to exercise this option.
(b) That the expert opinion will be based only on the information and documentation provided by the
Insured Person that will be shared with the Medical Practitioner
(c) This benefit can be availed once by an Insured Person during a Policy Year and once during the
lifetime of an Insured Person for the same Illness.
(d) This benefit is only a value added service provided by Us and does not deem to substitute the
Insured Person’s visit or consultation to an independent Medical Practitioner.
(e) The Insured Person is free to choose whether or not to obtain the expert opinion, and if obtained
then whether or not to act on it.
(f) We shall not, in any event be responsible for any actual or alleged errors or representations made
by any Medical Practitioner or in any expert opinion or for any consequence of actions taken or not
taken in reliance thereon.
(g) The expert opinion under this Policy shall be limited to covered Critical Illnesses and not be valid
for any medico legal purposes.
(h) We do not assume any liability towards any loss or damage arising out of or in relation to any
opinion, advice, prescription, actual or alleged errors, omissions and representations made by the
Medical Practitioner.
(i) For the purpose of this benefit covered Critical Illnesses shall include –
- Cancer of specific severity
- Myocardial Infarction (First Heart Attack of specified severity)
- Open Chest CABG
- Open Heart Replacement or Repair of Heart Valves
- Coma of specified severity
- Kidney Failure requiring regular dialysis
- Stroke resulting in permanent symptoms
- Major Organ/Bone Marrow Transplant
- Permanent Paralysis of Limbs
- Motor Neurone Disease with permanent symptoms
- Multiple Sclerosis with persisting symptoms
All Claims under this benefit can be made as per the process defined under Section VII.14.
III.3. Cumulative Bonus

a) On Sum Insured
We will increase Your Sum Insured as specified under the Plan opted at the end of the Policy Year if
the Policy is renewed with Us:
a) No Cumulative Bonus will be added if the Policy is not renewed with Us by the end of the Grace
Period.
b) The Cumulative Bonus will not be accumulated in excess of 200% of the Sum Insured under the
current Policy with Us under any circumstances.
c) Any Cumulative Bonus that has accrued for a Policy Year will be credited at the end of that Policy
Year if the policy is renewed with us within grace period and will be available for any claims made
in the subsequent Policy Year.
d) Merging of policies: If the Insured Persons in the expiring Policy are covered under multiple
policies and such expiring Policy has been Renewed with Us on a Family Floater basis then the
Cumulative Bonus to be carried forward for credit in such Renewed Policy shall be the lowest
percentage of Cumulative Bonus applicable on the lowest Sum Insured of the last policy year
amongst all the expiring polices being merged.
e) Splitting of policies: If the Insured Persons in the expiring Policy are covered on a Family Floater
basis and such Insured Persons Renew their expiring Policy with Us by splitting the Sum Insured
in to two or more Family Floater/Individual policies then the Cumulative Bonus shall be

apportioned to such Renewed Policies in the proportion of the Sum Insured of each
Renewed Policy.
f) Reduction in Sum Insured: If the Sum Insured has been reduced at the time of Renewal, the
applicable Cumulative Bonus shall be calculated on the revised Sum Insured on pro-rata basis.
g) Increase in Sum Insured: If the Sum Insured under the Policy has been increased at the time of
Renewal the Cumulative Bonus shall be calculated on the Sum Insured of the last completed
Policy Year.
h) Cumulative bonus shall not be available for claims made for maternity expenses, new born baby
cover, first year vaccination.
i) This clause does not alter Our right to decline a Renewal or cancellation of the Policy for reasons
as mentioned under Section VIII.12
b) On Health Maintenance Benefit for Accumulate Plan

We will provide a 5% Cumulative Bonus on the unutilized Health Maintenance Benefit limit (HMB)
available at the end of the Policy Year irrespective of whether a claim is made on the expiring policy.
This unutilized HMB limit plus the Earned Cumulative Bonus will get carried forward to the next Policy
Year.
o Available HMB limit in the current Policy will be total of Unutilised HMB limit plus Earned
Cumulative Bonus and the HMB limit of Current Policy Year.
o Each Year Cumulative Bonus will be calculated on the balance HMB value at the end of the year,
irrespective of any change in Sum Insured or HMB opted on the Plan.
o
If the Policy Period is two or three years, any Cumulative Bonus that has accrued for the
first/second Policy Year will be credited at the end of the first/second Policy Year as the case may
be and will be available for any claims made in the subsequent Policy Year.
o If the Insured Persons in the expiring Policy are covered on an individual basis and there is an
accumulated HMB limit plus Cumulative Bonus for each Insured Person under the expiring Policy,
and such expiring Policy has been Renewed with Us on a Family Floater basis then the HMB limit
plus Cumulative Bonus that will be carried forward for credit in such Renewed Policy shall be the
total of all the Insured Persons moving out.
o If the Insured Persons in the expiring Policy are covered on a Family Floater basis and such
Insured Persons renew their expiring Policy with Us by splitting the Sum Insured in to two or more
Family Floater/individual policies then the Unutilised HMB limit plus Cumulative Bonus of the
expiring Policy shall be apportioned to such Renewed Policies in the proportion of the Sum
Insured of each Renewed Policy.
o Cumulative Bonus on the HMB limit for Accumulate Plan shall not accrue if the Policy is not
renewed with us within the Grace Period.
III.4. Healthy Rewards

You can earn reward points equivalent to 1% of premium paid including taxes and levies for each
Policy. In addition to this You can accumulate rewards by opting for an array of Our wellness
programs listed below, that will help You to assess Your health status and aid in improving Your
overall well-being.
In an individual or floater policy:
There will be no limitation to the number of programs one can enrol however Rewards can be earned
only once for each specific program by a particular Insured Person in a policy year.
Maximum rewards that can be earned in a single policy period will be limited to 20% of premium paid
in the existing Policy.
Details of reward points that can be accrued are listed below.
Program Type Points to be earned as a percentage of

previous Policy Period Premium
Health Risk Assessment (HRA)/ Targeted Risk 2.5%

Assessment (TRA)
Lifestyle Management Program (LMP) 3%
Chronic Condition Management Programs 3%
Participating in CignaTTK Sponsored Programs 2% per program, Maximum 5 programs per policy
and Worksite or Online/Offline Health Initiatives year
Health Check Up 0.5%
Reward Points, wherever offered under any specific Sponsored Program will be the same for all
customers.
Each earned reward point will be valued at 1 Rupee. Accumulated reward points can be redeemed in
the following ways –
- Against payable premium (including Taxes) from 1st Renewal of the Policy.
- Equivalent value of Health Maintenance Benefit anytime during the policy.
- As equivalent value while availing services through our Network Providers as defined in the
Policy.
Details of Healthy Rewards earned on each Policy will be updated in our records against the policy as
and when earned. Accrual for reward points will be the same for 1, 2 & 3 year policies.
Policyholder/Insured can approach Us for redemption anytime during the policy period. Redemption
against renewal premium will be available only at the time such renewal is due.
Any earned reward points will lapse at the end of the grace period if the policy is not renewed with us.
Refer Annexure for Healthy Reward Process for details of delivery mechanism.
IV. OPTIONAL COVERS

The following optional covers shall apply under the Policy for an Insured Person if specifically
mentioned on the Schedule and shall apply to all Insured Persons under a single policy without any
individual selection.
IV.1. Hospital Daily Cash Benefit

We will pay the Hospital Daily Cash Benefit specified in the Policy for each continuous and completed
24 Hours of Hospitalisation during the Policy Year, provided that:
i. The hospitalisation claim is admissible under the Base cover.
ii. The Benefit will be available up to the maximum 30 days per Policy Year.
iii. The Benefit under this cover will be over and above the Sum Insured under Section II.
All claims under this Benefit can be made as per the process defined under Section V. 5. under the
Policy Terms and Conditions.
All other terms, conditions, waiting periods and exclusions shall apply.
IV.2.Deductible:
We will provide for a Deductible on specific Sum Insured Options. Where ever a Deductible is
selected such amounts will be applied for each Policy Year on the aggregate of all Claims in that
Policy Year other than for claims under fixed Benefit Covers, Health Maintenance Benefit and Health
Check Ups. Deductible shall apply to all sections other than Hospital Daily Cash Benefit, Health
Maintenance Benefit, Health Check Up benefits and Add On Riders if opted.
Any Voluntary Co-pay shall not apply to plans with Deductible option.

For the purpose of calculating the deductible and assessment of admissibility all claims must be
submitted in accordance with Section VII.17 of Claims Process.
All other terms, conditions, waiting periods and exclusions shall apply.
Waiver of Deductible:
We will offer the Insured Person an option to opt out of the Deductible Option under the product at the
time of renewal under below conditions:
-Opt out of deductible Within 48 Months

 The enhanced coverage during any policy renewals will not be available for an illness, disease,
injury already contracted under the preceding Policy Periods or earlier. All waiting periods as
mentioned under the policy shall apply afresh for this enhanced limit from the effective date of
such enhancement.
 Premium for the opted indemnity health insurance Policy (without any Deductible) would be
charged as per the age of the insured member at renewal.
-Opt out of deductible After 48 Months:
 The enhanced coverage will be available for any illness, disease, injury already contracted under
the preceding Policy Periods or earlier with continuity of coverage in terms of waiver of waiting
periods to the extent of benefits covered under this Policy, provided that it has been renewed with
Us continuously and without any interruption
 Premium for the opted indemnity health insurance Policy (without any Deductible) would be
charged as per the age of insured member at renewal.
IV.3. Reduction in Maternity Waiting:

We will provide for a waiver of waiting period for Maternity Expenses (Section II.12) from 48 months to
24 months from the date of inception of first Policy with Us.
New Born Baby cover and first year vaccinations will follow reduction in waiting period under
Maternity Expenses Cover
All other terms, conditions and exclusions under Maternity Expenses Cover (Section II.12) shall apply.
IV.4. Voluntary Co-Pay:

Irrespective of the Age and number of claims made by the Insured Person and subject to the Co-
payment option chosen by You, it is agreed that We will only pay 90% or 80% of any amount that We
assess (payable amount) for the payment or reimbursement in respect of any Claim under the Policy
made by that Insured Person and the balance will be borne by the Insured Person.
Co-pays shall apply to all sections other than Health Maintenance Benefit, Health Check-Ups,
Hospital Daily Cash Benefit and the Critical Illness Add on (if opted).
Co-pay will be applied on the admissible claim amount. In case You have selected the Voluntary co-
pay (Section IV.4), and/or if You chooses to take treatment out of Zone then the co-pay percentages
will apply in conjunction.
IV.5 Waiver of Mandatory Co-pay:

We will provide an option to remove Mandatory co-pay which is applicable for persons aged 65 years
and above will be available on payment of additional premium.
IV.6. Cumulative Bonus Booster

We will provide an option to increase the Sum Insured by 25% for each policy year up to a maximum
of 200% of Sum Insured provided that the Policy is renewed with Us without a break.

o No cumulative bonus will be added if the Policy is not renewed with Us by the end of the Grace
Period. The Cumulative Bonus will not be accumulated in excess of 200% of the Sum Insured
under the current Policy with Us.
o Any earned Cumulative Bonus will not be reduced for claims made in the future. Wherever the
earned Cumulative Bonus is used for payment of a claim during a particular Policy Year.
o In case of opting for Cumulative Bonus Booster, the Cumulative Bonus under section III. (iii) shall
not be available, however all terms and conditions of the said section shall apply.
o This Cumulative bonus shall not be available for claims made for Maternity Expenses under
Section II.12, New Born Baby Expenses Section II.13 and First Year Vaccinations Section II.14
V. WAITING PERIODS
We shall not be liable to make any payment under this Policy directly or indirectly caused by, based
on, arising out of or howsoever attributable to any of the following. All the waiting period shall be
applicable individually for each Insured Person and claims shall be assessed accordingly.
V.1. Pre-existing Disease Waiting Period

All Pre-existing Diseases / Illness / Injury / conditions as defined in the Policy, until 24/ 36/ 48 (as
specified in the Schedule) months of continuous covers have elapsed since inception of the first
Policy with Us. This exclusion doesn’t apply for Insured Person having any health insurance indemnity
policy in India at least for a period of 12/24/36/48 months as applicable, prior to taking this Policy and
accepted under portability cover, as well as for subsequent Renewals with Us without a break.
V.2. 30 days Waiting Period

Any disease contracted and/or Medical Expenses incurred in respect of any Disease/Illness by the
Insured/Insured Person during the first 30 days from the inception date of the Policy will not be
covered.
This exclusion doesn’t apply for Insured Person having any health insurance indemnity policy in India
at least for a period of 30 days prior to taking this Policy and accepted under portability cover, as well
as for subsequent Renewals with Us without a break.
V.3. Two year waiting period

A waiting period of 24 months shall apply to the treatment, of the following, whether medical or
surgical for all Medical Expenses along with their complications on treatment towards:
i. Cataract,
ii. Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus unless necessitated by
malignancy myomectomy for fibroids,
iii. Knee Replacement Surgery (other than caused by an Accident), Non-infectious Arthritis, Gout,
Rheumatism, Oestoarthritis and Osteoposrosis, Joint Replacement Surgery (other than caused
by Accident), Prolapse of Intervertibral discs(other than caused by Accident), all Vertibrae
Disorders, including but not limited to Spondylitis, Spondylosis, Spondylolisthesis, Congenital
Internal,
iv. Varicose Veins and Varicose Ulcers,
v. Stones in the urinary uro-genital and biliary systems including calculus diseases,
vi. Benign Prostate Hypertrophy, all types of Hydrocele,
vii. Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Hemorrhoids and any abscess
related to the anal region.
viii. Chronic Suppurative Otitis Media (CSOM), Deviated Nasal Septum, Sinusitis and related
disorders, Surgery on tonsils/Adenoids, Tympanoplasty and any other benign ear, nose and
throat disorder or surgery.
ix. gastric and duodenal ulcer, any type of Cysts/Nodules/Polyps/internal tumors/skin tumors, and
any type of Breast lumps(unless malignant), Polycystic Ovarian Diseases,
x. Any surgery of the genito-urinary system unless necessitated by malignancy.
If these diseases are pre-existing at the time of proposal or subsequently found to be pre-existing the
pre-existing waiting periods as mentioned in the Schedule to this Policy shall apply.

V.4. Maternity Waiting Period
Any treatment arising from or traceable to pregnancy, childbirth including caesarean section until 48
months of continuous coverage has elapsed for the particular Insured Person since the inception of
the first Policy with Us. However, this exclusion / waiting period will not apply to Ectopic Pregnancy
proved by diagnostic means and certified to be life threatening by the attending Medical Practitioner.
Wherever Optional Cover for ‘Reduction in Maternity Waiting Period’ has been applied this limit will be
reduced to 24 months of continuous cover.
V.5. Personal Waiting period:

A special Waiting Period not exceeding 48 months, may be applied to individual Insured Persons for
the list of acceptable Medical Ailments listed under Policy Clause VIII.16.Loadings & Special
Conditions, depending upon declarations on the proposal form and existing health conditions. Such
waiting periods shall be specifically stated in the Schedule and will be applied only after receiving
Your specific consent.
V.6 90 day waiting period for Critical Illness Add On Cover (if opted)
Any critical illness contracted and/or the disease incepts or manifests during the first 90 days from the
Inception Date of the policy will not be covered under the critical illness benefit wherever opted.
VI PERMANENT EXCLUSIONS
We shall not be liable to make any payment under this Policy directly or indirectly caused by, based
on, arising out of or howsoever attributable to any of the following:
1. Stem cell implantation/surgery, harvesting, storage or any kind of treatment using stem cells.
2. Dental treatment, dentures or surgery of any kind unless necessitated due to an accident and
requiring minimum 24 hours hospitalization or treatment of irreversible bone disease involving the
jaw which cannot be treated in any other way, but not if it is related to gum disease or tooth
disease or damage.
3. Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder
or due to an accident.
4. Birth control procedures, contraceptive supplies or services including complications arising due to
supplying services, hormone replacement therapy and voluntary termination of pregnancy during
the first 12 weeks from the date of conception, surrogate or vicarious pregnancy.
5. Routine medical, eye and ear examinations, cost of spectacles, laser surgery for cosmetic
purposes or corrective surgeries, contact lenses or hearing aids, cochlear implants, vaccinations
except post-bite treatment or for new born baby up to 90 days, any physical, psychiatric or
psychological examinations or testing , any treatment and associated expenses for alopecia,
baldness, wigs, or toupees and hair fall treatment & products, issue of medical certificates and
examinations as to suitability for employment or travel.
6. Laser Surgery for treatment of focal error correction other than for focal error of +/- 7 or more and
is medically necessary.
7. All expenses arising out of any condition directly or indirectly caused due to or associated with
human T-call Lymph tropic virus type III (HTLV-III or IITLB-III) or Lymphadinopathy Associated
Virus (LAV) and its variants or mutants, Acquired Immune Deficiency Syndrome (AIDS) whether
or not arising out of HIV, AIDS related complex syndrome (ARCS) and all diseases / illness /
injury caused by and/or related to HIV.
8. All sexually transmitted diseases including but not limited to Genital Warts, Syphilis, Gonorrhoea,
Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis.
9. Vitamins and tonics unless forming part of treatment for disease, illness or injury and prescribed
by a Medical Practitioner.
10. Instrument used in treatment of Sleep Apnea Syndrome (C.P.A.P.) and Continuous Peritoneal
Ambulatory Dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial Asthmatic condition,

Infusion pump or any other external devices used during or after treatment.
11. Artificial life maintenance, including life support machine use, where such treatment will not result
in recovery or restoration of the previous state of health.
12. Treatment for developmental problems, learning difficulties, behavioural problems.
13. Treatment for general debility, ageing, convalescence, sanatorium treatment, rehabilitation
measures, private duty nursing, respite care, ,run down condition or rest cure, congenital external
anomalies or defects, sterility, fertility, infertility including IVF and other assisted conception
procedures and its complications, subfertility, impotency, venereal disease, or intentional self-
injury, suicide or attempted suicide(whether sane or insane).
14. Certification / Diagnosis / Treatment by a family member, or a person who stays with the Insured
Person, or from persons not registered as Medical Practitioners under the respective Medical
Councils, or from a Medical Practitioner who is practicing outside the discipline that he is licensed
for, or any diagnosis or treatment that is not scientifically recognized or experimental or unproven,
or any form of clinical trials or any kind of self-medication and its complications.
15. Ailment requiring treatment due to use, abuse or a consequence or influence of an abuse of any
substance, intoxicant, drug, alcohol or hallucinogen and treatment for de-addiction, or
rehabilitation.
16 . Any illness or hospitalization arising or resulting from the Insured Person or any of his family
members committing any breach of law with criminal intent.
17. Any treatment received in convalescent homes, convalescent hospitals, health hydros, nature
cure clinics.
18. Prostheses, corrective devices and medical appliances, which are not required intra-operatively
for the disease/ illness/ injury for which the Insured Person was hospitalised.
19. Any stay in Hospital without undertaking any treatment or any other purpose other than for
receiving eligible treatment of a type that normally requires a stay in the hospital.
20. Any cosmetic surgery, aesthetic treatment unless forming part of treatment for cancer or burns,
surgery for sex change or treatment of obesity/morbid obesity (unless certified to be life
threatening) or treatment/surgery /complications/illness arising as a consequence thereof.
21. Treatment received outside India other than for coverage under World Wide Emergency Cover,
Expert Opinion on Critical Illnesses.
22. Any robotic, remote surgery or treatment using cyber knife.
23. Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic
studies not consistent with or incidental to the diagnosis and treatment even if the same requires
confinement at a Hospital.
24. Costs of donor screening or costs incurred in an organ transplant surgery involving organs not
harvested from a human body.
25. Any form of Non-Allopathic treatment, Hydrotherapy, Acupuncture, Reflexology, Chiropractic
treatment or any other form of indigenous system of medicine.
26 . Insured Persons whilst engaging in speed contest or racing of any kind (other than on foot),
bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding,
mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea
diving using hard helmet and breathing apparatus, polo, snow and ice sports or involving a naval
military or air force operation.
27. Insured Person whilst flying or taking part in aerial activities (including cabin) except as a
passenger in a regular scheduled airline or air Charter Company.
28 . All expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel
or from any nuclear waste from the combustion of nuclear fuel.
29 . All expenses directly or indirectly, caused by or arising from or attributable to foreign invasion, act
of foreign enemies, hostilities, warlike operations (whether war be declared or not or while
performing duties in the armed forces of any country), civil war, public defense, rebellion,
revolution, insurrection, military or usurped power.
30 . All non-medical expenses including convenience items for personal comfort not consistent with or

incidental to the diagnosis and treatment of the disease/illness/injury for which the Insured Person
was hospitalized, Ambulatory devices, walker, crutches, belts, collars, splints, slings, braces,
stockings of any kind, diabetic footwear, glucometer/thermometer and any medical equipment that
is subsequently used at home except when they form part of room expenses.
For complete list of Non-medical expenses, Please refer to the Annexure IV “Non-Medical
Expenses”.
31. Non-Medical Expenses including RMO charges, surcharges, night charges, service charges
levied by the hospital under whatever head, registration/admission charges.
32. Any deductible amount or percentage of admissible claim under co-pay if applicable and as
specified in the Schedule to this Policy.
33. We shall not be obliged to make any payment that is brought about as a consequence of
deliberate failure to seek or follow medical advice, or to intentional delay to circumvent the policy
term and condition
VII. CLAIM PROCESS & MANAGEMENT
VII.1. Condition Preceding

The fulfilment of the terms and conditions of this Policy (including the realization of premium by their
respective due dates) in so far as they relate to anything to be done or complied with by You or any
Insured Person, including complying with the following steps, shall be the condition precedent to the
admissibility of the claim.
Completed claim forms and processing documents must be furnished to Us within the stipulated
timelines for all reimbursement claims. Failure to furnish this documentation within the time required
shall not invalidate nor reduce any claim if You can satisfy Us that it was not reasonably possible for
You to submit / give proof within such time.
The due intimation, submission of documents and compliance with requirements as provided under
the Claims Process under this Section, by You shall be essential failing which We shall not be bound
to accept a claim.
Cashless and Reimbursement Claim processing and access to network hospitals is through our
service partner/TPA, details of the same will be available on the Health Card issued by Us as well as
on our website. For the latest list of network hospitals you can log on to our website. Wherever a TPA
is used, the TPA will only work to facilitate claim processing. All customer contact points will be with
Us including claim intimation, submission, settlement and dispute resolutions.
VII.2. Policy Holder’s / Insured Persons Duty at the time of Claim

You are required to check the applicable list of Network Providers, at Our website or call center before
availing the Cashless services.
On occurrence of an event which may lead to a Claim under this Policy, You shall:
(a) Forthwith intimate, file and submit the Claim in accordance to the Claim Procedure defined under
Section VII.3, VII.4, VII. 5 as mentioned below.
(b) If so requested by Us, You or the Insured Person must submit himself/ herself for a medical
examination by Our nominated Medical Practitioner as often as We consider reasonable and
necessary. The cost of such examination will be borne by Us.
(c) Allow the Medical Practitioner or any of Our representatives to inspect the medical and
Hospitalization records, investigate the facts and examine the Insured Person.
(d) Assist and not hinder or prevent Our representatives in pursuance of their duties for ascertaining
the admissibility of the claim, its circumstances and its quantum under the provisions of the Policy.
VII.3. Claim Intimation

Upon the discovery or occurrence of any Illness / Injury that may give rise to a Claim under this
Policy, You / Insured Person shall undertake the following:
In the event of any Illness or Injury or occurrence of any other contingency which has resulted in a
Claim or may result in a claim covered under the Policy, You/the Insured Person, must notify Us
either at the call center or in writing, in the event of:
• Planned Hospitalization, You/the Insured Person will intimate such admission at least 3 days prior to
the planned date of admission.
• Emergency Hospitalization, You /the Insured Person will intimate such admission within 48 hours of
such admission.
The following details are to be provided to Us at the time of intimation of Claim:
• Policy Number
• Name of the Policyholder
• Name of the Insured Person in whose relation the Claim is being lodged
• Nature of Illness / Injury
• Name and address of the attending Medical Practitioner and Hospital
• Date of Admission
• Any other information as requested by Us
VII.4. Cashless Facility

Cashless facility is available only at our Network Hospital. The Insured Person can avail Cashless
facility at the time of admission into any Network Hospital, by presenting the health card as provided
by Us with this Policy, along with a valid photo identification proof (Voter ID card / Driving License /
Passport / PAN Card / any other identity proof as approved by Us).
(a) For Planned Hospitalization:

i. The Insured Person should at least 3 days prior to admission to the Hospital approach the
Network Provider for Hospitalization for medical treatment.
ii. The Network Provider will issue the request for authorization letter for Hospitalization in the pre-
authorization form prescribed by the IRDA.
iii. The Network Provider shall electronically send the pre-authorization form along with all the
relevant details to the 24 (twenty four) hour authorization/cashless department along with contact
details of the treating Medical Practitioner and the Insured Person.
iv. Upon receiving the pre-authorization form and all related medical information from the Network
Provider, We will verify the eligibility of cover under the Policy.
v. Wherever the information provided in the request is sufficient to ascertain the authorisation We
shall issue the authorisation Letter to the Network Provider. Wherever additional information or
documents are required We will call for the same from the Network provider and upon satisfactory
receipt of last necessary documents the authorisation will be issued. All authorisations will be
issued within a period of 4 hours from the receipt of last complete documents.
vi. The Authorisation letter will include details of sanctioned amount, any specific limitation on the
claim, any co-pays or deductibles and non-payable items if applicable.
vii. The authorisation letter shall be valid only for a period of 15 days from the date of issuance of
authorization.
In the event that the cost of Hospitalization exceeds the authorized limit as mentioned in the
authorization letter:
i. The Network Provider shall request Us for an enhancement of authorisation limit as described
under Section VII.4 (a) including details of the specific circumstances which have led to the need
for increase in the previously authorized limit. We will verify the eligibility and evaluate the request
for enhancement on the availability of further limits.
ii. We shall accept or decline such additional expenses within 24 (twenty-four) hours of receiving the
request for enhancement from You.

In the event of a change in the treatment during Hospitalization to the Insured Person, the Network
Provider shall obtain a fresh authorization letter from Us in accordance with the process described
under VII.4 (a) above.
At the time of discharge:

i. the Network Provider may forward a final request for authorization for any residual amount to us
along with the discharge summary and the billing format in accordance with the process
described at VII.4.(a) above.
ii. Upon receipt of the final authorisation letter from us, You may be discharged by the Network
Provider.
(b) In case of Emergency Hospitalisation

i. The Insured Person may approach the Network Provider for Hospitalization for medical
treatment.
ii. The Network Provider shall forward the request for authorization within 48 hours of admission to
the Hospital as per the process under Section VII.4 (a).
iii. It is agreed and understood that we may continue to discuss the Insured Person’s condition with
the treating Medical Practitioner till Our recommendations on eligibility of coverage for the
Insured Person are finalised.
iv. In the interim, the Network Provider may either consider treating the Insured Person by taking a
token deposit or treating him as per their norms in the event of any lifesaving, limb saving, sight
saving, Emergency medical attention requiring situation.
v. The Network Provider shall refund the deposit amount to You barring a token amount to take
care of non-covered expenses once the pre-authorization is issued.
Note: Cashless facility for Hospitalization Expenses shall be limited exclusively to Medical Expenses
incurred for treatment undertaken in a Network Hospital for Illness or Injury which are covered under
the Policy and shall not be available to the Insured Person for coverage under Worldwide Emergency
Cover (Section II.8). For all Cashless authorisations, You will, in any event, be required to settle all
non-admissible expenses, Co-payment and / or Deductibles (if applicable), directly with the Hospital.
The Network Provider will send the claim documents along with the invoice and discharge voucher,
duly signed by the Insured Person directly to us. The following claim documents should be submitted
to Us within 15 days from the date of discharge from Hospital –
 Claim Form Duly Filled and Signed
 Original pre-authorisation request
 Copy of pre-authorisation approval letter (s)
 Copy of Photo ID of Patient Verified by the Hospital
 Original Discharge/Death Summary
 Operation Theatre Notes(if any)
 Original Hospital Main Bill and break up Bill
 Original Investigation Reports, X Ray, MRI, CT Films, HPE
 Doctors Reference Slips for Investigations/Pharmacy
 Original Pharmacy Bills
 MLC/FIR Report/Post Mortem Report (if applicable and conducted)
We may call for any additional documents as required based on the circumstances of the claim
There can be instances where We may deny Cashless facility for Hospitalization due to insufficient
Sum Insured or insufficient information to determine admissibility in which case You/Insured Person
may be required to pay for the treatment and submit the claim for reimbursement to Us which will be
considered subject to the Policy Terms &Conditions.

We in our sole discretion, reserves the right to modify, add or restrict any Network Hospital for
Cashless services available under the Policy. Before availing the Cashless service, the Policyholder /
Insured Person is required to check the applicable/latest list of Network Hospital on the Company’s
website or by calling our call centre.
VII.5. Claim Reimbursement Process

(a) Collection of Claim Documents
i. Wherever You have opted for a reimbursement of expenses, You may submit the following
documents for reimbursement of the claim to Our branch or head office at your own expense not
later than 15 days from the date of discharge from the Hospital. You can obtain a Claim Form from
any of our Branch Offices or download a copy from our website www.cignattkinsurance.in
ii. List of necessary claim documents to be submitted for reimbursement are as following:
Claim form duly signed

Copy of photo ID of patient
Hospital Discharge summary
Operation Theatre notes
Hospital Main Bill
Hospital Break up bill
Investigation reports
Original investigation reports, X Ray, MRI, CT films, HPE, ECG
Doctors reference slip for investigation
Pharmacy Bills
MLC/ FIR report, Post Mortem Report if applicable and conducted
KYC documents (Photo ID proof, address proof, recent passport size photograph)
Cancelled cheque for NEFT payment
Payment receipt.
We may call for any additional documents/information as required based on the circumstances of the
claim.
iii. Our branch offices shall give due acknowledgement of collected documents to You.
In case You/ Insured Person delay submission of claim documents as specified in 5(a) above, then in
addition to the documents mentioned in VII.5. (a)above, You are also required to provide Us the
reason for such delay in writing. In case You delay submission of claim documents, then in addition to
the documents mentioned above, You are also required to provide Us the reason for such delay in
writing. We will accept such requests for delay up to an additional period of 30 days from the
stipulated time for such submission. We will condone delay on merit for delayed Claims where the
delay has been proved to be for reasons beyond Your/Insured Persons control.
VII.6. Scrutiny of Claim Documents

a. We shall scrutinize the claim and accompanying documents. Any deficiency of documents shall
be intimated to You and the Network Provider, as the case may be within 5 days of their receipt.
b. If the deficiency in the necessary claim documents is not met or are partially met in 10 working
days of the first intimation, We shall remind You of the same and every 10 (ten) days thereafter.
c. We will send a maximum of 3 (three) reminders.
d. We shall settle the claim payable amount arrived post scrutinizing the claim documents excluding
the deficiency intimated to You.
e. In case a reimbursement claim is received when a Pre-Authorization letter has been issued,
before approving such claim a check will be made with the provider whether the Pre-
authorization has been utilized as well as whether the Policyholder has settled all the dues with
the provider. Once such check and declaration is received from the Provider, the case will be
processed.

VII.7. Claim Assessment
We will assess all admissible claims under the Policy in the following progressive order –
a) For Plans without Deductible Option

i) Where a room accommodation is opted for higher than the eligible room category under the plan,
the room rent for the applicable accommodation will be apportioned on pro rata basis. Such
apportioned amount will apply to all “Associated Medical Expenses”.
ii) Any Voluntary, Mandatory or Zonal Co-payment shall be applicable on the amount payable after
applying the Section VII.7 a (i)
b) For Plans with Deductible Option

i) Where a room accommodation is opted for higher than the eligible room category under the plan,
the room rent for the applicable accommodation will be apportioned on pro rata basis. Such
apportioned amount will apply to all “Associated Medical Expenses”.
ii) Arrived payable claim amount will be assessed against the deductible.
iii) Any Mandatory or Zonal Co-payment shall be applicable on the amount payable after applying
the Section VII.7 b (i), (ii)
c) The Claim amount assessed under Section VII.7 a) and b) will be deducted from the following
amounts in the following progressive order –
i) Deductible & Co-pays (if opted)
ii) Mandatory Copays (if applicable)
iii) Zonal Copays (if applicable)
iv) Sum Insured

v) Cumulative Bonus
vi) Restored Sum Insured
Claim Assessment for Benefit Plans:

We will pay fixed benefit amounts as specified in the Policy Schedule in accordance with the terms of
this Policy. We are not liable to make any reimbursements of Medical Expenses or pay any other
amounts not specified in the Policy
VII.8. Claims Investigation

We may investigate claims at Our own discretion to determine the validity of claim. Such investigation
shall be concluded within 15 days from the date of assigning the claim for investigation and not later
than 30 days from the date of receipt of last necessary document. Verification carried out, if any, will
be done by individuals or entities authorised by Us to carry out such verification / investigation(s) and
the costs for such verification / investigation shall be borne by the Us.
VII.9. Pre and Post-hospitalization claims

You should submit the Post-hospitalization claim documents at Your own expense within 15 days of
completion of Post-hospitalization treatment or eligible post hospitalisation period of cover, whichever
is earlier.
We shall receive Pre and Post- hospitalization claim documents either along with the inpatient
Hospitalization papers or separately and process the same based on merit of the claim subject to
Policy terms and conditions, derived on the basis of documents received.
VII.10. Settlement including Repudiation of a claim

We shall settle or reject the claim within 30 days from the date of receipt of last necessary document in
accordance with the provisions of Regulation 27 of IRDAI (Health Insurance) Regulations, 2016.
In the case of delay in the payment of a claim We shall be liable to pay interest from the date of receipt of last
necessary document to the date of payment of claim at a rate 2% above the bank rate.
However, where the circumstances of a claim warrant an investigation in Our opinion, We shall initiate and
complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last
necessary document. In such cases, We shall settle or reject the claim within 45 days from the date of receipt
of last necessary document.
In case of delay beyond stipulated 45 days We shall be liable to pay interest at a rate 2% above the bank rate
from the date of receipt of last necessary document to the date of payment of claim
VII.11 Representation against Rejection:

Where a rejection is communicated by Us, You may if so desired within 15 days represent to Us for
reconsideration of the decision.
VII.12. Payment Terms

The Sum Insured opted under the Plan shall be reduced by the amount payable / paid under the
Benefit(s) and the balance shall be available as the Sum Insured for the unexpired Policy Year.
If You/ Insured Person suffers a relapse within 45 days of the date of discharge from the Hospital for
which a claim has been made, then such relapse shall be deemed to be part of the same claim and all
the limits for “Any One Illness” under this Policy shall be applied as if they were under a single claim.
For Cashless Claims, the payment shall be made to the Network Hospital whose discharge would be
complete and final.
For Reimbursement Claims, the payment will be made to you. In the unfortunate event of Your death,
We will pay the nominee (as named in the Policy Schedule) and in case of no nominee to the Legal
Heir who holds a succession certificate or Indemnity Bond to that effect, whichever is available and
whose discharge shall be treated as full and final discharge of its liability under the Policy.
Claim process Applicable to the following Sections:

VII.13. Health Maintenance Benefit
(a) Submission of claim
You can send the Health Maintenance Benefit claim form along with the invoices, treating Medical
Practitioner’s prescription, reports, duly signed by You/ Insured Person as the case may be, to Our
branch office or Head Office at your own expense. The Health Maintenance Benefit under all Plans
can be claimed only once during the Policy Period up to the extent of limit under this benefit or a
maximum of Rs 15000.
Where a claim for Health Maintenance Benefit exceeds Rs 15,000 for a single claim the same can be
claimed at any time during the Policy Period.
In respect of Health Maintenance Benefit under the Accumulate Plan which is utilised for payment of
opted Deductible or Co-pay the same can be settled along with the claim under the respective
sections wherever applicable.
(b) Assessment of Claim Documents
We shall assess the claim documents and assess the admissibility of claim subject to terms and
conditions of the Policy .
(c) Settlement & Repudiation of a claim
We shall settle claims, including its rejection, within 5 (five) working days of the receipt of the last
‘necessary’ document but not later than 30 days.
VII.14. Expert Opinion on Critical Illness

(a) Receive Request for Expert Opinion on Critical Illness

You can submit Your request for an expert opinion by calling Our call centre or register request
through email.
(b) Facilitating the Process
We will schedule an appointment or facilitate delivery of Medical Records of the Insured Person to a
Medical Practitioner. The expert opinion is available only in the event of the Insured Person being
diagnosed with Covered Critical Illness.
VII.15. Health Check up

(a) You or The Insured Person shall seek appointment by calling Our call centre.
(b) We will facilitate Your appointment and We will guide You to the nearest Network Provider for
conducting the medical examination. Reports of the Medical Tests can be collected directly from the
centre.
VII.16. Worldwide Emergency Cover

a) In an unlikely event of You or the Insured Person requires Emergency medical treatment outside
India, You or Insured Person, must notify Us either at Our call centre or in writing within 48 hours of
such admission.
b) You shall file a claim for reimbursement in accordance with Section VII.5 of the Policy.
VII.17. Deductible
a) Any claim towards hospitalisation during the Policy Period must be submitted to Us for assessment
in accordance with the claim process laid down under Section VII.4 and Section VII.5.towards
cashless or reimbursement respectively in order to assess and determine the applicability of the
Deductible on such claim. Once the claim has been assessed, if any amount becomes payable after
applying the deductible, We will assess and pay such claim in accordance with Section VII.6. and VII.
7.b).
b) Wherever such hospitalisation claims as stated under VII.17. a) above is being covered under
another Policy held by You, We will assess the claim on available photocopies duly attested by Your
Insurer / TPA as the case may be.
VIII. GENERAL TERMS AND CONDITIONS
1. Duty of Disclosure
The Policy shall be null and void and no benefit shall be payable in the event of untrue or incorrect
statements, misrepresentation, mis-description or non-disclosure of any material particulars in the
proposal form, personal statement, declaration, claim form declaration, medical history on the claim
form and connected documents, or any material information having been withheld by You or any one
acting on Your behalf, under this Policy. You further understand and agree that We may at Our sole
discretion cancel the Policy and the premium paid shall be forfeited to Us.
2. Material Change
Material information to be disclosed includes every matter that You are aware of, that relates to
questions in the Proposal Form and which is relevant to Us in order to accept the risk of insurance
and if so on what terms. You must exercise the same duty to disclose those matters to Us before the
Renewal, extension, variation, endorsement or reinstatement of the contract.
3. Observance of Terms and Conditions

The due observance and fulfilment of the terms and conditions of the Policy (including the realisation
of premium by their respective due dates and compliance with the specified procedure on all Claims)
in so far as they relate to anything to be done or complied with by You or any of the Insured Persons,
shall be the condition precedent to Our liability under this Policy.

4. Alterations in the Policy
This Policy constitutes the complete contract of insurance. No change or alteration will be effective or
valid unless approved in writing which will be evidenced by a written endorsement, signed and
stamped by Us.
5. Change of Policyholder
The policyholder may be changed only at the time of Renewal of the Policy. The new policyholder
must be a member of the Insured Person’s immediate family. Such change would be solely subject to
Our discretion and payment of premium by You. The renewed Policy shall be treated as having been
renewed without break.
The policyholder may be changed upon request in case of his demise, his moving out of India or in
case of divorce during the Policy Period.
6. No Constructive Notice
Any knowledge or information of any circumstance or condition in relation to the Policyholder/ Insured
Person which is in Our possession and not specifically informed by the Policyholder / Insured Person
shall not be held to bind or prejudicially affect Us notwithstanding subsequent acceptance of any
premium.
7. Geography
The geographical scope of this policy applies to events within India other than for Worldwide
Emergency Cover and which are specifically covered in the Schedule. However all admitted or
payable claims shall be settled in India in Indian rupees.
8. Mandatory Co-pay
A compulsory Co-payment of 20% is applicable on all claims for Insured Persons aged 65 years and
above irrespective of age of entry in to the Policy. For persons who have opted for a Waiver of
Mandatory Co-pay the same will not apply.
Co-pay will be applied on the admissible claim amount. In case the Insured has selected the
Voluntary co-pay (Section IV.4), and/or if he chooses to take treatment out of Zone then the co-pay
percentages will apply in conjunction.
9. Multiple Policies
In case of multiple policies which provide fixed benefits, on the occurrence of the insured event in
accordance with the terms and conditions of the policies, We shall make the claim payments
independent of payments received under other similar polices.
If two or more policies are taken by an insured during a period from one or more insurers to indemnify
treatment costs, the policyholder shall have the right to require a settlement of his/her claim in terms
of any of his/her policies.
o In all such cases the insurer who has issued the chosen policy shall be obliged to
settle the claim as long as the claim is within the limits of and according to the terms
of the chosen policy.
o Claims under other policy/ies may be made after exhaustion of Sum Insured in the
earlier chosen policy / policies. The policyholder having multiple policies shall also
have the right to prefer claims from other policy / policies for the amounts disallowed
under the earlier chosen policy / policies, even if the sum insured is not exhausted.
Then the Insurer(s) shall settle the claim subject to the terms and conditions of the
other policy / policies so chosen.
o If the amount to be claimed exceeds the sum insured under a single policy after
considering the deductibles or co-pay, the policyholder shall have the right to choose
insurers from whom he/she wants to claim the balance amount.
o Where an insured has policies from more than one insurer to cover the same risk on
indemnity basis, the insured shall only be indemnified the hospitalization costs in
accordance with the terms and conditions of the chosen policy.

10. Records to be maintained
You or the Insured Person, as the case may be shall keep an accurate record containing all medical
records pertaining to claim and shall allow Us or our representative(s) to inspect such records. You or
the Insured Person as the case may be, shall furnish such information as may be required by Us
under this Policy at any time during the Policy Period and up to three years after the Policy expiration,
or until final adjustment (if any) and resolution of all Claims under this Policy.
11. Free Look period

All new individual health insurance policies issued by Us, except those with tenure of less than a year
shall have a free look period. The free look period shall be applicable at the inception of the policy and
 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 not acceptable.
 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 Us on medical
examination of the insured persons and the stamp duty charges or;
b) where the risk has already commenced and the option of return of the policy is
exercised by the policyholder, a deduction towards the proportionate risk premium for
period on cover or;
Where only a part of the insurance coverage has commenced, such proportionate premium
commensurate with the insurance coverage during such period;.
12. Cancellation
Request for Cancellation shall be intimated to Us from Your side by giving 15 days’ notice in which
case We shall refund the premium for the unexpired term as per the short period scale mentioned
below.
Premium shall be refunded only if no claim has been made under the Policy.
Refund Grid as a % of Premium
In force Period-Up to 1 Year 2 Year 3 Year
0 - 30 Days 75.00% 85.00% 90.00%

31 - 90 Days 50.00% 75.00% 85.00%
91 - 180 Days 25.00% 60.00% 75.00%
181 - 365 Days 50.00% 60.00%
366 - 455 Days 30.00% 50.00%
456 - 545 Days 20.00% 35.00%
546 - 730 Days NIL 30.00%
731 - 910 Days NIL 15.00%
More than 910 Days NIL
You further understand and agree that We may cancel the Policy by giving 15 days’ notice in writing
by Registered Post Acknowledgment Due / recorded delivery to Your last known address on grounds
of misrepresentation, fraud or non-disclosure of material fact without any refund of premium.
Cover may end immediately for all Insured Persons, if there is non-cooperation by You/ Insured
person, with refund of premium on pro rata basis after deducting Our expenses, by giving 15 days’
notice in writing by Registered Post Acknowledgment Due / recorded delivery to Your last known
address.

An individual policy with a single insured shall automatically terminate in case of Your death or if You
are no longer a resident of India. In case of an Individual Policy with multiple Insured Persons and in
case of a floater, the Policy shall continue to be in force for the remaining members of the family up to
the expiry of current Policy Period. The Policy may be Renewed on an application by another adult
Insured Person under the Policy whenever such is due. In case, the Insured Person is minor, the
Policy shall be renewed only through any one of his/her natural guardian or guardian appointed by
Court. All relevant particulars in respect of such person (including his/her relationship with You) must
be given to Us along with the Application.
All coverages and benefits including any earned Healthy Reward Points under the Policy shall
automatically lapse upon cancellation of the Policy.
Wherever a Policy under the Accumulate Plan is cancelled, any unclaimed Health Maintenance
Benefit limit will remain applicable on the Policy and available for a claim over the next 12 month
period. You may convert any available Healthy Reward Points in to the Health Maintenance Benefit
before initiating the cancellation of the Policy.
13. Grace Period

The Policy may be renewed by mutual consent and in such event the Renewal premium should be
paid to Us on or before the date of expiry of the Policy and in no case later than the Grace Period of
30 days from the expiry of the Policy. We will not be liable to pay for any claim arising out of an Injury/
Accident/ Condition that occurred during the Grace Period. . The provisions of Section 64VB of the
Insurance Act shall be applicable. All policies Renewed within the Grace Period shall be eligible for
continuity of cover.
14. Renewal Terms

a. The Policy will automatically terminate at the end of the Policy Period. The Policy is ordinarily
renewable on mutual consent for life, subject to application of Renewal and realization of
Renewal premium
b. The premium payable on Renewal shall be paid to Us on or before the Policy Period end date
and in any event before the expiry of the Grace Period. Policy would be considered as a fresh
policy if there would be break of more than 30 days between the previous policy expiry date and
current Policy start date. We, however shall not be liable for any claim arising out of an ailment
suffered or Hospitalisation commencing or disease/illness/condition contracted during the period
between the expiry of previous policy and date of inception of subsequent policy. In case of
Accumulate Plan only the unutilised Health Maintenance Benefit limit (excluding any Cumulative
Bonus) will be available for a claim during the grace period
c. Where the Policy is not renewed before the end of the Grace Period and the Policy is terminated,
any unutilized Health Maintenance Benefit limit in respect of the Accumulate Plan shall be
available for a claim as defined under II.(xi). above up to a period of 12 months from the date of
expiry of the Policy. All Such claims will be in respect of the Insured Members under the expiring
policy only.
d. Renewals will not be denied except on grounds of misrepresentation, moral hazard, fraud, non-
disclosure of material facts or non-co-operation by You.
e. Where We have discontinued or withdrawn this product/plan You will have the option to renewal
under the nearest substitute Policy being issued by Us, provided however benefits payable shall
be subject to the terms contained in such other policy which has been approved by IRDAI.
f. Insured Person shall disclose to Us in writing of any material change in the health condition at
the time of seeking Renewal of this Policy, irrespective of any claim arising or made. The terms
and condition of the existing policy will not be altered.
g. We may, revise the Renewal premium payable under the Policy or the terms of cover, provided
that all such changes are approved by IRDAI and in accordance with the IRDAI rules and
regulations as applicable from time to time. Renewal premium will not alter based on individual

claims experience. We will intimate You of any such changes at least 90 days prior to date of
such revision or modification.
h. Alterations like increase/ decrease in Sum Insured or Change in Plan/Product, addition/deletion
of members, addition deletion of Medical Condition existing prior to policy inception will be
allowed at the time of Renewal of the Policy. You can submit a request for the changes by filling
the proposal form before the expiry of the Policy. We reserve Our right to carry out underwriting
in relation to acceptance of request for change of Sum Insured or addition/deletion of members,
addition deletion of Medical Condition existing prior to policy inception, on renewal. The terms
and conditions of the existing policy will not be altered.
i. Any enhanced Sum Insured during any policy renewals will not be available for an illness,
disease, injury already contracted under the preceding Policy Periods. All waiting periods as
mentioned below shall apply afresh for this enhanced limit from the effective date of such
enhancement.
j. Wherever the Sum Insured is reduced on any Policy Renewals, the waiting periods as mentioned
below shall be waived only up to the lowest Sum Insured of the last 48/ 36/ 24 consecutive
months as applicable to the relevant waiting periods of the Plan opted.
k. Where an Insured Person is added to this Policy, either by way of endorsement or at the time of
renewal, all waiting periods under Section V.1 to V.5 will be applicable considering such Policy
Year as the first year of Policy with the Company.
l. Applicable Cumulative Bonus shall be accrued on each renewal as per eligibility under the plan
opted.
m. Once an Insured Person attain age of 65 years on renewal a Mandatory co-payment of 20% will
be applicable on all claims irrespective of the age of entry in to the Policy. This clause does not
apply to persons who have opted for a Waiver of Mandatory Co-pay.
n. In case of floater policies, children attaining 24 years at the time of renewal will be moved out of
the floater into an individual cover, however all continuity benefits on the policy will remain intact.
Cumulative Bonus earned on the Policy will stay with the floater cover.
15. Premium calculation

Premium will be calculated based on the Sum Insured opted, Age, gender, risk classification and
Zone of Cover. Default Zone of Cover will be based on Your City-Location based on Your
correspondence address. All Premiums are age based and will vary each year as per the change in
age group.
Zone Classification
Zone I: Mumbai, Thane & Navi Mumbai, Gujarat and Delhi & NCR
Zone II: Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana, Kolkata, Pune
Zone III: Rest of India excluding the locations mentioned under Zone I & Zone II
Identification of Zone will be based on the location-City of the proposed Insured Persons.
(a) Persons paying Zone I premium can avail treatment all over India without any Co-pay.
(b) Persons paying Zone II premium
i) Can avail treatment in Zone II and Zone III without any Co-pay.
ii) Availing treatment in Zone I will have to bear 10% of each and every claim.
(c) Person paying Zone III premium
i) Can avail treatment in Zone III, without any Co-pay.
ii) Availing treatment in Zone II will have to bear 10% of each and every claim.
iii) Availing treatment in Zone I will have to bear 20% of each and every claim.
***Option to select a Zone higher or lower than that of the actual Zone is available on payment of
applicable premium at the time of buying the First Policy and on subsequent renewals
Aforesaid Co-payments for claims occurring outside of the Zone will not apply in case of
Hospitalisation due to Accident. The aforesaid Co-payments applicable are in addition to the

Voluntary Co-pay under Section IV.3 (if opted) and Mandatory Co-pay under Section IV.4 (if
applicable) and will be applied in conjunction to Section IV.3 and Section IV.4 of the Policy.
For premium calculation of floater policies, age of eldest member would be considered
Premium towards Maternity Expenses, New born baby expenses and First Year Vaccinations shall be
applied to female Insured Members between age group of 18 to 45 years only.
16. Loadings & Special Conditions

We may apply a risk loading on the premium payable(excluding Statutory Levis and Taxes) or Special
Conditions on the Policy based upon the health status of the persons proposed for insurance and
declarations made in the Proposal Form.. These loadings will be applied from inception date of the
first Policy including subsequent Renewal(s) with Us. There will be no loadings based on individual
claims experience.
We may apply a specific sub-limit on a medical condition/ailment depending on the past history and
declarations or additional waiting periods (a maximum of 48 months from the date of inception of first
policy) on pre-existing diseases as part of the special conditions on the Policy. Details of applicable
loadings by ailments/ medical test results are listed as below along with the applicable sub-limits and
waiting periods..
We shall inform You about the applicable risk loading or special condition through a counter offer
letter and You would need to revert with consent and additional premium (if any), within 7 working
days of the issuance of such counter offer letter.
In case, You neither accept the counter offer nor revert to Us within 7 working days, We shall cancel
Your application and refund the premium paid. Your Policy will not be issued unless We receive Your
consent.
17. Communications & Notices

Any communication or notice or instruction under this Policy shall be in writing and will be sent to:
a. The policyholder’s, at the address as specified in Schedule
b. To Us , at the address specified in the Schedule.
c. No insurance agents, brokers, other person or entity is authorised to receive any notice on the
behalf of Us unless explicitly stated in writing by Us.
d. Notice and instructions will be deemed served 10 days after posting or immediately upon
receipt in the case of hand delivery, facsimile or e-mail.
18. Electronic Transactions

You agree to comply with all the terms, conditions as We shall prescribe from time to time, and
confirms that all transactions effected facilities for conducting remote transactions such as the
internet, World Wide Web, electronic data interchange, call centres, tele-service operations (whether
voice, video, data or combination thereof) or by means of electronic, computer, automated machines
network or through other means of telecommunication, in respect of this Policy, or Our other products
and services, shall constitute legally binding when done in compliance with Our terms for such
facilities.
Sales through such electronic transactions shall ensure that all conditions of Section 41 of the
Insurance Act, 1938 prescribed for the proposal form and all necessary disclosures on terms and
conditions and exclusions are made known to You . A voice recording in case of tele-sales or other
evidence for sales through the World Wide Web shall be maintained and such consent will be
subsequently validated / confirmed by You.

All terms and conditions in respect of Electronic Transactions shall be within the approved Terms and
Conditions of the Policy.
19. Fraudulent Claims

If any claim is found to be fraudulent, or if any false declaration is made, or if any fraudulent devices
are used by You or the Insured Person or anyone acting on their behalf to obtain any benefit under
this Policy then this Policy shall be void and all claims being processed shall be forfeited for all
Insured Persons. All sums paid under this Policy shall be repaid to Us by You on behalf of all Insured
Persons who shall be jointly liable for such repayment.
20. Limitation of Liability

If a claim is rejected or partially settled and is not the subject of any pending suit or other proceeding
or arbitration, as the case may be, within twelve months from the date of such rejection or settlement,
the claim shall be deemed to have been abandoned and Our liability shall be extinguished and shall
not be recoverable thereafter.
21. Portability & Continuity Benefits

You can port Your existing health insurance policy from another company to ProHealth Insurance,
provided that:
a. You have been covered under an Indian retail health insurance policy from a Non-life Insurance
or Health Insurance company registered with IRDAI without any break in the immediate previous
policy.
b. We should have received Your application for Portability with complete documentation at least 45
days before the expiry of Your present period of Insurance
c. If the Sum Insured under the previous Policy is higher than the Sum Insured chosen under this
Policy, the applicable waiting periods under Sections V.1, V.2, V.3, V.4, and V.5 shall be reduced
by the number of months of continuous coverage under such health insurance policy with the
previous insurer to the extent of the Sum Insured and the Eligible Cumulative Bonus under the
expiring health insurance policy.
d. In case the proposed Sum Insured opted for under Our Policy is more than the insurance cover
under the previous policy, then all applicable waiting periods under Sections V.1,V.2, V.3, V.4,
and V.5 shall be applicable afresh to the amount by which the Sum Insured under this Policy
exceed the total of sum insured and Eligible Cumulative Bonus under the expiring health
insurance policy;
e. All waiting periods under Sections V.1, V.2, V.3, V.4, and V.5 shall be applicable individually for
each Insured Person and Claims shall be assessed accordingly.
f. If You were covered on a floater basis under the expiring Policy and apply for a floater cover
under this Policy, then the Eligible Cumulative Bonus to be carried forward on this Policy shall
also be available on a floater basis.
g. If You were covered on an individual basis in the expiring Policy then the Eligible Cumulative
Bonus to be carried forward on this Policy shall be available on an individual basis.
For the purpose of this provision, Eligible Cumulative Bonus shall mean the Cumulative Bonus which
You or the Insured Person would have been eligible for had the same policy been Renewed with the
existing insurance company.
It is further agreed and understood that

a. Portability benefit will be offered to the extent of sum of previous sum insured and accrued
cumulative bonus (if opted for), and Portability shall not apply to any other additional increased
Sum Insured.

b. We may subject Your proposal to Our medical underwriting, restrict the terms upon which We
may offer cover, the decision as to which shall be in in line with our Board approved underwriting
policy.
c. There is no obligation on Us to insure all Insured Persons on the proposed terms, even if You
have given Us all documentation
d. We should have received the database and claim history from the previous insurance company
for Your previous policy.
The Portability provisions will apply to You, if You wish to migrate from this Policy to any other health
insurance policy on Renewals. All benefits under the Policy will terminate on successful porting of the
Policy other than any Health Maintenance Benefit under Accumulate Plan which will be available for a
claim up to a period of 12 months from the date of expiry of such policy.
In case You have opted to switch to any other insurer under portability provisions and the outcome of
acceptance of the portability request is awaited from the new insurer on the date of renewal,
a. We may upon Your request extend this Policy for a period of not less than one month at an
additional premium to be paid on a pro-rata basis.
b. If during this extension period a claim has been reported, You shall be required to first pay the
full premium so as to make the Policy Period of full 12 calendar months. Our liability for the
payment of such claim shall commence only once such premium is received. Alternately We may
deduct the premium for the balance period and pay the balance claim amount if any and issue
the Policy for the remaining period.
22. Complete Discharge

We will not be bound to take notice or be affected by any Notice of any trust, charge, lien, assignment
or other dealing with or relating to this Policy. The payment made by Us to You/Insured Person or to
Your Nominee/Legal Representative or to the Hospital, as the case may be, of any Medical Expenses
or compensation or benefit under the Policy shall in all cases be complete, valid and construe as an
effectual discharge in favour of Us.
23. Dispute Resolution

Any and all disputes or differences under or in relation to this Policy shall be determined by the Indian
Courts and subject to Indian law.
24. Grievances Redressal Procedure

If you have a grievance that you wish us to redress, you may contact us with the details of the
grievance through:
Our website: <<Website>>
Email: <<Email ID>>
Toll Free : <<Number>>
Fax: <<Will be added once available>>
Courier: Any of Our Branch office or corporate office during business hours.
You may also approach the grievance cell at any of Our branches with the details of the grievance
during Our working hours from Monday to Friday.
If You are not satisfied with Our redressal of Your grievance through one of the above methods, You
may contact Our Head of Customer Service at The Grievance Cell, CignaTTK Health Insurance
Company Limited, <<Address>> or email <<email of head of customer service>>.
If You are not satisfied with Our redressal of Your grievance through one of the above methods, You
may approach the nearest Insurance Ombudsman for resolution of Your grievance. The contact
details of Ombudsman offices attached as Annexure I to this Policy document.
IX Definitions

1. Accident or Accidental means a sudden, unforeseen and involuntary event caused by external,
visible and violent means.
2. Age or Aged is the age last birthday, and which means completed years as at the Inception Date
3. Any one Illness means continuous Period of illness and it includes relapse within 45 days from
the date of last consultation with the Hospital/Nursing Home where the treatment may have been
taken.
4. Ambulance means a road vehicle operated by a licenced/authorised service provider and

equipped for the transport and paramedical treatment of the person requiring medical attention.
5. Annexure means a document attached and marked as Annexure to this Policy
6. Associated Medical Expenses shall include Room Rent, nursing charges, operation theatre
charges, fees of Medical Practitioner/surgeon/ anesthetist/ Specialist and diagnostic tests,
excluding cost of medicine, conducted within the same Hospital where the Insured Person has
been admitted.
7. AYUSH treatment refers to the medical and /or hospitalisation treatments given under Ayurveda,
Yoga and Naturopathy, Unani, Siddha and Homeopathy Systems.
8. Cashless Facility means a facility extended by the insurer 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 to the extent pre-
authorization approved.
9. Critical Illness means the following:

a) Cancer of Specified Severity
A malignant tumour characterised by the uncontrolled growth & spread of malignant cells with
invasion & destruction of normal tissues. This diagnosis must be supported by histological
evidence of malignancy. The term cancer includes leukemia, lymphoma and sarcoma.
The following are excluded –

i. All tumors which are histologically described as carcinoma in situ, benign, pre-malignant,
borderline malignant, low malignant potential, neoplasm of unknown behavior, or non-invasive,
including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 and
CIN-3.
ii. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or
beyond;
iii. Malignant melanoma that has not caused invasion beyond the epidermis;
iv. All tumors of the prostate unless histologically classified as having a Gleason score greater
than 6 or having progressed to at least clinical TNM classification T2N0M0
v. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
vi. Chronic lymphocytic leukaemia less than RAI stage 3

vii. Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser
classification,
viii. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification)
or below and with mitotic count of less than or equal to 5/50 HPFs;
ix. All tumors in the presence of HIV infection.
1. .
b) Myocardial Infarction (First Heart Attack of Specified Severity)

I The first occurrence of heart attack or myocardial infarction, which means the death of a portion
of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis for
this will be evidenced by all of the following criteria:
i. a history of typical clinical symptoms consistent with the diagnosis of Acute Myocardial
Infarction (for e.g. typical chest pain)
ii. new characteristic electrocardiogram changes
iii. elevation of infarction specific enzymes, Troponins or other specific biochemical markers.
II The following are excluded:
1. Other acute Coronary Syndromes
2. Any type of angina pectoris.
3. A rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart disease OR
following an intra-arterial cardiac procedure.
c) Open Chest CABG

I The actual undergoing of heart surgery to correct blockage or narrowing in one or more coronary
artery(s), by coronary artery bypass grafting done via a sternotomy (cutting through the breast
bone) or minimally invasive keyhole coronary artery bypass procedures. The diagnosis must be
supported by a coronary angiography and the realisation of surgery has to be confirmed by a
cardiologist.
II The following are excluded:
a. Angioplasty and/or any other intra-arterial procedures
1.
d) Open Heart Replacement or Repair of Heart Valves

The actual undergoing of open-heart valve surgery is to replace or repair one or more heart
valves, as a consequence of defects in, abnormalities of, or disease-affected cardiac valve(s).
The diagnosis of the valve abnormality must be supported by an echocardiography and the
realization of surgery has to be confirmed by a specialist medical practitioner. Catheter based
techniques including but not limited to, balloon valvotomy/valvuloplasty are excluded.
e) Coma of Specified Severity

1. A state of unconsciousness with no reaction or response to external stimuli or internal needs.
This diagnosis must be supported by evidence of all of the following:
i. no response to external stimuli continuously for at least 96 hours;
ii. life support measures are necessary to sustain life; and
iii. permanent neurological deficit which must be assessed at least 30 days after the onset of the
coma.
2. The condition has to be confirmed by a specialist medical practitioner. Coma resulting directly
from alcohol or drug abuse is excluded.

f) Kidney Failure Requiring Regular Dialysis
End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a
result of which either regular renal dialysis (haemodialysis or peritoneal dialysis) is instituted or
renal transplantation is carried out. Diagnosis has to be confirmed by a specialist medical
practitioner.
g) Stroke Resulting in Permanent Symptoms

Any cerebrovascular incident producing permanent neurological sequelae. This includes infarction
of brain tissue, thrombosis in an intracranial vessel, haemorrhage and embolization from an extra
cranial source. Diagnosis has to be confirmed by a specialist medical practitioner and evidenced
by typical clinical symptoms as well as typical findings in CT Scan or MRI of the brain. Evidence
of permanent neurological deficit lasting for at least 3 months has to be produced.
The following are excluded:

1. Transient ischemic attacks (TIA)
2. Traumatic injury of the brain
3. Vascular disease affecting only the eye or optic nerve or vestibular functions.
h) Major Organ/Bone Marrow Transplant

The actual undergoing of a transplant of:
1. One of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from
irreversible end-stage failure of the relevant organ, or
2. Human bone marrow using haematopoietic stem cells. The undergoing of a transplant has to
be confirmed by a specialist medical practitioner.
The following are excluded:
i. Other stem-cell transplants
ii. Where only islets of langerhans are transplanted
i) Permanent Paralysis of Limbs

Total and irreversible loss of use of two or more limbs as a result of injury or disease of the
brain or spinal cord. A specialist medical practitioner must be of the opinion that the paralysis
will be permanent with no hope of recovery and must be present for more than 3 months.
j) Motor Neurone Disease with Permanent Symptoms

Motor neurone disease diagnosed by a specialist medical practitioner as spinal muscular
atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis.
There must be progressive degeneration of corticospinal tracts and anterior horn cells or bulbar
efferent neurons. There must be current significant and permanent functional neurological
impairment with objective evidence of motor dysfunction that has persisted for a continuous
period of at least 3 months.
k) Multiple Sclerosis with Persisting Symptoms

I The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the
following::
1. investigations including typical MRI findings which unequivocally confirm the diagnosis to
be multiple sclerosis;
2. there must be current clinical impairment of motor or sensory function, which must have
persisted for a continuous period of at least 6 months
II Other causes of neurological damage such as SLE and HIV are excluded.
10. Inception Date means the Inception date of this Policy as specified in the Schedule

11. Co-payment is a cost-sharing requirement under a health insurance policy that provides that the
policyholder/insured will bear a specified percentage of the admissible claim amount. A co-
payment does not reduce the Sum Insured.
12. Condition Precedent shall mean a policy term or condition upon which the Insurer’s Liability
under the Policy is conditional upon.
13. Cosmetic Surgery means Surgery or Medical Treatment that modifies, improves, restores or
maintains normal appearance of a physical feature, irregularity, or defect.
14. 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 is
called Internal Congenital Anomaly
b. External Congenital Anomaly - which is in the visible and accessible parts of the body is called
External Congenital Anomaly
15. Covered Relationships shall include spouse, children, brother and sister of the Policyholder
who are children of same parents, grandparents, grandchildren, parent in laws, son in law,
daughter in law, Uncle, Aunt, Niece and Nephew.
16. Cumulative Bonus

Cumulative Bonus shall mean any increase in the Sum Insured granted by the insurer without an
associated increase in premium.
17. Day Care Treatment refers to 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 advancement, and
ii) Which would have otherwise required a hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.
For the list of Day Care Treatments please refer Annexure II attached to and forming part of this
Policy. Day Care Centre - A day care centre means any institution established for day care
treatment of illness and / or injuries or a medical set -u p 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.
18. 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.
19. Dependent Child A dependent child refers to a child (natural or legally adopted), who is
financially dependent on the Policy Holder, does not have his / her independent source of
income, is up to the age of 23 years.

20. Dental Treatment - Dental treatment is treatment carried out by a dental practitioner including
examinations, fillings (where appropriate), crowns, extractions and surgery excluding any form of
cosmetic surgery/implants.
21. Disclosure to Information Norm means the 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.
22. Domiciliary Hospitalization 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.
23. Emergency shall mean a serious medical condition or symptom resulting from injury or sickness
which arises suddenly and unexpectedly, and requires immediate care and treatment by a
medical practitioner, generally received within 24 hours of onset to avoid jeopardy to life or
serious long term impairment of the insured person’s health, until stabilisation at which time this
medical condition or symptom is not considered an emergency anymore.
24. Emergency Care means management for a severe illness or injury which results insymptoms
which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner
to prevent death or serious long term impairment of the insured person’s health.
25. Family Floater means a Policy described as such in the Schedule where under You and Your
Dependents named in the Schedule are insured under this Policy as at the Inception Date. The
Sum Insured for a Family Floater means the sum shown in the Schedule which represents Our
maximum liability for any and all claims made by You and/or all of Your Dependents during each
Policy Period.
26. 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.
27. Hospital means any institution established for inpatient care and day care treatment o f 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 at least 10 in-patient beds, in towns having a population of less than 10,00,000 and at least
15 in-patient beds in all other places;
- has qualified nursing staff under its employment round the clock;
- 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.
28. Hospitalisation or Hospitalised means admission in a hospital 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.

29. Illness means sickness or disease or pathological condition leading to the impairment of normal
physiological function which manifests itself during the policy period and requires medical
treatment.
30. 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:-it needs ongoing or long-term monitoring through
consultations, examinations, check-ups, and/or tests- it needs on-going or long term control or
relief of symptoms- it requires your rehabilitation or for you to be specially trained to cope with it-it
continues indefinitely-it comes back or is likely to come back.
31. 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.
32. 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.
33. In-patient means an Insured Person who is admitted to hospital and stays for at least 24
consecutive hours for the sole purpose of receiving treatment.
34. 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.
35. Insured Person means the person(s) named in the Schedule to this Policy, who is / are covered
under this Policy, for whom the insurance is proposed and the appropriate premium paid.
36. Maternity Expense shall include the following:

i. Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during Hospitalisation);
ii. Expenses towards lawful medical termination of pregnancy during the Policy Period
37. Maternity Sum Insured means the sum specified in the Schedule against the Benefit
38. Medical Advice means any written consultation or advise from a Medical Practitioner including
the issue of any prescription or repeat prescription.
39. Medical Expenses means those expenses that an Insured Person has necessarily and actually
incurred for medical treatment on account of Illness or Accident on the advise 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.
40. Medically Necessary means any treatment, tests, medication, or stay in Hospital or part of a
stay in Hospital which
• Is required for the medical management of the Illness or injury suffered by the Insured;

• Must not exceed the level of care necessary to provide safe, adequate and appropriate medical
care in scope, duration or intensity.
• Must have been prescribed by a Medical Practitioner.
• Must conform to the professional standards widely accepted in international medical practice or
by the medical community in India.
41. Medical Practitioner - A Medical practitioner is a person who holds a valid registration from the
medical council of any state or Medical Council of India or Council for Indian Medicine or for
Homeopathy set up by Government of India or a State Governement and is and is thereby
entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction
of license.
42. New Born Baby means baby born during the Policy Period and is Aged between 1 day and 90
days, both days inclusive.
43. Network Provider means hospitals enlisted by an insurer, TPA or jointly by an insurer and TPA
to provide medical services to an insured by a cashless facility.
44. Non- Network Provider Any hospital, day care centre or other provider that is not part of the
network.
45. Notification of Claim Notification of claim means the process of intimating a claim to the insurer
or TPA through any of the recognized modes of communication.
46. OPD Treatment – Out Patient Treatment (OPD) is one in which the Insured visits a clinic /
hospital or associated facility like a consultation room for diagnosis and treatment based on the
advice of a Medical Practitioner. The Insured is not admitted as a day care or In-Patient.
47. Policy means this Terms & Conditions document, the Proposal Form, Policy Schedule, Add-On
Benefit Details (if applicable) and Annexures which form part of the Policy contract including
endorsements, as amended from time to time which form part of the Policy Contract and shall be
read together.
48. Policy Period means the period between the inception date and the expiry date of the policy as
specified in the Schedule to this Policy or the date of cancellation of this policy, whichever is
earlier.
49. Policy Year means a period of 12 consecutive months within the Policy Period commencing
from the Policy Anniversary Date.
50. Policy Schedule means Schedule attached to and forming part of this Policy mentioning the
details of the Insured Persons, the Sum Insured, the period and the limits to which benefits under
the Policy are subject to, including any annexures and/or endorsements, made to or on it from
time to time, and if more than one, then the latest in time.
51. Pre-existing Disease Pre-Existing Disease means any condition, ailment or injury or related
condition(s) for which there were signs or symptoms, and / or were diagnosed, and / or for which
medical advice / treatment was received within 48 months prior to the first policy issued by the
insurer and renewed continuously thereafter.
52. Pre-hospitalization Medical Expenses

Pre-hospitalization Medical Expenses means medical expenses incurred during predefined
number of days preceding the hospitalization of the Insured Person, provided that:

- Such Medical Expenses are incurred for the same condition for which the Insured Person’s
Hospitalization was required, and
- The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance
Company.
53. Post-hospitalization Medical Expenses

Post-hospitalization Medical Expenses means medical expenses incurred during predefined
number of days immediately after the insured person is discharged from the hospital provided
that:
i. Such Medical Expenses are for the same condition for which the insured person’s
hospitalization was required, and
ii. The inpatient hospitalization claim for such hospitalization is admissible by the insurance
company.
54. Portability means the right accorded to an individual health insurance policyholder (including
family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions,
from one insurer to another or from one plan to another plan of the same insurer.
55. Qualified Nurse is a person who holds a valid registration from the Nursing Council of India or
the Nursing Council of any state in India.
56. 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 the illness /
injury involved.
57. Renewal means 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
gaining credit for pre-existing diseases, time-bound exclusions and for all waiting periods.
58. Restored Sum Insured means the amount restored in accordance with Section 2.1.10 of this
Policy
59. Room Rent - Room Rent means the amount charged by a Hospital towards Room and Boarding
expenses and shall include the associated medical expenses.
60. Schedule means schedule issued by Us, attached to and forming part of this Policy mentioning
the details of the Policy Holder, Insured Persons, Sum Insured, Policy Period, Premium
Paid(including taxes)..
61. Single Private Room means a single Hospital room with any rating and of most economical
category available at the time of hospitalisation with/without air-conditioning facility where a
single patient is accommodated and which has an attached toilet (lavatory and bath). The room
should have the provision for accommodating an attendant. This excludes a suite or higher
category.
62. Sum Insured means, subject to terms, conditions and exclusions of this Policy, the amount
representing Our maximum liability for any or all claims during the Policy Period specified in the
Schedule to this Policy separately in respect of that Insured Person.

i. In case where the Policy Period for 2/3 years, the Sum Insured specified on the Policy is the
limit for the first Policy Year. These limits will lapse at the end of the first year and the fresh
limits up to the full Sum Insured as opted will be available for the second/third year.
ii. In the event of a claim being admitted under this Policy, the Sum Insured for the remaining
Policy Period shall stand correspondingly reduced by the amount of claim paid (including
’taxes’) or admitted and shall be reckoned accordingly.
63. 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
64. TPA Third Party Administrator (TPA)”, means a company registered with the Authority, and
engaged by Us, for a fee or remuneration, by whatever name called and as may be mentioned in
the agreement, for providing health services as mentioned under TPA Regulations.
65. Unproven/Experimental Treatment - Unproven/Experimental treatment is treatment, including

drug Experimental therapy, which is not based on established medical practice in India, is
treatment experimental or unproven.
66. We/Our/Us/Insurer means CignaTTK Health Insurance Company Limited
67. You/Your/Policy Holder means the person named in the Schedule as the policyholder and who
has concluded this Policy with Us.
Annexure – I:
Ombudsmen
CONTACT DETAILS JURISDICTION
AHMEDABAD
Office of the Insurance Ombudsman,
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Gujarat, Dadra & Nagar Haveli, Daman and Diu.
Ahmedabad – 380 014
Tel.:- 079-27546150/139
Fax:- 079-27546142
Email:-
[email protected]:[email protected]
BENGALURU

Jeevan Mangal Bldg., 2nd Floor,
Behind Canara Mutual Bldgs., Karnataka.
No.4, Residency Road,
Bengaluru – 560 025.
Tel.: 080 - 26652048 / 26652049
Email: [email protected]
BHOPAL
Madhya Pradesh and Chattisgarh.
Janak Vihar Complex,

2nd Floor, 6, Malviya Nagar, Opp. Airtel,
Bhopal – 462 011.
Tel.:- 0755-2769201/202
Fax:- 0755-2769203
Email:- [email protected]
BHUBANESHWAR
62, Forest park,
Bhubneshwar – 751 009. Orissa.
Tel.:- 0674-2596461/2596455
Fax:- 0674-2596429
CHANDIGARH
S.C.O. No. 101, 102 & 103, 2nd Floor,
Batra Building, Sector 17 – D, Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and
Chandigarh – 160 017. Chandigarh.
Tel.:- 0172-2706196/6468
Fax:- 0172-2708274
Email:[email protected]
CHENNAI
Fatima Akhtar Court,
4th Floor, 453 (old 312), Anna Salai, Teynampet, Tamil Nadu and Pondicherry Town and Karaikal (which are part of
CHENNAI – 600 018. Union Territory of Pondicherry).
Tel.:- 044-24333668/24335284
Fax:- 044-24333664
DELHI
2/2 A, Universal Insurance Building,
Asaf Ali Road,
Delhi.
New Delhi – 110 002.
Tel.:- 011-23239633/23237539
Fax:- 011-23230858
GUWAHATI
’Jeevan Nivesh’, 5th Floor,
Nr. Panbazar over bridge, S.S. Road, Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland
Guwahati – 781001(ASSAM). and Tripura.
Tel.:- 0361-2132204/2132205
Fax:- 0361-2732937
HYDERABAD
6-2-46, 1st floor, "Moin Court" Andhra Pradesh, Telangana, Yanam and part of the Territory of
Lane Opp. Saleem Function Palace, Pondicherry.
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.:- 040-65504123/23312122

Fax:- 040-23376599
JAIPUR

Jeevan Nidhi – II Bldg., Gr. Floor,
Rajasthan.
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 -2740363
Fax: 0141 [email protected]
ERNAKULAM
2nd Floor, CC 27 / 2603, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Kerala, Lakshadweep, Mahe-a part of Pondicherry.
Ernakulam - 682 015.
Tel.:- 0484-2358759/9338
Fax:- 0484-2359336
KOLKATA
Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 4, C.R.
Avenue, 4th Floor, KOLKATA - 700 072. West Bengal, Bihar, Sikkim, Jharkhand and Andaman and Nicobar
TEL : 033-22124340/22124339 Islands.
Fax : 033-22124341
LUCKNOW Districts of Uttar Pradesh :

Office of the Insurance Ombudsman, Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad,
6th Floor, Jeevan Bhawan, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi,
Phase-II, Nawal Kishore Road, Hazratganj, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur,
Lucknow-226 001. Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi,
Tel.:- 0522-2231330/1 Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur,
Fax:- 0522-2231310 Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur,
Email:- [email protected]:[email protected] Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
MUMBAI
3rd Floor, Jeevan Seva Annexe,
Goa,
S. V. Road, Santacruz (W),
Mumbai Metropolitan Region
Mumbai - 400 054.
excluding Navi Mumbai & Thane
Tel.:- 022-26106552/6960
Fax:- 022-26106052
State of Uttaranchal and the following Districts of Uttar Pradesh:

Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah,
NOIDA
Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar,
Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautambodhanagar,
Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
PUNE
Maharashtra,
Area of Navi Mumbai and Thane

Jeevan Darshan Bldg., 2nd Floor, excluding Mumbai Metropolitan Region.
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020 -32341320
Annexure – II:
List of Day Care Treatments/Surgeries/Procedures covered under Section II.4:
Microsurgical Operations on the middle ear Critical Care Related:

1. Stapedotomy to treat various lesions in 268. Insert Non- Tunnel CV cath
the middle ear 269. Insert PICC cath (Peripherally
2. Revision of Stapedotomy 270. Inserted Central Catheter)
3. Othe roperations of the auditory 271. Insertion Catheter, Intra Anterior
ossicles 272. Replace PICC cath (Peripherally
4. Myringoplasty (post-aura/ endural 273. Inserted Central Catheter)
approach as well as simple Type – I 274. Insertion of Portacath
Tympanoplasty)
5. Tympanoplasty (closure of an eardrum
perforation/ reconstruction of the auditory Dental Related:
ossicle) 275. Splinting of avulsed teeth
6. Revision of a Tympanoplasty 276. Suturing lacerated lip
7. Other microsurgical operations on the 277. Suturing oral mucosa
middle ear 278. Oral biopsy in case of abnormal
279. tissue presentation
280. FNAC
Other operations on the middle & 281. Smear from oral cavity
internal ear
8. Myringotomy
9. Removal of a tympanic drain ENT Related:
10. Incision of the mastoid process and 282. Myringotomy with grommet insertion
middle ear 283. Keratosis removal under GA
11. Mastoidectomy 284. Adenoidectomy
12. Reconstruction of the middle ear 285. Labyrinthectomy for severe vertigo
13. Other excisions of the middle and inner 286. Stapedectomy under GA
ear 287. Stapedectomy under LA
14. Fenestration of the inner ear 288. Tympanoplasty (type - IV)
15. Revision of a fenestration of the inner 289. Endolymphatic sac surgery for
ear meniere's disease
16. Incision (opening) and destruction 290. Turbinectomy
(elimination) of the inner ear 291. Endoscopic stapedectomy
17. Other operations on the middle ear 292. Incision and drainage of perichondritis
18. Removal of Keratosis Obturans 293. Septoplasty
294. Vestibular nerve section
295. Thyroplasty type - I
Operations on the nose & the nasal 296. Pseudocyst of the pinna - excision
sinuses 297. Incision and drainage - haematoma
19. Excision and destruction of diseased auricle
tissue of the nose 298. Tympanoplasty (type - II)
20. Operations on the turbinates (nasal 299. Reduction of fracture of nasal bone
concha) 300. Thyroplasty type - II
21. Other operations on the nose 301. Tracheostomy
22. Nasal sinus aspiration 302. Excision of angioma septum

23. Foreign body removal from nose 303. Turbinoplasty
304. Incision & drainage of retro pharyngeal
abscess
Operations on the eyes 305. UVULO palato pharyngo plasty
24. Incision of tear glands 306. Adenoidectomy with grommet insertion
25. Other operations on the tear ducts 307. Adenoidectomy without grommet
26. Incision of diseased eyelids insertion
27. Correction of Eyelids Ptosis by Levator 308. Vocal cord lateralisation procedure
Palpebrae Superioris Resection 309. Incision & drainage of para pharyngeal
(bilateral) abscess
28. Correction of Eyelids Ptosis by Fascia 310. Tracheoplasty
Lata Graft (bilateral)
29. Excision and destruction of diseased Gastroenterology Related
tissue of the eyelid 311. Pancreatic pseudocyst EUS & drainage
30. Operations on the canthus and 312. RF ablation for barrett's oesophagus
epicanthus 313. ERCP and papillotomy
31. Corrective surgery for entropion and 314. Esophagoscope and sclerosant
ectropion injection
32. Corrective surgery for blepharoptosis 315. EUS + submucosal resection
33. Removal of a foreign body from the 316. Construction of gastrostomy tube
conjunctiva 317. EUS + aspiration pancreatic CYST
34. Removal of a foreign body from the 318. Small bowel endoscopy (therapeutic)
cornea 319. Colonoscopy ,lesion removal
35. Incision of the cornea 320. ERCP
36. Operations for pterygium 321. Percutaneous endoscopic gastrostomy
37. Other operations on the cornea 322. EUS and pancreatic pseudo CYST
38. Removal of a foreign body from the lens drainage
of the eye 323. ERCP and choledochoscopy
39. Removal of a foreign body from the 324. Proctosigmoidoscopy volvulus
posterior chamber of the eye detorsion
40. Removal of a foreign body from the 325. ERCP and sphincterotomy
orbit and eyeball 326. Esophageal stent placement
41. Operation of cataract 327. ERCP + placement of biliary stents
42. Diathermy/ Cryotherapy to treat retinal 328. Sigmoidoscopy W / stent
tear 329. EUS + coeliac node biopsy
43. Anterior chamber Pancentesis/ 330. UGI scopy and injection of adrenaline,
Cyclodiathermy/ Cyclocryotherapy/ sclerosants bleeding ulcers
goniotomy/ Trabeculotomy and Filtering
and Allied operations to treat glaucoma
44. Enucleation of the eye without implant General Surgery Related:
45. Dacryocystorhinostomy for various 331. Fissure in ANO sphincterotomy
lesions of Lacrimal Gland 332. Incision of the breast abscess
46. Laser photocoagulation to treat ratinal 333. Surgical treatment of haemorrhoids
Tear 334. Infected keloid excision
335. Axillary lymphadenectomy
336. Wound debridement and cover
Operations on the skin & 337. Abscess-decompression
subcutaneous tissues 338. Cervical lymphadenectomy
47. Incision of a pilonidal sinus 339. Infected sebaceous CYST
48. Other incisions of the skin and 340. Inguinal lymphadenectomy
subcutaneous tissues 341. Incision and drainage of abscess
49. Surgical wound toilet (wound 342. Suturing of lacerations
debridement) and removal of diseased 343. SCALP suturing
tissue of the skin and subcutaneous 344. Infected lipoma excision
tissues 345. Maximal anal dilatation
50. Local excision of diseased tissue of the 346. Piles
skin and subcutaneous tissues A) injection sclerotherapy
B) piles banding
51. Other excisions of the skin and
347. Liver abscess- catheter drainage
subcutaneous tissues

52. Simple restoration of surface continuity 348. Fissure in ANO- fissurectomy
of the skin and subcutaneous tissues 349. Fibroadenoma breast excision
53. Free skin transplantation, donor site 350. Oesophageal varices sclerotherapy
54. Free skin transplantation, recipient site 351. ERCP - pancreatic duct stone removal
55. Revision of skin plasty 352. Perianal abscess I&D
56. Other restoration and reconstruction of 353. Perianal hematoma evacuation
the skin and subcutaneous tissues 354. Ugi scopy and polypectomy
57. Chemosurgery to the skin oesophagus
58. Destruction of diseased tissue in the 355. Breast abscess I & D
skin and subcutaneous tissues 356. Feeding gastrostomy
59. Recontruction of deformity/ defect in 357. Oesophagoscopy and biopsy of growth
NailBed oesophagus
358. ERCP - bile duct stone removal
359. Ileostomy closure
Operations on the tongue 360. Colonoscopy
60. Incision, excision and destruction of 361. Polypectomy colon
diseased tissue of the tongue 362. Splenic abscesses laparoscopic
61. Partial glossectomy drainage
62. Glossectomy 363. UGI scopy and polypectomy stomach
63. Reconstruction of the tongue 364. Rigid oesophagoscopy for FB removal
64. Other operations on the tongue 365. Feeding jejunostomy
366. Colostomy
367. Ileostomy
Operations on the salivary glands & 368. Colostomy closure
salivary ducts 369. Submandibular salivary duct stone
removal
65. Incision and lancing of a salivary gland
370. Pneumatic reduction of intussusception
and a salivary duct
371. Varicose veins legs – injection
66. Excision of diseased tissue of a salivary
sclerotherapy
gland and a salivary duct
372. Tips procedure for portal
67. Resection of a salivary gland
373. hypertension
68. Reconstruction of a salivary gland and
374. Rigid oesophagoscopy for plummer
a salivary duct
vinson syndrome
69. Other operations on the salivary glands
375. Pancreatic pseudocysts endoscopic
and salivary ducts
drainage
376. Zadek's nail bed excision
Other operations on the mouth & face 377. Subcutaneous mastectomy
70. External incision and drainage in the 378. Excision of ranula under GA
region of the mouth, jaw and face 379. Rigid oesophagoscopy for dilation of
71. Incision of the hard and soft palate benign strictures
72. Excision and destruction of diseased 380. Eversion of SAC unilateral/ bilateral
hard and soft palate 381. Lord's plication
73. Incision, excision and destruction in the 382. Jaboulay's procedure
mouth 383. Scrotoplasty
74. Palatoplasty 384. Circumcision for trauma
75. Other operations in the mouth 385. Meatoplasty
386. Intersphincteric abscess incision and
drainage
Operations on tonsils and adenoids 387. PSOAS abscess incision and drainage
76. Transoral incision and drainage of 388. Thyroid abscess incision and drainage
pharyngeal abscess 389. Tips procedure for portal hypertension
77. Tonsillectomy without adenoidectomy 390. Esophageal growth stent
78. Tonsillectomy with adenoidectomy 391. Pair procedure of hydatid CYST liver
79. Excision and destruction of a lingual 392. Tru cut liver biopsy
tonsil 393. Photodynamic therapy or esophageal
80. Other operations on the tonsil and tumour and lung tumour
adenoids 394. Excision of cervical RIB
81. Traumasurgery and orthopaedics 395. Laparoscopic reduction of
82. Incision on bone, septic and aseptic intussusception

83. Closed reduction on fracture, luxation 396. Microdochectomy breast
or epiphyseolysis with osteosynthesis 397. Surgery for fracture penis
84. Suture and other operations on tendons 398. Sentinel node biopsy
and tendon sheath 399. Parastomal hernia
85. Reduction of dislocation under GA 400. Revision colostomy
86. Adnoidectomy 401. Prolapsed colostomy - correction
402. Testicular biopsy
403. Laparoscopic cardiomyotomy (hellers)
Operations on the breast 404. Sentinel node biopsy malignant
87. Incision of the breast melanoma
88. Operations on the nipple 405. Laparoscopic pyloromyotomy
89. Excision of single breast lump (ramstedt)
406. Excision of fistula-in-ANO
407. Excision juvenile polyps rectum
Operations on the digestive tract, 408. Vaginoplasty
Kidney and bladder 409. Dilatation of accidental caustic stricture
oesophageal
90. Incision and excision of tissue in the
410. Presacral teratomas excision
perianal region
411. Removal of vesical stone
91. Surgical treatment of anal fistulas
412. Excision sigmoid polyp
92. Surgical treatment of haemorrhoids
413. Sternomastoid tenotomy
93. Division of the anal sphincter
414. Infantile hypertrophic pyloric stenosis
(sphincterotomy)
pyloromyotomy
94. Other operations on the anus
415. Excision of soft tissue
95. Ultrasound guided aspirations
rhabdomyosarcoma
96. Sclerotherapy etc.
416. Mediastinal lymph node biopsy
97. Laprotomy for grading Lymphoma with
417. High orchidectomy for testis tumours
Splenectomy/ Liver/ Lymph Node Biopsy
418. Excision of cervical teratoma
98. Therapeutic laproscopy with Laser
419. Rectal-myomectomy
99. Cholecystectomy and choledocho –
420. Rectal prolapse (delorme's procedure)
jejunostomy/ Duodenostomy/
421. Detorsion of torsion testis
Gastrostomy/ Exploration Common Bile
422. EUA + biopsy multiple fistula in ANO
Duct
423. Cystic hygroma – injection treatment
100. Esophagoscopy, gastroscopy,
dudenoscopy with polypectomy/ removal
of foreign body/ diathermy of bleeding
lesions Neurology Related:
101. Lithotripsy/ Nephrolithotomy for renal 424. Facial nerve physiotherapy
calculus 425. Nerve biopsy
102. Excision of renal cyst 426. Muscle biopsy
103. Drainage of Pyonephrosis/ Perinephric 427. Epidural steroid injection
Abscess 428. Glycerol rhizotomy
104. Appendicectomy with/ without Drainage 429. Spinal cord stimulation
430. Motor cortex stimulation
Operations on the female sexual 431. Stereotactic radiosurgery
organs 432. Percutaneous cordotomy
105. Incision of the ovary 433. Intrathecal baclofen therapy
106. Insufflation of the Fallopian tubes 434. Entrapment neuropathy release
107. Other operations on the Fallopian tube 435. Diagnostic cerebral angiography
108. Dilatation of the cervical canal 436. VP shunt
109. Conisation of the uterine cervix 437. Ventriculoatrial shunt
110. Theraputic curettage with Colposcopy/
Biopsy/ Diathermy/ Cryosurgery
111. Laser therapy of cervix for various Oncology Related:
lesions of Uterus 438. IV push chemotherapy
112. Other operations of the Uterine cervix 439. HBI-hemibody radiotherapy
113. Incesion of the uterus (hysterectomy) 440. Infusional targeted therapy
114. Local incision and destruction of 441. SRT-stereotactic arc therapy
diseased tissue of the vagina and the 442. SC administration of growth factors
pouch of Douglas 443. Continuous infusional chemotherapy

115. Incision of the vagina 444. Infusional chemotherapy
116. Incision of vulva 445. CCRT - concurrent chemo + RT
117. Culdotomy 446. 2D radiotherapy
118. Operations on Bartholin’s glands (cyst) 447. 3D conformal radiotherapy
119. Salpino-Oophorectomy via Laproscopy 448. IGRT - image guided radiotherapy
120. Hysteroscopic removal of myoma 449. IMRT- step & shoot
121. D&C 450. Infusional bisphosphonates
122. Hysteroscopic resection of septum 451. IMRT - DMLC
123. Thermal cauterisation of cervix 452. Rotational ARC therapy
124. Mirena insertion 453. Tele gamma therapy
125. Hysteroscopic adhesiolysis 454. FSRT-fractionated SRT
126. LEEP (loop electrosurgical excision 455. VMAT-volumetric modulated arc
procedure) therapy
127. Cryocauterisation of cervix 456. SBRT-stereotactic body radiotherapy
128. Polypectomy endometrium 457. Helical tomotherapy
129. Hysteroscopic resection of fibroid 458. SRS-stereotactic radiosurgery
130. LLETZ (large loop excision of 459. X-knife SRS
transformation zone) 460. Gammaknife SRS
131. Conization 461. TBI- total body radiotherapy
132. Polypectomy cervix 462. Intraluminal brachytherapy
133. Hysteroscopic resection of endometrial 463. Electron therapy
polyp 464. TSET-total electron skin therapy
134. Vulval wart excision 465. Extracorporeal irradiation of blood
135. Laparoscopic paraovarian CYST products
excision 466. Telecobalt therapy
136. Uterine artery embolization 467. Telecesium therapy
137. Laparoscopic cystectomy 468. External mould brachytherapy
138. Hymenectomy( imperforate hymen) 469. Interstitial brachytherapy
139. Endometrial ablation 470. Intracavity brachytherapy
140. Vaginal wall cyst excision 471. 3D brachytherapy
141. Vulval cyst excision 472. Implant brachytherapy
142. Laparoscopic paratubal CYST excision 473. Intravesical brachytherapy
143. Repair of vagina (vaginal atresia) 474. Adjuvant radiotherapy
144. Hysteroscopy, removal of myoma 475. Afterloading catheter brachytherapy
145. Ureterocoele repair –congenital internal 476. Conditioning radiothearpy for BMT
146. TURBT 477. Extracorporeal irradiation to the
147. Vaginal mesh for POP homologous bone grafts
148. Laparoscopic myomectomy 478. Radical chemotherapy
149. Surgery for SUI 479. Neoadjuvant radiotherapy
150. Repair recto- vagina fistula 480. LDR brachytherapy
151. Pelvic floor repair( excluding fistula 481. Palliative radiotherapy
repair) 482. Radical radiotherapy
152. URS + ll 483. Palliative chemotherapy
153. Laparoscopic oophorectomy 484. Template brachytherapy
154. Normal vaginal delivery & variants 485. Neoadjuvant chemotherapy
486. Adjuvant chemotherapy
487. Induction chemotherapy
488. Consolidation chemotherapy
Operations on the prostate & seminal 489. Maintenance chemotherapy
vesicles 490. HDR brachytherapy
155. Incision of the prostate
156. Transurethral excision and destruction
Operations on the Tongue:
of prostate tissue
157. Transurethral and percutaneous 491. Small reconstruction of the tongue
destruction of prostate tissue
158. Open surgical excision and destruction Ophthalmology related:
of prostate tissue
159. Radical prostatovesiculectomy 492. Biopsy of tear gland
160. Other excision and destruction of 493. Treatment of retinal lesion

prostate tissue
161. Operations on the seminal vesicles Plastic surgery related: mouth & face:
162. Incision and excision of periprostatic 494. Construction skin pedicle flap
tissue 495. Gluteal pressure ulcer-excision
163. Other operations on the prostate 496. Muscle-skin graft, leg
497. Removal of bone for graft
498. Muscle-skin graft duct fistula
Operations on the scrotum & tunica 499. Removal cartilage graft
vaginalis testis 500. Myocutaneous flap
164. Incision of the scrotum and tunica 501. Fibro myocutaneous flap
vaginalis testis 502. Breast reconstruction surgery after
165. Operation on a testicular hydrocele mastectomy
166. Excision and destruction of diseased 503. Sling operation for facial palsy
scrotal tissue 504. Split skin grafting under RA
167. Other operations on the scrotum and 505. Wolfe skin graft
tunica vaginalis testis 506. Plastic surgery to the floor of the mouth
under GA
Operations on the testes

Thoracic surgery related:
168. Incision of the testes
507. Thoracoscopy and lung biopsy
169. Excision and destruction of diseased
508. Excision of cervical sympathetic chain
tissue of the testes
thoracoscopic
170. Unilateral orchidectomy
509. Laser ablation of barrett's oesophagus
171. Bilateral orchidectomy
510. Pleurodesis
172. Orchidopexy
511. Thoracoscopy and pleural biopsy
173. Abdominal exploration in cryptorchidism
512. EBUS + biopsy
174. Surgical repositioning of an abdominal
513. Thoracoscopy ligation thoracic duct
testis
514. Thoracoscopy assisted empyaema
175. Reconstruction of the testis
drainage
176. Implantation, exchange and removal of
a testicular prosthesis
177. Other operations on the testis Urology related:
515. Biopsy oftemporal artery for various
lesions
Operations on the spermatic cord,
516. AV fistula – wrist
epididymis and ductus deferens 517. URSL with stenting
178. Surgical treatment of a varicocele and a 518. URSL with lithotripsy
hydrocele of the spermatic cord 519. Cystoscopic litholapaxy
179. Excision in the area of the epididymis 520. ESWL
180. Epididymectomy 521. Bladder neck incision
522. Cystoscopy & biopsy
523. AV fistula - wrist
Operations on the penis 524. Cystoscopy and removal of polyp
181. Operations on the foreskin 525. Suprapubic cystostomy
182. Local excision and destruction of 526. Percutaneous nephrostomy
diseased tissue of the penis 527. Cystoscopy and "sling" procedure
183. Amputation of the penis 528. Tuna- prostate
184. Other operations on the penis 529. Excision of urethral diverticulum
530. Removal of urethral stone
531. Excision of urethral prolapse
Operations on the urinary system 532. Mega-ureter reconstruction
185. Cystoscopical removal of stones 533. Kidney renoscopy and biopsy
186. Catheterisation of baldder 534. Ureter endoscopy and treatment
535. Vesico ureteric reflux correction
536. Surgery for pelvi ureteric junction
Other Operations obstruction
187. Lithotripsy 537. Anderson hynes operation (open
188. Coronary angiography pyelopalsty )

189. Biopsy of Temporal Artery for Various 538. Kidney endoscopy and biopsy
leisons 539. Paraphimosis surgery
190. External Arterio-venus shunt 540. Injury prepuce- circumcision
191. Haemodialysis 541. Frenular tear repair
192. Radiotherapy for Cancer 542. Meatotomy for meatal stenosis
193. Cancer Chemotherapy 543. Surgery for fournier's gangrene scrotum
194. Endoscopic polypectomy 544. Surgery filarial scrotum
545. Surgery for watering CAN perineum
546. Repair of penile torsion
Operation of bone and joints 547. Drainage of prostate abscess
195. Surgery for ligament tear 548. Orchiectomy
196. Surgery for meniscus tear 549. Cystoscopy and removal of FB
197. Surgery for hemoarthrosis/ pyoarthrosis
198. Removal of fracture pins/ nails
199. Removal of metal wire
200. Closed reduction on fracture, luxation
201. Reduction of dislocation under GA
202. Epiphyseolysis with osterosynthesis
203. Excision of Bursirtis
204. Tennis elbow release
205. Excision of various lesions in Coccyx
206. Arthroscopic knee aspiration
207. Surgery for meniscus tear
208. Arthroscopic repair of ACL tear KNEE
209. Closed reduction of minor fractures
210. Arthroscopic repair of PCL tear KNEE
211. Tendon shortening
212. Arthroscopic meniscectomy - KNEE
213. Treatment of clavicle dislocation
214. Haemarthrosis KNEE- lavage
215. Abscess KNEE joint drainage
216. Carpal tunnel release
217. Closed reduction of minor dislocation
218. Repair of KNEE cap tendon
219. ORIF with K wire fixation- small bones
220. Release of midfoot joint
221. ORIF with plating- small long bones
222. Implant removal minor
223. K wire removal
224. POP application
225. Closed reduction and external fixation
226. Arthrotomy hip joint
227. Syme's amputation
228. Arthroplasty
229. Partial removal of RIB
230. Treatment of sesamoid bone fracture
231. Shoulder arthroscopy / surgery
232. Elbow arthroscopy
233. Amputation of metacarpal bone
234. Release of thumb contracture
235. Incision of foot fascia
236. Calcaneum SPUR hydrocort injection
237. Ganglion wrist hyalase injection
238. Partial removal of metatarsal
239. Repair / graft of foot tendon
240. Revision/removal of knee cap
241. Amputation follow-up surgery
242. Exploration of ankle joint
243. Remove/graft leg bone lesion

244. Repair/graft achilles tendon
245. Remove of tissue expander
246. Biopsy elbow joint lining
247. Removal of wrist prosthesis
248. Biopsy finger joint lining
249. Tendon lengthening
250. Treatment of shoulder dislocation
251. Lengthening of hand tendon
252. Removal of elbow bursa
253. Fixation of knee joint
254. Treatment of foot dislocation
255. Surgery of bunion
256. Intra articular steroid injection
257. Tendon transfer procedure
258. Removal of knee cap bursa
259. Treatment of fracture of ULNA
260. Treatment of scapula fracture
261. Removal of tumor of arm/ elbow under
RA/GA
262. Repair of ruptured tendon
263. Decompress forearm space
264. Revision of neck muscle (torticollis
release )
265. Lengthening of thigh tendons
266. Treatment fracture of radius & ulna
267. Repair of knee joint
Annexure – III:
Description
Title Please refer to the Plan and Sum Insured you have opted to understand the
available benefits under your plan in brief
Your Accumulate
Identify your
Coverage Protect Plus Preferred Premier
Plan
Details:
Basic Cover ₹2.5 Lacs, ₹4.5 Lacs, ₹15 Lacs, ₹100 ₹5.5 Lac,
₹3.5 Lacs, ₹5.5 Lacs, ₹30 Lacs, Lacs ₹7.5 Lac,
₹4.5 Lacs ₹7.5 Lacs, ₹50 Lacs, ₹10 Lac
This section ₹15 Lac,
₹5.5 Lacs, ₹10 Lacs
lists the Identify your ₹20 Lac,
₹7.5 Lacs, ₹15 Lacs ₹25 Lac
Basic Opted Sum ₹10 Lacs ₹20 Lacs
benefits ₹30 Lacs
Insured ₹15 Lacs ₹25 Lacs ₹50 Lacs
available on ₹20 Lacs ₹30 Lacs
your plan ₹25 Lacs ₹50 Lacs
₹30 Lacs
₹50 Lacs
For Sum For Sum

Inpatient Insured up to Insured ₹ 5.5
Covered up to any Room Category
Hospitalisation
₹ 5.5 Lacs - except Suite or higher category Lacs -
(When you are
hospitalized) Covered up to Covered up to
Single Private Single Private

Room Room
For Sum For Sum

Insured ₹7.5 Insured ₹7.5
Lacs and Lacs and
Above -
Above -
Covered up to
any Room Covered up to
Category any Room
except Suite Category
or higher except Suite
category or higher
category
Pre -
Medical Expenses Covered up to 60 days before date of hospitalisation
hospitalization
Medical Covered up to
Expenses 90 days post
Post - Covered up to Medical Expenses Covered up to 180 discharge
hospitalization 90 days post days post discharge from hospital from hospital
discharge
from hospital
Day Care
Covered up to the limit of Sum Insured opted
Treatment
Domiciliary
Treatment
Covered up to the limit of Sum Insured opted
(Treatment at
Home)
Ambulance Up to ₹ 2000
Up to ₹ 2000 Up to ₹ 3000
Cover Actual incurred per
paid per paid per
(Reimbursement expenses paid per hospitalization
hospitalization hospitalization
of Ambulance hospitalization event event
event event
Expenses)
Donor Expenses
(Hospitalisation
Covered up to full Sum Insured
Expenses of the
donor providing
the organ)
Worldwide
Emergency Covered up to full Sum Insured once in a Policy Year
Cover (Outside
India)
Restoration of
Sum Insured Multiple Restoration is available in a Policy Year for unrelated illnesses in
(When opted addition to the Sum Insured opted
Sum Insured is
insufficient due
to claims)
Covered up to full Sum Insured
AYUSH Cover
Health Option to
Maintenance choose from -
Benefit ₹ 5000, ₹
10000, ₹
(Treatment that

does not require Covered up Covered up to Covered up to ₹ 15000 15000, ₹
hospitalization to ₹ 500 Per ₹ 2000 Per per policy year. 20000 Per
and can be policy Year policy Year policy Year
Can also be
carried out in an
used to pay for
Out Patient Co-pay or
Department ) Deductible.
Up to 50 % of
the
accumulated
Health
Maintenance
Benefit can be
utilised for
payment
against
premium from
first renewal of
the policy
NA NA NA 5%
Cumulative
Bonus on the
unutilized
Health
Maintenance
Cumulative Benefit limit
Bonus on Health (HMB)
available at
Maintenance
the end of the
Benefit Policy Year
irrespective of
whether a
claim is made
on the
expiring
policy.
Covered
Covered
upto ₹
upto ₹
Covered upto 100,000
50,000 for
₹ 15,000 for for normal
normal
normal delivery
delivery
delivery and ₹ and ₹
and ₹
25,000 for C- 200,000
Maternity 100,000
Section per for C- Not Available
Expenses for C-
event, Section
Not Available Section
after a per event,
per event,
Waiting after a
after a
Period of 48 waiting
waiting
months Period of
Period of
48
48 months
months
Covered for the inpatient hospitalisation
New Born Baby
expenses of a new born up to the limit
Expenses
provided under Maternity Expenses
First Year Covered as per national immunization

Vaccinations programme over and above Maternity
Sum Insured
Value Available Available each policy year(excluding Available
rd rd
Added once every 3 the first year) , to all insured persons once every 3
Covers Policy year to who have completed 18 years of Age Policy year to
all insured all insured
Health Check-
This section Up persons who persons who
lists the have have
additional completed 18 completed 18
value added years of Age years of Age
benefits that
are available Expert Opinion
along with on Critical
Available once during the Policy Year
your plan illness
(By a Specialist)
A guaranteed A guaranteed 10% Increase in Sum A guaranteed
5% Increase Insured per policy year, maximum up to 5% Increase
in Sum 200% of Sum Insured in Sum
Insured per
Cumulative Insured per
policy year,
Bonus maximum up policy year,
to 200% of maximum up
Sum Insured. to 200% of
Sum Insured.
Reward Points equivalent to 1% of paid premium, to be
earned each year. Rewards can also be earned for
enrolling and completing Our Array of Wellness
Programs. These earned Reward Points can be used
Healthy
against payable premium (including Taxes) from 1st
Rewards
Renewal of the Policy. OR they can be redeemed for
equivalent value of Health Maintenance Benefits any time
during the policy OR as equivalent value while availing
services through our Network Providers as defined in the
policy.
Optional ₹ 1000 for ₹ 2000 for each ₹ 1000 for
Covers each continuous and each
continuous completed 24 ₹ 3000 for each continuous
This section and Hours of continuous and and
lists the completed 24 Hospitalisation completed 24 Hours completed 24
available Hospital Daily Hours of during the Policy of Hospitalisation Hours of
optional Cash Benefit Hospitalisation Year up to a during the Policy Hospitalisation
covers under during the maximum of 30 Year up to a during the
your plan Policy Year up days in a policy maximum of 30 days Policy Year up
and the limits to a maximum year in a policy year to a maximum
under each of 30 days in a of 30 days in a
of these policy year policy year

options Deductible
(Please select
the Sum Insured
and Deductible
amount as you ₹ 1/ 2/ 3/ 4/ 5/ ₹ 1/ 2/ 3 / 4 / 5 / ₹ 0.5, 1/ 2/ 3/
have opted on 7.5 /10 Lacs 7.5 / 10 Lacs 4/ 5/ 7.5 / 10
Not Available
the Policy. Lacs
Deductible is the
amount beyond
which a claim
will be payable
in the Policy)
Waiver of Available Available Not Available Available

Deductible:
Reduction in Not Available

Maternity waiting period Reduced from
Maternity Not Available
48 months to 24 months
Waiting
Voluntary Co- 10% or 20%
pay voluntary co-
(The cost payment for
sharing each and
percentage that every claim as
you have opted opted on the
10% or 20% Voluntary Co-
will apply on Policy
payment for each and every claim Not Available
each claim.)
as opted
If you have
opted for a
Deductible,
Voluntary Co-
payment does
not apply
Waiver of
Waiver of Mandatory co-payment of 20% for Insured Persons aged 65
Mandatory Co-
years and above
pay
A guaranteed
25% increase
in Sum
A guaranteed 25% increase in Sum Insured
Cumulative Not Insured per
per policy year, maximum up to 200% of
Bonus booster Available policy year,
Sum Insured
maximum up
to 200% of
Sum Insured
Add on Lump sum
cover(Rider) payment of an
This section additional
Lump sum payment of an additional 100% Not
lists the Add Critical Illness 100% of Sum
of Sum Insured Opted Available
on cover Insured Opted
available
under your

plan
Annexure IV
List of Non-Medical Expenses
SNO Item
I TOILETRIES/COSMETICS/PERSONAL COMFORT OR CONVENIENCE

ITEMS/SIMILAR EXPENSES
1 HAIR REMOVAL CREAM
2 BABY CHARGES (UNLESS SPECIFIED/INDICATED)
3 BABY FOOD
4 BABY UTILITES CHARGES
5 BABY SET
6 BABY BOTTLES
7 BRUSH
8 COSY TOWEL
9 HAND WASH
10 M01STUR1SER PASTE BRUSH
11 POWDER
12 RAZOR
13 SHOE COVER
14 BEAUTY SERVICES
15 BELTS/ BRACES
16 BUDS
17 BARBER CHARGES
18 CAPS
19 COLD PACK/HOT PACK
20 CARRY BAGS
21 CRADLE CHARGES
22 COMB
23 DISPOSABLES RAZORS CHARGES ( for site preparations)
24 EAU-DE-COLOGNE / ROOM FRESHNERS
25 EYE PAD
26 EYE SHEILD
27 EMAIL / INTERNET CHARGES
28 FOOD CHARGES (OTHER THAN PATIENT'S DIET PROVIDED
BY HOSPITAL)
29 FOOT COVER
30 GOWN
31 LEGGINGS
32 LAUNDRY CHARGES

33 MINERAL WATER
34 OIL CHARGES
35 SANITARY PAD
36 SLIPPERS
37 TELEPHONE CHARGES
38 TISSUE PAPER
39 TOOTH PASTE
40 TOOTH BRUSH
41 GUEST SERVICES
42 BED PAN
43 BED UNDER PAD CHARGES
44 CAMERA COVER
45 CLINIPLAST
46 CREPE BANDAGE
47 CURAPORE
48 DIAPER OF ANY TYPE
49 DVD, CD CHARGES
50 EYELET COLLAR
51 FACE MASK
52 FLEXI MASK
53 GAUSE SOFT
54 GAUZE
55 HAND HOLDER
56 HANSAPLAST/ADHESIVE BANDAGES
57 INFANT FOOD
58 SLINGS
59 WEIGHT CONTROL PROGRAMS/ SUPPLIES/ SERVICES
60 COST OF SPECTACLES/ CONTACT LENSES/ HEARING AIDS ETC.

61 DENTAL TREATMENT EXPENSES THAT DO NOT REQUIRE
HOSPITALISATION
62 HORMONE REPLACEMENT THERAPY
63 HOME VISIT CHARGES
64 INFERTILITY/ SUBFERTILITY/ ASSISTED CONCEPTION PROCEDURE
65 OBESITY (INCLUDING MORBID OBESITY) TREATMENT IF EXCLUDED IN POLICY
66 PSYCHIATRIC & PSYCHOSOMATIC DISORDERS

67 CORRECTIVE SURGERY FOR REFRACTIVE ERROR
68 TREATMENT OF SEXUALLY TRANSMITTED DISEASES
69 DONOR SCREENING CHARGES
70 ADMISSION/REGISTRATION CHARGES
71 HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC
PURPOSE

72 EXPENSES FOR INVESTIGATION/ TREATMENT IRRELEVANT TO THE DISEASE FOR WHICH
ADMITTED OR DIAGNOSED
73 ANY EXPENSES WHEN THE PATIENT IS DIAGNOSED WITH RETRO VIRUS + OR SUFFERING
FROM /HIV/ AIDS ETC IS DETECTED/ DIRECTLY OR INDIRECTLY
74 STEM CELL IMPLANTATION/ SURGERY and STORAGE
75 WARD AND THEATRE BOOKING CHARGES

76 ARTHROSCOPY & ENDOSCOPY INSTRUMENTS
77 MICROSCOPE COVER
78 SURGICAL BLADES,HARMONIC SCALPEL,SHAVER
79 SURGICAL DRILL
80 EYE KIT
81 EYE DRAPE
82 X-RAY FILM
83 SPUTUM CUP
84 BOYLES APPARATUS CHARGES
85 BLOOD GROUPING AND CROSS MATCHING OF DONORS
SAMPLES
86 ANTISEPTIC or DISINFECTANT LOTIONS
87 BAND AIDS, BANDAGES, STERLILE INJECTIONS, NEEDLES,
SYRINGES
88 COTTON
89 COTTON BANDAGE
90 MICROPORE/ SURGICAL TAPE
91 BLADE
92 APRON
93 TORNIQUET
94 ORTHOBUNDLE, GYNAEC BUNDLE

95 URINE CONTAINER
II ELEMENTS OF ROOM CHARGE
96 LUXURY TAX
97 HVAC
98 HOUSE KEEPING CHARGES
99 SERVICE CHARGES WHERE NURSING CHARGE ALSO
CHARGED
100 TELEVISION & AIR CONDITIONER CHARGES
101 SURCHARGES
102 ATTENDANT CHARGES
103 IM IV INJECTION CHARGES
104 CLEAN SHEET

105 EXTRA DIET OF PATIENT(OTHER THAN THAT WHICH
FORMS PART OF BED CHARGE)
106 BLANKET/WARMER BLANKET
III ADMINISTRATIVE OR NON-MEDICAL CHARGES
107 ADMISSION KIT
108 BIRTH CERTIFICATE
109 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES
110 CERTIFICATE CHARGES
111 COURIER CHARGES
112 CONVENYANCE CHARGES
113 DIABETIC CHART CHARGES
114 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
115 DISCHARGE PROCEDURE CHARGES
116 DAILY CHART CHARGES
117 ENTRANCE PASS / VISITORS PASS CHARGES
118 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
119 FILE OPENING CHARGES
120 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
121 MEDICAL CERTIFICATE
122 MAINTENANCE CHARGES
123 MEDICAL RECORDS
124 PREPARATION CHARGES
125 PHOTOCOPIES CHARGES
126 PATIENT IDENTIFICATION BAND / NAME TAG
127 WASHING CHARGES
128 MEDICINE BOX
129 MORTUARY CHARGES
130 MEDICO LEGAL CASE CHARGES (MLC CHARGES)
IV EXTERNAL DURABLE DEVICES
131 WALKING AIDS CHARGES
132 BIPAP MACHINE
133 COMMODE
134 CPAP/ CAPD EQUIPMENTS
135 INFUSION PUMP - COST
136 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)
137 PULSEOXYMETER CHARGES
138 SPACER
139 SPIROMETRE
140 SP 02 PROBE
141 NEBULIZER KIT
142 STEAM INHALER
143 ARMSLING
144 THERMOMETER
145 CERVICAL COLLAR

146 SPLINT
147 DIABETIC FOOT WEAR
148 KNEE BRACES ( LONG/ SHORT/ HINGED)
149 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
150 LUMBOSACRAL BELT
151 NIMBUS BED OR WATER OR AIR BED CHARGES
152 AMBULANCE COLLAR

153 AMBULANCE EQUIPMENT
154 MICROSHEILD
155 ABDOMINAL BINDER
V ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
156 BETADINE \ HYDROGEN PEROXIDE\SPIRIT\ DSINFECTANTS ETC
157 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES

158 NUTRITION PLANNING CHARGES - DIETICIAN CHARGES - DIET CHARGES
159 SUGAR FREE Tablets
160 CREAMS POWDERS LOTIONS (Toiletries are not payable, only

prescribed medical pharmaceuticals payable)
161 Digestion gels
162 ECG ELECTRODES
163 GLOVES
164 HIV KIT

165 LISTERINE/ ANTISEPTIC MOUTHWASH
166 LOZENGES
167 MOUTH PAINT
168 NEBULISATION KIT
169 NOVARAPID
170 VOLINI GEL/ ANALGESIC GEL
171 ZYTEE GEL
172 VACCINATION CHARGES
VI PART OF HOSPITAL'S OWN COSTS AND NOT PAYABLE
173 AHD
174 ALCOHOL SWABES
175 SCRUB SOLUTION/STERILLIUM
VII OTHERS
176 VACCINE CHARGES FOR BABY

177 AESTHETIC TREATMENT / SURGERY
178 TPA CHARGES
179 VISCO BELT CHARGES
180 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC]
181 EXAMINATION GLOVES

182 KIDNEY TRAY
183 MASK
184 OUNCE GLASS
185 OUTSTATION CONSULTANT'S/ SURGEON'S FEES
186 OXYGEN MASK

187 PAPER GLOVES
188 PELVIC TRACTION BELT
189 REFERAL DOCTOR'S FEES

190 ACCU CHECK ( Glucometery/ Strips)
191 PAN CAN

192 SOFNET
193 TROLLY COVER
194 UROMETER, URINE JUG
195 AMBULANCE
196 TEGADERM / VASOFIX SAFETY

197 URINE BAG
198 SOFTOVAC
199 STOCKINGS


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CignaTTK ProHealth Insurance

Policy Terms and Conditions

I PREAMBLE & OPERATING CLAUSE

BENEFITS UNDER THE POLICY

II.1. Inpatient Hospitalization:

CignaTTK ProHealth Insurance_Terms & Conditions Page 1

II.3. Post - hospitalization:

II.4. Day Care Treatment:

II.5. Domiciliary Treatment:

a. We will pay for Pre-hospitalisation, Post-hospitalisation Medical Expenses up to 30 days

II.6. Ambulance Cover:

CignaTTK ProHealth Insurance_Terms & Conditions Page 2

b. Reasonable and Customary expenses shall include:

II.7. Donor Expenses:

II.8. Worldwide Emergency Cover:

(b)The Medical Expenses payable shall be limited to Inpatient Hospitalization only.

CignaTTK ProHealth Insurance_Terms & Conditions Page 3

II.9. Restoration of Sum Insured:

i. The Sum Insured

II.10. AYUSH Cover

CignaTTK ProHealth Insurance_Terms & Conditions Page 4

II.11. Health Maintenance Benefit:

i) Diagnostic tests, i. Fresh limits will be available as per

i. Diagnostic i. Fresh limits will be available as per

CignaTTK ProHealth Insurance_Terms & Conditions Page 5

iii. Towards payment of

II.12. Maternity Expenses:

CignaTTK ProHealth Insurance_Terms & Conditions Page 6

You understand and agree that:

II.13. New Born Baby Expenses:

II.14. First Year Vaccinations

Time Interval Vaccinations to be done (Age) Frequency

CignaTTK ProHealth Insurance_Terms & Conditions Page 7

III. VALUE ADDED COVERS:

III.1. Health Check Up:

(b) Original Copies of all reports will be provided to You.

Sum Insured Age List of tests

CignaTTK ProHealth Insurance_Terms & Conditions Page 8

III.2. Expert opinion on Critical Illness:

CignaTTK ProHealth Insurance_Terms & Conditions Page 9

III.3. Cumulative Bonus

CignaTTK ProHealth Insurance_Terms & Conditions Page 10

b) On Health Maintenance Benefit for Accumulate Plan

III.4. Healthy Rewards

In an individual or floater policy:

Details of reward points that can be accrued are listed below.

Program Type Points to be earned as a percentage of

CignaTTK ProHealth Insurance_Terms & Conditions Page 11

IV. OPTIONAL COVERS

IV.1. Hospital Daily Cash Benefit

CignaTTK ProHealth Insurance_Terms & Conditions Page 12

-Opt out of deductible Within 48 Months

-Opt out of deductible After 48 Months:

IV.3. Reduction in Maternity Waiting:

IV.4. Voluntary Co-Pay:

IV.5 Waiver of Mandatory Co-pay:

IV.6. Cumulative Bonus Booster

CignaTTK ProHealth Insurance_Terms & Conditions Page 13

V.1. Pre-existing Disease Waiting Period