United India Insurance Company Limited

Corporate Identity Number: U93090TN1938GOI000108

Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

Individual Health Insurance Policy – Platinum / Gold / Senior Citizen

Prospectus

1. PRODUCT – KEY FEATURES

The Policy provides cover on an Individual Sum Insured basis for an individual. The policy is offered on family package basis also,
for family comprising of the Proposer, Spouse, Dependent Children, and Parents, with Individual Sum Insured for each family
member. Policy is available under three plans based on age of entry into the policy.

COVERAGE AT A GLANCE:

Base Cover
In-Patient Hospitalisation Expenses
Day Care Treatments
Pre-Hospitalisation Expenses
Post-Hospitalisation Expenses
Ayurvedic Treatment Expenses
Domiciliary Hospitalisation Expenses
Named Modern Treatment Methods & Advancement in Technology
Cost of Health Check-Up

Optional Cover
Road Ambulance Expenses
Daily Cash Allowance on Hospitalisation

2. ELIGIBILITY
a. Any person aged between 18 years and 65 years can take this insurance for himself/herself and his/her family consisting of
Self, Spouse, Dependent Children and Parents on Individual Sum Insured basis.
b. Entry Age of Proposer and insured family members for different plans is as under:
i. Platinum: between 18 and 35 years. Children from the age of 91 days can be covered provided either or both of the
parents are covered
ii. Gold: between 36 and 60 years
iii. Senior Citizen: between 61 and 65 years
c. An Insured Person will continue to be in the same plan that they were under at the time of entry into the policy, even if they
cross the maximum age prescribed for that plan, provided the policies are renewed with us without break.
d. Dependent children between the age of 91 days and 18 years shall be covered provided either or both parents are covered
concurrently. Children above 18 years will continue to be covered along with parents provided they are
unmarried/unemployed and dependent. In the event of children becoming independent, employed, or getting married, a
separate policy can be taken on expiry of the current policy for which continuity benefits will be provided.
e. Midterm inclusion of family members is allowed at pro-rata premium only in case of:
i. Newly married spouse within 60 (sixty) days of marriage.
ii. New born baby, between the ages of 91 days to 180 days, born to mother insured under the policy.

1
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

3. SUM INSURED
The various Sum Insured options available under the three plans are as follows:
a. Platinum : ₹ 2 Lakhs, ₹ 3 Lakhs, ₹ 5 Lakhs, ₹ 8 Lakhs, ₹ 10 Lakhs, ₹ 15 Lakhs, ₹ 20 Lakhs
b. Gold : ₹ 2 Lakhs, ₹ 3 Lakhs, ₹ 5 Lakhs, ₹ 8 Lakhs, ₹ 10 Lakhs
c. Senior Citizen : ₹ 2 Lakhs, ₹ 3 Lakhs, ₹ 5 Lakhs

4. POLICY TERM
One Year. Renewable annually.

5. COVERAGE
The coverages available under this policy are classified as Base Cover and Optional Cover. Base Cover refers to the coverage
available as default under Individual Health Insurance Policy whereas Optional Cover is available only upon payment of additional
premium.

IMPORTANT: Please note that the coverage mentioned below is applicable for ALL the plans i.e. Platinum/Gold/Senior Citizen
under Individual Health Insurance Policy unless explicitly mentioned otherwise.

BASE COVER
The Policy provides base coverage as described below in this section provided that the expenses are incurred on the written
Medical Advice of a Medical Practitioner and are incurred on Medically Necessary Treatment of the Insured Person.

5.1 In-Patient Hospitalisation Expenses Cover

We will pay the Reasonable and Customary Charges for the following Medical Expenses of an Insured Person in case of Medically
Necessary Treatment taken during Hospitalisation provided that the admission date of the Hospitalisation due to Illness or Injury
is within the Policy Period:
i. Room, Boarding and Nursing expenses (all inclusive) incurred as provided by the Hospital/Nursing Home up to 1% of Sum
Insured per day or actual expenses whichever is less. These expenses will include nursing care, RMO charges, IV
Fluids/Blood transfusion/injection administration charges and similar expenses.
ii. Charges for accommodation in Intensive Care Unit (ICU)/ Intensive Cardiac Care Unit (ICCU) up to 2% of Sum Insured per
day or actual expenses whichever is less.
iii. The fees charged by the Medical Practitioner, Surgeon, Specialists, Consultants and Anaesthetists treating the Insured
Person.
iv. Operation theatre charges; Expenses incurred for Anaesthetics, Blood, Oxygen, Surgical Appliances and/or Medical
Appliances; Cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like pacemaker,
orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory/ diagnostic tests, X-Ray and
such other similar medical expenses related to the treatment.
v. All hospitalisation expenses (excluding cost of organ) incurred for donor in respect of organ transplant to the Insured
Person provided the donation conforms to The Transplantation of Human Organs Act 1994.

Note to 5.1
1. Expenses of Hospitalisation for a minimum period of 24 consecutive hours only shall be admissible. However, the time limit
shall not apply in respect of Day Care Treatment.

2. In case of admission to a room at rates exceeding the aforesaid limits in Clause 5.1.i, the reimbursement/payment of all
associated medical expenses incurred at the Hospital shall be effected in the same proportion as the admissible rate per day
bears to the actual rate per day of Room Rent.

2
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

Proportionate Deductions shall not be applied in respect of those hospitals where differential billing is not followed or for
those expenses where differential billing is not adopted based on the room category.

3. No payment shall be made under 5.1 (iii) other than as part of the hospitalisation bill. However, the bills raised by Surgeon,
Anaesthetist directly and not forming part of the hospital bill shall be paid provided a pre-numbered bill/receipt is produced
in support thereof, when such payment is made ONLY by cheque/ credit card/debit card or digital/online transfer.

5.1.1 Other expenses covered:

i. Dental treatment, necessitated due to injury
ii. Plastic surgery necessitated due to disease or injury
iii. All day care treatments as per standard definition

5.1.2 Expenses in respect of the following specified illnesses will be restricted as detailed below:
(Only Applicable for Gold & Senior Citizen Plans only)

Surgery / Illness / Disease / Procedure Maximum Limits per Surgery/Hospitalisation restricted to

Cataract Up to 25% of Sum Insured or Rs. 40,000 per eye, whichever is less
Hernia & Hysterectomy Up to 25% of Sum Insured or Rs. 1,00,000, whichever is less
Major surgeries which include Cardiac Surgeries;
Brain Tumour Surgeries; Pace Maker Implantation
Up to 70% of the Sum Insured
for Sick Sinus Syndrome; Cancer Surgeries; Hip,
Knee, Joint Replacement Surgery; Organ Transplant

5.2 Pre-Hospitalisation and Post-Hospitalisation Expenses

We will cover, on a reimbursement basis, the Insured Person’s
i. Pre-hospitalisation Medical Expenses incurred due to an Illness or Injury during the period up to 30 days prior to
hospitalisation; and
ii. Post-hospitalisation Medical Expenses incurred due to an Illness or Injury during the period up to 60 days after the
discharge from the hospital,

Subject to a maximum of 10% of Sum Insured, provided that:

i. We have accepted a claim for primary In-patient Hospitalization under Section 5.1 above;
ii. The Pre-hospitalisation & Post-hospitalisation Medical Expenses are related to the same Illness or Injury.
iii. The date of admission to the Hospital for the purpose of this Benefit shall be the date of the Insured Person’s first
admission to the Hospital in relation to the same Any One Illness.
Note: The maximum limit of 10% of Sum Insured will not be applicable for Platinum Plan.

5.3 Domiciliary Hospitalisation

We will cover, on a reimbursement basis, medical treatment for a period exceeding three days for such an illness/disease/injury
which in the normal course would require care and treatment at a hospital but is actually taken while confined at home under any
of the following circumstances:
i. The condition of the patient is such that he/she is not in a condition to be moved to a hospital or
ii. The patient takes treatment at home on account of non-availability of room in a hospital.

3
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

However, domiciliary hospitalisation benefits shall not cover:

i. Expenses incurred for treatment for any of the following diseases:
a. Asthma h. All Psychiatric or Psychosomatic Disorders
b. Bronchitis i. Influenza, Cough and Cold
c. Chronic Nephritis and Nephritic Syndrome j. Pyrexia of unknown Origin for less than 10
d. Diarrhoea and all type of Dysenteries days
including Gastroenteritis k. Tonsillitis and Upper Respiratory Tract
e. Diabetes Mellitus and Insipidus infection including Laryngitis and
f. Epilepsy pharyngitis
g. Hypertension l. Arthritis, Gout and Rheumatism

Liability of the Company under this clause is restricted as stated in the Schedule as per Annexure – 2 of the Policy Wordings.

5.4 Ayurvedic Treatment

We will pay the Reasonable & Customary Charges incurred as in-patient for an Insured Person in case of Medically Necessary
Treatment taken during Hospitalisation subject to the condition that the hospitalisation expenses are admissible only when the
treatment has been undergone in an AYUSH Hospital.

5.5 Modern Treatment Methods & Advancement in Technologies

In case of an admissible claim under section 5.1, expenses incurred on the following procedures (wherever medically indicated)
either as in-patient or as part of day care treatment in a hospital, shall be covered. The claim shall be subject to additional sub-
limits indicated against them in the table below:

Sr. No. Modern Treatment Methods & Limits per Surgery

Advancement in Technology
Uterine Artery Embolization & High Up to 20% of Sum Insured subject to a maximum of Rs.2 Lacs per policy period for
1
Intensity Focussed Ultrasound (HIFU) claims involving Uterine Artery Embolization & HIFU
Up to 10% of Sum Insured subject to a maximum of Rs.1 Lac per policy period for claims
2 Balloon Sinuplasty
involving Balloon Sinuplasty
3 Deep Brain Stimulation Up to 70% of Sum Insured per policy period for claims involving Deep Brain Stimulation
Up to 20% of Sum Insured subject to a maximum of Rs.2 Lacs per policy period for
4 Oral Chemotherapy
claims involving Oral Chemotherapy
Immunotherapy-Monoclonal Antibody
5 Up to 20% of Sum Insured subject to a maximum of Rs.2 Lacs per policy period
to be given as injection
6 Intra vitreal Injections Up to 10% of Sum Insured subject to a maximum of Rs. 1 Lac per policy period
 Up to 75% of Sum Insured per policy period for claims involving Robotic Surgeries
for (i) the treatment of any disease involving Central Nervous System irrespective
Robotic Surgeries (Including Robotic
7 of aetiology; (ii) Malignancies
Assisted Surgeries)
 Up to 50% of Sum Insured per policy period for claims involving Robotic Surgeries
for other diseases
8 Stereotactic Radio Surgeries Up to 50% of Sum Insured per policy period for claims involving Stereotactic Surgeries
Up to 30% of Sum Insured subject to a maximum of Rs.3 Lacs per policy period for
9 Bronchial Thermoplasty
claims involving Bronchial Thermoplasty.
Vaporisation of the Prostate (Green
10 laser treatment for holmium laser Up to 30% of Sum Insured subject to a maximum of Rs.2 Lacs per policy period.
treatment)
Intra Operative Neuro Monitoring Up to 15% of Sum Insured per policy period for claims involving Intra Operative Neuro
11
(IONM) Monitoring subject to a maximum of Rs. 1 Lac per policy period.
Stem Cell Therapy: Hematopoietic
Stem Cells for bone marrow transplant
12 No additional sub-limit
for haematological conditions to be
covered only

4
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

Note: If, for a given admissible claim, limits as listed in the Table above AND limits mentioned in Clause 5.1.2 are applicable
simultaneously, then the lower of the two limits shall apply.

Example:
A policyholder with a Sum Insured of Rs. 5 Lakhs makes an admissible claim of Rs. 1 Lakh for Robotic Cataract Surgery. As per Table
above, his limit is 50% of his SI (2.5 Lakhs) and thus he is entitled to the full amount of Rs. 1 Lakh.

However as per Clause 5.1.2, he is entitled to only Rs. 40,000. Since the lower of the two limits shall be applicable, the policyholder
will be paid Rs. 40,000 and NOT Rs. 1 Lakh.

5.6 Cost of Health Check-Up

We will cover expenses incurred towards cost of health check-up up to 1% of average Sum Insured of preceding 3 years, subject
to a maximum of Rs. 5,000 per person per policy period for a block of every three claim-free years provided the health check-up
is done at hospitals/diagnostic centre authorised by us within a year from the date when it got due and the policy is in force.
Payment under this benefit does not reduce the sum insured.
Note: Payment of expenses towards cost of health check-up will not prejudice the Company's right to deal with a claim in case of
non-disclosure of material fact and/or Pre-Existing Diseases in terms of the policy.

OPTIONAL COVERS

5.7 Road Ambulance Cover

We will cover the costs incurred up to Rs. 2500 per person per policy period on transportation of the Insured Person by road
Ambulance to a Hospital for treatment in an Emergency following an Illness or Injury which occurs during the Policy Period. The
necessity of use of an Ambulance must be certified by the treating Medical Practitioner and becomes payable if a claim has been
admitted under Section 5.1 and the expenses are related to the same Illness or Injury.
We will also cover the costs incurred on transportation of the Insured Person by road Ambulance in the following circumstances
up to the limits specified above under this cover, if:
i. it is medically required to transfer the Insured Person to another Hospital or diagnostic centre during the course of
Hospitalization for advanced diagnostic treatment in circumstances where such facility is not available in the existing
Hospital;
ii. it is medically required to transfer the Insured Person to another Hospital during the course of Hospitalization due to lack
of super speciality treatment in the existing Hospital.

5.8 Daily Cash Allowance on Hospitalisation

We will pay Daily Cash Allowance to the Insured Person for every continuous and completed period of 24 hours of Hospitalisation,
subject to the hospitalisation claim being admissible under the policy, as per the table below:

Additional Annual Premium Daily Cash Allowance Limit (in Rs.)

Rs. 150/- Rs. 250 per day subject to a maximum of Rs. 2500 per policy period
Rs. 300/- Rs. 500 per day subject to a maximum of Rs. 5000 per policy period

i. The aggregate of Daily Cash Allowance during the policy period shall not exceed ‘per policy period limits’ as mentioned
in the table above.
ii. Daily Cash Allowance will not be payable for Day Care Treatment claims.
iii. Deductible equivalent to Daily Cash Allowance for the first 48 hours Hospitalization will be levied on each Hospitalisation
during the Policy Period.

5
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

6. WHAT POLICY DOES NOT COVER

A. WAITING PERIODS (Only Applicable for Gold & Senior Citizen Plans)
The Company shall not be liable to make any payment under the policy in connection with or in respect of any expenses till the
expiry of waiting period mentioned below:

6.1 Pre-Existing Disease (Code- Excl01):

i. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the
expiry of 48 months of continuous coverage after the date of inception of the first policy with us.
ii. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
iii. If the Insured Person is continuously covered without any break as defined under the portability norms of the extant
IRDAI (Health Insurance) Regulations, then waiting period for the same would be reduced to the extent of prior coverage.
iv. Coverage under the policy after the expiry of 48 months for any pre-existing disease is subject to the same being declared
at the time of application and accepted by us.

6.2 Specific Disease/ Procedure Waiting Period (Code- Excl02):

i. Expenses related to the treatment of the listed Conditions, surgeries/treatments as per Table A and Table B below, shall
be excluded until the expiry of 24 months and 48 months respectively of continuous coverage after the date of inception
of the first policy with us. This exclusion shall not be applicable for claims arising due to an accident.
ii. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
iii. If any of the specified disease/procedure falls under the waiting period specified for Pre-Existing diseases, then the longer
of the two waiting periods shall apply.
iv. The waiting period for listed conditions shall apply even if contracted after the policy or declared and accepted without
a specific exclusion.
v. If the Insured Person is continuously covered without any break as defined under the applicable norms on portability
stipulated by IRDAI, then waiting period for the same would be reduced to the extent of prior coverage.
vi. List of specific diseases/procedures:

Table A: 24 Months’ Waiting Period

Cataract Piles, Fissures and Fistula-in-Ano

Benign Prostatic Hypertrophy Sinusitis and related disorders
Treatment for Menorrhagia/ Fibromyoma,
Gout and Rheumatism
Myoma and Prolapse of Uterus
Hernia of all types Calculus diseases
Hydrocele Congenital Internal diseases

Table B: 48 Months’ Waiting Period

Joint Replacement due to Degenerative condition,

Age-related Osteoarthritis & Osteoporosis
unless necessitated due to an accident.
Age-related Macular Degeneration (ARMD) All Neurodegenerative disorders

6.3 First Thirty Days Waiting Period (Code- Excl03):

i. Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be
excluded except claims arising due to an accident, provided the same are covered.
ii. This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.
iii. The within referred waiting period is made applicable to the enhanced sum insured in the event of granting higher sum
insured subsequently.

6
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

B. PERMANENT EXCLUSIONS (Applicable for ALL Plans)

The Company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or
in respect of:

6.4 All expenses 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 defence, rebellion, revolution, insurrection, military or usurped power.
6.5 All Illness/expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or
hazardous form) or from any nuclear waste from the combustion of nuclear fuel nuclear, chemical or biological attack.
6.6 a) Stem cell implantation/Surgery, harvesting, storage or any kind of Treatment using stem cells except as provided for
in clause 5.5 (12) above; b) growth hormone therapy.
6.7 Congenital External Diseases or Defects or anomalies.
6.8 Sterility and Infertility (Code-Excl17): Expenses related to Sterility and infertility. This includes:
i. Any type of contraception, sterilization
ii. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as
IVF, ZIFT, GIFT, ICSI
iii. Gestational Surrogacy
iv. Reversal of sterilization
6.9 Maternity (Code-Excl18):
i. Medical treatment expenses traceable to child birth (Including complicated deliveries and caesarean sections
incurred during hospitalisation) except ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during
the policy period.
6.10 Circumcision unless necessary for Treatment of an Illness or Injury not excluded hereunder or due to an Accident.
6.11 Cost of routine medical examination and preventive health check-up unless as provided for in Base Cover 5.6.
6.12 Investigation & Evaluation (Code-Excl04):
i. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded;
ii. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are
excluded.
6.13 Unproven Treatments (Code- Excl16): Expenses related to any unproven treatment, services and supplies for or in
connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical
documentation to support their effectiveness.
6.14 Change-of-Gender treatments (Code-Excl07): Expenses related to any treatment, including surgical management, to
change characteristics of the body to those of the opposite sex.
6.15 Cosmetic or plastic Surgery (Code-Excl08): Expenses for cosmetic or plastic surgery or any treatment to change
appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment
to remove a direct and immediate health risk to the Insured. For this to be considered a medical necessity, it must be
certified by the attending Medical Practitioner.
6.16 Vaccination or inoculation of any kind unless it is post animal bite.
6.17 i. Routine eye-examination expenses, cost of spectacles, contact lenses;
ii. Cost of hearing aids; including optometric therapy;
iii. Cochlear implants unless necessitated by an Accident or required intra-operatively.

6.18 Refractive Error (Code-Excl15): Expenses related to the treatment for correction of eyesight due to refractive error less
than 7.5 dioptres.
6.19 Rest Cure, Rehabilitation and Respite Care (Code-Excl05): Expenses related to any admission primarily for enforced bed
rest and not for receiving treatment. This also includes:

7
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living
such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address physical, social, emotional, and spiritual needs.

6.20 Obesity/ Weight Control (Code-Excl06): Expenses related to the surgical treatment of obesity that does not fulfil all the
below conditions:
i. Surgery to be conducted is upon the advice of the Doctor
ii. The surgery/Procedure conducted should be supported by clinical protocols
iii. The member has to be 18 years of age or older and
iv. Body Mass Index (BMI)
a. greater than or equal to 40 or
b. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following
failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnoea
iv. Uncontrolled Type2 Diabetes

6.21 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12)
6.22 Intentional self-inflicted Injury, attempted suicide.
6.23 Breach of law (Code-Excl10): Expenses for treatment directly arising from or consequent upon any Insured Person
committing or attempting to commit a breach of law with criminal intent.
6.24 Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins,
minerals and organic substances unless prescribed by a medical practitioner as part of hospitalisation claim or day care
procedure. (Code-Excl14)
6.25 Treatments other than Allopathy and Ayurvedic branches of medicine.
6.26 Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a
nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
(Code-Excl13)
6.27 Excluded Providers (Code-Excl11): Expenses incurred towards treatment in any hospital or by any Medical Practitioner or
any other provider specifically excluded by the Insurer and disclosed in its website/notified to the policyholders are not
admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of
stabilisation are payable but not the complete claim.
6.28 Unless used intra-operatively, any expenses incurred on prosthesis, corrective devices; External and/or durable Medical
/Non-medical equipment of any kind used for diagnosis and/or treatment and/or monitoring and/or maintenance and/or
support including instruments used in treatment of sleep apnoea syndrome; Infusion pump, Oxygen concentrator,
Ambulatory devices, sub cutaneous insulin pump and also any medical equipment, which are subsequently used at home.
This is indicative and please refer to Annexure – 1 in the Policy Wordings for the complete list of non-payable items.
6.29 Change of treatment from one system of medicine to another system unless recommended by the consultant/hospital
under whom the treatment is taken.
6.30 Treatments including Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP),
Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy, chondrocyte or osteocyte implantation,
procedures using platelet rich plasma, Trans Cutaneous Electric Nerve Stimulation; Use of oral immunomodulatory/
supplemental drugs.
6.31 Artificial life maintenance including life support machine use, from the date of confirmation by the treating doctor that
the patient is in a vegetative state.
6.32 Any item(s) or treatment specified in ‘List of Non-Medical Expenses– Payable/Non-Payable’ as per Annexure – 1 of the
Policy Wordings and available on Company web site also, unless specifically covered under the Policy.

8
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

7. PROCEDURE FOR TAKING A POLICY

a. The duly completed and signed Proposal form giving details of all Insured persons and a signed copy of the Prospectus along
with Pre-Acceptance Health Check-up reports, if any, should be submitted to the nearest office of the Company.
b. The pre-acceptance health check-up reports, wherever required at Company’s discretion have to be submitted at proposer’s
cost in the following cases:
i. Persons with adverse medical history as revealed from the proposal form (fresh entrants)
ii. Persons above 60 years of age (fresh entrants)
iii. Persons above 60 years of age (Break in insurance)
iv. Persons seeking enhancement of Sum Insured

Physical examination (report to be signed by the Serum Creatinine

Doctor with minimum MD/MS qualification
CBC SGOT & SGPT
Urine Routine & Microscopic ECG
HbA1c (Glycosylated Haemoglobin) Stress Test if necessitated
Lipid Profile Any other investigation required by the company
The date of medical reports should not exceed 30 (thirty) days prior to the date of proposal.
i. Pre–acceptance medical check–up shall be conducted at designated centres authorized by us.
ii. 50% of the cost of Pre-Acceptance Health check-up shall be reimbursed to the insured in cases where the proposal is
accepted by the Company.

8. PAYMENT OF PREMIUM
a. Full premium must be paid before commencement of risk for this Policy to have effect.
b. Premium payable – As per Premium Table attached.
i. Premium can be paid online for both, new policy and renewals.
ii. PAN details must be submitted by the insured. In case PAN is not available, Form 60 or Form 61 must be submitted.
iii. Underwriting Loading for Pre-existing Conditions: We may apply a risk loading on the premium payable (excluding
statutory levies & taxes) based on your health status, if accepted at the time of underwriting. Loadings will be applied
from Inception Date of the first Policy including subsequent renewal(s).
The loadings are applicable on individual ailments only. In case of loading on two ailments, the loadings shall apply in
conjunction on additive basis.
Note: The application of loading does not mean that the illness/ condition, for which loading has been applied, would
be covered from inception. Waiting period as mentioned in Section 6 (A) above shall be applied on illness/condition, as
applicable.
iv. Discounts:
i. Family Discount: A Discount of 5% is offered on the total premium if the policy covers the Policyholder and any
one or more of the following:
a. Spouse
b. Dependent Children
c. Parent(s)
ii. Online Discount: A discount of 10%, subject to a maximum of Rs. 2000 per policy, will be applicable for fresh
policies purchased online through the Company’s website.

9
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
 United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

9. CHANGE OF SUM INSURED

i. The Insured Person can apply for change of Sum Insured at the time of renewal by submitting a fresh proposal form/written
request to the Company.
ii. Any request for enhancement of Sum Insured must be accompanied by a declaration that the Insured or any other Insured
Person in respect of whom such enhancement is sought is not aware of any symptoms or other indications that may give rise
to a claim under the policy. The Company may require such Insured Person/s to undergo a Medical examination to enable
the Company to take a decision on accepting the request for enhancement in the Sum Insured.
iii. The acceptance of enhancement of Sum Insured would be at the discretion of the Company, based on the health condition
of the insured members & claim history of the policy.
iv. All waiting periods as defined in the Policy shall apply for this enhanced Sum Insured limit from the effective date of
enhancement of such Sum Insured considering such Policy Period as the first Policy with the Company.

10. CANCELLATION
i. The Policyholder may cancel this policy by giving 15 days’ written notice and in such an event, the Company shall refund
premium for the unexpired Policy Period as detailed in the table below:

Cancellation after Period on Risk Rate of Premium to be refunded

Up to One Month 75% of Annual Premium
> 1 Month and Up to 3 Months 50% of Annual Premium
> 3 Month and Up to 6 Months 25% of Annual Premium
Exceeding 6 Months No Refund

ii. The Company may cancel the policy at any time on grounds of misrepresentation, non-disclosure of material facts, fraud by
the Insured Person, by giving 15 days’ written notice. There would be no refund of premium on cancellation on grounds of
misrepresentation, non-disclosure of material facts or fraud.

11. AUTOMATIC CHANGE IN COVERAGE UNDER THE POLICY

The coverage for the Insured Person(s) shall automatically terminate:
i. In the case of his/her (Insured Person) demise:
However, the cover shall continue for the remaining Insured Persons till the end of the Policy Period. The other Insured
Persons may also apply to renew the policy.
Provided no claim has been made, and termination takes place on account of death of the Insured Person, pro-rata refund
of premium of the deceased Insured Person for the balance period of the policy will be effective.
ii. Upon exhaustion of sum insured for the policy year. However, the policy is subject to renewal on the due date as per the
applicable terms and conditions.

12. FREE LOOK PERIOD

The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time of
porting/migrating the policy.
The Insured Person shall be allowed free look period of fifteen days from date of receipt of the policy document to review the
terms and conditions of the policy, and to return the same if not acceptable.

If the Insured has not made any claim during the Free Look Period, the Insured shall be entitled to:
10
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

i. A refund of the premium paid less any expenses incurred by the Company on medical examination of the Insured Person
and the stamp duty charges or
ii. Where the risk has already commenced and the option of return of the policy is exercised by the Insured Person, a
deduction towards the proportionate risk premium for period of cover or
iii. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the
insurance coverage during such period

13. RENEWAL
The policy shall ordinarily be renewable except on grounds of fraud, misrepresentation, non-disclosure of material facts by the
Insured Person.
i. The Company shall endeavour to give notice for renewal. However, the Company is not under obligation to give any notice
for renewal.
ii. Renewal shall not be denied on the ground that the Insured Person had made a claim or claims in the preceding policy
years.
iii. Request for renewal along with requisite premium shall be received by the Company before the end of the policy period.
iv. At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30 days to
maintain continuity of benefits without break in policy. Coverage is not available during the grace period.
v. No loading shall apply on renewals based on individual claims experience.

14. MIGRATION OF POLICY

The Insured Person will have the option to migrate the policy to other health insurance products/plans offered by the company
by applying for migration of the policy at least 30 days before the policy renewal date as per IRDAI guidelines on Migration. If such
person is presently covered and has been continuously covered without any lapses under any health insurance product/plan
offered by the company, the Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on
migration.

For Detailed Guidelines on Migration, kindly refer the link:

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1

15. PORTABILITY
The Insured Person will have the option to port the policy to other Insurers by applying to such Insurer to port the entire policy
along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the policy renewal date
as per IRDAI guidelines related to portability. If such person is presently covered and has been continuously covered without any
lapses under any health insurance policy with an Indian General/Health Insurer, the proposed Insured Person will get the accrued
continuity benefits in waiting periods as per IRDAI guidelines on portability.

For Detailed Guidelines on Portability, kindly refer the link:

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1

16. NOMINATION
The Policyholder is required at the inception of the policy to make a nomination for the purpose of payment of claims under the
policy in the event of death of the Policyholder. Any change of nomination shall be communicated to the company in writing and
such change shall be effective only when an endorsement on the policy is made. ln the event of death of the Policyholder, the
Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no

11
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

subsisting nominee, to the legal heirs or legal representatives of the policyholder whose discharge shall be treated as full and final
discharge of its liability under the policy.

17. TAX BENEFIT

Tax rebate is available as per provision of Income Tax Rules under Section 80-D.

18. CLAIM PROCEDURE

A. Notification of Claim
Upon the happening of any event which may give rise to a claim under this Policy, the Insured Person/Insured Person’s
representative shall notify the TPA (if claim is processed by TPA)/Company (if claim is processed by the Company) in writing
providing all relevant information relating to claim including plan of treatment, policy number etc. within the prescribed time limit
as under:
i. Within 24 hours from the date of emergency hospitalization required or before the Insured Person’s discharge from
Hospital, whichever is earlier.
ii. At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.

B. Procedure for Cashless Claims

i. Cashless facility for treatment in network hospitals only shall be available to Insured if opted for claim processing by TPA.
ii. Treatment may be taken in a network provider/PPN hospital and is subject to pre authorization by the TPA. Booklet
containing list of network provider/PPN hospitals shall be provided by the TPA. Updated list of network provider/PPN is
available on website of the Company (https://uiic.co.in/en/tpa-ppn-network-hospitals) and the TPA mentioned in the
schedule.
iii. Call the TPA’s toll free phone number provided on the health ID card for intimation of claim and related assistance. Inform
the ID number for easy reference
iv. On admission in the network provider/PPN hospital, produce the ID card issued by the TPA at the Hospital Helpdesk.
Cashless request form available with the network provider/PPN and TPA shall be completed and sent to the TPA for
authorization.
v. The TPA upon getting cashless request form and related medical information from the Insured Person/Network
Provider/PPN shall issue pre-authorization letter to the hospital after verification.
vi. At the time of discharge, the Insured Person shall verify and sign the discharge papers and pay for non-medical and
inadmissible expenses.
vii. The TPA reserves the right to deny pre-authorization in case the Insured Person is unable to provide the relevant medical
details.
viii. Denial of a Pre-authorization request is in no way to be construed as denial of treatment or denial of coverage. The Insured
Person may get the treatment as per treating doctor’s advice and submit the claim documents to the TPA for possible
reimbursement.

C. Procedure for Reimbursement of Claims

i. In non-network hospitals payment must be made up-front and for reimbursement of claims the Insured Person may submit
the necessary documents to TPA (if claim is processed by TPA)/Company (if claim is processed by the Company) within the
prescribed time limit.
ii. Claims for Pre and Post-Hospitalization will be settled on reimbursement basis on production of relevant claim papers and
cash receipts within the prescribed time limit.
iii. Claims for Cost of Health Check-up will be settled on reimbursement basis on production of test reports and cash receipts
within the prescribed time limit.

12
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

D. Supporting Documents
The claim is to be supported with the following original documents and submitted within the prescribed time limit.
i. Duly completed claim form
ii. Attending medical practitioner’s / surgeon’s certificate regarding diagnosis/ nature of operation performed, along with
date of diagnosis, advise for admission, investigation test reports etc. supported by the prescription from attending medical
practitioner.
iii. Medical history of the patient recorded, bills (including break up of charges) and payment receipts duly supported by the
prescription from attending medical practitioner/ hospital.
iv. Discharge certificate/ summary from the hospital.
v. Cash-memo from the Diagnostic Centre(s)/ hospital(s)/ chemist(s) supported by proper prescription.
vi. Payment receipts from doctors, surgeons and anaesthetist.
vii. Bills, receipt, Sticker of the Implants.
viii. Any other document required by Company/ TPA

Note
In the event of a claim lodged as per Settlement under multiple policies clause and the original documents having been submitted
to the other Insurer, the Company may accept the duly certified documents listed under condition 18 (D) above and claim
settlement advice duly certified by the other Insurer subject to satisfaction of the Company.

E. Time Limit for Submission of Documents

Type of Claim Time Limit for Submission of Documents to Company / TPA

Reimbursement of hospitalisation and pre
Within 15 (fifteen) days of date of discharge from hospital
hospitalisation expenses (limited to 30 days)
Reimbursement of post-hospitalisation expenses Within 15 (fifteen) days from completion of post-hospitalisation
(limited to 60 days) treatment
Reimbursement of Cost of Health Check-up Within 15 (fifteen) days from Health Check-up

Note
i. Waiver of this Condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the
Company that under the circumstances in which the Insured was placed it was not possible for him or any other person to
give such notice or file claim within the prescribed time-limit.
ii. The Company shall only accept bills/invoices/medical treatment related documents only in the Insured Person’s name for
whom the claim is submitted.
iii. The Insured Person shall also give the TPA / Company such additional information and assistance as the TPA / Company
may require in dealing with the claim including an authorisation to obtain Medical and other records from the hospital, lab,
etc.
iv. All the documents submitted to TPA shall be electronically collected by us for settlement/denial of the claims by the
appropriate authority.
v. Any medical practitioner or Authorised Person authorised by the TPA / Company shall be allowed to examine the Insured
Person in case of any alleged injury or disease leading to Hospitalisation if so required.

F. Claim Settlement (provision for Penal Interest)

i. The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary
document.
ii. In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the Policyholder from the date
of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.
iii. However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it 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, the Company shall settle or reject the claim within 45 days from the date of receipt of last
necessary document.
13
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

iv. In case of delay beyond stipulated 45 days, the company shall be liable to pay interest to the Policyholder at a rate 2%
above the bank rate from the date of receipt of last necessary document to the date of payment of claim.

(Explanation: "Bank rate" shall mean the rate fixed by the Reserve Bank of India (RBl) at the beginning of the financial year
in which claim has fallen due).

G. Services Offered by TPA

Servicing of claims i.e. claim admissions and assessments, under this Policy by way of pre-authorization of cashless treatment or
processing of claims, as per the terms and conditions of the policy.
The services offered by a TPA shall not include:
i. Claim settlement and claim rejection;
ii. Any services directly to any Insured Person or to any other person unless such service is in accordance with the terms and
conditions of the Agreement entered into with the Company.

H. Payment of Claim
All claims under the policy shall be payable in Indian currency only.

19. POSSIBILITY OF REVISION OF TERMS OF THE POLICY INCLUDING THE PREMIUM RATES

The Company, with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The Insured
Person shall be notified three months before the changes are effected.

20. WITHDRAWAL OF POLICY

i. In the likelihood of this product being withdrawn in future, the Company will intimate the Policyholders about the same 90
days prior to date of withdrawal of the product.
ii. Insured Person will have the option to migrate to similar health insurance product available with the Company at the time
of renewal with all the accrued continuity benefits such as waiver of waiting period as per IRDAI guidelines, provided the
policy has been maintained without a break.

21. REDRESSAL OF GRIEVANCE

In case of any grievance the Insured Person may contact the company through:

Website: www.uiic.co.in
Toll free: 1800 425 333 33
E-mail: [email protected]
Courier: Customer Care Department, Head Office, United India Insurance Co. Ltd., 19, IV Lane, Nungambakkam
High Road, Chennai, Tamil Nadu- 600034

Insured Person may also approach the grievance cell at any of the Company's branches with the details of grievance. If Insured
Person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may contact the
grievance officer at [email protected]

For updated details of grievance officer, kindly refer the link https://uiic.co.in/en/customercare/grievance

14
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured Person may also approach
the office of Insurance Ombudsman of the respective area/region for redressal of grievance as per Insurance Ombudsman Rules
2017. The contact details of the Insurance Ombudsman offices have been provided as Annexure – 3 of the Policy Wordings.

Grievance may also be lodged at IRDAI Integrated Grievance Management System: https://igms.irda.gov.in/

22. REGULATIONS
This policy is subject to Provisions of Insurance Act, 1938, IRDAI (Health Insurance) Regulations, 2016 and IRDAI (Protection of
Policyholders’ Interest) Regulations, 2017 as amended from time to time.

--------------------------o--------------------------

Insurance is the subject matter of Solicitation.

15
Individual Health Insurance Policy – Prospectus
UIN: UIIHLIP21114V032021
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

Individual Health Insurance Policy – Platinum / Gold / Senior Citizen

Table of Benefits
The following table of Benefits is intended as a brief indicative list for quick and easy reference. For details
of what your coverage is, please refer to your Policy Schedule along with the Policy Wordings.

Features Platinum Plan Gold Plan Senior Citizen Plan

18-35 years
(Children above 91 days of age
Age of Entry 36-60 years 61-65 years
can be covered provided one or
both the parents are covered)
2 Lakh, 3 Lakh, 4 Lakh, 5
2 Lakh, 3 Lakh, 4 Lakh, 5 2 Lakh, 3 Lakh, 4 Lakh and 5
Sum Insured Options Lakh, 8 Lakh, 10 Lakh, 15
Lakh, 8 Lakh and 10 Lakh Lakh
Lakh and 20 Lakh
Policy Period 1 Year
Base Cover
Room Rent 1% of SI 1% of SI 1% of SI
ICU/ICCU 2% of SI 2% of SI 2% of SI
Proportionate Deduction Applicable Applicable Applicable
Organ Donor Medical Expenses Covered Covered Covered
Day Care Treatments All as per Definition All as per Definition All as per Definition
Up to 25% of SI or Rs. Up to 25% of SI or Rs.
Cataract Actuals 40,000 per eye, whichever 40,000 per eye, whichever
is less is less
Up to 25% of SI or Rs. Up to 25% of SI or Rs.
Hernia & Hysterectomy Actuals
1,00,000, whichever is less 1,00,000, whichever is less
Major Surgeries# Actuals Up to 70% of SI Up to 70% of SI
30 Days subject to max of 30 Days subject to max of
Pre-Hospitalisation 30 Days
10% of SI 10% of SI
60 Days subject to max of 60 Days subject to max of
Post-Hospitalisation 60 Days
10% of SI 10% of SI
Domiciliary Hospitalisation Covered Covered Covered
Ayurvedic Treatment Covered Covered Covered
Modern Treatment Methods# Covered Covered Covered
Every three claim free
Every three claim free years Every three claim free years
years up to 1% of average
up to 1% of average SI per up to 1% of average SI per
Cost of Health Check Up SI per Insured Person
Insured Person subject to a Insured Person subject to a
subject to a maximum of
maximum of Rs. 5000. maximum of Rs. 5000.
Rs. 5000.
Optional Cover
Up to a maximum of Up to a maximum of Up to a maximum of
Road Ambulance Rs.2500/- per person per Rs.2500/- per person per Rs.2500/- per person per
policy period. policy period. policy period.
Up to Rs. 2500/5000 per Up to Rs. 2500/5000 per Up to Rs. 2500/5000 per
Daily Cash
person per policy period person per policy period person per policy period
# Please refer to Policy Wordings for details on what constitutes Major Surgeries and Modern Treatment Methods

Individual Health Insurance Prospectus

UIN: UIIHLIP21114V032021