Policy Copy New KVGB - 2407002818P113738874
Policy Copy New KVGB - 2407002818P113738874
Policy Copy New KVGB - 2407002818P113738874
PERIOD OF INSURANCE
FROM 00:00 Hrs on 01/08/2018
To Midnight on 31/03/2019
Insured
MS KARNATAKA VIKAS GRAMEENA BANK
HEAD OFFICE P B ROAD DHARWAD, DIST. : DHARWAD, KARNATAKA
DHARWAD
KARNATAKA
580008
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.
For any Information, Service Requests and Grievances please write to [email protected]
For ID Cards & Claim Intimations Please contact the TPA mentioned in the Policy document.
Coinsurance:-
Coverage Details:-
Cover Group Sum Insured( ) Premium( )
Hospitalization 185,600,000.00 4,089,297.28
Total Sum Insured 185,600,000.00 Premium 4,089,297.28
Insured Details
As Per Annexure Attached.
Premium: 4,089,297.00
CGST(9%): 368,037.00
SGST(9%): 368,037.00
Stamp Duty: 1.00
Total: 4,825,371.00
Receipt Number : 10124070018114404729
Receipt Date: 24/01/2019
Development Officer Code/ Agent Code: BKA92140090004008
KARNATAKA VIKAS GRAMEENA BANK - H O
BRANCH
POLICY NO.:2407002818P113738874
UIN NO. IRDA/NL-HLT/UII/P-H/V.1/236/13-14
Underwriter Remarks POLICY TERMS & CONDITIONS AS PER IBA POLICY. CORPORATE BUFFER : RS.40,00,000/- (INCLUSIVE OF
POLICY NO.2407002818P102854139) SUBJECT TO LIMIT OF SUM INSURED PER FAMILY
This Schedule and the attached policy shall be read together as one contract and any word or expression to which a specific meaning has
been attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear.
Anti Money Laundering Clause:-In the event of a claim under the policy exceeding 1 lakh or a claim for refund of premium exceeding
1 lakh, the insured will comply with the provisions of AML policy of the company. The AML policy is available in all our operating offices as
well as Company's web site.
Affix Policy
Stamp here.
Authorized Signatory
Underwritten By - KUL20958 ( DO UNDERWRITER )
POLICY NO.: 2407002818P113738874
UIN NO. IRDA/NL-HLT/UII/P-H/V.1/236/13-14
Details of TPA
Please contact the following TPA for Issue of Identity Cards, Cashless Approvals & Claims Settlement.
1 WHEREAS the insured designated in the Schedule hereto has by a proposal and declaration dated as stated in the Schedule which
shall be the basis of this Contract and is deemed to be incorporated herein has applied to UNITED INDIA INSURANCE COMPANY LTD.
(hereinafter called the COMPANY) for the insurance hereinafter set forth in respect of Employees/Members (including their eligible
family members) named in the Schedule hereto (hereinafter called the INSURED PERSON) and has paid premium as consideration
for such insurance.
1.1 NOW THIS POLICY WITNESSES that subject to the terms, conditions, exclusions and definitions contained herein or endorsed, or
otherwise expressed hereon the Company undertakes that if during the period stated in the Schedule or during the continuance of
this policy by renewal any insured person shall contract any disease or suffer from any illness (hereinafter called DISEASE) or sustain
any bodily injury through accident (hereinafter called INJURY) and if such disease or injury shall require any such insured Person,
upon the advice of a duly qualified Physician/Medical Specialist/Medical practitioner (hereinafter called MEDICAL PRACTITIONER) or
of a duly qualified Surgeon (hereinafter called SURGEON) to incur hospitalisation/domiciliary hospitalisation expenses for
medical/surgical treatment at any Nursing Home/Hospital in India as herein defined (hereinafter called HOSPITAL) as an inpatient,
the Company will pay through TPA to the Hospital / Nursing Home or Insured the amount of such expenses incurred as are Medically
Necessary and reasonable and customary in respect thereof by or on behalf of such Insured Person but not exceeding t h e S u m
Insured in aggregate in any one period of insurance stated in the schedule hereto.
1.2 In the event of any claim becoming admissible under this scheme, the company will pay through TPA to the Hospital / Nursing
Home or insured person the amount of such expenses as would fall under different heads mentioned below and as are reasonably
and necessarily incurred thereof by or on behalf of such insured person but not exceeding the Sum Insured in aggregate mentioned
in the schedule hereto.
A. Room, Boarding and Nursing expenses as provided by the Hospital/Nursing Home not exceeding 1% of the sum insured per
day or the actual amount whichever is less. This also includes nursing care, RMO charges, IV Fluids/Blood transfusion/injection
administration charges and similar expenses.
B. Intensive Care Unit (ICU) expenses not exceeding 2% of the sum insured per day or actual amount whichever is less.
C. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
D. Anesthetic, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Dialysis, Chemotherapy,
Radiotherapy, Cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like pacemaker,
orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests, X-ray and such
similar expenses that are medically necessary.
E. Hospitalisation expenses (excluding cost of organ) incurred for/by donor in respect of organ transplant to the insured.
Note:
1. The amount payable under 1.2 C & D above shall be at the rate applicable to the entitled room category. In case the Insured
person opts for a room with rent higher than the entitled category as in 1.2 A above, the charges payable under 1.2 C & D shall be
limited to the charges applicable to the entitled category. This will not be applicable in respect of medicines & drugs and implants.
2. No payment shall be made under 1.2 C other than as part of the hospitalisation bill.
1.2.1 Expenses in respect of the following specified illnesses/surgeries will be restricted as detailed below:
Hospitalisation Benefits LIMITS per surgery RESTRICTED TO
a.Cataract, a.Actual expenses incurred or 25% of the sum insured whichever
Hernia,Hysterectomy is less
b.Major surgeries* b.Actual expenses incurred or 70% of the Sum Insured whichever
is less
* Major surgeries include Cardiac surgeries, Brain Tumor surgeries, Pacemaker implantation for sick sinus syndrome, Cancer surgeries,
Hip, Knee, joint replacement surgery, Organ Transplant.
* The above limits specified are applicable per hospitalization/surgery.
POLICY NO.:2407002818P113738874
UIN NO. IRDA/NL-HLT/UII/P-H/V.1/236/13-14
1.3 Pre and Post Hospitalisation expenses payable in respect of each hospitalisation shall be the actual expenses incurred subject to a
maximum of 10% of the Sum Insured.
1.4 In addition to the above, the following would apply to claims arising out of persons aged more than 60 years
2.1 ACCIDENT:
An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means.
2.2 A. "Acute condition"-Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return
the person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery.
B. "Chronic condition"-A c h r o n i c c o n d i t i o n i s d e f i n e d a s a d i s e a s e , i l l n e s s , o r i n j u r y t h a t h a s o n e o r m o r e o f t h e f o l l o w i n g
characteristics-
i. it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests-
ii. it needs ongoing or long-term control or relief of symptoms
iii. it requires your rehabilitation or for you to be specially trained to cope with it
iv. it continues indefinitely
v. it comes back or is likely to come back.
3.1 Expenses on Hospitalisation for minimum period of 24 hours are admissible. However, this time limit is not applied to specific
treatments, such as
This condition will also not apply in case of stay in hospital of less than 24 hours provided -
a. The treatment is undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hours because of
technological advancement and
b. Which would have otherwise required a hospitalisation of more than 24 hours.
Procedures/treatments usually done in out patient department are not payable under the policy even if converted as an in-patient in the
hospital for more than 24 hours or carried out in Day Care Centres.
3.2 Domiciliary Hospitalisation means medical treatment for a period exceeding three days for such an illness/disease/injury which in
the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the
following circumstances :
a . The condition of the patient is such that he/she is not in a condition to be removed to a hospital
or
b . The patient takes treatment at home on account of non-availability of room in a hospital.
POLICY NO.:2407002818P113738874
UIN NO. IRDA/NL-HLT/UII/P-H/V.1/236/13-14
Subject however that domiciliary hospitalisation benefits shall not cover:
i) Expenses incurred for pre and post hospital treatment and
ii) Expenses incurred for treatment for any of the following diseases:-
a. Asthma
b. Bronchitis
c. Chronic Nephritis and Nephritic Syndrome
d. Diarrhoea and all type of Dysenteries including Gastroenteritis
e. Diabetes Mellitus and Insipidus
f. Epilepsy
g. Hypertension
h. Influenza, Cough and Cold
i. All Psychiatric or Psychosomatic Disorders
j. Pyrexia of unknown Origin for less than 10 days
k. Tonsillitis and Upper Respiratory Tract infection including Laryngitis and pharangitis
l. Arthritis, Gout and Rheumatism
Liability of the company under this clause is restricted as stated in the Schedule attached hereto
3.3 For Ayurvedic Treatment, hospitalisation expenses are admissible only when the treatment has been undergone in a
Government Hospital or in any Institute recognised by the Government and/or accredited by Quality Council of India/National
Accreditation Board on Health.
Company's Liability for all claims admitted in respect of any/all insured person/s during the period of insurance shall not exceed the Sum
Insured stated in the schedule.
4. Exclusions:
The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured
Person in connection with or in respect of:
4.1 Any pre-existing condition(s) as defined in the policy, until 48 months of continuous coverage of such insured person have
elapsed, since inception of his/her first Policy with the Company.
4.2 Any disease other than those stated in clause 4.3 below, contracted by the Insured person during the first 30 days from the
commencement date of the policy. This exclusion shall not however, apply in case of the Insured person having been covered
under an Insurance scheme with our Company for a continuous period of preceding 12 months without any break.
4.3 Unless the Insured has 24 months of continuous coverage, the expenses on treatment of diseases such as Cataract, Benign
Prostatic Hyperthrophy, Hysterectomy for Menorrhagia, or Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in
anus, piles, Sinusitis and related disorders, Gall Bladder Stone removal, Gout & Rheumatism, Calculus Diseases are not payable.
Internal Congenital Disease means anomaly which is not visible and accessible parts of the body.
4.4 Unless the Insured has 48 months of continuous coverage, the expenses related to treatment of Joint Replacement due to
Degenerative Condition and age-related Osteoarthritis & Osteoporosis are not payable.
If these diseases mentioned in Exclusion no.4.3 and 4.4 (other than Congenital Internal Diseases) are pre-existing at the time of
proposal they will not be covered even during subsequent period of renewal subject to the pre-existing disease exclusion clause. If
the Insured is aware of the existence of congenital internal disease before inception of the policy, the same will be treated as pre-
existing.
4.5 Injury / disease directly or indirectly caused by or arising from or attributable to War, invasion, Act of Foreign enemy, War like
operations (whether war be declared or not).
4.6 a .Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident.
b .Vaccination or inoculation
c. Change of life or cosmetic or aesthetic treatment of any description such as correction of eyesight, etc.
d Plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
4.7 Cost of spectacles, contact lenses and hearing aids.
4.8 Dental treatment or surgery of any kind unless necessitated by accident and requiring hospitalisation.
4.9 Convalescence, general debility; run-down condition or rest cure, obesity treatment and its complications including morbid obesity,
Congenital external disease or defects or anomalies, treatment relating to all psychiatric and and psychomatic disorders. Infertility,
Sterility, Venereal disease, intentional self injury and use of intoxication drugs / alcohol
4.10 All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type
I I I ( H T L B - III) or lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any
syndrome or condition of a similar kind commonly referred to as AIDS.
POLICY NO.:2407002818P113738874
UIN NO. IRDA/NL-HLT/UII/P-H/V.1/236/13-14
4.11 Charges incurred at Hospital or Nursing Home primarily for diagnosis, x-ray or Laboratory examinations or other diagnostic studies
not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury,
for which confinement is required at a Hospital / Nursing Home
4.12 Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician
4.13 Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials
4.14 Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these including
caesarean section, except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy) which is proved by submission of
Ultra Sonographic report and Certificate of Gynaecologist that it is life threatening one if left untreated.
4.15 Naturopathy Treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven treatments/therapies.
Treatment including drug experimental therapy which is not based on established medical practice in India, is treatment
experimental or unproven.
4.16 External and or durable Medical / Non-medical equipment of any kind used for diagnosis and/or treatment and/or monitoring
and/or maintenance and/or support including CPAP, CAPD, Infusion pump, Oxygen concentrator etc., Ambulatory devices i.e.,
walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, elastrocepe bandages, external orthopaedic pads, sub
cutaneous insulin pump, Diabetic foot wear, Glucometer/Thermometer, alpha/water bed and similar related items etc. and also any
medical equipment, which are subsequently used at home.
4.17 Genetic disorders and stem cell implantation/surgery.
4.18 Change of treatment from one system of medicine to another unless recommended by the consultant/hospital under whom the
treatment is taken.
4.19 Treatment for Age Related Mascular Degeneration (ARMD), treatment such as Rotational Field Quantum Magnetic Resonance
(RFQMR), Enhanced External Counter Pulsation (EECP), etc.
4.20 A l l n o n-medical expenses including convenience items for personal comfort such as charges for telephone, television, ayah,
private nursing/barber or beauty services, diet charges, baby food, cosmetic, tissue paper, diapers, sanitary pads, toiletry items
and similar incidental expenses.
4.21 Any kind of Service charges, Surcharges, Admission Fees/Registration Charges, Luxury tax and similar charges levied by the
hospital.
4.22 All non-Medical expenses. For detailed list of non-medical expenses, please log on to our website www.uiic.co.in.
5. CONDITIONS:
5.1 Contract: The Proposal form, Prospectus, Pre-acceptance Health check-up and the Policy issued shall constitute complete Contract
of Insurance.
5.2 Every notice or communication regarding hospitalization or claim to be given or made under this Policy shall be delivered in writing
at the address of the TPA office as shown in the Schedule. Other matters relating to the policy may be communicated to the policy
issuing office.
5.3 The premium payable under this Policy shall be paid in advance. No receipt for Premium shall be valid except on the official form
of the company signed by a duly authorised official of the company. T h e d u e p a y m e n t o f p r e m i u m a n d t h e o b s e r v a n c e a n d
fulfilment of the terms, provisions, conditions and endorsements of this Policy by the Insured Person in so far as they relate to
anything to be done or complied with by the Insured Person shall be a condition precedent to any liability of the Company to make
any payment under this Policy. No waiver of any terms, provisions, conditions and endorsements of this policy shall be valid unless
made in writing and signed by an authorised official of the Company.
5.4 Notice of Communication: Upon the happening of any event which may give rise to a claim under this Policy notice with full
particulars shall be sent to the TPA named in the schedule immediately and in case of emergency hospitalization within 24 hours
from the time of Hospitalisation/Domiciliary Hospitalisation
5.5 All supporting documents relating to the claim must be filed with TPA within 15 days from the date of discharge from the hospital.
I n c a s e o f p o s t-hospitalisation, treatment (limited to 60 days), all claim documents should be submitted within 7 days after
completion of such treatment.
POLICY NO.:2407002818P113738874
UIN NO. IRDA/NL-HLT/UII/P-H/V.1/236/13-14
Note:Waiver of this Condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the
Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such
notice or file claim within the prescribed time-limit.
5.6 The Insured Person shall obtain and furnish to the TPA with all original bills, receipts and other documents upon which a claim is
based and shall also give the TPA / Company such additional information and assistance as the TPA / Company may require in
dealing with the claim.
5.7 Any medical practitioner 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.
5.8 The Company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner
fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his
behalf.
5.9 DISCLOSURE TO INFORMATION NORM
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.
5.10 If at the time when a claim arises under the policy, there is in existence any other insurance taken by the insured to indemnify the
treatment costs, the insured person shall have the right to require a settlement of the claim in terms of any of his policies. If the
amount to be claimed exceeds the sum insured under a single policy, after considering deductibles or co-pay, the insured person
shall have the right to choose the insurers by whom the claim is to be settled. In such cases, the Company shall not be liable to
pay or contribute more than its rateable proportion of any loss, liability, compensation costs or expenses.
Note: The insured person must disclose such other insurance at the time of making the claim under this policy.
5.11 The Policy may be renewed by mutual consent and in such event the renewal premium shall be paid to the Company on or before
the date of expiry of the Policy or of the subsequent renewal thereof.The Company shall not be bound to give notice that such
renewal premium is due, provided however that if the insured shall apply for renewal and remit the requisite premium before the
expiry of this policy, renewal shall not normally be refused, unless the Company has reasonable justification to do so.
5.12 ENHANCEMENT OF SUM INSURED
The insured may seek enhancement of Sum Insured in writing at or before payment of premium for renewal, which may be
granted at the discretion of the Company. However, notwithstanding enhancement, for claims arising in respect of ailment, disease
or injury contracted or suffered during a preceding policy period, liability of the company shall be only to the extent of the Sum
Insured under the policy in force at the time when it was contracted or suffered during the currency of such renewed policy or any
subsequent renewal thereof.
Any such request for enhancement must be accompanied by a declaration that the insured or any other insured person in respect
of whom such enhancement is sought is not aware of any symptoms or other indications that may give rise to a claim under the
policy. The Company may require such insured person/s to undergo a Medical examination to enable the company to take a
decision on accepting the request for enhancement in the Sum Insured.
5.13 Cancellation Clause :
The Company may at any time cancel the Policy on grounds of misrepresentation, fraud, non-disclosure of material fact or non-
cooperation by the insured by sending fifteen days notice in writing by Registered A/D to the insured at his last known address in
which case the Company shall return to the insured a proportion of the last premium corresponding to the unexpired period of
insurance if no claim has been paid under the policy. The insured may at any time cancel this policy and in such event the
Company shall allow refund of premium at Company's short period rate table given below provided no claim has occurred upto the
date of cancellation.
Note:
1. Low Claim Ratio Discount (Bonus) or High Claim Ratio loading (Malus) will be applicable to the Premium at renewal of the Policy
depending on the incurred claims Ratio for the entire Group Insured.
2. Incurred claim would mean claims paid plus claims outstanding in respect of the entire group insured under the policy during the
relevant period.
The insured shall throughout the period of insurance keep and maintain a proper record of register containing the names of all the
insured persons and other relevant details as are normally kept in any institution/ Organisation. The insured shall declare to the company
any additions in the number of insured persons as and when arising during the period of insurance and shall pay the additional premium
as agreed.
POLICY NO.:2407002818P113738874
UIN NO. IRDA/NL-HLT/UII/P-H/V.1/236/13-14
It is hereby agreed and understood that, that this insurance being a Group Policy availed by the Insured covering Members, the benefit
thereof would not be available to Members who cease to be part of the group for any reason whatsoever.
Such members may obtain further individual insurance directly from the Company and any claims shall be governed by the terms thereof.
6 MATERNITY EXPENSES BENEFIT EXTENSION: (Wherever applicable)
This is an optional cover, which can be obtained on payment of 10% of total basic premium for all the Insured Persons under the
Policy.
Option for Maternity Benefits has to be exercised at the inception of the Policy period and no refund is allowable in case of Insured's
cancellation of this option during currency of the policy.
The hospitalization expenses in respect of the new born child can be covered within the Mother's Maternity expenses. The maximum
benefit allowable under this clause will be up to Rs. 50,000/- or the sum insured opted by the group whichever is lower.
Special conditions applicable to Maternity expenses Benefit Extension:
1. These Benefits are admissible only if the expenses are incurred in Hospital / Nursing Home as in-patients in India
2. A waiting period of 9 months is applicable for payment of any claim relating to normal delivery or caesarean section or
abdominal operation for extra uterine pregnancy. The waiting period may be relaxed only in case of delivery, miscarriage or
abortion induced by accident or other medical emergency.
3. Claim in respect of delivery for only first two children and / or operations associated therewith will be considered in respect of
any one Insured Person covered under the policy or any renewal thereof. Those Insured Persons who are already having two or
more living children will not be eligible for this benefit.
4. Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of
conception are not covered.
5. Pre-natal and postnatal expenses are not covered unless admitted in Hospital / Nursing Home and treatment is taken there.
Note: When group policy is extended to include Maternity Expenses Benefit, the exclusion No.4.14 of the policy stands deleted.
7 IRDA REGULATIONS : This policy is subject to IRDA (Health Insurance) Regulations 2013 and IRDA (Protection of Policyholders’
Interest) Regulations 2002 as amended from time to time.
8. GRIEVANCE REDRESSAL : I n the event of the policyholder having any grievance relating to the insurance, the insured person may
submit in writing to the Policy Issuing Office or Grievance cells at Regional Office of the Company for redressal. If the grievance
remains unaddressed, the insured person may contact the Officer, Uni-Customer Care Department, Head Office.
9 IMPORTANT NOTICE
The Company may revise any of the terms, conditions and exceptions of this insurance including the premium payable on renewal
in accordance with the guidelines/rules framed by the Insurance Regulatory and Development Authority (IRDA) and after obtaining
prior approval from the Authority. We shall notify you of such changes at least three months before the revision are to take effect.
The Company may also withdraw the insurance as offered hereunder after following the due process as laid down by the IRDA and
after obtaining prior approval of the Authority and we shall offer to cover you under such revised/new terms, conditions, exceptions
and premium for which we shall have obtained prior approval from the Authority.
*****