Insurance

Date: 09/09/2023
Policy Number: 31341466202303

Customer ID: 2000895337
MR. ANKIT JAIN

HNO.402,
GREEN AVENUE,
AMRITSAR,
PUNJAB - 143001
Mobile: XXXXXX3442
Subject : Niva Bupa Health Insurance Policy No. 31341466202303
Dear MR. ANKIT JAIN,
Thank you for renewing your Niva Bupa health insurance policy. At Niva Bupa, we put your health first and are committed to provide you access to
the very best of healthcare, backed by the highest standards of service.
Please find enclosed your Niva Bupa Policy Kit which will help you understand your policy in detail and give you more information on
how to access our services easily. Your policy kit includes the following:
• Insurance Certificate: Confirming your specific policy details like date of commencement, persons covered and specific conditions related to
your plan.
• Premium Receipt: Receipt issued for the premium paid by you.
Do visit us online at www.nivabupa.com to view and download our updated list of network hospitals in your city, download claim forms and for other
useful information. You can register with us online using your policy number, date of birth & email id and access your policy details. In case of any
further assistance, call us at 1860-500-8888 (customer helpline number) or email us at [email protected].
We request you to read your policy terms and conditions carefully so that you are fully aware of your policy benefits. For benefits related to section
80D, please consult your tax advisor.
Assuring you of our best services and wishing you and your loved ones good health always.
Yours Sincerely,
Director - Operations & Customer Service

For and on behalf of Niva Bupa Health Insurance Co. Ltd.
(Formerly known as Max Bupa Health Insurance Co. Ltd.)
Important - Please read this document and keep in a safe place.
Product Name: ReAssure | Product UIN: NBHHLIP23107V022223, Add On Name: Smart Health+ | Add On UIN: NBHHLIA22164V012122
Policy Schedule
Policyholder Name: MR. ANKIT JAIN Policy Number 31341466202303

Policyholder Address: Policy Commencement Date and Time From 09/09/2023 00:00
HNO.402, Policy Expiry Date and Time To 08/09/2024 23:59
GREEN AVENUE, Plan Opted Family Floater
AMRITSAR, Policy Period 1 Year
PUNJAB - 143001 Renewal / Payment Due Date 08/09/2024

Reported claims in the policy since 2
Details of Electronic Insurance Account (eIA) inception
eIA Number None
Insurance Repository Name None
Cover Details
Name of the Insured Base Sum Sum Insured Booster Sum Insured (Base Sum Live Healthy Personal
Person(s) Insured Safeguard (in Benefit Insured + Booster Benefit + Discount % Accident opted
(in Rs.) Rs.) accrued (in Sum Insured Safeguard) (in
Rs.) Rs.)
Mr. Ankit Jain 10,00,000 1,84,900 1,000,000 21,84,900 0.00 No
Mrs. Sanchi Kohli No

.
Premium Details
Net Integrated Central Goods and State/UT Goods and Gross Premium (Rs.) Gross Premium (Rs.)
Premium/Taxable Goods and Service Tax (9.00 Service Tax (9.00 %) (in words)
Value (Rs.) Service Tax %)
(18.00%)
17,451.00 0.00 1,570.59 1,570.59 20,592.00 Twenty Thousand Five Hundred
Ninety-Two Only
Nominee Details
Nominee Name Relationship with the Policyholder
Sanchi Kohli Spouse
Intermediary Details
Intermediary Name Intermediary Code Intermediary Contact No.

Amit Sehgal LUD0152737 8725961184
Claim Administrator Servicing Branch Details
Niva Bupa Health Insurance Company Limited Niva Bupa Health Insurance Company Ltd,Unit no 3 Plot No. 88, 2nd Floor,Kunal Tower,Mall
Road,Opp Axis Bank, Ludhiana (Punjab)-141001
Optional Benefit/Feature Details
Particulars Details
Personal Accident Cover Not opted
Safeguard Yes
Signature Not Verified

Digitally signed by PADMESH
NAIR
Date: 2023.09.10 20:19:00 +05:30
Hospital Cash Not opted
Smart Health+ (Disease Management) Not Opted
Smart Health+ (Acute Care) Best Consult
Pre Existing Disease Waiting Time Not opted

Modification
Co-payment Not opted
Room Type Modification Not opted
Annual Aggregate Deductible Not opted
Product Benefit Table1

Inpatient Care Covered up to Sum Insured
Day Care Treatment Covered up to Sum Insured
Alternative treatment Covered up to Sum Insured
Domiciliary Hospitalization Covered up to Sum Insured
Modern treatments Covered up to Sum Insured with a sub-limit of Rs. 1 Lac on few robotic surgeries
Pre-hospitalization Medical Expenses (60 Days) Covered up to Sum Insured
Post-hospitalization Medical Expenses (180 Days) Covered up to Sum Insured
Living Organ Donor Transplant Covered up to Sum Insured
Emergency Ambulance Covered upto Rs. 2,000 per hospitalization
Air Ambulance Cashless claim: Covered up to Sum Insured/Reimbursement claim: Covered up to
Rs. 2.5 Lacs
Home care treatment Covered up to Sum Insured
Booster Benefit In case of claim free year, increase of 50% of expiring Base Sum Insured in a Policy
Year; maximum up to 100% of Base Sum Insured (In case of a claim, reduction of
accumulated Cumulative Bonus by 50% of expiring Base Sum Insured)
ReAssure Unlimited reinstatement up to base Sum Insured
Shared accommodation Cash Benefit Rs. 800 per day; maximum Rs. 4,800
Health Check-up For define list of tests; up to Rs. 5,000 Per Policy
Second Medical Opinion Once for any condition for which hospitalization is triggered
Live healthy benefit Discount on renewal premium basis number of steps taken(Applicable for Insured
Persons other than son / daughter)
1
The details of the benefits will change depending upon the plan opted. All the benefits are on per Policy Year basis, if otherwise not mentioned.
Insured Person Details
Name of the Age Insured Gender Relationship Insured Additional Pre Existing Personal Waiting
Insured Person DOB with Sum Insured Condition* Period
(s) Niva Bupa
(Since)
Mr. Ankit Jain 39 23/04/1984 Male Applicant 30/08/2020 0 None None
Mrs. Sanchi 35 28/12/1987 Female Spouse 30/08/2020 0 1. Endometriosis of None

Kohli ovary
2. Noninflammatory
disorders of ovary,
fallopian tube and
broad ligament
(* -Pre existing Disease as disclosed by You / Insured Person or discovered by us during medical underwriting)
Permanent Exclusion (if any):
None
Pursuant to Notification no 13/2020- Central Tax and Notification no 14/2020- Central Tax both dated 21st March 2020 read with rule 54 (2) of
CGST Rules 2017, the provisions of E Invoicing & QR code are not applicable to an Insurance company, hence E Invoice number and QR code has not
been printed on this document. GST under RCM: NIL
GSTI No.: 03AAFCM7916H1ZI SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 3 Customer State Code / Customer GSTI No.: 3 /NA
Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
Location: New Delhi Director - Operations & Customer Service

Date: 09/09/2023 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)
Premium Receipt
Dear MR. ANKIT JAIN
HNO.402
GREEN AVENUE
AMRITSAR
PUNJAB - 143001
We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policyholder Name Mr. Ankit Jain Policy Number 31341466202303
Product Name ReAssure Plan Opted Family Floater Base Sum Insured 10,00,000
Policy Commencement Date # 09/09/2023 Policy Expiry Date 08/09/2024
Premium Calculation:
(A) Premium (Rs.) - Base Product 14,442.00
(B) Premium (Rs.) - Personal Accident Cover 0.00
(C) Premium (Rs.) - Safeguard 1,083.00
(D) Premium (Rs.) - Hospital Cash 0.00
(E) Premium (Rs.) - Smart Health+: Acute Care Add-on 1,926.00
Underwriting Loading (Rs.) 0.00
Total Discount (Rs.) 0.00
Net Premium / Taxable value (Rs.) 17,451.00
Integrated Goods and Service Tax (18.00 %) 0.00
Central Goods and Service Tax (9.00 %) 1,570.59
State/UT Goods and Service Tax (9.00 %) 1,570.59
Gross Premium (Rs.) 20,592.00

#
Issuance of policy is subject to clearance of premium paid
Details of persons Insured:

Name of Person Insured Age Gender Relationship**
Mr. Ankit Jain 39 Male Applicant
Mrs. Sanchi Kohli 35 Female Spouse
Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. For the
purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax Act, 1961 and any amendments made
thereafter.
You may get tax benefits up to Rs. 20,592.00.subject to maximum permissible limits applicable under Income Tax Act 1961 as modified from
time to time. For more details, kindly consult your tax advisor. In the event of non-realization of premium, benefits cannot be obtained against
this premium receipt.
For your eligibility and deductions, please refer to provisions of Income Tax Act 1961 as modified and consult your tax consultant.
GSTI No.: 03AAFCM7916H1ZI SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 3 Customer State Code / Customer GSTI No.: 3 /NA
Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
Location: New Delhi Director - Operations & Customer Service

Date: 09/09/2023 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)
List of Un-recognized Hospitals
Sr. State City Hospital Address
No.
1 Gujarat Surat Aakanksha Hospital 126, Aaradhnanagar Soc., B/H. Bhulkabhavan
School, Aanand-Mahal Rd., Adajan, Surat
2 Gujarat Surat Abhinav Hospital Harsh Apartment, Nr Jamna Nagar Bus Stop,
God Dod Road Surat
3 Gujarat Surat Adhar Ortho Hospital Dawer Chambers, Nr. Sub Jail, Ring Rd., Surat
4 Gujarat Surat Aris Care Hospital A 223-224, Mansarovar Soc, 60 Feet ,
Godadara Road, Surat
5 Gujarat Surat Arzoo Hospital Opp. L.B. Cinema, Bhatar Rd., Surat
6 Gujarat Surat Auc Hospital B-44 Gujarat Housing Board, Nandeshara
7 Gujarat Surat Dharamjivan General Hospital Karmayogi - 1, Plot No. 20/21, Near Piyush Point,
& Trauma Centre Pandesara
8 Gujarat Surat Dr. Santosh Basotia Hospital Bhatar Road, Surat
9 Gujarat Surat Ghevariya Dental Clinic 202, M K Complex, Variya Compound, Hirabag
Circal
10 Gujarat Surat God Father Hospital 344, Nandvan Soc., B/H. Matrushakti Soc.,
Puna Gam, Surat.
11 Gujarat Surat Govind-Prabha Arogya Opp. Ratna-Sagar Vidhyalaya, Kaji Medan,
Sankool Gopipura, Surat
12 Gujarat Surat Hari Milan Hospital L H Road
13 Gujarat Surat Jaldhi Ano-Rectal Hospital
Tadwadi, Surat
14 Gujarat Surat Jeevan Path Gen. Hospital 2nd. Fl., Dwarkesh Nagri, Nr. Laxmi Farsan,
Sayan, Surat.
15 Gujarat Surat Kalrav Children Hospital Yashkamal Complex, Nr. Jivan Jyot, Udhna
16 Gujarat Surat Kanchan General Surgical Plot No. 380, Ishwarnagar Soc, Bhamroli-Bhatar,
Hospital Pandesara Surat
17 Gujarat Surat Krishnavati General Hospital Bamroli Road
18 Gujarat Kutch Mantra Orthopaedic Hospital Dr. Bhavin N. Patel
Gandhidham(Kutch)
19 Gujarat Surat Niramayam Hosptial & Shraddha Raw House, Near Natures Park
Prasutigruah
20 Gujarat Surat Patna Hospital 25, Ashapuri Soc - 2, Bamroli Road, Surat
21 Gujarat Surat Poshia Children Hospital Harekrishan Shoping Complex 1St Floor, Varachha
Road, Surat
22 Gujarat Surat Prayosha Hospital A-102/103, Shagun Residency, Puna Bombay Mar-
ket Road, Puna, Surat, Gujarat
23 Gujarat Surat R.D Janseva Hospital 120 Feet Bamroli Road, Pandesara, Surat
24 Gujarat Surat Radha Hospital & Maternity 239/240 Bhagunagar Society, Opp Hans Society,
Home L H Road, Varachha Road
25 Gujarat Surat Santosh Hospital L H Road
26 Gujarat Surat Shaurya Hospital Udhna, Surat
27 Gujarat Surat Shikha General Hospital 14 – Umiya Nagar – 1, Navagam Dindoli Road,
- Changed Name To Sai Udhna
Hospital
28 Gujarat Surat Shishumangal Children Surat
Hospital
Product
Product Name:Companion
Name: Health Product
ReAssure|| Product UIN:
UIN: NBHHLIP23107V022223
NBHHLIP23007V052223
No.
29 Gujarat Surat Shree Ramdev General & 248,Shiv Nagar G.I.D.C. Road,Nr:Udhna Citizen
Surgical Hospital Co-Operative Bank,Pandasara
30 Gujarat Surat Shree Sai Hospital & Prasuti 14, Umiya Nagar-1, Navagam Dindoli Road, Udhna
Gruh
31 Gujarat Surat Shreyans Anorectal & Daycare 5Th Floor, Opp. Ayurvedic Collage,
Hospital Station Road, Surat
32 Gujarat Surat Shri Panchratna Hospital & Geetanagar, Near Dindoli Jakat Naka,
Prasutugruah Navagam, Udhna, Surat
33 Gujarat Surat Shubham General Hospital 2nd Floor, Nirmal Complex, Near Maruti Gaushala,
Opp. Bhagwati Rus
34 Gujarat Surat Siddhi Clinic & Nursing Home 33- Nandanvan Apt., Naginawadi, Surat
35 Gujarat Surat Sparsh Multy Specality G.I.D.C Road, Nr Udhana Citizan Co-Op.Bank
Hospital & Trauma Care
Center
36 Gujarat Surat Sree Uday Narayan General 193,Sukhi Nagar, Bamroli Road, Near New Bridge,
Hospital Pandesara, Surat
37 Gujarat Surat Tripathi Chartiable Hospital Geetanagar, Near Dindoli Jakat Naka, Navagam,
Udhna, Surat
38 Gujarat Ahmedabad Umiya Medical & Surgical 2Nd Floor, Centre Plaza, Sattadhar Char Rasta,
Hospital Sola Road
39 Gujarat Surat Varachha General Hospital 17-26, Samarth Park Near Archana School
40 Uttar Kushi Nagar Aastha Multispecialty Hospital Padrauna Road, Kushinagar, Up, Ph :
Pradesh 9598440966/9793196178
41 Maharashtra Thane Ashwini Nursing Home Prashanti, Ground Floor, Agarkar Road,
Dombivli East, Thane
42 Maharashtra Thane Asmita Nursing Home Prashanti, Ground Floor, Agarkar Road,
43 Maharashtra Thane Balaji Nursing Home Prashanti, Ground Floor, Agarkar Road,
44 Haryana Rohtak Channan Devi Memorial Plot No.952, Ward No.23, Lal Chand Colony Chowk,
Hopital Near Durga Mandir, Rohtak
45 Telangana Hyderabad Goodlife Hospitals #1-7-309, Hanuman Nagar, Opp. Jaginis Foodland,
Chaitanyapri X Roads, Dilskhnagar
46 Orissa Dhenkanal Jagannath Clinic & Nursing Durgabazar, Nuahata, Kantabania, Banarpal
Home
47 Uttar Allahabad Jeevan Jyoti Hospital 162, Bai Ka Bagh, Lowther Road, Allahabad, Up
Pradesh
48 Tamilnadu Mayiladuthurai Krishna Hospital No 8 Pattamangala Street Mayiladuthurai
49 Maharashtra Mumbai Mumtaz Nursing Home 3/299/3774, Opp. Choti Masjid, Tagore Nagar,
Near Hariyali Police Chowki, Vikhroli (E),
Mumbai-400083
50 Telangana Kesava Nagar Padmaja Hospital # 17-1- 386/1/18 Kesava Nagar Colony Champapet
Colony Hyderabad
51 Bihar Harnaut Pragya Nurshing Home Harnaut
52 Telangana Jeedimetla Ram Hospitals Shapur Nagar, Ida, Jeedimetla
53 Haryana Gurgaon Ramanarayan Hospital Vill Bass Hariya P.O Bass Lambi Ggn-122503
54 Maharashtra Mumbai Royal Nursing Home Plot No 7, Sector-1, Airoli,, Navi Mumbai-400708
55 Orrissa Cuttak Sabarmati General Hospital Mahanadi Vihar
56 Uttar Meerut Sahara Hospital Ajanta Colony, Garh Road
Pradesh
Product
NBHHLIP23007V052223
No.
57 Maharashtra Mumbai Sb Nursing Home Powai
58 Uttar Meerut Shagun Hospital 24 Tyagi Market Tej Garhi
Pradesh
59 Haryana Gurgaon Shri Balaji Hospital & Trauma Gadoli, Pataudi Road, Gurgaon
Center
60 Telangana Hyderabad Sri Sai Thirumala Hospitals Kishan Kumar Complex, Durga Nagar, Karmanghat
Main Road
61 Madhya Bhopal Venus Hospital And Medical H. No-2,Pipal Square,Karond, Bhopal
Pradesh Research Centre
62 Telangana Vanasthali Vijaya Nursing Home Near Double Road, Vanasthali Puram
Puram
63 Uttar Allahabad Virendra Hospital 7 Stanley Road (Next To Mishra Bhavan)Civil Lines,
Pradesh Allahabad
64 Uttar Meerut Yog Nursing Home Near Tej Garhi, University Road
Pradesh
Note:
1. Claims whether Cashless or reimbursement pertaining to treatments taken at the above mentioned Hospitals shall not
be entertained, processed or paid by Niva Bupa.
2. The above list is only for the purpose of admissibility of claims with respect to any health insurance policies of Niva
Bupa Health Insurance Company Limited.
3. The above list is subject to be updated from time to time. For updated list please visit this site at www.nivabupa.com
or call our customer care at 1860 500 8888
Product
NBHHLIP23007V052223
CUSTOMER INFORMATION SHEET
POLICY CLAUSE
S. No. TITLE DESCRIPTION
NUMBER
1. Product Name ReAssure
2. What am I covered Base Coverage:

for: Ÿ Hospital admission longer than 24 hrs 4.1
Ÿ Day Care Treatment would be covered if admitted for more than 2 hours and would also cover treatment taken for 4.2
Angiography, Dialysis, Radiotherapy or Chemotherapy for cancer.
Ÿ Alternative treatment covered up to Sum Insured 4.3
Ÿ Domiciliary hospitalization covered up to Sum Insured 4.4
Ÿ Modern treatments like Robotic surgeries, oral chemotherapy etc. are covered 4.5
Ÿ Related medical expenses up to Sum Insured incurred 60 days prior to hospitalization 4.6
Ÿ Related medical expenses incurred up to Sum Insured within 180 days from date of discharge 4.7
Ÿ Living organ donor transplant covered up to Sum Insured 4.8
Ÿ Emergency Ambulance covered up to Rs. 2,000 per Hospitalization 4.9
Ÿ Air Ambulance covered up to Sum Insured (for Cashless claims) and up to Rs. 2.5 Lacs (for Reimbursement claims) 4.10
Ÿ Home care treatment covered up to Sum Insured 4.11
Ÿ Booster benefit - In case of claim free year, increase of 50% of expiring Base Sum Insured in a Policy Year; maximum 4.12
up to 100% of Base Sum Insured (In case of a claim, reduction of accumulated Cumulative Bonus by 50% of expiring
Base Sum Insured)
Ÿ ReAssure - Unlimited reinstatement up to base Sum Insured. (Applicable for both same & different illness) 4.13
Ÿ Shared accommodation Cash Benefit as per plan chosen by You 4.14
Ÿ Health Check-up can be availed for Diagnostic Tests as per plan chosen by You 4.15
Ÿ Coverage for Second Medical Opinion for any condition for which Hospitalization is triggered (once in a Policy Year) 4.16
Ÿ Live healthy benefit - Discount on renewal premium basis number of steps taken 4.17
Optional Coverage:
Ÿ Personal Accident coverage against accident death, permanent total and partial disability (for insured aged 18 years 5.1
& above on individual basis)
Ÿ Hospital Cash benefit is paid as per the plan chosen for a maximum for 30 days per insured person per policy year, 5.2
provided that the Insured Person should have been Hospitalized for a minimum period of 48 hours continuously and
In-patient Care Hospitalization should have been paid by Us.
Ÿ Safeguard - 5.3
Ø Claim safeguard: Non-payable items paid up to Sum Insured (List I)
Ø Booster Benefit safeguard: No impact on Booster Benefit if claim in a policy year is less than Rs. 50,000
Ø Sum Insured safeguard: CPI linked increase in Base Sum Insured
Ÿ Safeguard+ -
Ø Claim safeguard+: Non-payable items paid up to Sum Insured (List I,II,III,IV) 5.4
Ø Booster Benefit safeguard+: No impact on Booster Benefit if claim in a policy year is less than Rs. 1,00,000
Ø Sum Insured safeguard+: CPI linked increase in Base Sum Insured
3. What are the Ÿ Investigation & Evaluation 6

major exclusions Ÿ Rest Cure, rehabilitation and respite care
in the policy Ÿ Obesity/ Weight Control
Ÿ Change-of-Gender treatments
Ÿ Cosmetic or plastic Surgery
Ÿ Hazardous or Adventure sports
Ÿ Breach of law
Ÿ Excluded Providers
Ÿ Refractive Error
Ÿ Unproven Treatments
Ÿ Sterility and Infertility
Ÿ Maternity Expenses
Ÿ Circumcision
Ÿ Conflict & Disaster
Ÿ External Congenital Anomaly
Ÿ Unrecognized Physician or Hospital
(Note: the above is a partial listing of the policy exclusions. Please refer to the policy clauses for the full listing)
Product Name: ReAssure. Product UIN: NBHHLIP23107V022223

4. Waiting Period Ÿ Initial waiting Period: 30 days for all illness (not applicable on renewal or for accidents) 6.3
Ÿ Specific Waiting periods: 24 months for few conditions as specified in policy clause number 6.2, unless the condition 6.2
is directly caused by Cancer (covered after Initial Waiting Period of 30 days) or an Accident (covered from day 1)
Ÿ Pre-existing diseases: Covered after 36 months of continuous coverage 6.1
The aforementioned Waiting Periods shall not apply to Health Checkup, Second Medical Opinion, Live Healthy benefit
and Personal Accident Cover.
5. Payment basis Ÿ Cashless treatment or Reimbursement of covered expenses up to specified limits 7.2
Ÿ Fixed amount on the occurrence of a covered event under Shared accommodation Cash Benefit, Personal Accident
Cover and Hospital Cash 4.14, 5.1, 5.2
6. Loss Sharing Ÿ In case of a claim, this policy will cover up to the amount / limits mentioned below:
Ÿ Sub-limits
Ø Modern Treatments -sublimit of Rs. 1Lac applicable on few robotic surgeries 4.5
Ø Emergency Ambulance is covered up to Rs. 2,000 per Hospitalization 4.9
Ø Air Ambulance is covered Up to Rs. 2.5 Lacs 4.10
Ø Shared accommodation Cash Benefit as per plan chosen by You 4.14
Ø Health Check up limits as per plan chosen by you 4.15
Ø Hospital Cash Benefit as per plan chosen by You 5.2
7. Renewal Ÿ The Policy shall ordinarily be renewable except on grounds of fraud, moral hazard, misrepresentation by the Insured 8.3
Conditions Person.
Ÿ The Company shall endeavor to give notice for renewal. However, the Company is not bound to give any notice for
renewal.
Ÿ Renewal shall not be denied on the ground that the Insured had made a claim or claims in the preceding policy
years.
Ÿ Request for renewal along with requisite premium shall be received by the Company before the end of the Policy
Period.
Ÿ At the end of the Policy Period, the Policy shall terminate and can be renewed within the Grace Period to maintain
continuity of benefits without Break in Policy. Coverage is not available during the Grace Period.
Ÿ If not renewed within Grace Period after due renewal date, the Policy shall terminate.
Ÿ No loading shall apply on renewals based on individual claims experience.
8. Renewal Ÿ Booster benefit - In case of claim free year, increase of 50% of expiring Base Sum Insured in a Policy Year; maximum 4.12
Benefits up to 100% of Base Sum Insured (In case of a claim, reduction of accumulated Cumulative Bonus by 50% of expiring
Base Sum Insured)
Ÿ Live healthy benefit - Discount on renewal premium basis step taken 4.17
9. Cancellation This policy would be cancelled, and no claim or refund would be due to you if: 8.2
Ÿ you have not correctly disclosed details about current and past health status OR
Ÿ you have otherwise encouraged or participated in any fraudulent claim under the policy.
10 Claims For Cashless Service: 7.2.a

Ÿ Hospital Network details can be obtained from www.nivabupa.com
Ÿ We must be contacted to pre-authorize Cashless Facility for planned treatment at least 72 hours prior to the
proposed treatment.
Ÿ If the Insured Person has been Hospitalized in an Emergency, We must be contacted to pre-authorize Cashless
Facility within 48 hours of the Insured Person's Hospitalization or before discharge from the Hospital, whichever is
earlier.
For Reimbursement of Claim: 7.2.b

Ÿ We shall be provided with the necessary information and documentation in respect of all claims within 30 days of
Insured Event giving rise to a claim or within 30 days from the date of occurrence of an Insured Event.
11. Policy Servicing/ Ÿ In case of any grievance the Insured Person may contact the company through: 8.8
Grievances/ Customer Services Department
Complaints Niva Bupa Health Insurance Company Limited
2nd Floor, Plot No D-5, Sec-59, Noida,
Gautam Buddh Nagar, Uttar Pradesh – 201301.
Contact No: 1860-500-8888
Fax No.: 011-41743397
Email ID: [email protected]
Senior citizens may write to us at: [email protected]
Ÿ 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:
Grievance Redressal Officer
Niva Bupa Health Insurance Company Limited
2nd Floor, Plot No D-5, Sec-59, Noida ,
Gautam Buddh Nagar, Uttar Pradesh – 201301.
Email: [email protected] or [email protected]
For details of grievance officer, kindly refer the link https://www.nivabupa.com/customer-care/
health-services/grievance-redressal.aspx
Ÿ IRDAI/(IGMS/Call Centre): Email ID: www.igms.irdai.gov.in
Ÿ Ombudsman (Refer Annexure III of policy document for List of Insurance Ombudsmen)
12. Insured's Rights Ÿ Free Look - If you do not agree to the terms and conditions of the Policy, you may cancel the Policy, stating your 8.1
reasons within 15 days (30 days if the Policy with Policy Period as 3 years has been sold through distance marketing)
of receipt of the Policy document provided no claims have been made under any benefits. The free look provision is
not applicable at the time of Renewal of the Policy.
Ÿ Implied renewability - Your policy is ordinarily renewable for life provided the due premium is paid on time 8.3
Ÿ Migration and Portability - You can port your policy at the time of renewal according to the IRDAI guidelines. You can 8.14 & 8.15
contact Customer Service Department (phone no. and email ID provided above) for migration and portability.
Ÿ Increase in Sum Insured during the Policy term - You may opt for enhancement of Sum Insured at the time of 8.20
Renewal, subject to underwriting. You can contact Customer Service Department (phone no. and email ID provided
above) for increasing the Sum Insured.
Ÿ Turn Around Time (TAT) for issue of Pre-Auth - 4 hours
7.4
Ÿ Turn Around Time (TAT) for settlement of Reimbursement - We shall settle or repudiate a claim within 30 days of the
receipt of the last necessary information and documentation
13. Insured's Ÿ Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-disclosure may result in claim 8.12
Obligations not being paid.
Ÿ Disclosure of material information at the time of Renewal such as change in occupation, address etc. 8.17
Legal Disclaimer Note: The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the CIS and the policy document,
the terms and conditions mentioned in the policy document shall prevail.
Disclaimer: Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company
Limited) (IRDAI Registration Number 145). 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa
Health Insurance Company Limited under license. Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024, Customer Helpline:
1860-500-8888. Fax No.: 011 - 41743397. Website: www.nivabupa.com. CIN: U66000DL2008PLC182918.

may contact the grievance officer at:
Benefit Illustration
Grievance Redressal OfficerIllustration (5 Lac Sum Insured, Policy Term 1 year)
Benefit
Age of the Coverage opted 2ndon Floor, PlotCoverage opted
No D-5, Sec-59, Noidaon, individual basis Coverage opted on family floater basis with overall
members individual basis covering
Gautam Buddhcovering multiple
Nagar, Uttar Pradesh –members
201301. of the family Sum Insured (Only one Sum Insured is available for
insured each member ofEmail:
the [email protected]
under a single policyor(Sum Insured is
[email protected] the entire family)
family separatelyFor(at
details
a of grievance
availableofficer, kindly member
for each refer the linkofhttps://www.nivabupa.com/customer-care/
the family)
health-services/grievance-redressal.aspx
single point in time)
Ÿ IRDAI/(IGMS/Call Centre): Email ID: www.igms.irdai.gov.in
Premium ŸSum Premium
Ombudsman (Refer AnnexureDiscount, Premium
III of policy document for List Sum Premium or
of Insurance Ombudsmen) Floater Premium Sum
(Rs.) Insured (Rs.) if any after Insured Consolidated discount, after Insured
12. Insured's Rights Ÿ Free Look - If you do not agree to the terms and conditions of the Policy, you may cancel the Policy, stating your discount
(Rs.) discount (Rs.) premium for if any (Rs.)
8.1
reasons within 15 days (30 days if the Policy with all been
(Rs.)Policy Period as 3 years has members (Rs.)
sold through distance marketing)
of family (Rs.)
of receipt of the Policy document provided no claims have been made under any benefits. The free look provision is
not applicable at the time of Renewal of the Policy.
Illustration 1
Ÿ Implied renewability - Your policy is ordinarily renewable for life provided the due premium is paid on time 8.3
18 7,862.00 Ÿ 500,000 7,862.00- You786.00
Migration and Portability 7,076.00
can port your policy 500,000
at the time 7,862.00to the IRDAI 14,693.00
of renewal according 20,665.008.14 &500,000
guidelines. You can 8.15
21 7,862.00 contact Customer
500,000 Service Department
7,862.00 786.00(phone7,076.00
no. and email ID provided above)
500,000 for migration and portability.
7,862.00
Ÿ Increase in Sum Insured during the Policy term - You may opt for enhancement of Sum Insured at the time of 8.20
39 9,817.00 500,000 9,817.00
Renewal, subject 982.00
to underwriting. 8,835.00
You can contact Customer 500,000 9,817.00
Service Department (phone no. and email ID provided
above) for increasing the Sum Insured.
45 9,817.00 500,000 9,817.00 982.00 8,835.00 500,000 9,817.00
Ÿ Turn Around Time (TAT) for issue of Pre-Auth - 4 hours
7.2
Total premium for all members Total
Ÿ TurnofAround Time premium
(TAT) for all
for settlement of members of the
Reimbursement - Wefamily
shall settleTotal premium
or repudiate a claimwhen
withinthe policy
30 days is opted on
of the
the family is Rs.35,358, whenreceipt is Rs.31,822,
eachof the last when they
necessary information are covered under
and documentation floater basis is Rs.20,665.
member is covered separately. a single policy.
13. Insured's Ÿ Please disclose all pre-existing disease/s or condition/s before buying a policy. Insured of Rs.500,000
SumNon-disclosure is available for the
may result in claim 8.12 entire
Sum Insured available for each
Obligations not being paid.Sum Insured available for each family family.
individual is Rs.500,000. Ÿ Disclosure of material
member is Rs.500,000.
information at the time of Renewal such as change in occupation, address etc. 8.17
Illustration 2
55 18,522.00 500,000 18,522.00 1,852.00 16,670.00 500,000 18,522.00 9,142.00 40,578.00 500,000
Legal Disclaimer Note: The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the CIS and the policy document,
63 and conditions
the terms 31,198.00 500,000
mentioned 31,198.00
in the policy document 3,120.00
shall prevail. 28,078.00 500,000 31,198.00
Total premium for all members of Total premium for all members of the Total premium when the policy is opted on floater
the family is Rs.49,720, when each family is Rs.44,748, when they are basis is Rs.40,578.
member is covered separately. covered under a single policy.
Sum Insured of Rs.500,000 is available for the entire
Sum Insured available for each Sum Insured available for each family family.
individual is Rs.500,000. member is Rs.500,000.
Illustration 3
65 31,198.00 500,000 31,198.00 3,120.00 28,078.00 500,000 31,198.00 18,035.00 52,409.00 500,000
70 39,246.00 500,000 39,246.00 3,925.00 35,321.00 500,000 39,246.00
Total premium for all members of Total premium for all members of the Total premium when the policy is opted on floater
the family is Rs.70,443, when each family is Rs.63,399, when they are covered basis is Rs.52,409.
member is covered separately. under a single policy.
Sum Insured of Rs.500,000 is available for the entire
Sum Insured available for each Sum Insured available for each family family.
individual is Rs.500,000. member is Rs.500,000.
Note: Premium rates specified in the above illustration are standard premium rates without considering any loading. Also, the premium rates
are exclusive of taxes applicable.
Zone 1 premium is considered
Disclaimer: Insurance is a subject matter of solicitation.Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company
Limited) (IRDAI Registration Number 145). 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa
Health Insurance Company Limited under license. Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024, Customer Helpline:
1860-500-8888. Fax No.: 011 - 41743397. Website: www.nivabupa.com. CIN: U66000DL2008PLC182918.

ReAssure
Policy Wordings
1. Preamble
This ‘ReAssure’ policy is a contract of insurance between You and Us which is subject to payment of full premium in advance and the terms, conditions and
exclusions of this Policy. This Policy has been issued on the basis of the Disclosure of Information, including the information provided by You in the Proposal
Form and / or the Information Summary Sheet.
Please inform Us immediately of any change in the address or any other changes affecting You or any Insured Person which would impact the benefits, terms
and conditions under this Policy.
In addition, please note the list of exclusions is set out in Section 6 of this Policy.
2. Definitions & Interpretation
For the purposes of interpretation and understanding of this Policy, We have defined, in Section 3, some of the important words used in the Policy which will
have the special meaning accorded to these terms for the purposes of this Policy. For the remaining language and words used, the usual meaning as described
in standard English language dictionaries shall apply. The words and expressions defined in the Insurance Act 1938, IRDA Act 1999, regulations notified by the
IRDAI and circulars and guidelines issued by the IRDAI, together with their amendment shall carry the meanings given therein.
Note: Where the context permits, the singular will be deemed to include the plural, one gender shall be deemed to include the other genders and references to
any statute shall be deemed to refer to any replacement or amendment of that statute.
3. Defined Terms
The terms listed below in Section 3 and used elsewhere in the Policy in Initial Capitals shall have the meaning set out against them in Section 3.
3.1. Standard Definitions
3.1.1. Accident or Accidental means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
3.1.2. AYUSH Hospital is a healthcare facility wherein medical / surgical / para-surgical treatment procedures and interventions are carried out by AYUSH
Medical Practitioner(s) comprising of any of the following:
a. Central or state government AYUSH Hospital; or
b. Teaching Hospital attached to AYUSH college recognized by the Central Government / Central Council of Indian Medicine / Central Council of
Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine, registered with the local
authorities, wherever applicable and is under the supervision of a qualified registered AYUSH Medical Practitioner and must comply with all
the following criterion:
i. Having at least five in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures are to be
carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized representative.
AYUSH Hospitals referred above shall also obtain either pre-entry level certificate (or higher level of certificate) issued by National Accreditation
Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or higher level of certificate) under National Quality Assurance
Standards (NQAS), issued by National Health Systems Resources Centre (NHSRC).
3.1.3. AYUSH Treatment refers to the medical and / or hospitalization treatments given under Ayurveda, Yoga and Naturopathy, Unani, Sidha and
Homeopathy systems.
Product Name: ReAssure | Product UIN: NBHHLIP23107V022223

3.1.4. 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 is
approved.
3.1.5. Condition Precedent shall mean a Policy term or condition upon which the Insurer’s liability under the Policy is conditional upon.
3.1.6. Congenital Anomaly means a condition which is present since birth, and which is abnormal with reference to form, structure or position.
a. Internal Congenital Anomaly: Congenital Anomaly which is not in the visible and accessible parts of the body.
b. External Congenital Anomaly: Congenital Anomaly which is in the visible and accessible parts of the body.
3.1.7. Co-payment means 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.
3.1.8. Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer without an associated increase in premium.
3.1.9. Day Care Center means any institution established for Day Care Treatment of Illness and/or Injuries or a medical set-up with 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 criterion as under:
a. has Qualified Nursing staff under its employment;
b. has qualified Medical Practitioner(s) in charge;
c. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
d. maintains daily records of patients and will make these accessible to the insurance company’s authorized personnel.
3.1.10. Day Care Treatment refers to medical treatment, and/or Surgical Procedure which is:
a. undertaken under General or Local Anaesthesia in a Hospital/Day Care Center in less than 24 hrs because of technological advancement, and
a. which would have otherwise required a Hospitalization of more than 24 hours.
Treatment normally taken on an OPD basis is not included in the scope of this definition.
3.1.11. Deductible means a cost-sharing requirement under a health insurance policy that provides that the Insurer will not be liable for a specified rupee
amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies which will apply before any benefits
are payable by the insurer. A deductible does not reduce the Sum Insured.
3.1.12. Dental Treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings (where appropriate), crowns,
extractions and Surgery.
3.1.13. Disclosure of Information means the Policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of
misrepresentation, mis-description or non-disclosure of any material fact. (Note: “Material facts” for the purpose of this Policy shall mean all
important, essential and relevant information sought by the Company in the proposal form and other connected documents to enable him to take
informed decision in the context of underwriting the risk)
3.1.14. 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.
3.1.15. Emergency care (Emergency) means management for an Illness or Injury which results in symptoms 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.
3.1.16. Grace Period means the specified period of time (30 days) immediately following the premium due date during which a payment can be made to
Renew or continue a policy in force without loss of continuity benefits such as Waiting Periods and coverage of Pre-existing Diseases. Coverage is
not available for the period for which no premium is received.

3.1.17. Hospital means any institution established for Inpatient Care and Day Care Treatment of Illness and / or Injuries and which has been registered as
a Hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified
under the Schedule of Section 56(1) of the said Act OR complies with all minimum criteria as under:
a. has Qualified Nursing staff under its employment round the clock;
b. has at least 10 Inpatient beds in towns having a population of less than 10,00,000 and at least 15 Inpatient beds in all other places;
c. has qualified Medical Practitioner(s) in charge round the clock;
d. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
e. maintains daily records of patients and makes these accessible to the Insurance company’s authorized personnel.
3.1.18. Hospitalization or Hospitalized means the admission in a Hospital for a minimum period of 24 consecutive Inpatient Care hours except for
specified procedures/treatments, where such admission could be for a period of less than 24 consecutive hours.
3.1.19. Injury means Accidental physical bodily harm excluding Illness or disease solely and directly caused by external, violent and visible and evident
means which is verified and certified by a Medical Practitioner.
3.1.20. ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses which shall include the expenses for ICU bed,
general medical support services provided to any ICU patient including monitoring devices, critical care nursing and intensivist charges.
3.1.21. Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function and requires medical
treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to
his or her state of health immediately before suffering the disease/ illness/ injury which leads to full recovery
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the following characteristics:
i. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
ii. it needs ongoing or long-term control or relief of symptoms
iii. it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
iv. it continues indefinitely
v. it recurs or is likely to recur
3.1.22. Intensive Care Unit means an identified section, ward or wing of a Hospital which is under the constant supervision of a dedicated Medical
Practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require
life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other
wards.
3.1.23. Inpatient Care means treatment for which the Insured Person has to stay in a Hospital for more than 24 hours for a covered event.
3.1.24. Maternity Expense shall include:

a. Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization);
b. Expenses towards lawful medical termination of pregnancy during the Policy Period.
3.1.25. Medical Advice means any consultation or advice from a Medical Practitioner including the issuance of any prescription or follow-up prescription.
3.1.26. 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 advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been
insured and no more than other Hospitals or doctors in the same locality would have charged for the same medical treatment.
3.1.27. Medical Practitioner means 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 the Government of India or a State Government and is thereby entitled to practice medicine within
its jurisdiction; and is acting within the scope and jurisdiction of his licence.

3.1.28. Medically Necessary Treatment means any treatment, tests, medication, or stay in Hospital or part of a stay in Hospital which:
a. is required for the medical management of the Illness or Injury suffered by the insured;
b. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity;
c. must have been prescribed by a Medical Practitioner;
d. must conform to the professional standards widely accepted in international medical practice or by the medical community in India.
3.1.29. Migration means the right accorded to health insurance policyholders (including all members under family cover and members of group health
insurance policy), to transfer the credit gained for pre-existing conditions and time bound exclusions, with the same insurer.
3.1.30. Network Provider means Hospital enlisted by an insurer, TPA or jointly by an insurer and TPA to provide medical services to an insured by a
Cashless Facility.
3.1.31. Non-Network means any Hospital, Day Care Center or other provider that is not part of the network.
3.1.32. Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes of communication.
3.1.33. OPD Treatment means the 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.
3.1.34. Pre-existing Disease means any condition, ailment, injury or disease

a. That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or
b. For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the
policy issued by the insurer or its reinstatement.
3.1.35. Pre-hospitalization Medical Expenses means medical expenses incurred during pre-defined number of days preceding the hospitalization of the
Insured Person, provided that:
a. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
3.1.36. Post-hospitalization Medical Expenses means medical expenses incurred during pre-defined number of days immediately after the Insured
Person is discharged from the Hospital, provided that:
a. Such Medical Expenses are for the same condition for which the Insured Person’s Hospitalization was required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
3.1.37. Portability means the right accorded to an individual health insurance policyholders (including all members under family cover), to transfer the
credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer.
3.1.38. Qualified Nurse means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India.
3.1.39. 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.
3.1.40. 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.
3.1.41. Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the associated medical expenses.
3.1.42. 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 from suffering or prolongation of life, performed in a Hospital or Day Care Centre by
a Medical Practitioner.
3.1.43. Unproven/Experimental treatment means the treatment including drug experimental therapy which is not based on established medical practice
in India, is treatment experimental or unproven.

3.2. Specific Definitions
3.2.1. Age means age as on last birthday.
3.2.2. Base Sum Insured means the amount stated in the Policy Schedule.
3.2.3. Bone Marrow Transplant is the actual undergoing of a transplant of human bone marrow using haematopoietic stem cells. The undergoing of a
transplant has to be confirmed by a specialist medical practitioner. The following will be excluded:
a. Other stem-cell transplants
b. Where only islets of langerhans are transplanted
3.2.4. Break in Policy means the period of gap that occurs at the end of the existing policy term, when the premium due for renewal on a given policy is
not paid on or before the premium renewal date or within 30 days thereof.
3.2.5. Diagnostic Services means those diagnostic tests and exploratory or therapeutic procedures required for the detection, identification and
treatment of a medical condition.
3.2.6. Family Floater Policy means a Policy described as such in the Policy Schedule where the family members (two or more) named in the Policy
Schedule are insured under this Policy.
3.2.7. First Policy means for the purposes of this Policy the Policy Schedule issued to the Policyholder at the time of inception of the first Policy mentioned
in the Policy Schedule with Us.
3.2.8. Individual Policy means a Policy described as such in the Policy Schedule where the individual(s) named in the Policy Schedule is / are the Insured
Person(s) under this Policy.
3.2.9. Information Summary Sheet means the information and details provided to Us or Our representatives over the telephone for the purposes of
applying for this Policy which has been recorded by Us and confirmed by You.
3.2.10. Inpatient means admission for treatment in a Hospital for more than 24 hours for an Insured Event.
3.2.11. IRDAI means the Insurance Regulatory and Development Authority of India.
3.2.12. Insured Event means any event specifically mentioned as covered under this Policy.
3.2.13. Insured Person means person(s) named as insured persons in the Policy Schedule.
3.2.14. Medical Record means the collection of information as submitted in claim documentation concerning a Insured Person’s Illness or Injury that is
created and maintained in the regular course of management, made by Medical Practitioners who have knowledge of the acts, events, opinions or
diagnoses relating to the Insured Person’s Illness or Injury, and made at or around the time indicated in the documentation.
3.2.15. Policy means these terms and conditions, the Policy Schedule (as amended from time to time), Your statements in the Proposal and the Information
Summary Sheet and any endorsements attached by Us to the Policy from time to time.
3.2.16. Policy Period is the period between the inception date and the expiry date of the Policy as specified in the Policy Schedule or the date of cancellation
of this Policy, whichever is earlier.
3.2.17. Policy Year means the period of one year commencing on the date of commencement specified in the Policy Schedule or any anniversary thereof.
3.2.18. Policy Schedule means a certificate issued by Us, and, if more than one, then the latest in time. The Policy Schedule contains details of the
Policyholder, Insured Persons, the Sum Insured and other relevant details related to the coverage.
3.2.19. Reimbursement means settlement of claims paid directly by Us to the Policyholder/Insured Person.
3.2.20. Service Provider means any person, organization, institution that has been empanelled with Us to provide services specified under the benefits
to the Insured Person.

3.2.21. Standby Services are services of another Medical Practitioner requested by treating Medical Practitioner and involving prolonged attendance
without direct (face-to-face) patient contact or involvement.
3.2.22. Sum Insured:

In case of Individual Policy, Sum Insured means the total of the Base Sum Insured, Booster Benefit, and Sum Insured Safeguard/Safeguard+ (if
applicable) for that Insured Person. Our maximum, total and cumulative liability for all claims during the Policy Year in respect of the Insured
Person will be Sum Insured and amount provided under ReAssure benefit.
In case of Family Floater Policy, Sum Insured means the total of the Base Sum Insured, Booster Benefit and Sum Insured Safeguard/Safeguard+
(if applicable). Our maximum, total and cumulative liability for all claims during the Policy Year in respect of all Insured Persons taken together will
be Sum Insured and amount provided under ReAssure benefit.
If the Policy Period is 2 years or 3 years, then the Sum Insured shall be applied separately for each Policy Year in the Policy Period.
3.2.23. Waiting Period means a time-bound exclusion period related to condition(s) specified in the Policy Schedule or the Policy which shall be served
before a claim related to such condition(s) becomes admissible.
3.2.24. We/Our/Us means Niva Bupa Health Insurance Company Limited.
3.2.25. You/Your/Policyholder means the person named in the Policy Schedule who has concluded this Policy with Us.
4. Benefits available under the Policy
The benefits available under this Policy are described below.

a. The Policy covers Reasonable and Customary Charges incurred towards Medically Necessary Treatment taken by the Insured Person during the Policy
Period for an Illness, Injury or condition as described in the sections below and contracted or sustained during the Policy Period. The benefits listed in the
sections below will be payable subject to the terms, conditions and exclusions of this Policy and the availability of the Sum Insured and any sub-limits for
the benefit as maybe specified in the Policy Schedule.
b. The expenses that are not covered or subsumed into room charges / procedure charges / costs of treatment are placed as Annexure II
c. All the benefits (including optional benefits) which are available under the Policy along with the respective limits / amounts applicable based on the Sum
Insured have been summarized in the Product Benefit Table in Annexure I.
d. All claims under the Policy must be made in accordance with the process defined under Section 8 (Claim Process & Requirements).
e. All claims paid under any benefit except for those admitted under Section 4.14 (Shared accommodation Cash Benefit), Section 4.15 (Health Checkup),
Section 4.16 (Second Medical Opinion), Section 4.17 (Live Healthy benefit), Section 5.1 (Personal Accident Cover) and Section 5.2 (Hospital Cash) shall
reduce the Sum Insured for the Policy Year in which the Insured Event in relation to which the claim is made has been occurred, unless otherwise specified
in the respective section. Thereafter only the balance Sum Insured after payment of claim amounts admitted shall be available for future claims arising in
that Policy Year.
4.1. Inpatient Care
What is covered:
We will indemnify the Medical Expenses incurred for one or more of the following due to the Insured Person’s Hospitalization during the Policy Period
following an Illness or Injury:
a. Room Rent;
b. Room boarding and nursing charges during Hospitalization as charged by the Hospital where the Insured Person availed medical treatment;
c. Medical Practitioners’ fees, excluding any charges or fees for Standby Services;
d. Investigative tests or diagnostic procedures directly related to the Insured Event which lead to the current Hospitalization;
e. Medicines, drugs as prescribed by the treating Medical Practitioner related to the Insured Event that led to the current Hospitalization;
f. Intravenous fluids, blood transfusion, injection administration charges, allowable consumables and /or enteral feedings;
g. Operation theatre charges;
h. The cost of prosthetics and other devices or equipment, if implanted internally during Surgery;
i. Intensive Care Unit Charges.

Conditions - The above coverage is subject to fulfilment of following conditions:
a. The Hospitalization is for Medically Necessary Treatment and advised in writing by a Medical Practitioner.
b. We will pay the consultation charges for any Medical Practitioner visiting the Insured Person only if:
i. The Medical Practitioner’s treatment or advice has been specifically sought by the Hospital; and
ii. The consultation charges are included in the Hospital’s bill
4.2. Day Care Treatment
What is covered:
We will indemnify the Medical Expenses incurred on the Insured Person’s under any Day Care Treatment during the Policy Period following an Illness or
Injury.

a. The Day Care Treatment is advised in writing by a Medical Practitioner as Medically Necessary Treatment.
b. The Day Care Treatment would be covered if the Insured Person is admitted for more than 2 hours and would also cover treatment taken for
Angiography, Dialysis, Radiotherapy or Chemotherapy for cancer.
c. If We have accepted a claim under this benefit, We will also indemnify the Insured Person’s Pre-hospitalization Medical Expenses and Post-
hospitalization Medical Expenses in accordance with Sections 4.6 and 4.7.
What is not covered:

a. OPD Treatment and Diagnostic Services costs are not covered under this benefit.
4.3. Alternative Treatments
What is covered:
We will indemnify the Medical Expenses incurred on the Insured Person’s Hospitalization for Inpatient Care during the Policy Period on treatment taken
under Ayurveda, Unani, Siddha and Homeopathy.

a. The treatment should be taken in AYUSH Hospital.
b. If We have accepted a claim under this benefit, We will also indemnify the Insured Person’s Pre-hospitalization Medical Expenses and Post-
hospitalization Medical Expenses in accordance with Sections 4.6 and 4.7, provided that these Medical Expenses relate only to Alternative Treatments
and not Allopathy.
c. Any non-allopathic treatment taken by the Insured Person shall only be covered under Section 4.3 (Alternative Treatments) as per the applicable terms
and conditions.

a. Medical Expenses incurred on treatment taken under Yoga shall not be covered.
4.4. Domiciliary Hospitalization
What is covered.
We will indemnify on Reimbursement basis only, the Medical Expenses incurred for the Insured Person’s Domiciliary Hospitalization during the Policy
Period following an Illness or Injury.

a. The Domiciliary Hospitalization continues for at least 3 consecutive days, wherein We will make payment under this benefit in respect of Medical
Expenses incurred from the first day of Domiciliary Hospitalization;
b. The treating Medical Practitioner confirms in writing that the Insured Person’s condition was such that the Insured Person could not be transferred to
a Hospital OR the Insured Person satisfies Us that a Hospital bed was unavailable.

a. Sections 4.6 (Pre-hospitalization Medical Expenses) and Section 4.7 (Post- hospitalization Medical Expenses) are not payable under this benefit.

4.5. Modern Treatments
What is covered:
a. The following procedures / treatments will be covered either as Inpatient Care or as part of Day Care Treatment as per Section 4.1 and Section 4.2
respectively, in a Hospital :
i. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
ii. Balloon Sinuplasty
iii. Deep Brain stimulation
iv. Oral chemotherapy
v. Immunotherapy- Monoclonal Antibody to be given as injection
vi. Intra vitreal injections
vii. Robotic surgeries
viii. Stereotactic radio surgeries
ix. BronchicalThermoplasty
x. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)
xi. IONM - (Intra Operative Neuro Monitoring)
xii. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.
b. If We have accepted a claim under this benefit, We will also indemnify the Insured Person’s Pre-hospitalization Medical Expenses and Post-
hospitalization Medical Expenses in accordance with Sections 4.6 and 4.7 within the overall benefit sub-limit.
Special condition applicable for robotic surgeries:

A limit of maximum INR 1 Lac will apply to all robotic surgeries, except the following:
i. Robotic total radical prostatectomy
ii. Robotic cardiac surgeries
iii. Robotic partial nephrectomy
iv. Robotic surgeries for malignancies
4.6. Pre-hospitalization Medical Expenses
What is covered:
We will indemnify on Reimbursement basis only, the Insured Person’s Pre-hospitalization Medical Expenses incurred in respect of an Illness or Injury.

a. We have accepted a claim under Section 4.1 (Inpatient Care) or Section 4.2 (Day Care Treatment) or Section 4.3 (Alternative Treatments) or Section
4.5 (Modern Treatments).
b. Pre-hospitalization Medical Expenses are incurred for the same condition for which We have accepted the Inpatient Care or Day Care Treatment or
Alternative Treatments or Modern Treatments claim.
c. The expenses are incurred after the inception of the First Policy with Us. If any portion of these expenses is incurred before the inception of the First
Policy with Us, then We shall be liable only for those expenses incurred after the commencement date of the First Policy, irrespective of the initial
waiting period.
d. Pre-hospitalization Medical Expenses incurred on physiotherapy will also be payable provided that such physiotherapy is prescribed in writing by the
treating Medical Practitioner as Medically Necessary Treatment and is directly related to the same condition that led to Hospitalization.
e. Any claim admitted under this Section shall reduce the Sum Insured for the Policy Year in which Inpatient Care or Day Care Treatment or Alternative
Treatments or Modern Treatments claim has been incurred.
Sub-limit:
a. We will pay above mentioned Pre-hospitalization Medical Expenses only for period up to 60 days immediately preceding the Insured Person’s
admission for Inpatient Care or Day Care Treatment or Alternative Treatments or Modern Treatments.

4.7. Post-hospitalization Medical Expenses
What is covered:
We will indemnify on Reimbursement basis only, the Insured Person’s Post-hospitalization Medical Expenses incurred following an Illness or Injury.

a. We have accepted a claim under Section 4.1 (Inpatient Care) or Section 4.2 (Day Care Treatment) or Section 4.3 (Alternative Treatments) or Section
4.5 (Modern Treatments).
b. Post-hospitalization Medical Expenses are incurred for the same condition for which We have accepted the Inpatient Care or Day Care Treatment or
Alternative Treatments or Modern Treatments claim.
c. The expenses incurred shall be as advised in writing by the treating Medical Practitioner.
d. Post-hospitalization Medical Expenses incurred on physiotherapy will also be payable provided that such physiotherapy is prescribed in writing by the
treating Medical Practitioner as Medically Necessary Treatment and is directly related to the same condition that led to Hospitalization.
e. Any claim admitted under this Section shall reduce the Sum Insured for the Policy Year in which Inpatient Care or Day Care Treatment or Alternative
Treatments or Modern Treatments claim has been incurred.
Sub-limit:
a. We will pay Post-hospitalization Medical Expenses only for up to 180 days immediately following the Insured Person’s discharge from Hospital or Day
Care Treatment or Alternative Treatments or Modern Treatments.
4.8. Living Organ Donor Transplant
What is covered:
We will indemnify the Medical Expenses incurred for a living organ donor’s treatment as an Inpatient for the harvesting of the organ donated.

a. The donation conforms to the Transplantation of Human Organs Act 1994 and any amendments thereafter and the organ is for the use of the Insured
Person.
b. The organ transplant is certified in writing by a Medical Practitioner as Medically Necessary Treatment for the Insured Person.
c. We have accepted the recipient Insured Person’s claim under Section 4.1 (Inpatient Care).

a. Stem cell donation whether or not it is Medically Necessary Treatment except for Bone Marrow Transplant.
b. Pre-hospitalization Medical Expenses or Post-hospitalization Medical Expenses of the organ donor.
c. Screening or any other Medical Expenses related to the organ donor, which are not incurred during the duration of Insured Person’s Hospitalization
for organ transplant.
d. Transplant of any organ/tissue where the transplant is Unproven / experimental treatment or investigational in nature.
e. Expenses related to organ transportation or preservation.
f. Any other medical treatment or complication in respect of the donor, which is directly or indirectly consequence to harvesting.
4.9. Emergency Ambulance
What is covered:
We will indemnify the costs incurred, on transportation of the Insured Person by road Ambulance to a Hospital for treatment in an Emergency following
an Illness or Injury.

a. The medical condition of the Insured Person requires immediate ambulance services from the place where the Insured Person is injured or is ill to a
Hospital where appropriate medical treatment can be obtained or;
b. The medical condition of the Insured Person requires immediate ambulance services from the existing Hospital to another Hospital with advanced
facilities as advised by the treating Medical Practitioner for management of the current Hospitalization.
c. This benefit is available for only one transfer per Hospitalization.
d. The ambulance service shall be offered by a healthcare or ambulance Service Provider.

e. We have accepted a claim under Section 4.1 (Inpatient Care) or Section 4.2 (Day Care Treatment).
f. We will cover expenses up to Rs. 2,000 per Hospitalization.

The Insured Person’s transfer to any Hospital or diagnostic centre for evaluation purposes only.
4.10. Air Ambulance
What is covered:
We will indemnify the costs incurred for ambulance transportation in an airplane or helicopter, for Emergency life threatening health conditions which
require immediate and rapid ambulance transportation to the Hospital / medical centre that ground transportation cannot provide.

a. We have accepted a claim under Section 4.1 (Inpatient Care) or Section 4.2 (Day Care Treatment).
b. Medically Necessary treatment is not available at the location where the Insured Person is situated at the time of Emergency.
c. The Medical Evacuation has been prescribed by a Medical Practitioner and is Medically Necessary.
d. The insured person is in India and the treatment is required in India only and not overseas in any condition whatsoever.
e. The air ambulance provider is registered in India.
f. We will cover expenses up to the amount specified in the Policy Schedule for transportation of the Insured Person under this benefit.

a. Expenses incurred in return transportation to Insured Person’s home by air ambulance is excluded.
4.11. Home Care treatment
What is covered:
We will indemnify the Medical Expenses incurred on the Insured Person’s treatment taken at home for Chemotherapy or Dialysis.

a. These services shall be offered by a registered homecare provider.

a. Treatment taken by automation machine for peritoneal dialysis.
b. Sections 4.6 (Pre-hospitalization Medical Expenses) and Section 4.7 (Post- hospitalization Medical Expenses) are not payable under this benefit.
4.12. Booster benefit
What is covered:
a. If the Policy is Renewed with Us without a break or if the Policy continues to be in force for the 2nd / 3rd Policy Year in the 2 year / 3 year Policy
Period respectively (if applicable) and no claim has been made in the immediately preceding Policy Year, We will provide Booster Benefit in the form
of Cumulative Bonus by increasing the Sum Insured applicable under the Policy by 50% of the Base Sum Insured of the immediately preceding Policy
Year per claim free Policy Year subject to a maximum of 100% of the Base Sum Insured. There will be no change in the sub-limits applicable to various
benefits due to increase in Sum Insured under this benefit.

a. If the Insured Persons in the expiring Policy is covered under Individual Policies and has an accumulated Cumulative Bonus in the expiring Policies
under this benefit, and such expiring Policies are merged and Renewed with Us on a Family Floater Policy with or without an addition of a new Insured
Person, then the accumulated Cumulative Bonus to be carried forward to the Family Floater Policy would be the least of the accumulated Cumulative
Bonus amongst the Insured Persons of the expiring Policy.
b. If the Insured Person in the expiring Policy is covered under an Individual Policy and has an accumulated Cumulative Bonus in the expiring Policy
under this benefit, and such expiring Policy is Renewed with Us on a Family Floater Policy by addition of a new Insured Person, then the accumulated
Cumulative Bonus to be carried forward to the Family Floater Policy would be the accumulated Cumulative Bonus of the expiring Policy.
c. If the Insured Persons in the expiring Policy are covered on a Family Floater Policy and such Insured Persons Renew their expiring Policy with Us by
splitting the Floater Sum Insured stated in the Policy Schedule in to two or more floater / individual Policy, then We will provide the credit of the
accumulated Cumulative Bonus to each of the split Policy.

d. If the Insured Persons covered on a Family Floater Policy are reduced at the time of Renewal, the applicable accumulated Cumulative Bonus shall
remain same under the Policy.
e. In case the Base Sum Insured under the Policy is reduced at the time of Renewal, the applicable accumulated Cumulative Bonus shall also be reduced
in proportion to the Base Sum Insured.
f. In case the Base Sum Insured under the Policy is increased at the time of Renewal, the applicable accumulated Cumulative Bonus shall also be
increased in proportion to the Base Sum Insured.
g. This benefit is not applicable for Health Check-up, Second Medical Opinion, Personal Accident Cover and Hospital Cash. Enhancement of Sum Insured
due to Booster benefit cannot be utilized for the aforementioned benefits.
h. If a claim has been made in the immediately preceding Policy Year, We will reduce the accumulated Cumulative Bonus by 50% of expiring Base Sum
Insured. Whereas, if a reported claim has been denied by Us, the Insured Persons will be eligible for this benefit.
i. If a claim has been made in the immediately preceding Policy Year under Individual Policy, the reduction in accumulated Cumulative Bonus shall be
applicable only to the Insured Person(s) who have claimed.
4.13. ReAssure
What is covered:
This benefit is triggered with the first paid claim itself and is available for all subsequent claims in a Policy Year.

a. The maximum liability under a single claim under this benefit shall not be more than Base Sum Insured.
b. The sequence of utilization of Sum Insured will be as below:
i. Base Sum Insured followed by;
ii. Sum Insured Safeguard/Safeguard+ (if applicable) followed by;
iii. Accumulated Cumulative Bonus under Booster benefit (if any) followed by;
iv. ReAssure benefit
c. Claims under this benefit will be payable only under Section 4.1 (Inpatient Care) or Section 4.2 (Day Care Treatment) or Section 4.3 (Alternative
Treatments) or Section 4.4 (Domiciliary Hospitalization) or Section 4.5 (Modern Treatments) or Section 4.8 (Living Organ Donor Transplant) or Section
4.11 (Home Care Treatment) arising in that Policy Year for any or all Insured Person(s).
d. For Family Floater Policies, the amount under this benefit will be available on a floater basis to all Insured Persons in that Policy Year.
4.14. Shared accommodation Cash Benefit
What is covered:
If We have accepted an Inpatient Care Hospitalization claim and the Insured Person has occupied a shared room accommodation during such Hospitalization
in a Network Hospital, We will pay a daily cash amount as specified in the Policy Schedule for the Insured Person for each continuous and completed period
of 24 hours of Hospitalization.

a. The Insured Person has been admitted in a Hospital for a minimum period of 48 hours continuously.

a. This benefit will not be payable if the Insured Person stays in an Intensive Care Unit or High Dependency Units / wards.
4.15. Health Checkup
What is covered:
The Insured Person may avail a health check-up, only for Diagnostic Tests, up to a sub-limit as specified in Your Policy Schedule. This benefit is available
ONLY on cashless and no re-imbursement is allowed.
a. This benefit is available only once in a Policy Year and if you undergo multiple tests, make sure that all these are done within 7 days.
b. The list of tests covered under this benefit will be Complete blood count, Urine Routine, Erythrocyte Sedimentation Rate (ESR), Fasting Blood
Glucose, Electrocardiogram, S Cholesterol, Complete Physical Examination by Physician, Post prandial / lunch blood sugar (PPBS / PLBS), Uric
Acid, Lipid Profile, Kidney function test, Serum Vitamin D, Serum Electrolytes, HbA1C, Thyroid profile (TSH), Liver Function Test (LFT), Treadmill
test (TMT) and Ultrasound test.

a. Any unutilized test or amount cannot be carried forward to the next Policy Year.
4.16. Second Medical Opinion
What is covered:
We will indemnify the costs incurred for availing a second medical opinion from any Medical Practitioner for which we have admitted a claim of
Hospitalization.

a. This benefit can be availed only once during a Policy Year.
b. We have accepted a claim under Section 4.1 (Inpatient Care) or Section 4.2 (Day Care Treatment) for which opinion is sought.

a. The second medical opinion under this benefit shall not be valid for any medico legal purposes.
b. We do not assume any liability and shall not be deemed to 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.
4.17. Live Healthy benefit
What is covered:
We will offer a discount on Renewal premium if the eligible Insured Person(s) achieves the health points target on the mobile application provided by Us
as per the grid mentioned below.

a. Steps taken by the Insured Person everyday, earn ‘health points’. Steps counted by the mobile App We provide you to use ONLY would be considered.
b. 1 health point would be earned for every completed 1000 steps.
c. Health points accumulated in last 3 months of the Policy Period would not be considered for discount on premium for the first renewal. The last 3
months are NOT LOST and will be considered in the next Policy Period. All renewals thereafter, will consider points gained in the Policy Period.
d. The mobile app must be downloaded within 30 days of the Policy commencement to avail this benefit. The step count completed by an eligible Insured
Person would be tracked on this mobile application.
e. We reserve the right to remove or reduce any count of steps if found to be achieved in unfair manner by manipulation.
Policy Period: 1 year
Policy duration End of 9 months Points at the end Points in next 3 Total points Discount on renewal premium (Renewal
of 9 months (A) months (B) considered for policy start date 1st Jan 2021
This will be discount (A + B)
considered for from 2nd Policy NOTE: Discount applicable on the member’s
discount on the Period onwards premium in Individual sum insured policies
first renewal. and on the Policy premium in case of Floater
Individual sum insured Floater policies with
policy and Floater more than 1 Adult
policies with 1 Adult
1st Jan 2020 30th September 2020 Upto 1500 0% 0%
1501 –2250 5% 2.5%
2251 – 3000 15% 7.5%
3001 – 3750 20% 10%
>=3751 30% 15%

3001 – 4500 5% 2.5%
4501 – 6000 15% 7.5%
6001 – 7500 20% 10%
>=7501 30% 15%
4501 – 6750 5% 2.5%
6751 – 9000 15% 7.5%
9001 – 11250 20% 10%
>=11251 30% 15%
5. Optional Benefits
The following optional benefits shall apply under the Policy only if it is specified in the Policy Schedule. Optional benefits can be selected by You only at the time
of issuance of the First Policy or at Renewal, unless specified otherwise, on payment of the corresponding additional premium.
The optional benefits ‘Personal Accident Cover’ and ‘Hospital Cash’ will be payable (only on Reimbursement basis) if the conditions mentioned in the below
sections are contracted or sustained by the Insured Person covered under these optional benefits during the Policy Period.
The applicable optional benefits will be payable subject to the terms, conditions and exclusions of this Policy and subject always to any sub-limits for the
optional benefit as specified in Your Policy Schedule.
All claims for any applicable optional benefits under the Policy must be made in accordance with the process defined under Section 7 (Claim Process &
Requirements).
5.1. Personal Accident Cover
What is covered:
If the Insured Person covered under this optional benefit dies or sustains any Injury resulting solely and directly from an Accident occurring during the
Policy Period at any location worldwide, and while the Policy is in force, We will provide the benefits described below.

a. Accident Death (AD)
What is covered:
If the Injury due to Accident solely and directly results in the Insured Person’s death within 365 days from the occurrence of the Accident, We will make
payment of Personal Accident Cover Sum Insured specified in the Policy Schedule. If a claim is made under this optional benefit, the coverage for that
Insured Person under the Policy shall immediately and automatically cease. Any claim incurred before death of such Insured person shall be admissible
subject to terms and conditions under this Policy.
b. Accident Permanent Total Disability (APTD)
What is covered:
If the Injury due to Accident solely and directly results in the Permanent Total Disability of the Insured Person which means that the Injury results in
one or more of the following conditions within 365 days from the occurrence of an Accident, We will make payment of 125% of the Personal Accident
Cover Sum Insured as specified in the Policy Schedule.
1. Loss of use of limbs or sight

The Insured Person suffers from total and irrecoverable loss of:
1. The use of two limbs (including paraplegia and hemiplegia) OR
2. The sight in both eyes OR
3. The use of one limb and the sight in one eye
2. Loss of independent living

The Insured Person is permanently unable to perform independently three or more of the following six activities of daily living.
1. Washing: the ability to maintain an adequate level of cleanliness and personal hygiene.
2. Dressing: the ability to put on and take off all necessary garments, artificial limbs or other surgical appliances that are medically necessary.
3. Feeding: the ability to transfer food from a plate or bowl to the mouth once food has been prepared and made available.
4. Toileting: the ability to manage bowel and bladder function, maintaining an adequate and socially acceptable level of hygiene.
5. Mobility: the ability to move indoors from room to room on level surfaces at the normal place of residence.
6. Transferring: the ability to move from a lying position in a bed to a sitting position in an upright chair or wheel chair and vice versa.

a. The Permanent Total Disability is proved through a disability certificate issued by a Medical Board duly constituted by the Central and/or the State
Government; and
b. We will admit a claim under this optional benefit only if the Permanent Total Disability continues for a period of at least 6 continuous calendar months
from the commencement of the Permanent Total Disability unless it is irreversible, such as in case of amputation/loss of limbs etc; and
c. If the Insured Person dies before a claim has been admitted under this optional benefit, no amount will be payable under this optional benefit, however
We will consider the claim under Section 5.1.a (Accident Death) subject to terms and conditions mentioned therein; and
d. We will not make payment under Accident Permanent Total Disability more than once in the Insured Person’s lifetime for any and all Policy Periods.
e. If a claim under this optional benefit is admitted, then coverage for the Insured Person will immediately and automatically cease under Section
5.1(Personal Accident Cover) and this optional benefit shall not be applied in respect of that Insured Person on any Renewal thereafter. However, other
applicable benefits can be Renewed in respect of the Insured Person.
c. Accident Permanent Partial Disability (APPD)
What is covered:
If the Injury due to Accident solely and directly results in the Permanent Partial Disability of the Insured Person which is of the nature specified in the
table below within 365 days from the occurrence of such Accident, We will make payment under this optional benefit in accordance with the table
below:

a. The Permanent Partial Disability is proved through a disability certificate issued by a Medical Board duly constituted by the Central and/or the
State Government; and
b. We will admit a claim under this optional benefit only if the Permanent Partial Disability continues for a period of at least 6 continuous calendar
months from the commencement of the Permanent Partial Disability, unless it is irreversible; and
c. If the Insured Person dies before a claim has been admitted under this optional benefit, no amount will be payable under this optional benefit,
however We will consider the claim under Section 5.1.a (Accident Death) subject to the terms and conditions mentioned therein.

d. If a claim under this optional benefit has been admitted, then no further claim in respect of the same condition will be admitted under this optional
benefit.
e. If a claim under this optional benefit is paid and the entire Personal Accident Sum Insured specified in the Policy Schedule does not get utilized,
then the balance Personal Accident Cover Sum Insured shall be available for further claims under Section 5.1 (Personal Accident Cover) until the
entire Personal Accident Cover Sum Insured is consumed. The Personal Accident Cover Sum Insured specified in the first Policy Schedule shall
be a lifetime limit for the Insured Person and once this limit is exhausted, coverage for the Insured Person will immediately and automatically
cease under Section 5.1 (Personal Accident Cover) and this optional benefit shall not be applied in respect of that Insured Person on any Renewal
thereafter. However, other applicable benefits can be Renewed in respect of the Insured Person
Permanent Partial Disability Grid

S. No. Nature of Disability % of Personal Accident Cover
Sum Insured payable
1 Loss or total and permanent loss of use of both the hands from the wrist joint 100%
2 Loss or total and permanent loss of use of both feet from the ankle joint 100%
3 Loss or total and permanent loss of use of one hand from the wrist joint and of one foot from the 100%
ankle joint
4 Loss or total and permanent loss of use of one hand from the wrist joint and total and 100%
permanent loss of sight in one eye
5 Loss or total and permanent loss of use of one foot from the ankle joint and total and permanent 100%
loss of sight in one eye
6 Total and permanent loss of speech and hearing in both ears 100%
7 Total and permanent loss of hearing in both ears 50%
8 Loss or total and permanent loss of use of one hand from wrist joint 50%
9 Loss or total and permanent loss of use of one foot from ankle joint 50%
10 Total and permanent loss of sight in one eye 50%
11 Total and permanent loss of speech 50%
12 Permanent total loss of use of four fingers and thumb of either hand 40%
13 Permanent total loss of use of four fingers of either hand 35%
14 Uniplegia 25%
15 Permanent total loss of use of one thumb of either hand
a. Both joints 25%
b. One joint 10%
16 Permanent total loss of use of fingers of either hand
a. Three joints 10%
b. Two joints 8%
c. One joint 5%
17 Permanent total loss of use of toes of either foot
a. All toes- one foot 20%
b. Great toe- both joints 5%
c. Great toe- one joint 2%
d. Other than great toe, one toe 1%

5.2. Hospital Cash
What is covered:
If We have accepted an Inpatient Care Hospitalization claim under Section 4.1 (In-patient Care), We will pay the Hospital Cash amount specified in the
Policy Schedule up to a maximum 30 days of Hospitalization during the Policy Year for the Insured Person for each continuous period of 24 hours of
Hospitalization from the first day of Hospitalization.

a. The Insured Person has been admitted in a Hospital for a minimum period of 48 hours continuously.
5.3. Safeguard
What is covered:
a. Claim Safeguard: If We have accepted a Hospitalization claim under Section 4, then the items which are not payable as per List I – ‘Expenses not
covered’ under Annexure II related to that particular claim will become payable.
b. Booster Benefit Safeguard: Cumulative Bonus under Section 4.12 (Booster Benefit) will not be impacted or reduced at Renewal if any one claim or
multiple claims admissible in the previous Policy Year does not exceed the overall amount of Rs. 50,000.
c. Sum Insured Safeguard: The Base Sum Insured will be increased on Cumulative Basis at each Policy Year on the basis of inflation rate in previous
year. Inflation rate would be computed as the average Consumer Price index (CPI) of the entire calendar year published by the Central Statistical
Organisation (CSO).
Conditions - The coverage under ‘Sum Insured Safeguard’ is subject to fulfilment of following conditions:
a. The % increase will be applicable only on Base Sum Insured under the Policy and not on Booster Benefit or any other benefit which leads to increase
in Sum Insured.
b. Consumer Price index (CPI) is a measure of inflation, changes in the CPI are used to assess price changes associated with the cost of living. It is a
measure that examines the weighted average of prices of a basket of consumer goods and services, such as transportation, food and medical care. It
is calculated by taking price changes for each item in the predetermined basket of goods and averaging them.
c. The Central Statistics Office (CSO) is a government agency in India under the Ministry of Statistics and Programme Implementation responsible for
co-ordination of statistical activities in India, and evolving and maintaining statistical standards.
d. In case of Sum Insured enhancement or reduction at the time of Renewal, any accumulated Sum Insured due to Sum Insured Safeguard Benefit will be
added to the enhanced or reduced Sum Insured opted by Insured at the time of Renewal.
e. All accumulated Sum Insured Safeguard benefit will lapse and will roll back to the Base Sum Insured opted if this optional benefit is not Renewed.
Illustration of calculation of inflation rate based on CPI figures

Month CPI 2019 CPI 2018
January 139.6 136.9
February 139.9 136.4
March 140.4 136.5
April 141.2 137.1
May 142.0 137.8
June 142.9 138.5
July 144.2 139.8
August 145.0 140.4
September 145.8 140.2
October 147.2 140.7
November 148.6 140.8
December 150.4 140.1
Average 143.9 138.8
3.72%
CPI inflation rate for calendar year 2019
i.e. (Average CPI for 2019 – Average CPI for 2018) / Average CPI for 2018

As per the table above:
• The average CPI for 2019 is 143.9, whereas the average CPI for 2018 is 138.8
• The increase in average CPI is calculated as:
• (Average CPI for 2019 – Average CPI for 2018) / Average CPI for 2018
• Hence, the average increase in Base Sum Insured applicable in 2020 will be 3.72%.
Note: CPI figure for a particular month is recorded from the following link: http://mospi.nic.in/cpi
5.4. Safeguard+
What is covered:
a. Claim Safeguard+: If We have accepted a Hospitalization claim under Section 4, then the items which are not payable as per List I,II,III,IV – under
Annexure II related to that particular claim will become payable.
b. Booster Benefit Safeguard+: Cumulative Bonus under Section 4.12 (Booster Benefit) will not be impacted or reduced at Renewal if any one claim
or multiple claims admissible in the previous Policy Year does not exceed the overall amount of Rs. 1,00,000.
c. Sum Insured Safeguard+: The Base Sum Insured will be increased on Cumulative Basis at each Policy Year on the basis of inflation rate in
previous year. Inflation rate would be computed as the average Consumer Price index (CPI) of the entire calendar year published by the Central
Statistical Organisation (CSO).
Conditions - The coverage under ‘Sum Insured Safeguard+’ is subject to fulfilment of following conditions:
a. The % increase will be applicable only on Base Sum Insured under the Policy and not on Booster Benefit or any other benefit which leads to increase
in Sum Insured.
b. Consumer Price index (CPI) is a measure of inflation, changes in the CPI are used to assess price changes associated with the cost of living. It is a
measure that examines the weighted average of prices of a basket of consumer goods and services, such as transportation, food and medical care.
It is calculated by taking price changes for each item in the predetermined basket of goods and averaging them.
c. The Central Statistics Office (CSO) is a government agency in India under the Ministry of Statistics and Programme Implementation responsible
for co-ordination of statistical activities in India, and evolving and maintaining statistical standards.
d. In case of Sum Insured enhancement or reduction at the time of Renewal, any accumulated Sum Insured due to Sum Insured Safeguard+ Benefit will
be added to the enhanced or reduced Sum Insured opted by Insured at the time of Renewal.
e. All accumulated Sum Insured Safeguard+ benefit will lapse and will roll back to the Base Sum Insured opted if this optional benefit is not Renewed.
Illustration of calculation of inflation rate based on CPI figures
Month CPI 2019 CPI 2018

January 139.6 136.9
February 139.9 136.4
March 140.4 136.5
April 141.2 137.1
May 142.0 137.8
June 142.9 138.5
July 144.2 139.8
August 145.0 140.4
September 145.8 140.2
October 147.2 140.7
November 148.6 140.8
December 150.4 140.1
Average 143.9 138.8
3.72%
CPI inflation rate for calendar year 2019
i.e. (Average CPI for 2019 – Average CPI for 2018) / Average CPI for 2018

As per the table above:
• The average CPI for 2019 is 143.9, whereas the average CPI for 2018 is 138.8
• The increase in average CPI is calculated as:
• (Average CPI for 2019 – Average CPI for 2018) / Average CPI for 2018
• Hence, the average increase in Base Sum Insured applicable in 2020 will be 3.72%.
Note: CPI figure for a particular month is recorded from the following link: http://mospi.nic.in/cpi
Note: You can either choose Safeguard or Safeguard+ at a given point in time.
6. Exclusions
A permanent exclusion will be applied on any medical or physical condition or treatment of an Insured Person, if specifically mentioned in the Policy Schedule
and has been accepted by You. This option as per company’s underwriting policy, will be used for such condition(s) or treatment(s) that otherwise would have
resulted in rejection of insurance coverage under this Policy to such Insured Person.
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 unless specifically mentioned elsewhere in the Policy. Sections 6.1 to 6.35 are not applicable to Section 5.1 (Personal Accident Cover).
The permanent exclusions applicable to Section 5.1 (Personal Accident Cover) have been specified separately under Section 6.36.
Standard Exclusions
6.1. Pre-existing Diseases (Code–Excl01):

a. Expenses related to the treatment of a Pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous
coverage after the date of inception of the first Policy with Us.
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. 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.
d. Coverage under the Policy after the expiry of 36 months for any Pre-existing Disease is subject to the same being declared at the time of application
and accepted by Us.
6.2. Specified disease/procedure waiting period (Code- Excl02)

a. Expenses related to the treatment of the listed conditions, surgeries/treatments shall be excluded until the expiry of 24 months 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 (covered from day 1)
or Cancer (covered after 30-days waiting period).
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. 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.
d. The waiting period for listed conditions shall apply even if contracted after the Policy or declared and accepted without a specific exclusion.
e. 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.
f. List of specific diseases/procedures:
i. Pancreatitis and stones in biliary and urinary system
ii. Cataract, glaucoma and retinal detachment
iii. Hyperplasia of prostate, hydrocele and spermatocele
iv. Prolapse uterus and cervix, endometriosis, Fibroids, PCOD, hysterectomy (unless necessitated by Malignancy)
v. Hemorrhoids, fissure or fistula or abscess of anal and rectal region
vi. Hernia of all sites,
vii. Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies, Rheumatoid
Arthritis, gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair
viii. Varicose veins of lower extremities
ix. All internal or external benign or neoplasms/ tumours, cyst, sinus, polyp, nodules, mass or lump
x. Ulcer, erosion and varices of gastro intestinal tract
xi. Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of tympanic
membrane), Tonsils and adenoids, nasal septum and nasal sinuses

6.3. 30-day waiting period (Code- Excl03):
a. 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.
b. This exclusion shall not, however, apply if the Insured Person has continuous coverage for more than twelve months
c. The within referred waiting period is made applicable to the enhanced Sum Insured in the event of granting higher Sum Insured subsequently.
6.4. Investigation & Evaluation (Code-Excl04)

a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
6.5. 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:
a. 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.
b. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
6.6. Obesity/ Weight Control (Code-Excl06)
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Doctor.
b. The surgery/Procedure conducted should be supported by clinical protocols.
c. The member has to be 18 years of age or older and;
d. Body Mass Index (BMI);
i. greater than or equal to 40 or
ii. 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:
1. Obesity-related cardiomyopathy
2. Coronary heart disease
3. Severe Sleep Apnea
4. Uncontrolled Type2 Diabetes
6.7. 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.
6.8. 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.
6.9. Hazardous or Adventure sports (Code-Excl09)
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-
jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.

6.10. 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.
6.11. Excluded Providers (Code-Excl11)
Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically excluded by Us and disclosed in Our
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 stabilization are payable but not the complete claim.
6.12. Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12)
6.13. Treatments received in heath 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)
6.14. 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 Hospitalization claim or Day Care procedure (Code-Excl14)
6.15. Refractive Error (Code-Excl15)
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
6.16. 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.
6.17. Sterility and Infertility (Code-Excl17)
Expenses related to sterility and infertility. This includes:

a. Any type of contraception, sterilization
b. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
6.18. Maternity Expenses (Code-Excl18)

a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except
ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the Policy Period.
Specific Exclusions
6.19. Personal Waiting Periods:
Conditions specified for an Insured Person under Personal Waiting Period in the Policy Schedule will be subject to a Waiting Period of 24 months from the
inception of the First Policy with Us for that Insured Person and will be covered from the commencement of the third Policy Year for that Insured Person as
long as the Insured Person has been insured continuously under the Policy without any break.
6.20.Charges related to a Hospital stay not expressly mentioned as being covered. This will include charges for RMO charges, surcharges and service charges
levied by the Hospital.
6.21. Circumcision:
Circumcision unless necessary for the treatment of a disease or necessitated by an Accident.

6.22. Conflict & Disaster:
Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or
not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
6.23. External Congenital Anomaly:
Screening, counseling or treatment related to external Congenital Anomaly.
6.24. Dental/oral treatment:
Treatment, procedures and preventive, diagnostic, restorative, cosmetic services related to disease, disorder and conditions related to natural teeth and
gingiva except if required by an Insured Person while Hospitalized due to an Accident.
6.25. Hormone Replacement Therapy:
Treatment for any condition / illness which requires hormone replacement therapy.
6.26. Multifocal Lens and ambulatory devices such as walkers, crutches, splints, stockings of any kind and also any medical equipment which is subsequently
used at home.
6.27. Sexually transmitted Infections & diseases (other than HIV / AIDS):
Screening, prevention and treatment for sexually related infection or disease (other than HIV / AIDS).
6.28. Sleep disorders:

Treatment for any conditions related to disturbance of normal sleep patterns or behaviors.
6.29. Any treatment or medical services received outside the geographical limits of India.
6.30.Any expenses incurred on OPD treatment.
6.31. Unrecognized Physician or Hospital:

a. Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Indian Medicine
or by Central council of Homeopathy.
b. Treatment provided by anyone with the same residence as an Insured Person or who is a member of the Insured Person’s immediate family or relatives.
c. Treatment provided by Hospital or health facility that is not recognized by the relevant authorities in India.
6.32. The condition which is not clinically significant or is related to anxiety, bereavement, relationship or academic problems, acculturation difficulties or work
pressure.
6.33. Treatment related to intentional self inflicted Injury or attempted suicide by any means.
6.34. Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state as demonstrated by:
a. Deep coma and unresponsiveness to all forms of stimulation; or
b. Absent pupillary light reaction; or
c. Absent oculovestibular and corneal reflexes; or
d. Complete apnea.
6.35. If as per any or all of the medical references herein below containing guidelines and protocols for evidence based medicines, the Hospitalization for
treatment under claim is not necessary or the stay at the Hospital is found unduly long:
a. Medical text books,
b. Standard treatment guidelines as stated in clinical establishment act of Government of India,
c. World Health Organisation (WHO) protocols,
d. Published guidelines by healthcare providers,
e. Guidelines set by medical societies like cardiological society of India, neurological society of India etc.

6.36. Permanent Exclusions for Personal Accident Cover
We shall not be liable to make any payment under any benefits under Section 5.1 (Personal Accident Cover) if the claim is attributable to, or based on, or
arises out of, or is directly or indirectly connected to any of the following:
a. Suicide or self inflicted Injury, whether the Insured Person is medically sane or insane.
b. Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is
declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
c. Service in the armed forces, or any police organization, of any country at war or at peace or service in any force of an international body or participation
in any of the naval, military or air force operation during peace time.
d. Any change of profession after inception of the Policy or any Renewal which results in the enhancement of Our risk, if not accepted and endorsed by
Us on the Policy Schedule.
e. Committing an assault, a criminal offence or any breach of law with criminal intent.
f. Taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by a Medical
Practitioner other than the Policyholder or an Insured Person.
g. Participation in aviation/marine activities (including crew) other than as a passenger in an aircraft/water craft that is authorized by the relevant
regulations to carry such passengers between established airports or ports.
h. Engaging in or taking part in professional/adventure sports or any hazardous pursuits, 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, polo, snow and ice sports, hunting.
7. Claims Process & Requirements
The fulfillment of the terms and conditions of this Policy (including payment of full premium in advance by the due dates mentioned in the Policy Schedule) 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 in relation to claims, shall be
Condition Precedent to Admission of Liability under this Policy.
7.1. Claims Administration:
On the occurrence or discovery of any Illness or Injury that may give rise to a claim under this Policy, the Claims Procedure set out below shall be followed:
a. We advise You to submit all claims related documents, including documents for claims within the Deductible amount, once the Deductible limit has
been exhausted.
b. We/Our Service Provider must be permitted to inspect the medical and Hospitalization records pertaining to the Insured Person’s treatment and to
investigate the circumstances pertaining to the claim.
c. We and Our Service Provider must be given all reasonable co-operation in investigating the claim in order to assess Our liability and quantum in
respect of the claim.
d. It is hereby agreed and understood that no change in the Medical Record provided under the Medical Advice information, by the Hospital or the
Insured Person to Us or Our Service Provider during the period of Hospitalization or after discharge by any means of request will be accepted by Us.
Any decision on request for acceptance of such change will be considered on merits where the change has been proven to be for reasons beyond the
claimant’s control.
7.2. Claims Procedure: On the occurrence or the discovery of any Illness or Injury that may give rise to a claim under this Policy, then as a Condition Precedent
to Admission of Liability under the Policy the following procedure shall be complied with:
a. For Availing Cashless Facility: Cashless Facility can be availed only at Our Network Providers or Service Providers (as applicable). The complete list of
Network Providers are available on Our website and at Our branches and can also be obtained by contacting Us over the telephone. In order to avail
Cashless Facility, the following process must be followed:
i. Process for Obtaining Pre-Authorization

A. For Planned Treatment:
We must be contacted to pre-authorize Cashless Facility for planned treatment at least 72 hours prior to the proposed treatment. Once the
request for pre-authorisation has been granted, the treatment must take place within 15 days of the pre-authorization date at a Network
Provider.

B. In Emergencies:
If the Insured Person has been Hospitalized in an Emergency, We must be contacted to pre-authorize Cashless Facility within 48 hours of
the Insured Person’s Hospitalization or before discharge from the Hospital, whichever is earlier.
All final authorization requests, if required, shall be sent at least six hours prior to the Insured Person’s discharge from the Hospital.
Each request for pre-authorization must be accompanied with completely filled and duly signed pre-authorization form including all of the
following details:
I. The health card We have issued to the Insured Person at the time of inception of the Policy (if available) supported with KYC document;
II. The Policy Number;
III. Name of the Policyholder;
IV. Name and address of Insured Person in respect of whom the request is being made;
V. Nature of the Illness/Injury and the treatment/Surgery required;
VI. Name and address of the attending Medical Practitioner;
VII. Hospital where treatment/Surgery is proposed to be taken;
VIII. Date of admission;
IX. First and any subsequent consultation paper / Medical Record since beginning of diagnosis of that treatment/Surgery;
X. Admission note;
XI. Treating Medical Practitioner certificate for Illness / Insured Event history with justification of Hospitalization.
If these details are not provided in full or are insufficient for Us to consider the request, We will request additional information or documentation
in respect of that request.
When We have obtained sufficient details to assess the request, We will issue the authorization letter specifying the sanctioned amount,
any specific limitation on the claim, applicable Deductibles / Co-payment and non-payable items, if applicable, or reject the request for pre-
authorisation specifying reasons for the rejection.
In case of preauthorization request where chronicity of condition is not established as per clinical evidence based information, We may reject
the request for preauthorization and ask the claimant to claim as Reimbursement. Claim document submission for Reimbursement shall not be
deemed as an admission of Our liability.
Once the request for pre-authorisation has been granted, the treatment must take place within 15 days of the pre-authorization date and
pre-authorization shall be valid only if all the details of the authorized treatment, including dates, Hospital, locations, indications and disease
details, match with the details of the actual treatment received. For Hospitalization on a Cashless Facility basis, We will make the payment of
the amount assessed to be due, directly to the Network Provider / Service Provider.
We reserve the right to modify, add or restrict any Network Provider or Service Provider for Cashless Facility at Our sole discretion.
ii. Reauthorization
Cashless Facility will be provided subject to re-authorization if requested for either change in the line of treatment or in the diagnosis or for any
procedure carried out on the incidental diagnosis/finding prior to the discharge from the Hospital.
b. For Reimbursement Claims:
For all claims for which Cashless Facility has not been pre-authorized or for which treatment has not been taken at a Network Provider/Service Provider
or for which Cashless Facility is not available, We shall be given written notice of the claim along with the following details within 48 hours of admission
to the Hospital or before discharge from the Hospital, whichever is earlier:
i. The Policy Number;
ii. Name of the Policyholder;
iii. Name and address of the Insured Person in respect of whom the request is being made;
iv. Nature of Illness or Injury and the treatment/Surgery taken;
v. Name and address of the attending Medical Practitioner;
vi. Hospital where treatment/Surgery was taken;
vii. Date of admission and date of discharge;
viii. Any other information that may be relevant to the Illness/ Injury/ Hospitalization.

7.3. Claims Documentation:
For medical claims – Reimbursement Facility:
We shall be provided with the following necessary information and documentation in respect of all claims at Your/Insured Person’s expense within 30 days
of the Insured Event giving rise to a claim or within 30 days from the date of occurrence of an Insured Event.
For medical claims – Cashless Facility:
We will be provided these documents by the Network Provider immediately following the Insured Person’s discharge from Hospital.
Necessary information and documentation for medical claims
a. Claim form duly completed and signed by the claimant.

b. Details of past medical history record, first and subsequent consultation.
c. Age / Identity proof document of Insured Person in case of claim approved under Cashless Facility (not required if submitted at the time of pre-
authorization request) and Policyholder in case of Reimbursement claim.
i. Self attested copy of valid age proof (passport / driving license / PAN card / class X certificate / birth certificate);
ii. Self attested copy of identity proof (passport / driving license / PAN card / voter identity card);
iii. Recent passport size photograph
d. Cancelled cheque/ bank statement / copy of passbook mentioning account holder’s name, IFSC code and account number printed on it of Policyholder
/ nominee ( in case of death of Policyholder).
e. Original discharge summary.
f. Bar code sticker and invoice for implants and prosthesis (if used and only in case of Surgery/Surgical Procedure).
g. Original final bill from Hospital with detailed break-up and paid receipt.
h. Room tariff of the entitled room category (in case of a Non-Network provider and if room tariff is not a part of Hospital bill): duly signed and stamped
by the Hospital in which treatment is taken.
(In case You are unable to submit such document, then We shall consider the Reasonable and Customary Charges of the Insured Person’s eligible room
category of Our Network Provider within the same geographical area for identical or similar services.)
i. Original bills of pharmacy/medicines purchased, or of any other investigation done outside Hospital with reports and requisite prescriptions.
j. For Medico-legal cases (MLC) or in case of Accident
i. MLC/ Panchnama / First Information Report (FIR) copy attested by the concerned Hospital / police station (if applicable);
ii. Original self-narration of incident in absence of MLC / FIR.
k. Original laboratory investigation, diagnostic, radiological & pathological reports with supporting prescriptions.
In the event of the Insured Person’s death during Hospitalization, written notice accompanied by a copy of the post mortem report (if any) shall be
given to Us regardless of whether any other notice has been given to Us.
For Personal Accident claims
Additional claim documentation for Personal Accident Cover under Section 5.1:
a. Accident Death
i. Copy of death certificate (issued by the office of Registrar of Births and Deaths or any other authorized legal institution)
ii. Copy of post mortem report wherever applicable
b. Accident Permanent Total Disability or Accident Permanent Partial Disability

iii. Certificate of disability issued by a Medical Board duly constituted by the Central and/or the State Government.
7.4. Claims Assessment & Repudiation:

a. At Our discretion, We may investigate claims to determine the validity of a claim. All costs of investigation will be borne by Us and all investigations
will be carried out by those individuals/entities that are authorized by Us in writing.

b. 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 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 the claim within 45 days from the date of receipt of last necessary document.
iv. In case of delay beyond stipulated 45 days, the Company 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.
c. Complete discharge: Any payment to the Insured Person or his/ her nominees or his/ her legal representative or to the Hospital/Nursing Home or
assignee, as the case may be, for any benefit under the Policy shall in all cases be a full, valid and an effectual discharge towards payment of claim by
the Company to the extent of that amount for the particular claim.
d. All admissible claims under this Policy shall be assessed by Us in the following progressive order:-
i. If a room has been opted in a Hospital for which the room category is higher than the eligible limit as applicable for that Insured Person as
specified in the Policy Schedule, then the Associated Medical Expenses payable shall be pro-rated as per the applicable limits in accordance
with Section 4.1.
ii. The Deductible (if applicable) shall be applied to the aggregate of all claims that are either paid or payable under this Policy. Our liability to
make payment shall commence only once the aggregate amount of all eligible claims as per policy terms and conditions exceeds the Deductible
limit within the same Policy Year.
iii. Co-payment (if applicable) as specified in the Policy Schedule shall be applicable on the amount payable by Us.
e. The claim amount assessed in Section 7.4 d above would be deducted from the amount / sub-limit mentioned against each benefit or treatment as
per terms and conditions and Sum Insured as specified in the Policy Schedule.
7.5. Delay in Claim Intimation or Claim Documentation:
If the claim is not notified to Us or claim documents are not submitted within the stipulated time as mentioned in the above sections, then We shall
be provided the reasons for the delay, in writing. We will condone such delay on merits where the delay has been proved to be for reasons beyond the
claimant’s control.
7.6. Claims process for Section 4.10 (Air Ambulance), if availed on Cashless Facility:
a. In the event of an Emergency, Our Service Provider shall be contacted immediately on the helpline number.
b. Our Service Provider will evaluate the necessity for evacuation of the Insured Person and if the request for Medical Evacuation is approved by Us, the
Service Provider shall pre-authorise the type of travel that can be utilized to transport the Insured Person and provide information on the Hospital that
may be approached for medical treatment of the Insured Person.
c. If the Service Provider pre-authorises the Medical Evacuation of the Insured Person by means of Air Transportation through an air ambulance or
commercial flight whichever is best suited, the Service Provider shall also arrange for the same to be provided to the Insured Person unless there are
any logistical constraints or the medical condition of the Insured Person prevents Emergency Medical Evacuation.
7.7. Claims process for Section 4.15 (Health Checkup), if availed on Cashless Facility:
a. The Insured Person shall seek appointment by contacting Our Service Provider.
b. Our Service Provider will facilitate Your appointment.
c. Reports of the medical tests can be collected directly from the Service Provider.
7.8. Claim process for Section 4.16 (Second Medical Opinion), if availed on Cashless Facility:
a. In the event of submission of request for Second Medical Opinion, Our Service Provider shall be contacted on the helpline number.
b. Our Service Provider will evaluate the information of the Insured Person and if the request for Second Medical Opinion is approved, the Service
Provider will facilitate arrangement as per conditions specified in the Section 4.16.

8. General Terms and Conditions
Standard General Terms and Clauses
8.1. Free Look Provision
The Free Look Period shall be applicable at the inception of the Policy and not on renewals or at the time of porting the Policy.
The Insured Person shall be allowed a period of fifteen days (30 days if the Policy with Policy Period as 3 years has been sold through distance marketing)
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:
a. 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
8.2. Cancellation
a. The Insured Person may cancel this Policy by giving 15 days written notice and in such an event, the Company shall refund premium on short term rates
for the unexpired Policy Period as per the rates detailed below.
1 year 2 year 3 year
Policy in-force up to Refund of Policy in-force Refund of Policy in-force Refund of
Premium (%) up to Premium (%) up to Premium (%)
Up to 30 days 75% Up to 30 days 87.5% Up to 30 days 90%
31 to 90 days 50% 31 to 90 days 75% 31 to 90 days 87.5%
91 to 180 days 25% 91 to 180 days 62.5% 91 to 180 days 75%
exceeding 180 days 0% 181 to 365 days 50% 181 to 365 days 60%
366 to 455 days 25% 366 to 455 days 50%
456 to 545 days 12% 456 to 545 days 25%
0% 545 to 720 days 12%
Exceeding 545 days
Exceeding 720 days 0%
The above grid shall be applicable for ‘Yearly / Annual’ premium payment frequency. For Half Yearly or Quarterly premium payment frequencies, the
Company shall refund premium as per below grid:
No. of completed months at the time Refund %
of cancellation Half Yearly Quarterly
0 62.5% 50%
1 33.3% 16.7%
2 25% 0%
3 8.3% 50%
4 4.2% 16.7%
5 0% 0%
6 62.5% 50%
7 33.3% 16.7%
8 25% 0%
9 8.3% 50%
10 4.2% 16.7%
11 0% 0%
For monthly premium payment frequency, no refund shall be applicable for cancellation of the Policy

b. Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of cancellation where, any claim has been
admitted or has been lodged or any Benefit has been availed by the Insured Person under the Policy. The Company may cancel the Policy at any
time on grounds of mis-representation, 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 mis-representation, non-disclosure of material facts or fraud.
In case of death of an Insured, pro-rate refund of the premium for the deceased insured will be refunded, provided there is no history of claim.
8.3. Renewal of Policy
The Policy shall ordinarily be renewable except on grounds of fraud, moral hazard, misrepresentation by the Insured Person.
a. The Company shall endeavor to give notice for renewal. However, the Company is not bound to give any notice for renewal.
b. Renewal shall not be denied on the ground that the Insured had made a claim or claims in the preceding policy years.
c. Request for renewal along with requisite premium shall be received by the Company before the end of the Policy Period.
d. At the end of the Policy Period, the Policy shall terminate and can be renewed within the Grace Period to maintain continuity of benefits without Break
in Policy. Coverage is not available during the Grace Period.
e. If not renewed within Grace Period after due renewal date, the Policy shall terminate.
f. No loading shall apply on renewals based on individual claims experience.
8.4. 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. For claim settlement under Reimbursement, the Company will pay the Policyholder. In 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
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.
8.5. Fraudulent claims

If any claim made by the Insured Person, is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof, or if any
fraudulent means or devices are used by the Insured Person or anyone acting on his / her behalf to obtain any benefit under this Policy, all benefits under
this Policy shall be forfeited.
Any amount already paid against claims which are found fraudulent later under this Policy shall be repaid by all person(s) named in the Policy Schedule,
who shall be jointly and severally liable for such repayment.
For the purpose of this clause, the expression “fraud” means any of the following acts committed by the Insured Person or by his agent, with intent to
deceive the insurer or to induce the insurer to issue an insurance policy:
a. the suggestion, as a fact of that which is not true and which the Insured Person does not believe to be true;
b. the active concealment of a fact by the Insured Person having knowledge or belief of the fact;
c. any other act fitted to deceive; and
d. any such act or omission as the law specially declares to be fraudulent
The Company shall not repudiate the Policy on the ground of Fraud, if the Insured Person / beneficiary can prove that the misstatement was true to the
best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of material fact are within
the knowledge of the insurer. Onus of disproving is upon the Policyholder, if alive, or beneficiaries.
8.6. 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.
8.7. Withdrawal of Product

a. In the likelihood of this product being withdrawn in future with due approval of IRDAI, the Company will intimate the Insured Person about the same
90 days prior to expiry of the Policy.
b. 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 cumulative bonus, waiver of waiting period etc. provided the Policy has been maintained without a break as per
extant regulatory framework.

8.8. Redressal of Grievance:
In case of any grievance the Insured Person may contact the company through:
Website: www.nivabupa.com
Toll free: 1860-500-8888
E-mail: [email protected] (Senior citizens may write to us at: [email protected])
Fax : +91 11 41743397
Courier: Customer Services Department
D-5, 2nd Floor, Logix Infotech Park
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301
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:
Grievance Redressal Officer

opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301 Email: [email protected] or [email protected]
For details of grievance officer, kindly refer the link https://www.nivabupa.com/customer-care/health-services/grievance-redressal.aspx
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 at the addresses given in Annexure III.
Grievance may also be lodged at IRDAI Integrated Grievance Management System - https://igms.irda.gov.in/
8.9. Moratorium Period
After completion of eight continuous years under the Policy no look back to be applied. This period of eight years is called as moratorium period. The
moratorium would be applicable for the sums insured of the first Policy and subsequently completion of 8 continuous years would be applicable from date
of enhancement of sums insured only on the enhanced limits. After the expiry of Moratorium Period no health insurance claim shall be contestable except
for proven fraud and permanent exclusions specified in the Policy contract. The policies would however be subject to all limits, sub limits, co-payments,
deductibles as per the Policy contract.
8.10. Loading on Premium

a. Upon the disclosure of the health status of the persons proposed for insurance and declarations made in the Proposal or Insurance Summary Sheet, We
may apply a risk loading on the premium payable (excluding statutory levies and taxes) or Special Conditions on the Policy. The maximum risk loading
applicable shall not exceed more than 100% of the premium per diagnosis / medical condition and an overall risk loading shall not exceed more than
150% of the premium per Insured Person.
b. These loadings will be applied from inception date of the First Policy including subsequent Renewal(s) with Us.
c. We may apply a specific personal Waiting Period on a medical condition/ailment depending on the past history or additional Waiting Periods on Pre-
existing Diseases as part of the special conditions on the Policy.
8.11. Multiple Policies

a. In case of multiple policies taken by an Insured Person during a period from one or more insurers to indemnify treatment costs, the Insured Person shall
have the right to require a settlement of his / her claim in terms of any of his / her policies. In all such cases the insurer chosen by the Policyholder 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.
b. Insured Person having multiple policies shall also have the right to prefer claims under this Policy for the amounts disallowed under any other policy
/ policies even if the sum insured is not exhausted. Then the Insurer(s) shall independently settle the claim subject to the terms and conditions of this
Policy.
c. If the amount to be claimed exceeds the sum insured under a single Policy after considering the deductibles or co-pay, the Insured Person shall have
the right to choose insurer from whom he / she wants to claim the balance amount.
d. Where an Insured Person has policies from more than one insurer to cover the same risk on indemnity basis, the Insured Person shall only be
indemnified the hospitalization costs in accordance with the terms and conditions of the chosen Policy.

8.12. Disclosure of Information
The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, mis-description or non-
disclosure of any material fact by the policyholder
(Explanation: “Material facts” for the purpose of this policy shall mean all relevant information sought by the company in the proposal form and other
connected documents to enable it to take informed decision in the context of underwriting the risk)
8.13. Condition Precedent to Admission of Liability
The terms and conditions of the policy must be fulfilled by the insured person for the Company to make any payment for claim(s) arising under the policy.
8.14. Migration
The Insured Person will have the option to migrate the Policy to other health insurance products / plans offered by the Company policy by applying for
migration of the policy 30 days before the premium due date of his / her existing Policy as per extant 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 proposed insured
person will get the accrued continuity benefits in waiting periods as per extant 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
8.15. 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 premium due date of his / her existing Policy as per extant 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 extant 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
Specific Terms and conditions
8.16. Renewal Premium:
Renewal premium will alter based on Age. The reference of age for calculating the premium for Family Floater Policies shall be the age of the eldest Insured
Person.
8.17. Disclosures on Renewal:
You shall make a full disclosure to Us in writing of any material change in the health condition or geographical location of any Insured Person 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.
8.18. Renewal for Insured Persons who have achieved Age 31:
If any Insured Person who is a child and has completed Age 31 years at the time of Renewal in a Family Floater Policy, then such Insured Person will have
to take a separate policy based on Our underwriting guidelines, as per Our Board approved underwriting policy as he/she will no longer be eligible to be
covered under such Policy. In such cases, the credit of the Waiting Periods served under the Policy will be passed on to the separate policy taken by such
Insured Person.
8.19. Addition of Insured Persons on Renewal:
Where an individual is added to this Policy, either by way of endorsement or at the time of Renewal, the Pre-existing Disease clause, exclusions, loading (if
any) and Waiting Periods will be applicable considering such Policy Year as the first year of the Policy with Us for that Insured Person.
8.20.Changes to Sum Insured on Renewal:
You may opt for enhancement of Sum Insured at the time of Renewal, subject to underwriting. All Waiting Periods as defined in the Policy shall apply
afresh for this enhanced limit or any benefit’s enhanced sub-limit from the effective date of such enhancement.

8.21. Change of Policyholder
a. The Policyholder may be changed only at the time of Renewal. 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 Your death, Your emigration from India or in case of Your divorce during the
Policy Period.
b. Any alteration in the Policy due to unavoidable circumstances as in case of the Policyholder’s death, emigration or divorce during the Policy Period
should be reported to Us immediately.
c. Renewal of such Policies will be according to terms and conditions of existing Policy.
8.22. Obligations in case of a minor
If an Insured Person is less than 18 years of Age, You or another adult Insured Person or legal guardian (in case of Your and all other adult Insured Person’s
demise) shall be completely responsible for ensuring compliance with all the terms and conditions of this Policy on behalf of that minor Insured Person.
8.23. Authorization to obtain all pertinent records or information:
As a Condition Precedent to Admission of Liability for payment of benefits, We and/or Our Service Provider shall have the authority to obtain all pertinent
records or information from any Medical Practitioner, Hospital, clinic, insurer, individual or institution to assess the validity of a claim submitted by or on
behalf of any Insured Person.
8.24. Policy Disputes
Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions contained herein shall be governed by Indian law and shall
be subject to the jurisdiction of the Indian Courts.
8.25. Territorial Jurisdiction
All benefits are available in India only and all claims shall be payable in India in Indian Rupees only.
8.26. Notices
Any notice, direction or instruction given under this Policy shall be in writing and delivered by hand, post, or facsimile to:
a. You/the Insured Person at the address specified in the Policy Schedule or at the changed address of which We must receive written notice.
b. Us at the following address:
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301
Fax No.: +91 11 41743397
c. No insurance agents, brokers or other person/entity is authorized to receive any notice on Our behalf.
d. In addition, We may send You/the Insured Person other information through electronic and telecommunications means with respect to Your Policy
from time to time.
8.27. Alteration to the Policy
This Policy constitutes the complete contract of insurance. Any change in the Policy will only be evidenced by a written endorsement signed and stamped
by Us. No one except Us can within the permission of the IRDAI change or vary this Policy.
8.28. Zonal pricing
For the purpose of calculating premium, the country has been divided into the following 2 zones:
a. Zone 1: Delhi NCR, Mumbai (including Navi Mumbai and Thane), Kolkata and Gujarat State, Delhi NCR includes Delhi, Baghpat, Bulandshahr, Gautam
Buddh Nagar, Ghaziabad, Hapur, Meerut, Muzaffarnagar, Shamli, Charkhi Dadri, Faridabad, Gurugram, Jhajjar, Jind, Karnal, Mahendragarh, Nuh,
Palwal, Panipat, Rewari, Rohtak and Sonipat
b. Zone 2: Rest of India

8.29. Assignment
The Policy can be assigned subject to applicable laws.
8.30. Premium Payment in Installments
lf the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or Monthly, as mentioned in the policy Schedule/
Certificate of insurance, the following Conditions shall apply (notwithstanding any terms contrary elsewhere in the policy)
i. Grace Period of 30 days in case of single premium policies, and a period of 15 days in case of other than single premium policies, would be given to
pay the instalment premium due for the policy.
ii. During such grace period, coverage will not be available from the due date of instalment premium till the date of receipt of premium by Company.
iii. The insured person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific Waiting Periods” in the event of payment
of premium within the stipulated grace Period.
iv. No interest will be charged lf the instalment premium is not paid on due date
v. ln case of instalment premium due not received within the grace period, the policy will get cancelled.
vi. ln the event of a claim, all subsequent premium instalments shall immediately become due and payable.
The company has the right to recover and deduct all the pending installments from the claim amount due under the policy.
Disclaimer: Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration No. 145). ‘Bupa’ and
‘HEARTBEAT’ logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited under license. Registered
Office Address: C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024, Customer Helpline No.: 1860-500-8888. Fax: +91 11 41743397. Website: www.nivabupa.com.
CIN: U66000DL2008PLC182918. For more details on risk factors, terms and conditions, please read sales brochure carefully before concluding the sale.

ANNEXURE I –
Product Benefit Table (all limits in INR unless defined as percentage)
Plan Type (all limits in Rs unless

Individual / Family Floater
defined as percentage)
12.5 100
Base Sum Insured 3 lacs 4 lacs 5 lacs 7.5 lacs 10 lacs 15 lacs 20 lacs 25 lacs 50 lacs 75 lacs
lacs lacs
Benefits
Inpatient Care Covered up to Sum Insured
Day Care Treatment Covered up to Sum Insured
Alternative Treatments Covered up to Sum Insured
Domiciliary Hospitalization Covered up to Sum Insured
Modern treatments Covered up to Sum Insured with sub-limit of Rs. 1Lac on few robotic surgeries
Pre-Hospitalization Medical Expenses
Covered up to Sum Insured
(60 days)
Post-Hospitalization Medical Expenses
Covered up to Sum Insured
(180 days)
Living Organ Donor Transplant Covered up to Sum Insured
Emergency Ambulance Covered upto Rs.2,000 per hospitalization
Air Ambulance Cashless claim: Covered up to Sum Insured / Reimbursement claim: Covered up to Rs. 2.5 Lacs
Home care treatment Covered up to Sum Insured
In case of claim free year, increase of 50% of expiring Base Sum Insured in a Policy Year; maximum up to 100% of Base
Booster Benefit
Sum Insured (In case of a claim, reduction of accumulated Cumulative Bonus by 50% of expiring Base Sum Insured)
ReAssure Unlimited reinstatement up to base Sum Insured. (Applicable for both same & different illness)
Shared accommodation Cash Benefit Rs. 800 per day; maximum Rs. 4,800 Rs. 1,000 per day; maximum Rs. 6,000
Annual (From Day 1); For defined list of tests; up to Rs. 500 for every Rs. 1 Lac Sum Insured
Health Check-up
(Individual policy: maximum Rs. 5,000 per Insured; Family Floater policy: maximum Rs. 10,000 per policy)
Second Medical Opinion Once for any condition for which hospitalization is triggered
Live healthy benefit Discount on renewal premium basis number of steps taken
Optional benefits
Hospital Cash (1) 1,000/day 2,000/day 4,000/day
Personal Accident cover (for insured
aged 18 years & above on individual Personal Accident cover will be equal to 5 times of Base Sum Insured; subject to maximum of Rs. 100 Lacs
basis)
a. Claim Safeguard: Non-payable items paid up to Sum Insured (List I)
Safeguard b. Booster Benefit Safeguard: No impact on Booster benefit if claim in a policy year is less than Rs. 50,000
c. Sum Insured Safeguard: CPI linked increase in Base Sum Insured
a. Claim Safeguard+: Non-payable items paid up to Sum Insured (List I,II,III,IV)
Safeguard+ b. Booster Benefit Safeguard:+ No impact on Booster benefit if claim in a policy year is less than Rs. 1,00,000
c. Sum Insured Safeguard:+ CPI linked increase in Base Sum Insured

Annexure II -
The expenses that are not covered or subsumed into room charges / procedure charges / costs of treatment
List I – Expenses not covered
Sl. No. Item Sl. No. Item

1 Baby Food 35 Oxygen Cylinder (For Usage Outside The Hospital)
2 Baby Utilities Charges 36 Spacer
3 Beauty Services 37 Spirometre
4 Belts/ Braces 38 Nebulizer Kit
5 Buds 39 Steam Inhaler
6 Cold Pack/Hot Pack 40 Armsling
7 Carry Bags 41 Thermometer
8 Email / Internet Charges 42 Cervical Collar
9 Food Charges (Other Than Patient's Diet Provided By Hospital) 43 Splint
10 Leggings 44 Diabetic Foot Wear
11 Laundry Charges 45 Knee Braces (Long/ Short/ Hinged)
12 Mineral Water 46 Knee Immobilizer/Shoulder Immobilizer
13 Sanitary Pad 47 Lumbo Sacral Belt
14 Telephone Charges 48 Nimbus Bed Or Water Or Air Bed Charges
15 Guest Services 49 Ambulance Collar
16 Crepe Bandage 50 Ambulance Equipment
17 Diaper Of Any Type 51 Abdominal Binder
18 Eyelet Collar 52 Private Nurses Charges- Special Nursing Charges
19 Slings 53 Sugar Free Tablets
Creams Powders Lotions (Toiletries Are Not Payable, Only
20 Blood Grouping And Cross Matching Of Donors Samples 54
Prescribed Medical Pharmaceuticals Payable)
21 Service Charges Where Nursing Charge Also Charged 55 Ecg Electrodes
22 Television Charges 56 Gloves
23 Surcharges 57 Nebulisation Kit
Any Kit With No Details Mentioned [Delivery Kit, Orthokit,
24 Attendant Charges 58
Recovery Kit, Etc]
Extra Diet Of Patient (Other Than That Which Forms Part Of Bed
25 59 Kidney Tray
Charge)
26 Birth Certificate 60 Mask
27 Certificate Charges 61 Ounce Glass
28 Courier Charges 62 Oxygen Mask
29 Conveyance Charges 63 Pelvic Traction Belt
30 Medical Certificate 64 Pan Can
31 Medical Records 65 Trolly Cover
32 Photocopies Charges 66 Urometer, Urine Jug
33 Mortuary Charges 67 Ambulance
34 Walking Aids Charges 68 Vasofix Safety

List II – Items that are to be subsumed into Room Charges

1 Baby Charges (Unless Specified/Indicated) 20 Luxury Tax
2 Hand Wash 21 Hvac
3 Shoe Cover 22 House Keeping Charges
4 Caps 23 Air Conditioner Charges
5 Cradle Charges 24 Im Iv Injection Charges
6 Comb 25 Clean Sheet
7 Eau-De-Cologne / Room Freshners 26 Blanket/Warmer Blanket
8 Foot Cover 27 Admission Kit
9 Gown 28 Diabetic Chart Charges
10 Slippers 29 Documentation Charges / Administrative Expenses
11 Tissue Paper 30 Discharge Procedure Charges
12 Tooth Paste 31 Daily Chart Charges
13 Tooth Brush 32 Entrance Pass / Visitors Pass Charges
14 Bed Pan 33 Expenses Related To Prescription On Discharge
15 Face Mask 34 File Opening Charges
16 Flexi Mask 35 Incidental Expenses / Misc. Charges (Not Explained)
17 Hand Holder 36 Patient Identification Band / Name Tag
18 Sputum Cup 37 Pulseoxymeter Charges
19 Disinfectant Lotions
List III – Items that are to be subsumed into Procedure Charges

1 Hair Removal Cream 13 Surgical Drill
2 Disposables Razors Charges (For Site Preparations) 14 Eye Kit
3 Eye Pad 15 Eye Drape
4 Eye Sheild 16 X-Ray Film
5 Camera Cover 17 Boyles Apparatus Charges
6 Dvd, Cd Charges 18 Cotton
7 Gause Soft 19 Cotton Bandage
8 Gauze 20 Surgical Tape
9 Ward And Theatre Booking Charges 21 Apron
10 Arthroscopy And Endoscopy Instruments 22 Torniquet
11 Microscope Cover 23 Orthobundle, Gynaec Bundle
12 Surgical Blades, Harmonicscalpel,Shaver

List IV – Items that are to be subsumed into costs of treatment

1 Admission/Registration Charges 10 Hiv Kit
2 Hospitalisation For Evaluation/ Diagnostic Purpose 11 Antiseptic Mouthwash
3 Urine Container 12 Lozenges
4 Blood Reservation Charges And Ante Natal Booking Charges 13 Mouth Paint
5 Bipap Machine 14 Vaccination Charges
6 Cpap/ Capd Equipments 15 Alcohol Swabes
7 Infusion Pump– Cost 16 Scrub Solution/Sterillium
8 Hydrogen Peroxide\Spirit\ Disinfectants Etc 17 Glucometer & Strips
9 Nutrition Planning Charges - Dietician Charges- Diet Charges 18 Urine Bag

Annexure III
List of Insurance Ombudsmen
Office Details Jurisdiction

AHMEDABAD - Shri Kuldip Singh
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Tilak Marg, Relief Road, Gujarat, Dadra & Nagar Haveli, Daman and Diu
AHMEDABAD – 380 001.
Tel.: 079 - 25501201/02/05/06
Email: [email protected]
BENGALURU - Mr Vipin Anand
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road, Karnataka
JP Nagar, Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
BHOPAL - Shri R. M. Singh
Insurance Ombudsman
Janak Vihar Complex, 2nd Floor,
Madhya Pradesh, Chhattisgarh
6, Malviya Nagar, Opp. Airtel Office,
Near New Market, Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
BHUBANESWAR - Shri Suresh Chandra Panda
62, Forest park,
Odisha
Bhubaneswar – 751 009.
Tel.: 0674 - 2596461 /2596455
CHANDIGARH - Mr Atul Jerath
S.C.O. No. 101, 102 & 103, 2nd Floor, Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and
Batra Building, Sector 17 – D, Bahadurgarh), Himachal Pradesh, Union Territories of Jammu &
Chandigarh – 160 017. Kashmir,Ladakh & Chandigarh
Tel.: 0172 - 2706196 / 2706468
CHENNAI - Shri Segar Sampathkumar
Fatima Akhtar Court, 4th Floor, 453,
Tamil Nadu, PuducherryTown and Karaikal
Anna Salai, Teynampet,
(which are part of Puducherry)
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
DELHI - Shri Sudhir Krishna
2/2 A, Universal Insurance Building,
Delhi & following Districts of Haryana -
Asaf Ali Road,
Gurugram, Faridabad, Sonepat & Bahadurgarh
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504

GUWAHATI - Shri Somnath Ghosh
Jeevan Nivesh, 5th Floor,
Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh,
Nr. Panbazar over bridge, S.S. Road,
Nagaland and Tripura
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
HYDERABAD - Shri N. Sankaran
6-2-46, 1st floor, “”Moin Court””,
Andhra Pradesh, Telangana, Yanam and part of
Lane Opp. Saleem Function Palace,
Union Territory of Puducherry
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.
Tel.: 040 - 23312122
JAIPUR - Shri Rajiv Dutt Sharma
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg, Rajasthan
Jaipur - 302 005.
Tel.: 0141 - 2740363
ERNAKULAM - Shri G. Radhakrishnan
2nd Floor, Pulinat Bldg.,
Kerala, Lakshadweep, Mahe-a part of
Opp. Cochin Shipyard, M. G. Road,
Union Territory of Puducherry
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
KOLKATA - Shri P. K. Rath
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue, West Bengal, Sikkim, Andaman & Nicobar Islands
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
LUCKNOW Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda,
Office of the Insurance Ombudsman, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
6th Floor, Jeevan Bhawan, Phase-II, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Nawal Kishore Road, Hazratganj, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad,
Lucknow - 226 001. Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur,
Tel.: 0522 - 2231330 / 2231331 Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria,
Email: [email protected] Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar
MUMBAI - Shri Bharatkumar S. Pandya
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W), Goa, Mumbai Metropolitan Region (excluding Navi Mumbai & Thane)
Mumbai - 400 054.
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31

NOIDA - Shri Chandra Shekhar Prasad
State of Uttarakhand and the following Districts of Uttar Pradesh: Agra,
Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj,
Bhagwan Sahai Palace
Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit,
4th Floor, Main Road, Naya Bans, Sector 15,
Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi,
Distt: Gautam Buddh Nagar, U.P-201301.
Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha,
Tel.: 0120-2514252 / 2514253
Hathras, Kanshiramnagar, Saharanpur
PATNA - Shri N. K. Singh
2nd Floor, Lalit Bhawan,
Bailey Road, Bihar, Jharkhand
Patna 800 001.
Tel.: 0612-2547068
PUNE - Shri Vinay Sah
Jeevan Darshan Bldg., 3rd Floor,
Maharashtra, Areas of Navi Mumbai and Thane (excluding Mumbai
C.T.S. No.s. 195 to 198, N.C. Kelkar Road,
Metropolitan Region)
Narayan Peth, Pune – 411 030.
Tel.: 020-41312555
Council for Insurance Ombudsmen,

3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 -69038800/69038812

ENDORSEMENT DOCUMENT - Smart Health+
"Smart Health+" covers treatment taken within India only.
You are covered under Smart Health+ only if you have paid additional premium for this and it has been endorsed in to
your policy. Means it appears in your policy schedule.
Benefits applicable to you will depend on the chosen variant, mentioned in your policy schedule.
Unutilized Sum Insured will expire at the end of policy year.
1. Variants & Benefits description
A. Best consult
i. What is covered?
This plan covers 'Acute conditions' ONLY.
ii. What you get

You can avail UNLIMITED tele-consultation with general medical practitioner, specialists and super specialist
consultations through OUR PARTNER ONLY, whenever you need, 24 hours a day 7 days a week, 365 days a
year. 366 days if it's a leap year.
What is an 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
What it means?
These are the conditions that one suffers from every now and then and are unexpected like fever, cough, cold,
injury, diarrhea etc. In these conditions, once treated for a few days you get better completely and the
condition is 'cured'. No regular treatment, medicines, follow up, or monitoring is required for such conditions.
Example:
• Mr. X is suffering from diabetes and is on regular medication for diabetes. He falls ill and has urinary tract
infection. He can consult doctor through our partner to get treatment for the same.
• Mr. Y is a healthy individual. He has fever for which he can consult doctor through our partner.
iii. What is NOT covered?

a. Chronic conditions.
b. Consultations NOT availed through our partner
c. Cost of medicines, investigations, procedures, in-hospital treatment (whether out-patient, in-patient or day
care)
What is a chronic condition?
A chronic condition is defined as a disease, illness, or injury that has one or more of the following
characteristics:
1. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
2. it needs ongoing or long-term control or relief of symptoms
3. it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
4. it continues indefinitely
5. it recurs or is likely to recur
What it means?
Those conditions that are not completely cured by treatment. Regular treatment, medicines, follow ups and
monitoring is required to keep these conditions under control. These are conditions like Diabetes, High blood
pressure, Asthma, Arthritis etc.
Example:
• Mr X is suffering from diabetes and take regular medication to control his sugar level. Diabetes is a chronic
condition and consultation to manage diabetes is not covered
• Mr. Y is suffering from Psoriasis. He consults his doctor every quarter and takes regular medication to keep
the condition under control. Psoriasis is a chronic condition and consultation to manage this is not covered
• Mr. Z falls down at home, goes to nearby Doctor for consultation. Doctor prescribes medication for the
injury. This is not covered because i) he has not availed consultation through our partner and ii) cost of
medication/investigation is not covered under Best Consult
Smart Health+_Endorsement Document_15 Dec 2021_v1
Rider Name:
Product Smart
Name: Health+
Smart | Rider
Health+, UIN:UIN:
Product NBHHLIA22164V012122
xxxxxxxxxxxxxxxxx
iv. How it works
Simple!! Call the number we have provided to you. Doctor will receive your call directly.
We recommend you store the number on your phone, stick it on your refrigerator or a place easily accessible.
B. Best care
i. What is covered?
This plan covers 'Acute conditions' ONLY.
ii. What you get

a. You can avail UNLIMITED tele-consultation with general practitioner, specialists, and super specialist
consultations through OUR PARTNER ONLY, whenever you need, 24 hours a day 7 days a week, 365 days a
year. 366 days if it's a leap year :.
b. Investigations up to Sum Insured as per your policy schedule per year as prescribed by the general
practitioner, specialist or super specialist consulted through OUR PARTNER ONLY. We can help organize it
and we will pay. OR you can do it at centers of your choice and we still will pay. Of course, both instances,
up to limit only.
c. Medicines up to Sum Insured per your policy schedule year as prescribed by the general practitioner,
specialist or super specialist consulted through OUR PARTNER ONLY. We can help deliver it at your home
and we will pay. OR you can buy it from pharmacy of your choice and we still will pay. Of course, both
instances, up to limit only.
What is an 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
What it means?
These are the conditions that one suffers from every now and then and are unexpected like fever, cough,
cold, injury, diarrhea etc. In these conditions, once treated for a few days you get better completely and the
condition is 'cured'. No regular treatment, medicines, follow up, or monitoring is required for such
conditions.
Example:
• Mr X is suffering from diabetes and is on regular medication for diabetes. He falls ill and has urinary tract
infection. He can consult doctor through our partner to get treatment for the same including medicine
and investigation prescribed by the doctor
• Mr. Y is a healthy individual. He has fever for which he can consult doctor through our partner to get
treatment for the same including medicine and investigation prescribed by the doctor
iii. What is NOT covered?

a. Chronic conditions.
b. Consultations NOT availed through our partner
What is a chronic condition?

A chronic condition is defined as a disease, illness, or injury that has one or more of the following
characteristics:
1. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
2. it needs ongoing or long-term control or relief of symptoms
3. it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
4. it continues indefinitely
5. it recurs or is likely to recur
What it means?
Those conditions that are not completely cured by treatment. Regular treatment, medicines, follow ups and
monitoring is required to keep the condition under control. These are conditions like Diabetes, High blood
pressure, Asthma, Arthritis etc.
Examples of not covered cases:

• Mr X is suffering from diabetes and take regular medication to keep his sugar level under control. Diabetes
is a chronic condition and consultation/medication to manage diabetes is not covered
• Mr. Y is suffering from Psoriasis. He consults his doctor every quarter and takes regular medication to keep
the condition under control. Psoriasis is a chronic condition and consultation/medication to manage is not
covered.
• Mr. Z falls down at home, goes to nearby Doctor for consultation. Doctor prescribes medication for the
injury. This is not covered because he has not availed consultation through our partner
Rider Name:
Product Smart
Name: Health+
Smart | Rider
Health+, UIN:UIN:
xxxxxxxxxxxxxxxxx
v. How it works
Simple!! Call the number we have provided to you. Doctor will receive your call directly.
We recommend you store the number on your phone, stick it on your refrigerator or a place easily accessible.
The following diagram will give a simple step wise view of how it works, what to expect
What you do
What our partners' doctors do
Call on Helpline
Doctor will speak to you and will decide if

• it's an emergency or not
• It's an Acute condition for which you are calling
OR Chronic condition
Non-emergency acute condition
Chronic condition
Prescription Referred to specialist Emergency
Process ends Specialist consultation Referred to hospital
Pharmacy Investigation
Process ends
Process ends
C. Disease Management "Gold"
What do you get?

• Day 0 Coverage for inpatient hospitalization or day-care treatment for any complications arising out of
diabetes or hypertension from the date of this policy inception
• Up to 20% discount on renewal premium of base product and rider. The discount will be calculated as per the
grid in Annexure 1
Getting renewal premium discount is easy, here is how:

• You get discount for undergoing health check-up. Just undergo the complete set of tests mentioned under
Health Check-up in Annexure 1, and you can get up to 4% discount
• You get discount for results you get in these tests. Submit the test reports to us and get discounts as per test
report
• Take the tests up to 4 times a year and get the discount for every time you get the test done
• Just ensure that there is a gap of at least 60 days between 2 set of tests
• And remember, you must submit the report to us at least 75 days prior to the policy renewal date
D. Disease Management "Platinum"
What do you get?

• Day 0 Coverage for inpatient hospitalization or day-care treatment for any complications arising out of
diabetes or hypertension from the date of this policy inception
• Up to 20% discount on renewal premium of base product and rider. The discount will be calculated as per the
grid in Annexure 1
• We will cover the cost of tests mentioned in Annexure 1. You can get them done through us, in our network, on
cashless basis. Or you can get them done at the center of your choice. We will still pay for the tests, on
reimbursement basis, up to Rs. 3,000 for all the tests in a policy year.
Rider Name:
Product Smart
Name: Health+
Smart | Rider
Health+, UIN:UIN:
xxxxxxxxxxxxxxxxx
Getting renewal premium discount is easy, here is how:
• You get discount for undergoing health check-up. Just undergo the complete set of tests mentioned under
Health Check-up in Annexure 1, and you can get up to 4% discount
• If you are getting the tests done on cashless basis, no need to do anything further. Just sit back, relax, and we
will take care of the rest
• If you are getting them done on reimbursement basis, you will need to submit the report to us and follow the
steps below:
¢ You get discount for results you get in these tests. Submit the test reports to us and get discounts as per
test report
¢ Take the tests up to 4 times a year and get the discount for every time you get the test done
¢ Just ensure that there is a gap of at least 60 days between 2 set of tests
¢ And remember, you must submit the report to us at least 75 days prior to the policy renewal date
E. Complete Care
Combination of either of Disease Management "Gold" or Disease Management "Platinum" plan with Best Consult
or Best Care Plan
Annexure 1
Health Check-up tests:
• BMI
• Lipid Profile
• HbA1C
The applicable discount would be aggregate of discount accrued for undergoing health check-up, and reported
value of the individual components of the health check-up (HbA1C Check-up, Lipid Profile, and BMI outcomes) as
per the below grid:
Check-up Discount
Health Check-up Done Discount/Quarter (%) Total Discount/Annum (%)
Yes 1 4
No 0 0
HbA1C
Reading Discount/Quarter (%) Total Discount/Annum (%)
<6.50 2.5 10
6.51 -7.00 2 8
7.01-8.00 1 4
>8.00 0 0
Lipid Profile
Total Cholesterol: HDL Cholesterol ratio
<4.00 1 4
4.01-5.00 0.5 2
>5.00 0 0
BMI
<18.5 0 0
18.5 - 24.9 0.5 2
>24.9 0 0
Disclaimer:
Niva Insurance
Bupa Health Insurance is a subject
Company matter
Limited; of solicitation.
Registered office:- C-98,Niva BupaLajpat
First Floor, Health Insurance
Nagar, Company
Part 1, New Limited (formerly known as Max Bupa Health
Delhi-110024
InsuranceInsurance
Disclaimer: Company is a Limited) (IRDAI
subject matter Registration
of solicitation. Number
Niva Bupa Health 145). 'Bupa'
Insurance and 'HEARTBEAT'
Company logo are
Limited (formerly known registered
as Max trademarks
Bupa Health of theirLimited)
Insurance Company respective
(IRDAI
owners and
Registration No. are
145).being used
‘Bupa’ and by Nivalogo
‘HEARTBEAT’ Bupa Health Insurance
are registered trademarks ofCompany Limited
their respective ownersunder
and arelicense.
being usedRegistered
by Niva Bupa office:- C-98, Company
Health Insurance First Floor, Lajpat
Limited under
Nagar,Customer
license. Part 1,Helpline:
New Delhi-110024, Customer
1860-500-8888. Website: Helpline: 1860-500-8888.
www.nivabupa.com. Website: www.nivabupa.com. CIN: U66000DL2008PLC182918.
CIN: U66000DL2008PLC182918.
Product Name: Smart Health, Product UIN: xxxxxxxxxxxxxxxxxxxx. Please read sales brochure carefully before concluding a sale.
Rider Name:
Product Smart
Name: Health+
Smart | Rider
Health+, UIN:UIN:
xxxxxxxxxxxxxxxxx
Customer ID: 2000895337
Member No. Name Age Valid From
9336214 Ankit Jain 39 30/08/2020
9336215 Sanchi Kohli 35 30/08/2020

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Date: 09/09/2023

Policy Number: 31341466202303

MR. ANKIT JAIN

Subject : Niva Bupa Health Insurance Policy No. 31341466202303

Dear MR. ANKIT JAIN,

Director - Operations & Customer Service

Important - Please read this document and keep in a safe place.

Policyholder Name: MR. ANKIT JAIN Policy Number 31341466202303

HNO.402, Policy Expiry Date and Time To 08/09/2024 23:59

GREEN AVENUE, Plan Opted Family Floater

AMRITSAR, Policy Period 1 Year

PUNJAB - 143001 Renewal / Payment Due Date 08/09/2024

Mrs. Sanchi Kohli No

Nominee Name Relationship with the Policyholder

Sanchi Kohli Spouse

Intermediary Name Intermediary Code Intermediary Contact No.

Claim Administrator Servicing Branch Details

Optional Benefit/Feature Details

Personal Accident Cover Not opted

Signature Not Verified

Smart Health+ (Disease Management) Not Opted

Smart Health+ (Acute Care) Best Consult

Pre Existing Disease Waiting Time Not opted

Co-payment Not opted

Room Type Modification Not opted

Annual Aggregate Deductible Not opted

Product Benefit Table1

Insured Person Details

Mrs. Sanchi 35 28/12/1987 Female Spouse 30/08/2020 0 1. Endometriosis of None

Permanent Exclusion (if any):

Location: New Delhi Director - Operations & Customer Service

Policyholder Name Mr. Ankit Jain Policy Number 31341466202303

Policy Commencement Date # 09/09/2023 Policy Expiry Date 08/09/2024

(A) Premium (Rs.) - Base Product 14,442.00

(B) Premium (Rs.) - Personal Accident Cover 0.00

(C) Premium (Rs.) - Safeguard 1,083.00

(D) Premium (Rs.) - Hospital Cash 0.00

(E) Premium (Rs.) - Smart Health+: Acute Care Add-on 1,926.00

Underwriting Loading (Rs.) 0.00

Total Discount (Rs.) 0.00

Net Premium / Taxable value (Rs.) 17,451.00

Integrated Goods and Service Tax (18.00 %) 0.00

Central Goods and Service Tax (9.00 %) 1,570.59

State/UT Goods and Service Tax (9.00 %) 1,570.59

Gross Premium (Rs.) 20,592.00

Details of persons Insured:

Mr. Ankit Jain 39 Male Applicant

Mrs. Sanchi Kohli 35 Female Spouse

Location: New Delhi Director - Operations & Customer Service

1. Product Name ReAssure

2. What am I covered Base Coverage:

3. What are the Ÿ Investigation & Evaluation 6

Product Name: ReAssure. Product UIN: NBHHLIP23107V022223

10 Claims For Cashless Service: 7.2.a

For Reimbursement of Claim: 7.2.b

Product Name: ReAssure. Product UIN: NBHHLIP23107V022223

Product Name: ReAssure. Product UIN: NBHHLIP23107V022223

Product Name: ReAssure. Product UIN: NBHHLIP23107V022223

2. Definitions & Interpretation