Policy Wordings

Easy Domestic Travel Insurance
Quick reference guide to benefits offered
www. apollomunichinsurance.com
Specially designed for makemytrip customers
Benefit
Coverage
Does not cover
Accident: Medical
Treatment, Assistance &
Evacuation
Reimbursement upto Rs 100,000 for Medical Treatment of any illness even if caused by Accident, unless necessitated to
maintain life and relieve pain.
expenses incurred for Hospitalization or outpatient treatment by an Insured Person due to an Treatment which is not medically necessary
accident during the risk period.
Dental treatment unless necessitate by an Accident
Total Loss of Checked-in

Baggage
Reimbursement upto Rs 10,000 for expenses Valuables, money, any kind of securities
incurred to purchase new similar quality items Any partial loss or not amounting to total loss
in an event of total loss of checked-in baggage Any claim not supported by a written confirmation from the competent airline
while travelling by a Carrier.
authority confirming baggage lost was checked in.
Maximum reimbursement for any one item within
one piece of baggage will be 10% of the Sum
Insured. If the Insured Person has checked in
more than one item of baggage, then maximum
reimbursement for all items within one piece of
baggage will be 50% of the Sum Insured.
Delay of Checked-in
Baggage
Reimbursement upto Rs 5,000 for purchasing Any delay which is of less than 12 hours
essential personal items of medication, toiletries Delay on return to the usual place of residence
or clothing in an event of delay of accompanying Destinations not mentioned on travel tickets
checked-in baggage while travelling by a Carrier.
Any claim not supported by a written confirmation from the competent airline
authority confirming delay of checked in baggage.
Personal Liability
Indemnification upto Rs 100,000 against actual Legal liability other than third party civil claim
legal liability (including defence costs) to pay Transmission of an illness
damages for negligence which results from a Deliberate, willful, malicious or unlawful act or omission
third party civil claim made for third party death,
bodily injury or property damage.
Personal Accident [24

hours]
Lumpsum benefit upto Rs 750,000 hedging Bacterial infection other than (pyogenic infection which occurs due to Accident )
against risk of permanent total disablement or Medical or surgical treatment except as an result of Accident
death of the Insured Person in an event of an
accident during risk period.
Flight delay
Reimbursement upto Rs 2,000 for expenses Any delay which is of less than continuous and completed 6 hours
incurred by the Insured Person for meals and Any claim not supported by a written confirmation from the competent airline
accommodation due to delay in flight for a
authority confirming reason and duration of said delay.
continuous and completed 6 hour period beyond Voluntary suspension of services by Carrier
its scheduled departure or scheduled arrival time,
provided that the delay is due to severe weather
conditions, strike or industrial action of the airline
employees and due to unforeseen breakdown of
Carriers equipment
Trip Cancellation
Reimbursement upto Rs 20,000 for travel and Any charges that could have been avoided but were incurred because of any
delay in cancelling travel or accommodation.
accommodation expenses that the Insured Person
has paid and cannot recover, if outward journey Facts or matters of which was aware or ought to be aware which may result in a
is cancelled due to death or Hospitalisation of
cancellation while booking the ticket
Insured Person or Insured Persons immediate
family member
Trip Curtailment
Reimbursement upto Rs 20,000 for travel and Any charges that could have been avoided but were incurred because of any
accommodation expenses that the Insured
Person has paid and cannot recover, if the trip is Facts or matters of which was aware or ought to be aware which may result in a
unavoidably curtailed during the Risk period due
cancellation while booking the ticket
to death or Hospitalisation of insured Person or
Insured Persons immediate family member.

Quick reference guide to benefits offered
Benefit
Coverage
Does not cover
Emergency Travel
Reimbursement of return economy class airfare Hospitalisation less than 7 consecutive days
upto Rs 10,000 for one immediate family Immediate family member does not reside in India
member in case of accidental hospitalization of
insured person for more than 7 consecutive days
Emergency Hotel
Reimbursement upto Rs 10,000 of costs for Hospitalisation less than 7 consecutive days
accommodation (boarding and lodging) for an Immediate family member does not reside in India
immediate family member in case of accidental
hospitalization of insured person for more than 7
consecutive days.
This is a summary of benefits and exclusions, pl refer to policy terms and conditions for full description.
IMPORTANT INFORMATION
Risk Period would be upto 30 days. Inception of certificate of insurance is the date of commencement of journey. In case of a roundtrip the coverage will end with the return
journey to the originating station or 30 days from the date of commencement of policy whichever is earlier. If the Insured is coming back to origin, either by a return flight or
connecting flight, then the travel policy expires on the date on which he reaches to the Originating City.
We would be happy to assist you. For any help contact us at: E-mail : customerservice@apollomunichinsurance.com Toll Free : 1800-102-0333
Apollo Munich Health Insurance Co. Ltd. 2nd & 3rd Floor, iLABS Centre, Plot No. 404-405, Udyog Vihar, Phase-III, Gurgaon-122016, Haryana Corp. Off. 1st Floor, SCF-19, Sector-14,
Gurgaon-122001, Haryana Reg. Off. Apollo Hospitals Complex, Jubilee Hills, Hyderabad-500033, Andhra Pradesh Insurance is the subject matter of solicitation For more details on risk
factors, terms and conditions, please read sales brochure carefully before concluding a sale IRDA Registration Number - 131 Corporate Identity Number: U66030AP2006PLC051760

Policy Wording

Apollo Munich Health Insurance Company Limited will provide the insurance cover
detailed in the master Policy to the Insured Person up to the Sum Insured subject
to the terms and conditions of this master Policy, Your payment of premium, and
Your statements in the Proposal, which is incorporated into the master Policy and
is the basis of it.
i) Any costs relating to the Insured Persons pregnancy, childbirth or the

consequences of either.
j) Any congenital internal or external diseases, defects or anomalies.
Section. 2 Total Loss of Checked-in Baggage

If an Insured Persons accompanying checked-in baggage is permanently lost by a
Carrier on which the Insured Person is travelling as a fare paying passenger to his
destination and to whom it was entrusted against a receipt during the Risk Period,
then We will pay the amount required to purchase new items of the same kind and
quality less the amount representing the condition and reasonable
depreciation of the articles lost, provided that:
a) Our maximum liability for any one item within one piece of baggage will be
10% of the Sum Insured. If the Insured Person has checked in more than
one item of baggage, then Our maximum liability for all items within one
piece of baggage will be 50% of the Sum Insured.
b) The Insured Person obtains a property irregularity report from the Carrier
confirming the loss.
c) Our liability will be limited to the travel destinations specified in the Insured
Persons original travel ticket, including all halts and destinations specified
therein.
d) Our payment will be reduced by any sum for which the Carrier is liable to
make payment.
BENEFITS
We will provide the Benefits as detailed below and shown in the Schedule to be
operative for an event or occurrence described in such Benefits that occurs during
the Policy Period. The Sum Insured for each Section represents Our maximum
liability for each Insured Person for any and all claims made under that Section
during the Policy Period.
Section. 1 Accident: Medical Treatment, Assistance & Evacuation
If any Insured Person suffers an Accident during the Risk Period that alters the
Insured Persons state of health and requires immediate medical treatment in order
to maintain life or relieve immediate pain or distress, then We will pay:
1) Medical Treatment
The Medical Expenses incurred for Hospitalisation or Out-patient Treatment
during the Risk Period for:
a) Room rent, boarding expenses,
b) Nursing,
c) Intensive care unit,
d) Medical Practitioner,
e) Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances,
f) Medicines, drugs and consumables,
g) Diagnostic procedures,
h) The cost of prosthetic and other devices or equipment if implanted internally
during a Surgical Procedure.
2) Medical Evacuation
We will reimburse the reasonable cost of the transportation of the Insured
Person (and an attending Medical Practitioner if We are satisfied this is
necessary) during the Risk Period (a) from a Hospital to the nearest facility
which is prepared to admit the Insured Person and provide the necessary
medical services if such medical services cannot satisfactorily be provided at a
Hospital where the Insured Person is situated, and (b) following the treatment,
from the place in which the Hospital is based to the Insured Persons usual
place of residence, provided in both cases that:
Special Exclusions to Section 2

We will not make any payment for any claim in respect of any Insured Person directly
or indirectly for, caused by, arising from or in any way attributable to:
a) Valuables, Money, any kinds of securities or tickets.
b) Any loss of checked-in baggage amounting to a partial loss or not amounting
to a permanent loss.
c) Any item within the checked-in baggage that is valued at more than Rs.
2000 if the Insured Person cannot provide Us with satisfactory proof of
ownership.
d) Any actual or alleged loss arising from any delay, detention, confiscation or
distribution of baggage by customs, police or other public authorities.
e) Any item that the Carriers Policy or rule specifies should not have been
carried.
f) Animals, perishables and consumables.
g) Any loss of baggage sent in advance or souvenirs and articles mailed or
shipped separately.
a) Transportation has been prescribed by a Medical Practitioner and is

medically necessary, and
b) Our Assistance Company has agreed to the reimbursement of the costs of
transportation in advance of the transportation, and has arranged the same.
3) Transportation of mortal remains
If the Insured Person dies during the Risk Period, then We will reimburse the
reasonable cost of either transporting his mortal remains to his usual place of
residence or to a cremation or burial ground.
Section 3. Delay of Checked-in Baggage

If the delivery of an Insured Persons accompanying checked-in baggage is delayed by
a Carrier on which the Insured Person is travelling as a fare paying passenger and to
whom it was entrusted against a receipt during the Risk Period, then We will reimburse
the actual expenses incurred by the Insured Person in purchasing essential personal
items of medication, toiletries or clothing, provided that:
a) The delay is 12 or more hours from the scheduled arrival time.
b) The Insured Person gives Us written proof of delay from the Carrier.
c) Our liability will be limited to the travel destinations within India specified in
the Insured Persons original travel ticket, including all halts and destinations
specified therein.
d) Our payment will be reduced by any sum for which the Carrier is liable to make
payment.

a) The treatment of any Illness even if caused by the Accident suffered by
the Insured Person except any caused by Accident and requiring immediate
medical treatment in order to maintain life or relieve immediate pain or
distress.
b) Any medical treatment which was not medically necessary.
c) Plastic or cosmetic surgery unless this is certified by the attending Medical
Practitioner to be medically necessary for reconstruction following an
Accident.
d) Dental treatment or surgery of any kind, unless to sound natural teeth and
necessitated by an Accident.
e) Any health check-ups or examinations or measures primarily carried out
for diagnostic or investigative reasons for any purpose other than treatment
related to an Accident
f) Any costs relating to physiotherapy unless undertaken while the Insured
Person is Hospitalised.
g) Any costs or periods of residence incurred in connection with rest cures or
recuperation at spas or health resorts, sanatorium, convalescence homes or
any similar institution.
h) Any costs in any way related to psychiatric or mental disorders.
Special Exclusion to Section 3

We will not make any payment for any delay directly or indirectly caused by, arising
from or in any way attributable to:
a) Any actual or alleged delay arising from detention, confiscation or distribution by
customs, police or other public authorities.
b) Any delay of checked-in baggage on the return to the Insured Persons usual
place of residence.
Section 4. Personal Liability
a) We will indemnify an Insured Person subject to the Limit of Indemnity specified
in the Schedule against his actual legal liability (including defence costs) to pay
damages for his negligence which results from a third party civil claim first made
against the Insured Person during the Policy Period for third party death, bodily
injury or property damage.

Policy Wording
b) To the extent that We accept a claim under a) then We will also, subject to the
Limit of Indemnity, pay all costs, fees and expenses incurred with Our prior written
consent in the investigation, defence or settlement of any claim.
c) Coverage under a) is limited to third party civil claims which are made against an
Insured Person during the Policy Period for an event or occurrence which took
place during the Risk Period.
% of Sum
Insured
Accidental death
Special Conditions to Section 4

a) The Insured Person shall:
i) Immediately and in any event within 10 days give Us written notice of
any claim or demand made against him or any circumstance which might
reasonably be expected to give rise to a claim or demand.
ii) Not admit liability for or settle or compromise or make or promise any
payment in respect of any claim or incur any costs or expenses in
connection with it without Our prior written consent.
iii) Allow Us (in Our sole and absolute discretion) to take over and conduct
in the name of the Insured Person the investigation, defence and/
or settlement of any claim, for which purpose the Insured Person shall
provide all the cooperation and assistance We may require. Having taken
over the defence of any claim, We may in Our sole and absolute discretion
relinquish the same.
b) We will not settle any claim without the Insured Persons consent but if the
Insured Person refuses to consent to any settlement We recommend and
chooses to contest or continue any legal proceedings, then Our liability will not
exceed the amount for which the claim could have been settled plus the defence
costs incurred with Our consent up to the date of such refusal.
c) In respect of any claim, We may in Our sole and absolute discretion make
payment of the lesser of the amount available under the Limit of Indemnity
or of any lesser amount for which the claim could be settled in full and final
settlement of any liability We may have under this Policy in respect of the claim,
including the costs of defending it.
d) Any and all amounts We expend in the payment of any claim or defence costs
will reduce the Limit of Indemnity.
100%
Complete and irrecoverable loss of sight of both eyes
100%
Loss of a Limb
50%
Complete and irrecoverable loss of sight of an eye
50%
In no event shall Our payment under this Section exceed the Sum Insured.
Special Conditions to Section 5
a) If the Insured Person dies as a result of the Accident within 365 days of
its occurrence, or thereafter for any other covered reason, and a claim for
permanent impairment had been made prior to the death, then We will
make payment of the Sum Insured less any sum paid for the permanent
impairment, and any sum that was due to be paid for the permanent
impairment shall not be paid.
b) If the Insured Person is not found within 365 days of the disappearance,
sinking or wrecking of the Carrier in which he was travelling as a fare paying
passenger, the Insured Person will be presumed to have died as a result of
the Accident.
or indirectly for, caused by, arising from or in any way attributable to any of the
following unless expressly stated to the contrary in this Policy:
a) Bacterial infections (except pyogenic infection which occurs through an
Accidental cut or wound).
b) Medical or surgical treatment except as necessary solely and directly as a
result of an Accident.
c) Hernia.
Section. 6 Trip Cancellation
If an Insured Persons outward journey as a fare paying passenger (as shown on his
original travel booking and ticket) on a Carrier is unavoidably cancelled because of:
a) The death of the Insured Person or the travelling Insured Persons Immediate
Family Member or travelling companion, or
b) The Hospitalisation of the Insured Person or the travelling Insured Persons
parent, spouse or child due to a sudden Illness or injury where a Medical
Practitioner has recommended that due to the severity of the medical
condition it is necessary to cancel the trip.
Then We will reimburse up to the Trip Cancellation Sum Insured, for those travel and
accommodation expenses that the Insured Person has paid and cannot recover or
for which no value can be derived or he is liable to pay.
a) Childbirth, pregnancy or related medical complications.
b) Any charges that could have been avoided but were incurred because of any
c) Facts or matters of which the Insured Person was aware or should have
been aware might result in the cancellation of the trip.
d) The Hospitalisation of the Insured Person or the travelling Insured Persons
parent, spouse or child for due to depression or anxiety, mental, nervous or
emotional disorders, alcohol or drug abuse, addiction or overdose, elective,
cosmetic, or plastic surgery
e) Travel and accommodation expenses that the Insured Person has paid and
cannot recover or for which no value can be derived or he is liable to pay
if he paid or committed to such expenses when he knew or should have
known of the possibility of cancellation.
Section. 7 Trip Curtailment
If an Insured Persons journey as a fare paying passenger (as shown on his original
travel booking and ticket) on a Carrier is unavoidably curtailed during the Risk Period
Section. 5 Personal Accident [24 Hours]

a) If during the Risk Period an Insured Person suffers an Accident and this
solely and directly results in:
Loss of a Limb and an eye
Complete and irrecoverable loss of speech & hearing

100%
of both ears

a) A claim by one Insured Person against another Insured Person with whom he
had arranged to travel or against an Insured Person by a relation, a travelling
companion or work colleague.
b) The transmission of an Illness by an Insured Person.
c) The Insured Persons professional activities or the supply of goods or services.
d) Being a keeper or owner of animals.
e) The ownership, possession or use of vehicles, aircraft or watercraft.
f) The use or misuse of weapons, including firearms.
g) Any deliberate, wilful, malicious or unlawful act or omission.
h) Insanity, the use or abuse of solvents, alcohol or drugs (except as medically
prescribed but not including for the treatment of drug addiction).
i) Any ownership or occupation of land or buildings except as a temporary
residence by the Insured Person.
j) Any agreed assumption of risk except to the extent that liability would have
attached in the absence of such agreement.
100%
Loss of 2 Limbs (both hands or both feet or one hand

100%
and one foot)
i) His death within 365 days of the Accident, then We will pay the Sum
Insured.
ii) The permanent impairment of the Insured Persons physical capabilities
as detailed in the table below only within 365 days of the Accident,
then We will make payment in accordance with the table below if that
permanent impairment is claimed for and confirmed by the attending
Medical Practitioner and Our medical advisor within 365 days of the
Accident.

Policy Wording
GENERAL EXCLUSIONS:
or indirectly for, caused by, arising from or in any way attributable to any of the
following unless expressly stated to the contrary in this Policy:
a) War or any act of war, invasion, act of foreign enemy, war like operations
(whether war be declared or not or caused during service in the armed forces
of any country), civil war, public defence, rebellion, revolution, insurrection,
military or usurped acts, nuclear weapons/materials, chemical or biological
weapons, radiation of any kind.
b) Any Insured Persons participation or involvement in naval, military or air
force operation or professional or semi-professional sporting, racing, diving,
aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
c) Arising or resulting from the Insured Person(s) committing any breach of law
with criminal intent, or intentional self injury, suicide or attempted suicide
while sane or insane.
d) The abuse or the consequences of the abuse of intoxicants or hallucinogenic
substances such as drugs and alcohol, including smoking cessation
programs and the treatment of nicotine addiction or any other substance
abuse treatment or services, or supplies.
e) The loss or destruction or damage to any property whatsoever or any loss
or expenses whatsoever resulting or arising therefrom or any consequential
loss directly or indirectly caused by or contributed to by or arising from:

i) Ionising radiation or contamination by radioactivity from any nuclear
waste from combustion of nuclear fuel; or

ii) The radioactive, toxic, explosive or other hazardous properties of any
explosion nuclear assembly or nuclear component, thereof

iii) Asbestosis or other related sickness or disease resulting from the
existence, production, handling, processing, manufacture, and sale,
distribution of asbestos or other products thereof.
f) Obesity or morbid obesity or any weight control program, where obesity
means a condition in which the Body Mass Index (BMI) is above 29 & morbid
obesity means a condition where BMI is above 37.
g) Pregnancy (including voluntary termination), miscarriage (except as a result
of an Accident or Illness), maternity or birth (including caesarean section)
except in the case of ectopic pregnancy.
h) Any non allopathic treatment.
i) Charges related to a Hospital stay not expressly mentioned as being covered,
including but not limited to charges for admission, discharge, administration,
registration, documentation and filing.
j) Items of personal comfort and convenience including but not limited to television,
telephone, foodstuffs, cosmetics, hygiene articles, body care products and bath
additive, barber or beauty service, guest service as well as similar incidental
services and supplies, and vitamins and tonics, unless vitamins and tonics
are certified to be required by the attending Medical Practitioner as a direct
consequence of an otherwise covered claim.
k) Treatment rendered by a Medical Practitioner which is outside his
discipline or the discipline for which he is licensed; referral-fees or outstation consultations; treatments rendered by a Medical Practitioner who
shares the same residence as an Insured Person or who is a member of
an Insured Persons family, however proven material costs are eligible for
reimbursement in accordance with the applicable cover.
l) The provision or fitting of hearing aids, spectacles or contact lenses including
optometric therapy, any treatment and associated expenses for alopecia,
baldness, wigs, or toupees, medical supplies including elastic stockings, and
similar products unless it is used for and during the hospital stay.
m) Non-prescription drugs or treatments.
n) If the Insured Person is travelling against the advice of a Medical Practitioner,
or is receiving or on a waiting list for specified medical treatment, or is
traveling for the purpose of obtaining medical treatment, or has received a
terminal prognosis for a medical condition.
o) Venereal disease, sexually transmitted disease or illness; AIDS (Acquired
Immune Deficiency Syndrome) and/or infection with HIV (Human
immunodeficiency virus) including but not limited to conditions related to or
arising out of HIV/AIDS such
as ARC (AIDS related complex), Lymphomas in brain, Kaposis sarcoma,
tuberculosis.
p) Any act of Terrorism which means an act, including but not limited to the
use of force or violence and/or the threat thereof, by any person or group
of persons, whether acting alone or on behalf of or in connection with any
before completion and after it has commenced because of:

a) The death of the Insured Person or the travelling Insured Persons Immediate
Family Member or travelling companion, or
b) The Hospitalisation of the Insured Person or the travelling Insured Persons
parent, spouse or child for due to a sudden Illness or injury where a Medical
Practitioner has recommended that due to the severity of the medical
condition it is necessary to curtail the trip.
Then We will reimburse up to the Trip Curtailment Sum Insured, for those travel and
accommodation expenses that the Insured Person has paid and cannot recover or
for which no value can be derived or he is liable to pay.
a) Childbirth, pregnancy or related medical complications.
b) Any charges that could have been avoided but were incurred because of any
c) Facts or matters of which the Insured Person was aware or should have
been aware might result in the curtailment of the trip.
d) The Hospitalisation of the Insured Person or the travelling Insured Persons
parent, spouse or child for due to depression or anxiety, mental, nervous or
emotional disorders, alcohol or drug abuse, addiction or overdose, elective,
cosmetic, or plastic surgery
e) Travel and accommodation expenses that the Insured Person has paid and
cannot recover or for which no value can be derived or he is liable to pay
if he paid or committed to such expenses when he knew or should have
known of the possibility of curtailment.
Section. 8 Emergency Travel
If We have accepted a claim under Section 1-1) and the Accident suffered by the
Insured Person necessitates his Hospitalisation for more than 7 consecutive days,
We will reimburse the actual cost of an economy return airfare for one Immediate
Family Member to travel to the Insured Persons place of Hospitalisation subject to
the Emergency Travel Sum Insured, provided that:
a) The Immediate Family Member resides in India, and
b) The Insured Person was travelling alone.
Section. 9 Emergency Hotel
If We have accepted a claim under Section 1-1) and the Accident suffered by the
Insured Person necessitates his Hospitalisation for more than 7 consecutive days,
We will reimburse the reasonable costs of accommodation (boarding and lodging),
of the Immediate Family Member subject to the Emergency Hotel Sum Insured,
provided that:
a) The Immediate Family Member resides in India, and
b) The Insured Person was travelling alone.
Section. 10 Flight Delay
If an Insured Persons journey on a Carrier as a fare paying passenger is delayed
for a continuous and completed 6 hour period beyond its scheduled departure or
scheduled arrival time during the Risk Period because of any of the reasons below,
then We will reimburse up to the Flight Delay Sum Insured for those expenses
incurred by the Insured Person for meals and accommodation provided that neither
meals nor accommodation were offered by the Carrier or any other person without
charge:
a) Delay of the Carrier due to any severe weather conditions.
b) Delay caused by strike or industrial action by the employees of the Carrier.
c) Delay caused by any sudden or unforeseen breakdown of the Carriers
equipment.
Special Condition to Section 10
a) The Insured Person must provide Us with written confirmation from the
Carrier of the length and exact nature of the delay.
a) Facts or matters of which the Insured Person was aware or should have
been aware might result in a delay at the time the Insured Person booked
his ticket.
b) Any delay arising from the order or action of any government, civil authority
or official government body.
c) Voluntary suspension of services by the Carrier.

Policy Wording
q)
r)
s)
t)
the reasonable costs towards performing such medical examination (at
the specified location) of the Insured Person.
e) Claims Payment
1) We shall be under no obligation to make any payment under this Policy
unless We have been provided with the documentation and information We
or Our Assistance Company has requested to establish the circumstances of
the claim, its quantum, Our liability for it, the Insured Persons usual place of
residence, and unless the Insured Person has complied with his obligations
under this Policy.
2) All payments made shall be subject to an applicable Deductible (if any) for
such payment for each and every claim made, and to the Accumulation
Limit.
3) We will only make payment to an Insured Person who will be deemed to be
authorised by You to receive the concerned payment. If the Insured Person
has died, We will only make payment to:

i. The Nominee (as named in the Certificate of Insurance), or

ii. The Insured Persons, legal heirs if no nominee has been appointed, or if
the nominee has died.
4) All payments under this Policy will be in Indian Rupees only.
5) We are not obliged to make payment for any claim or that part of any claim
that could have been avoided or reduced if the Insured Person had taken
reasonable care or could reasonably have minimised the costs incurred,
or that is brought about or contributed to by the Insured Person failing to
follow the directions, advice or guidance provided by Us by Our Assistance
Company or by a Medical Practitioner.
6) We shall make the payment of claim that has been admitted as payable by
Us under the Policy terms and conditions within 30 days of submission of
all necessary documents / information and any other additional information
required for the settlement of the claim. All claims will be settled in
accordance with the applicable regulatory guidelines, including IRDA
(Protection of Policyholders Regulation), 2002. In case of delay in payment
of any claim that has been admitted as payable by Us under the Policy
terms and condition, beyond the time period as prescribed under IRDA
(Protection of Policyholders Regulation), 2002, we shall pay interest at a rate
which is 2% above the bank rate prevalent at the beginning of the financial
year in which the claim is reviewed by Us. For the purpose of this clause,
bank rate shall mean the existing bank rate as notified by Reserve Bank of
India, unless the extent regulation requires payment based on some other
prescribed interest rate.
f) Fraud
If any claim is in any manner dishonest or fraudulent, or is supported by any
dishonest or fraudulent means or devices, whether by You or any Insured Person
or anyone acting on behalf of You or an Insured Person, then this Policy shall be
void and all benefits paid under it shall be forfeited.
g) Other Insurance
If at the time when any claim is made under this Policy, insured has two or
more policies from one or more Insurers to indemnify treatment cost, which also
covers any claim (in part or in whole) being made under this Policy, then the
Policy holder shall have the right to require a settlement of his claim in terms of
any of his policies. The insurer so chosen by the Policy holder shall settle the
claim, as long as the claim is within the limits of and according to terms of the
chosen policy.
Provided further that, If the amount to be claimed under the Policy chosen by the
Policy holder, exceeds the sum insured under a single Policy after considering
the deductibles or co-pay (if applicable), the Policy holder shall have the right to
choose the insurers by whom claim is to be settled. In such cases, the respective
insurers may then settle the claim by applying the Contribution clause.
h) Subrogation
You and/or any Insured Persons shall at Your own expense do or concur in
doing or permit to be done all such acts and thingsthat may be necessary or
reasonably required by Us for the purpose of enforcing and/or securing any civil
or criminal rights andremedies or obtaining relief or indemnity from any other
party to which We are or would become entitled upon Us makingreimbursement
under this Policy, whether such acts or things shall be or become necessary or
required before or after Our payment.Neither You nor any Insured Person shall
prejudice these subrogation rights in any manner and shall at Your own expense
provideUs with whatever assistance or cooperation is required to enforce such
rights. Any recovery We make pursuant to this clause shallfirst be applied to the
amounts paid or payable by Us under this Policy and Our costs and expenses of
effecting a recovery,where-after we shall pay any balance remaining to You.
organisation or government, committed for political, religious, ideological,

or ethnic purposes or other reasons including the intention to influence any
government and/or to put the public, or any section of the public, in fear.
Experimental, investigational or unproven treatment devices and
pharmacological regimens, or measures primarily for diagnostic, X-ray or
laboratory examinations or other diagnostic studies which are not consistent
with or incidental to the diagnosis and treatment of the positive existence or
presence of any Illness for which confinement is required at a Hospital.
Any Pre-existing Condition declared or not declared or any complication
arising from it.
Any person who has obtained cover and is under Age 180 days or above Age
70 years.
Any non medical expenses mentioned in Annexure I
GENERAL CONDITIONS
a) Conditions Precedent
The fulfilment of the terms and conditions of this Policy (including the payment
of premium by the due dates mentioned in the Schedule) insofar as they relate
to anything to be done or complied with by You or any Insured Person shall be
conditions precedent to Our liability.
b) Insured Person
Only those persons to whom a Certificate of Insurance has been issued shall be
covered under this master Policy. Any person may be accepted as an Insured
Person during the Policy Period only after his application has been accepted
by Us, additional premium has been paid and We have issued a Certificate of
Insurance to such person.
c) Notification of Claim
1) If any treatment, consultation or procedure for which a claim may be made
is required in an emergency, then We or Our Assistance Company must be
informed within 7 days of the beginning of such treatment, consultation or
procedure.
2) In all other cases, We or Our Assistance Company must be informed of any
event or occurrence that may give rise to a claim under this Policy within 7
days of the occurrence of the event giving rise to the claim.
d) Supporting Documentation & Examination
1) The Insured Person shall provide Us with any documentation and information
We or Our Assistance Company may request to establish the circumstances
of the claim, its quantum or Our liability for it within 30 days of the earlier
of Our request or the Insured Persons discharge from Hospitalisation or
completion of treatment or the completion of the event or occurrence giving
rise to a claim. The Company may accept claims where documents have
been provided after a delayed interval only in special circumstances and
for the reasons beyond the control of the insured. Such documentation will
include but is not limited to the following in English:

i. Our claim form duly completed and signed for on behalf of the Insured
Person.

ii. Original Bills (including but not limited to pharmacy purchase bill,
consultation bill, and diagnostic bill) and any attachments thereto like
receipts or prescriptions in support of any amount claimed which will
then become Our property.

iii. All reports, including but not limited to all medical reports, case histories,
investigation reports, treatment papers, discharge summaries.

iv. A precise diagnosis of the treatment for which a claim is made.

v. A detailed list of the individual medical services and treatments provided
and a unit price for each.

vi. Prescriptions that name the Insured Person and in the case of drugs: the
drugs prescribed, their price and a receipt for payment. Prescriptions
must be submitted with the corresponding Medical Practitioners invoice.

vii. Obs history/ Antenatal card

viii. Previous treatment record along with reports, if any

ix. Indoor case papers

x. Indoor case papers

xi. MLC/ FIR copy/ certificate regarding abuse of Alcohol/intoxicating agent,
in case of Accidental injury
2) The Insured Person additionally hereby consents to:

i. The disclosure to Us of documentation and information that may be held
by medical professionals and other insurers.

ii. Being examined by any Medical Practitioner We authorise for this
purpose when and so often as We may reasonably require. We will bear

Policy Wording
i) Alterations to the Policy

This master Policy constitutes the complete contract of insurance. This master
Policy cannot be changed or varied by anyone(including an insurance agent
or broker) except Us, and any change We make will be evidenced by a written
endorsement signed and stamped by Us.
j) Notices
Any notice, direction or instruction under this Policy shall be in writing and if it is
to:
1) Any Insured Person, then it shall be sent to You at Your address specified in
the Schedule and You shall act for all Insured Persons for these purposes.
2) Us, it shall be delivered to Our address specified in the Schedule. No
insurance agents, brokers or other person or entity is authorised to receive
any notice, direction or instruction on Our behalf unless We have expressly
stated to the contrary in writing.
k) Dispute Resolution Clause
Any and all disputes or differences under or in relation to this Policy shall be
determined by the Indian Courts and subject to Indian law.
l) Geography
This Policy applies to incidents anywhere within India only, and it is expressly
agreed that an Insured Persons usual place of residence for the purposes of
this Policy and the benefits payable under it will be and remain within India.
m) Termination
1) You (MakeMyTrip) may terminate this master Policy at any time by giving
us written notice, and the master Policy shall terminate when such written
notice is received by Us. If no claim has been made under the master Policy
then We will refund premium in accordance with the table below:
Length of time Policy in force
Refund of premium
up to 1 month
75%
up to 3 months
50%
up to 6 months
25%
exceeding 6 months
0%
benefits from all Insured Persons arising from the same Accident, event
or occurrence or series of related Accidents, events or occurrences, and
if at any time the total value of unpaid claims would, if paid, result in the
Accumulation Limit being exceeded (even if the Sum Insured is not) the
individual benefits attributable to those outstanding claims shall be reduced
pro rata as necessary to ensure that the Accumulation Limit is not exceeded.
c)
Age or Aged means completed years as at the commencement date.
d)
Carrier means a civilian air carrier :

1) which is operating under a valid licence issued by the appropriate Indian

governmental authority for the transportation of passengers within India by
air for a fee, and
2) Which maintains and publishes tariffs for regular passenger air services
which it operates between named cities at regular and specified times.
e)
Certificate of Insurance means the certificate we issue to an Insured
Person. The Certificate of Insurance can only be issued prior to the
commencement of the Risk Period.
f)
Condition Precedent shall mean a policy term or condition upon which the
Insurers liability under the policy is conditional upon.
g)
Deductible is a cost-sharing requirement under a health insurance policy
that provides that the insurer will not be liable for a specified rupee amount
in case of indemnity policies and for a specified number of days/hours
in case of hospital cash policies which will apply before any benefits are
payable by the insurer. A deductible does not reduce the Sum Insured
h)
Disclosure to information norm- The Policy shall be void and all
premium paid hereon shall be forfeited to the Company, in the event of
misrepresentation, mis-description or non-disclosure of any material fact.
i)
Emergency Care means management for a severe 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 persons health.
j)
Hospitalisation means admission in a Hospital for a minimum period
of 24 In patient Care consecutive hours except for specified procedures/
treatments, where such admission could be for a period of less than
24consecutive hours
2) We may terminate this master Policy on grounds of misrepresentation,

fraud, non-disclosure of material facts or non-cooperation by You or any
Insured Person or anyone acting on Your behalf or on behalf of an Insured
Person upon 30 days notice by sending an endorsement to Your address
shown in the Schedule, and We shall refund a rateable proportion of the
premium as long as no claim has been made under the master Policy.
3) If the master Policy is cancelled, then each Certificate of Insurance which is
already in force under the master Policy will continue in force until the end
of the Risk Period.
4) The amount paid for any Certificate of Insurance will be non-refundable.
n) Renewal
1) This master Policy will terminate no later than the expiry date of the Policy
Period unless We have agreed in writing to an extension of the Policy Period
and Our conditions for agreeing to the extension, including as to the payment
of additional premium, have been met.
2) We are under no obligation to give notice that the master Policy is due
for renewal, or to renew it or to renew it on the same terms whether as
to premium or otherwise. We shall be entitled to call for and receive any
information or documentation before agreeing to renew the master Policy,
and in renewing We are not bound to renew for all Insured Persons.
3) The Certificate of Insurance will terminate no later than the expiry date
mentioned therein or the end of the Risk Period (whichever is earlier). No
renewal or extension of the Certificate of Insurance will be permitted. After
the commencement of the Risk Period, the amount paid for the Certificate of
Insurance will be non-refundable.
DEFINITIONS
The terms defined below have the meanings ascribed to them wherever they appear
in this Policy and, where appropriate, references to the singular include references to
the plural; references to the male include the female and references to any statutory
enactment include subsequent changes to the same.
k)
Hospital means any institution established for in-patient 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 in-patient beds in towns having a population of less

than 10,00,000 and at least 15 in-patient beds in all other places;
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 companys authorized personnel.
l)
Illness means a sickness or a disease or pathological condition leading
to the impairment of normal physiological function which manifests itself
during the Policy Period and requires medical treatment.
a)
Accident or Accidental means a sudden, unforeseen and unexpected
event caused by external, violent and visible means.
b)
Accumulation Limit means the amount stated in the Schedule
which represents Our maximum liability for all claims under any and all
i. 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.
ii. Chronic condition - A chronic condition is defined as a disease, illness,

or injury that has one or more of the following characteristics:it needs
ongoing or long-term monitoring through consultations, examinations,
check-ups, and / or testsit needs ongoing or long-term control or
relief of symptoms it requires your rehabilitation or for you to be
specially trained to cope with itit continues indefinitelyit comes
back or is likely to come back.

Policy Wording
m)
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.
y)
Notification of Claim means the process of notifying a claim to the insurer
or TPA by specifying the timeliness as well as the address / telephone
number to which it should be notified.
z)
Outpatient Treatment is one in which the Insured visits a clinic / hospital
or associated facility like a consultation room for diagnosis and treatment
based on the advice of a Medical Practitioner. The Insured is not admitted as
a day care or in-patient.
n)
Medically Necessary treatment is defined as any treatment, tests,
medication, or stay in hospital or part of a stay in hospital which

i.
is required for the medical management of the illness or injury suffered

by the insured;
aa)
Policy means your statements in the proposal form, Certificate of Insurance,
this Policy wording (including Annexure 1, endorsements, if any) and the
Schedule.
ii. must not exceed the level of care necessary to provide safe,
adequate and appropriate medical care in scope, duration, or intensity;
bb)
Policy Period means the period between the commencement date and the
expiry date specified in the Schedule.
iii. must have been prescribed by a medical practitioner;
iv. must conform to the professional standards widely accepted in

international medical practice or by the medical community in India.
cc)
Pre-existing Condition means any condition, ailment or injury or related
condition(s) for which you had signs or symptoms, and / or were diagnosed,
and / or received medical advice/ treatment, within 48 months prior to the
first policy issued by the insurer.
o)
Medical Practitioner is a person who holds a valid registration from the
Medical Council of any State or Medical Council of India or Council for
Indian Medicine or for Homeopathy set up by 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 licence
dd)
Risk Period means only the period between:
p)
Illness means a sickness or a disease or pathological condition leading
to the impairment of normal physiological function which manifests itself
during the Policy Period and requires medical treatment.

i. 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.
1) The scheduled time of departure of the Carrier on which the Insured

Person is booked to travel as a fare paying passenger, and
2) The earlier of:
a. The time when the Insured Person returns to his usual place of
residence as shown in the Certificate of Insurance, and
b. The expiry date specified in the Certificate of Insurance.
The Risk Period will be evidenced only by the Certificate of

Insurance issued by Us during the Policy Period.
ee)
Schedule means the schedule attached to and forming part of this master
Policy, and if more than one then latest in time.
ii. Chronic condition - A chronic condition is defined as a disease, illness,

or injury that has one or more of the following characteristics:it needs
ongoing or long-term monitoring through consultations, examinations,
check-ups, and / or testsit needs ongoing or long-term control or
relief of symptoms it requires your rehabilitation or for you to be
specially trained to cope with itit continues indefinitelyit comes back
or is likely to come back.
ff)
Scheduled Railway Carrier means a civilian railway carrier
q)
Immediate Family Member means the Insured Persons legal spouse,
parent, parent-in-law, child.
r)
Insured Person means the persons to whom a Certificate of Insurance has
been issued.
1) Which is operated between named cities under a valid licence issued

by the appropriate Indian governmental authority for the transportation
of passengers within India by railroad for a fee, and
2) Which maintains and publishes regular tariffs for regular passenger

rail services which it operates between named cities at regular and
specified times.
gg)
Sum Insured means, in respect of each Section, the sum shown in the
Schedule against that Section and such sum represents our maximum
liability for each Insured Person for any and all claims made during the Policy
Period under that Section.
s)
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.
hh)
Surgical Procedure means an operative procedure for the correction of
deformities and defects, repair of injuries, cure of diseases, relief of suffering
and prolongation of life.
t)
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.
ii)
Assistance Company means the service provider that We appoint from
time to time as specified in the Schedule.
jj)
Valuables means photographic, audio, video, computer (including personal
data assistants or handheld computers), telecommunications, electronic
and electrical equipment, cellular phones, data recorded on tapes, cards,
discs or otherwise, business goods or samples, securities such as credit
cards, debit cards, membership cards, tickets or documents, musical
instruments, telescopes, binoculars, spectacles, contact or corneal lenses,
artificial teeth, bridges or prosthetic limbs, hearing aids, sunglasses, snow
skis, motor vehicles (including accessories), motorcycles, boats, motors,
any conveyance (except bicycles while checked as baggage with a Carrier),
household effects, antiques, watches, art, jewellery, furs and any articles
made of precious stones and metals.
u)
Medical Practitioner means a person who holds a qualification in medicine
from a recognized institution and is registered by the state council, governed
by the Medical Council of India in which he operates and is practicing within
the scope of such license and will include (but is not limited to) physicians,
specialists and surgeons who satisfy the aforementioned criteria.
v)
Money means cash, bank drafts, current coins, bank and currency notes,
treasury notes, cheques, travellers cheques, postal orders and current
postage stamps (which are not part of a collection).
w)
Network Provider means Hospitals or health care providers enlisted by an
insurer or by a TPA and insurer together to provide medical services to an
insured on payment by a cashless facility
kk)
We/Our/Us means the Apollo Munich Health Insurance Company Limited.
ll)
You/Your or Policyholder means the person (MakeMyTrip) named in the
Schedule who has concluded this Policy with Us.
x)
Non Network means any Hospital, day care centre or other provider that is
not part of the Network

Policy Wording
SCHEDULE OF BENEFITS
Benefits
Sum Insured
Deductible
Benefit 1.1 Accident: Medical Treatment
Rs. 100,000
Nil
Benefit 1.2 Accident: Medical Evacuation
Rs. 100,000
Nil
Benefit 1.3 Transportation of Mortal Remains
Rs. 100,000
Nil
Benefit 2 Total Loss of Checked-in Baggage
Rs. 10,000
Nil
Benefit 3 Delay of Checked-in Baggage
Rs. 5,000
12 Hrs.
Benefit 4 Personal Liability
Rs. 100,000
Nil
Benefit 5 Personal Accident [24 Hrs.]
Rs. 750,000
Nil
Benefit 6 Trip Cancellation
Rs. 20,000
Nil
Benefit 7 Trip Curtailment
Rs. 20,000
Nil
Benefit 8 Emergency Travel
Rs. 10,000
Nil
Benefit 9 Emergency Hotel
Rs. 10,000
10%
Benefit 10 Flight Delay
Rs. 2,000
Nil
Claim Related Information

For any claim related queries, intimation of claim, preauthorization, claim processing,
claim status, and submission of claim related documents, You can contact Us:

Address
: Claims Department,
Apollo Munich Health Insurance Company Limited
10th Floor, Building No. 10, Tower B, DLF City Phase II,
DLF Cyber City, Gurgaon-122002

Toll Free : 1800 - 102 - 0333

Fax
: +91 - 124 - 4584112
Email
: claim@apollomunichinsurance.com
Website : www.apollomunichinsurance.com
Grievance Redressal Procedure
If You have a grievance that You wish Us to redress, You may contact Us with the
details of Your grievance through:
Our website : www.apollomunichinsurance.com
Email
: customerservice@apollomunichinsurance.com
Telephone : 1800-102-0333
Fax
: +91-124-4584111
Courier
: Any of our Branch office or corporate office
You may also approach the grievance cell at any of Our branches with the details of
Your grievance during Our working hours from Monday to Friday.
If You are not satisfied with Our redressal of Your grievance through one of the above
methods, You may contact Our Head of Customer Service at The Grievance Cell,
Apollo Munich Health Insurance Company Ltd., Tenth Floor, Building No. 10,
Tower - B, DLF Cyber City, DLF City Phase II, Gurgaon, Haryana - 122002
If You are not satisfied with Our redressal of Your grievance through one of the above
methods, You may approach the nearest Insurance Ombudsman for resolution of
Your grievance. The contact details of Ombudsman offices are mentioned below.
Jurisdiction
Office Address
Orissa
Shri B. P. Parija (Ombudsman)

Insurance Ombudsman, Office of the Insurance
Ombudsman, 62, Forest Park,
BHUBANESHWAR-751 009.
Tel.:- 0674-2596455 Fax : 0674-2596429
Email: ioobbsr@dataone.in
Punjab, Haryana,
Himachal Pradesh,
Jammu & Kashmir,
UT of Chandigarh
Shri Manik Sonawane (Ombudsman)

Insurance Ombudsman, Office of the Insurance
Ombudsman, S.C.O. No.101-103, 2nd Floor, Batra
Building. Sector 17-D, CHANDIGARH-160 017.
Tel.:- 0172-2706468 Fax : 0172-2708274
Email: ombchd@yahoo.co.in
Tamil Nadu, UTPondicherry Town

and Karaikal (which
are part of UT of
Pondicherry)
Insurance Ombudsman,
Office of the Insurance Ombudsman,
Fathima Akhtar Court, 4th Floor, 453 (old 312), Anna
Salai, Teynampet, CHENNAI-600 018.
Tel.:- 044-24333668 /5284 Fax : 044-24333664
Email: chennaiinsuranceombudsman@gmail.com
Delhi & Rajasthan
Shri Surendra Pal Singh (Ombudsman)

Office of the Insurance Ombudsman, 2/2 A, Universal
Insurance Bldg., Asaf Ali Road, NEW DELHI-110 002.
Tel.:- 011-23239633 Fax : 011-23230858
Email: iobdelraj@rediffmail.com
Assam, Meghalaya,
Manipur, Mizoram,
Arunachal Pradesh,
Nagaland and
Tripura
Shri D.C. Choudhury (Ombudsman)

Office of the Insurance Ombudsman, Jeevan Nivesh,
5th Floor, Near Panbazar Overbridge, S.S. Road,
GUWAHATI-781 001 (ASSAM).
Tel.:- 0361-2132204/5 Fax : 0361-2732937
Email: ombudsmanghy@rediffmail.com
Andhra Pradesh,
Karnataka and
UT of Yanam - a
part of the UT of
Pondicherry
Office of the Insurance Ombudsman,

6-2-46, 1st Floor, Moin Court, A.C. Guards, Lakdi-KaPool,
HYDERABAD-500 004.
Tel : 040-65504123 Fax: 040-23376599
Email: insombudhyd@gmail.com
Kerala, UT of (a)
Lakshadweep, (b)
Mahe - a part of UT
of Pondicherry
Shri R. Jyothindranathan (Ombudsman)

Office of the Insurance Ombudsman, 2nd Floor, CC
27/2603, Pulinat Bldg., Opp. Cochin Shipyard, M.G.
Road,
ERNAKULAM-682 015.
Tel : 0484-2358759 Fax : 0484-2359336
Email: iokochi@asianetindia.com
West Bengal , Bihar,

Jharkhand and
UT of Andeman &
Nicobar Islands ,
Sikkim
Ms. Manika Datta (Ombudsman)

Office of the Insurance Ombudsman, 4th Floor,
Hindusthan Bldg. Annexe, 4, C.R.Avenue,
KOLKATTA - 700 072.
Tel: 033 22124346/(40) Fax: 033 22124341
Email: iombsbpa@bsnl.in
Uttar Pradesh and

Uttaranchal
Shri G. B. Pande (Ombudsman)

Office of the Insurance Ombudsman, Jeevan Bhawan,
Phase-2, 6th Floor, Nawal Kishore Road, Hazaratganj,
LUCKNOW-226 001.
Tel : 0522 -2231331 Fax : 0522-2231310
Email: insombudsman@rediffmail.com
Maharashtra , Goa
Office of the Insurance Ombudsman, S.V. Road,
Santacruz(W), MUMBAI-400 054.
Tel : 022-26106928 Fax : 022-26106052
Email: ombudsmanmumbai@gmail.com
Ombudsman Offices
Jurisdiction
Office Address
Gujarat, UT of Dadra
& Nagar Haveli,
Daman and Diu
Shri P. Ramamoorthy (Ombudsman)

Office of the Insurance Ombudsman, 2nd Floor,
Ambica House, Nr. C.U. Shah College, Ashram Road,
AHMEDABAD-380 014.
Tel.:- 079-27546840 Fax : 079-27546142
Email: ins.omb@rediffmail.com
Madhya Pradesh &

Chhattisgarh
Office of the Insurance Ombudsman, Janak Vihar
Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel, Near
New Market, BHOPAL(M.P.)-462 023.
Tel.:- 0755-2569201 Fax : 0755-2769203
Email: bimalokpalbhopal@airtelmail.in
IRDA REGULATION NO 5: This policy is subject to regulation 5 of IRDA (Protection of

Policyholders Interests) Regulation.

Policy Wording
Annexure I
S
NO.
List of excluded expenses (NonMedical) under indemnity Policy
Expenses
32
LAUNDRY CHARGES
Not Payable
S
NO.
Expenses
HAIR REMOVAL CREAM CHARGES
Not Payable
33
MINERAL WATER
Not Payable
BABY CHARGES (UNLESS SPECIFIED/

INDICATED)
Not Payable
34
OIL CHARGES
Not Payable
BABY FOOD
Not Payable
35
SANITARY PAD
Not Payable
BABY UTILITES CHARGES
Not Payable
36
SLIPPERS
Not Payable
BABY SET
Not Payable
37
TELEPHONE CHARGES
Not Payable
BABY BOTTLES
Not Payable
38
TISSUE PAPER
Not Payable
BRUSH
Not Payable
39
TOOTH PASTE
Not Payable
COSY TOWEL
Not Payable
40
TOOTH BRUSH
Not Payable
HAND WASH
Not Payable
41
GUEST SERVICES
Not Payable
10
MOISTURISER PASTE BRUSH
Not Payable
42
BED PAN
Not Payable
11
POWDER
Not Payable
43
BED UNDER PAD CHARGES
Not Payable
12
RAZOR
Payable
44
CAMERA COVER
Not Payable
13
SHOE COVER
Not Payable
45
CLINIPLAST
Not Payable
14
BEAUTY SERVICES
Not Payable
46
CREPE BANDAGE
Not Payable/ Payable by the

patient
15
BELTS/ BRACES
Essential and should be paid

at least specifically
for cases who have
undergone surgery
of thoracic or lumbar
spine
47
CURAPORE
Not Payable
48
DIAPER OF ANY TYPE
Not Payable
49
DVD, CD CHARGES
Not Payable (However if

CD is specifically sought by
Insurer/TPA then payable)
50
EYELET COLLAR
Not Payable
51
FACE MASK
Not Payable
52
FLEXI MASK
Not Payable
53
GAUSE SOFT
Not Payable
54
GAUZE
Not Payable
55
HAND HOLDER
Not Payable
56
HANSAPLAST/ ADHESIVE BANDAGES
Not Payable
57
INFANT FOOD
Not Payable
58
SLINGS
Reasonable costs for one

sling in case of upper arm
fractures may be considered
16
BUDS
Not Payable
17
BARBER CHARGES
Not Payable
18
CAPS
Not Payable
19
COLD PACK/HOT PACK
Not Payable
20
CARRY BAGS
Not Payable
21
CRADLE CHARGES
Not Payable
22
COMB
Not Payable
23
DISPOSABLES RAZORS CHARGES ( for

site preparations)
Payable
24
EAU-DE-COLOGNE / ROOM FRESHNERS
Not Payable
25
EYE PAD
Not Payable
26
EYE SHEILD
Not Payable
27
EMAIL / INTERNET CHARGES
Not Payable
28
FOOD CHARGES (OTHER THAN PATIENTs Not Payable

DIET PROVIDED BY HOSPITAL)
29
FOOT COVER
Not Payable
30
GOWN
Not Payable
31
LEGGINGS
Essential in bariatric and

varicose vein surgery and
may be considered for at
least these conditions
where surgery itself is
payable.
ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES
59
WEIGHT CONTROL PROGRAMS/

SUPPLIES/ SERVICES
Exclusion in policy unless

otherwise specified
60
COST OF SPECTACLES/ CONTACT

LENSES/ HEARING AIDS ETC.,

otherwise specified
61
DENTAL TREATMENT EXPENSES THAT

DO NOT REQUIRE HOSPITALISATION

otherwise specified
62
HORMONE REPLACEMENT THERAPY

otherwise specified
63
HOME VISIT CHARGES

otherwise specified

Policy Wording
S
NO.
Expenses
S
NO.
Expenses
64
INFERTILITY/ SUBFERTILITY/ ASSISTED

CONCEPTION PROCEDURE

otherwise specified
86
ANTISEPTIC OR DISINFECTANT LOTION
Not Payable - Part of

Dressing charges
65
OBESITY (INCLUDING MORBID OBESITY)

TREATMENT

otherwise specified
87
BAND AIDS, BANDAGES, STERLILE

INJECTIONS, NEEDLES, SYRINGES

Dressing charges
66
PSYCHIATRIC & PSYCHOSOMATIC

DISORDERS

otherwise specified
88
COTTON

Dressing charges
67
CORRECTIVE SURGERY FOR REFRACTIVE Exclusion in policy unless

ERROR
otherwise specified
89
COTTON BANDAGE

Dressing charges
68
TREATMENT OF SEXUALLY
TRANSMITTED DISEASES

otherwise specified
90
MICROPORE/ SURGICAL TAPE
69
DONOR SCREENING CHARGES

otherwise specified
Not Payable-Payable by the

patient when prescribed,
otherwise included as
Dressing Charges
70
ADMISSION/REGISTRATION CHARGES

otherwise specified
91
BLADE
Not Payable
92
APRON
71
HOSPITALISATION FOR EVALUATION/

DIAGNOSTIC PURPOSE

otherwise specified
Not Payable -Part of Hospital

Services/ Disposable linen to
be part of OT/ICU charges
72
EXPENSES FOR INVESTIGATION/

TREATMENT IRRELEVANT TO THE
DISEASE FOR WHICH ADMITTED OR
DIAGNOSED
Not Payable - Exclusion

in policy unless otherwise
specified
93
TORNIQUET
Not Payable (service is

charged by hospitals,
consumables cannot be
separately charged)
73
ANY EXPENSES WHEN THE PATIENT IS

DIAGNOSED WITH RETRO VIRUS + OR
SUFFERING FROM /HIV/ AIDS ETC IS
DETECTED/ DIRECTLY OR INDIRECTLY
Not payable as per HIV/AIDS

exclusion
94
ORTHOBUNDLE, GYNAEC BUNDLE
Part of Dressing Charges
95
URINE CONTAINER
Not Payable
STEM CELL IMPLANTATION/ SURGERY

AND STORAGE
Not Payable except Bone

Marrow Transplantation
where covered by policy
74
ELEMENTS OF ROOM CHARGE

96
LUXURY TAX
Actual tax levied by

government is payable.Part of
room charge for sub limits
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE

SEPARATE5CONSUMABLES ARE NOT PAYABLE BUT THE SERVICE IS
97
HVAC
Part of room charge not

payable separately
75
WARD AND THEATRE BOOKING

CHARGES
Payable under OT Charges,

not payable separately
98
HOUSE KEEPING CHARGES

payable separately
76
ARTHROSCOPY & ENDOSCOPY

INSTRUMENTS
Rental charged by the

hospital payable. Purchase
of Instruments not payable.
99
SERVICE CHARGES WHERE NURSING

CHARGE ALSO CHARGED

payable separately
77
MICROSCOPE COVER

not separately
100
TELEVISION & AIR CONDITIONER

CHARGES
Payable under room charges

not if separately levied
78
SURGICAL BLADES,HARMONIC
SCALPEL,SHAVER

not separately
101
SURCHARGES
Part of Room Charge, Not

payable separately
79
SURGICAL DRILL

not separately
102
ATTENDANT CHARGES
Not Payable - Part of Room

Charges
80
EYE KIT

not separately
103
IM IV INJECTION CHARGES
Part of nursing charges, not

payable
81
EYE DRAPE

not separately
104
CLEAN SHEET
Part of Laundry/
Housekeeping not payable
separately
82
X-RAY FILM
Payable under Radiology

Charges, not as consumable
105
Patient Diet provided by

hospital is payable
83
SPUTUM CUP
Payable under Investigation

Charges, not as consumable
EXTRA DIET OF PATIENT(OTHER THAN

THAT WHICH FORMS PART OF BED
CHARGE)
106
BLANKET/WARMER BLANKET
84
BOYLES APPARATUS CHARGES
Part of OT Charges, not

seperately
Not Payable - Part of Room

Charges
85
BLOOD GROUPING AND CROSS

MATCHING OF DONORS SAMPLES
Part of Cost of Blood, not

payable
ADMINISTRATIVE OR NON-MEDICAL CHARGE

107
ADMISSION KIT
Not Payable

Policy Wording
S
NO.
Expenses
S
NO.
Expenses
108
BIRTH CERTIFICATE
Not Payable
140
SPO2 PROBE
Not Payable
109
BLOOD RESERVATION CHARGES AND

ANTE NATAL BOOKING CHARGES
Not Payable
141
NEBULIZER KIT
Not Payable
110
CERTIFICATE CHARGES
Not Payable
142
STEAM INHALER
Not Payable
111
COURIER CHARGES
Not Payable
143
ARMSLING
Not Payable
112
CONVENYANCE CHARGES
Not Payable
144
THERMOMETER
Not Payable (paid by patient)
113
DIABETIC CHART CHARGES
Not Payable
145
CERVICAL COLLAR
Not Payable
114
DOCUMENTATION CHARGES /
ADMINISTRATIVE EXPENSES
Not Payable
146
SPLINT
Not Payable
147
DIABETIC FOOT WEAR
Not Payable
115
DISCHARGE PROCEDURE CHARGES
Not Payable
148
KNEE BRACES ( LONG/ SHORT/ HINGED)
Not Payable
116
DAILY CHART CHARGES
Not Payable
149
Not Payable
117
ENTRANCE PASS / VISITORS PASS

CHARGES
Not Payable
KNEE IMMOBILIZER/SHOULDER
IMMOBILIZER
150
LUMBO SACRAL BELT
118
EXPENSES RELATED TO PRESCRIPTION

ON DISCHARGE
To be claimed by patient
under Post Hosp where
admissible
Essential and should be paid

at least specifically for cases
who have undergone surgery
of lumbar spine.
151
NIMBUS BED OR WATER OR AIR BED

CHARGES
Payable for any ICU

patient requiring more
than 3 days in ICU, all
patients with paraplegia/
quadriplegia for any reason
and at reasonable cost of
approximately Rs 200/ day
119
FILE OPENING CHARGES
Not Payable
120
INCIDENTAL EXPENSES / MISC.

CHARGES (NOT EXPLAINED)
Not Payable
121
MEDICAL CERTIFICATE
Not Payable
122
MAINTAINANCE CHARGES
Not Payable
152
AMBULANCE COLLAR
Not Payable
123
MEDICAL RECORDS
Not Payable
153
AMBULANCE EQUIPMENT
Not Payable
124
PREPARATION CHARGES
Not Payable
154
MICROSHIELD
Not Payable
125
PHOTOCOPIES CHARGES
Not Payable
155
ABDOMINAL BINDER
126
PATIENT IDENTIFICATION BAND / NAME

TAG
Not Payable
127
WASHING CHARGES
Not Payable
128
MEDICINE BOX
Not Payable
129
MORTUARY CHARGES
Payable upto 24 hrs, shifting

charges not payable
Essential and should be

paid at least in post surgery
patients of major abdominal
surgery including TAH, LSCS,
incisional hernia repair,
exploratory laparotomy for
intestinal obstruction, liver
transplant etc.
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
130
MEDICO LEGAL CASE CHARGES (MLC

CHARGES)
Not Payable
156
BETADINE \ HYDROGEN PEROXIDE\

SPIRIT\\DETTOL \SAVLON\
DISINFECTANTS ETC
May be payable when

prescribed for patient, not
payable for hospital use in
OT or ward or for dressings
in hospital
157
PRIVATE NURSES CHARGES- SPECIAL

NURSING CHARGES
Post hospitalization nursing

charges not Payable
158
NUTRITION PLANNING CHARGES DIETICIAN CHARGES-DIET CHARGES
Patient Diet provided by

hospital is payable
159
SUGAR FREE TABLET
Payable -Sugar free variants

of admissable medicines are
not excluded
160
CREAMS POWDERS LOTIONS (Toileteries Payable when prescribed

are not payable,only prescribed medical
pharmaceuticals payable)
161
DIGENE GEL/ ANTACID GEL
EXTERNAL DURABLE DEVICES

131
WALKING AIDS CHARGES
Not Payable
132
BIPAP MACHINE
Not Payable
133
COMMODE
Not Payable
134
CPAP/ CAPD EQUIPMENTS
Device not payable
135
INFUSION PUMP - COST
Device not payable
136
OXYGEN CYLINDER (FOR USAGE

OUTSIDE THE HOSPITAL)
Not Payable
137
PULSEOXYMETER CHARGES
Device not payable
138
SPACER
Not Payable
139
SPIROMETRE
Device not payable
10
Payable when prescribed

Policy Wording
S
NO.
Expenses
S
NO.
Expenses
162
ECG ELECTRODES
Upto 5 electrodes are

required for every case
visiting OT or ICU. For longer
stay in ICU, may require a
change and at least one set
every second day must be
payable.
181
EXAMINATION GLOVES
Not Payable
182
KIDNEY TRAY
Not Payable
183
MASK
Not Payable
184
OUNCE GLASS
Not Payable
185
OUTSTATION CONSULTANTS/
SURGEONS FEES
Not payable, except for

telemedicine consultations
where covered by policy
186
OXYGEN MASK
Not Payable
187
PAPER GLOVES
Not Payable
188
PELVIC TRACTION BELT
Should be payable in case

of PIVD requiring traction as
this is generally not reused
163
GLOVES
Sterilized Gloves payable

/ unsterilized gloves not
payable
164
HIV KIT
Payable - payable Pre

operative screening
165
LISTERINE/ ANTISEPTIC MOUTHWASH
166
LOZENGES
167
MOUTH PAINT
189
REFERAL DOCTORS FEES
Not Payable
168
NEBULISATION KIT
If used during hospitalization

is payable reasonably
190
ACCU CHECK ( Glucometery/ Strips)
169
NOVARAPID
170
VOLINI GEL/ ANALGESIC GEL
Not payable pre

hospitilasation or post
hospitalisation / Reports and
Charts required/ Device not
payable
171
ZYTEE GEL
191
PAN CAN
Not Payable
172
VACCINATION CHARGES
Routine Vaccination
not Payable / Post Bite
Vaccination Payable
192
SOFNET
Not Payable
193
TROLLY COVER
Not Payable
PART OF HOSPITALS OWN COSTS AND NOT PAYABLE
194
UROMETER, URINE JUG
Not Payable
173
AHD

Hospitals internal Cost
195
AMBULANCE
174
ALCOHOL SWABES

Payable-Ambulance
from home to hospital
or interhospital shifts is
payable/ RTA as specific
requirement is payable
175
SCRUB SOLUTION/STERILLIUM

196
TEGADERM / VASOFIX SAFETY
Payable - maximum of 3 in
48 hrs and then 1 in 24 hrs
197
URINE BAG
Payable where medicaly

necessary till a reasonable
cost - maximum 1 per 24
hrs
198
SOFTOVAC
Not Payable
199
STOCKINGS
Essential for case like CABG

etc. where it should be paid.
OTHERS
176
VACCINE CHARGES FOR BABY
Not Payable
177
AESTHETIC TREATMENT / SURGERY
Not Payable
178
TPA CHARGES
Not Payable
179
VISCO BELT CHARGES
Not Payable
180
ANY KIT WITH NO DETAILS MENTIONED

[DELIVERY KIT, ORTHOKIT, RECOVERY
KIT, ETC]
Not Payable
DT/PW/V0.08/072014
AMHI/PR/H/0012/0008A/102010/P

Quick reference guide for making a claim
Benefit
Claim Supporting Documents
Accident: Medical
Treatment, Assistance &
Evacuation
Apollo Munich Health Insurance Company Limited will provide the insurance cover detailed in the master Policy
Signed claim form
Medical reports and discharge summary issued by the Hospital or prescriptions and medical report from the Medical Practitioner
furnishing the name of the Insured, period of treatment and details of treatment rendered.
Bills / receipts for
a. Charges paid towards Hospital accommodation, nursing facilities and other medical services rendered;
b. Fees paid to the medical practitioner, special nursing charges, etc.
c. Charges incurred towards any and all test and / or examinations rendered in connection with the treatment.
d. Charges incurred towards medicines or drugs purchased from a registered pharmacy other than the Hospital duly supported
by the prescriptions of the Medical Practitioner attending to the Insured.
Address proof
Total Loss of Checked-in

Baggage
Signed claim form

Statement of claim furnishing the details of items contained in the Checked-In Baggage.
Property Irregularity Report issued by the Common Carrier clearly accepting the Total Loss of Checked in baggage along with
Compensation details
Address proof
Delay of Checked-in
Baggage
Signed claim form

Property irregularity report stating the scheduled time of delivery and actual time of delivery of the Checked-In Baggage issued by the
Common Carrier;
Voucher of the Common Carrier for the compensation paid for the delay in delivery of the Checked-In Baggage;
Invoices and receipts towards personal items purchased
Address proof
Personal Liability
Signed claim form

An application letter/statement detailing the incident of personal liability, circumstances, location and liability.
Witness statements
Proof of judicial decision rendered by a court of law.
Copy of police report (in case of legal case)
Apart from the above, any other documents as required by the claims department.
Address proof
Personal Accident [24

hours]
Signed claim form

Discharge summary
Death certificate mentioning cause of death (in case of death)
Disability certificate
Copy of policy report
Address proof
Flight delay
Signed claim form

Invoices and Receipts Towards meals and accommodation
Letter from the Airline clearly stating the reason for delay along with duration of delay
Address proof
Trip Cancellation
Signed claim form

Proof of Cancellation of the Trip
Discharge Summary along with recommendation from the Medical Practitioner on necessity of Trip Cancellation
Death certificate in case of Cancellation due to death
Proof of incurred expenses which is paid and cannot recover (only towards travel and accommodation)
Address proof

Quick reference guide for making a claim

Benefit
Claim Supporting Documents
Trip Curtailment
Emergency Travel
Address proof
Attested copy of Discharge Summary
Original Invoice, Receipts and Boarding pass along with copy of Air tickets
Signed claim form
Emergency Hotel
Signed claim form

Proof of Cancellation of the Trip
Discharge Summary along with recommendation from the Medical Practitioner on necessity of Trip Cancellation
Death certificate in case of Cancellation due to death
Proof of incurred expenses which is paid and cannot recover (only towards travel and accommodation)
Address proof
Signed claim form

Attested copy of Discharge Summary
Copy of Air ticket along with Original Boarding pass
Original Invoice and receipts towards boarding and Lodging
Address proof
This is a summary of benefits and exclusions, pl refer to policy terms and conditions for full description.
Insurance is subject a matter of solicitation.

Policy Wordings

Uploaded by

Copyright:

Available Formats

Policy Wordings

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Policy Wordings

Uploaded by

Copyright:

Available Formats

Easy Domestic Travel Insurance

Quick reference guide to benefits offered

Specially designed for makemytrip customers

Does not cover

Total Loss of Checked-in

Personal Accident [24

Easy Domestic Travel Insurance

Specially designed for makemytrip customers

Does not cover

Easy Domestic Travel Insurance

i) Any costs relating to the Insured Persons pregnancy, childbirth or the

Section. 2 Total Loss of Checked-in Baggage

Special Exclusions to Section 2

a) Transportation has been prescribed by a Medical Practitioner and is

Section 3. Delay of Checked-in Baggage

Special Exclusions to Section 1

Special Exclusion to Section 3

Easy Domestic Travel Insurance

Special Conditions to Section 4

Complete and irrecoverable loss of sight of both eyes

Complete and irrecoverable loss of sight of an eye

Section. 5 Personal Accident [24 Hours]

Loss of a Limb and an eye

Complete and irrecoverable loss of speech & hearing

Special Exclusions to Section 4

Loss of 2 Limbs (both hands or both feet or one hand

Easy Domestic Travel Insurance

before completion and after it has commenced because of:

Easy Domestic Travel Insurance

organisation or government, committed for political, religious, ideological,

Easy Domestic Travel Insurance

i) Alterations to the Policy

1) which is operating under a valid licence issued by the appropriate Indian

2) We may terminate this master Policy on grounds of misrepresentation,

b. has at least 10 in-patient beds in towns having a population of less

c. has qualified medical practitioner(s) in charge round the clock;

d. has a fully equipped operation theatre of its own where surgical

e. maintains daily records of patients and makes these accessible to the

i. Acute condition - Acute condition is a disease, illness or injury that is

ii. Chronic condition - A chronic condition is defined as a disease, illness,

Easy Domestic Travel Insurance

is required for the medical management of the illness or injury suffered

iii. must have been prescribed by a medical practitioner;

iv. must conform to the professional standards widely accepted in

i. Acute condition - Acute condition is a disease, illness or injury that is

1) The scheduled time of departure of the Carrier on which the Insured

2) The earlier of:

b. The expiry date specified in the Certificate of Insurance.

The Risk Period will be evidenced only by the Certificate of

ii. Chronic condition - A chronic condition is defined as a disease, illness,

1) Which is operated between named cities under a valid licence issued

2) Which maintains and publishes regular tariffs for regular passenger

Easy Domestic Travel Insurance

Benefit 1.1 Accident: Medical Treatment

Benefit 1.2 Accident: Medical Evacuation

Benefit 1.3 Transportation of Mortal Remains

Benefit 2 Total Loss of Checked-in Baggage

Benefit 3 Delay of Checked-in Baggage

Benefit 4 Personal Liability