THE NEW INDIA ASSURANCE CO. LTD.

REGISTERED & HEAD OFFICE: 87, MAHATMA GANDHI ROAD, MUMBAI 400001

NEW INDIA MEDICLAIM POLICY

PROSPECTUS
We welcome You as Our Customer. This document explains how the NEW INDIA MEDICLAIM
could provide value to You. In the document the word ‘You’, ‘Your’ means you, the Insured
under the Policy. ‘We’, ‘Our’, ‘Us’ means New India Assurance Co. Ltd.

NEW INDIA MEDICLAIM is a Policy designed to cover Hospitalisation expenses.

1. WHO CAN TAKE THIS POLICY?

All the persons proposed for this Insurance should be between the age of 18 years and
65 years. Children between the age of 3 months and 18 years are covered provided one
or both parents are covered concurrently. Children between 18 years to 25 years can be
covered provided they are financially dependent on the parents and one or both
parents are covered simultaneously. On attaining the age of 18 years or ceasing to be
financially dependent on the parents, they can, on renewal take a separate Policy. In
such an event the benefits on Continuous Coverage can be ported to the new Policy.
The upper age limit will not apply to a mentally challenged children and an unmarried
dependent daughter(s). The persons beyond 65 years can continue their Insurance
provided they are Insured under the Policy with us without any break.
Midterm inclusion is allowed for newly married spouse by charging pro-rata Premium
for the remaining period of the Policy. A New Born Baby, born to an Insured mother, will
be covered from date of birth till the expiry of the Policy, without any additional
Premium. No coverage for the New Born Baby would be available during subsequent
Renewals unless the child is declared for Insurance and covered as an Insured Person.

2. CAN I COVER MY FAMILY MEMBERS IN ONE POLICY?

Yes. You can cover Your family members in one policy, with separate Sum Insured for
each Insured Person.

The members of the family who could be covered under the Policy are:

a) Proposer
b) Proposer’s Spouse
c) Proposer’s Children
d) Proposer’s Parents

3. WHAT DOES THE POLICY COVER?

This Policy is designed to give You, the Insured, protection against unforeseen
Hospitalisation expenses.

4. WHAT IS A PRE EXISTING DISEASE?

The term Pre-existing condition/disease is defined in the Policy. It is defined as:

"Any condition, ailment or Injury or related condition(s) for which there were signs or
symptoms, and/or were diagnosed, and/or for which medical advice / treatment was received
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 within forty eight months prior to the first policy issued by Us and renewed continuously
thereafter."

If You had:

a) Signs or symptoms, or
b) Been diagnosed or received Medical Advice, or
c) Been Treated for any condition or disease within forty eight months prior to
the commencement of the first policy with us,

Such a condition or disease shall be considered as Pre-existing. Any Hospitalisation

arising out of such pre-existing disease or condition is not covered under the Policy until
forty eight months of Continuous Coverage have elapsed for the Insured Person.

5. IS PRE-ACCEPTANCE MEDICAL CHECK-UP REQUIRED?

Pre-acceptance medical check-up is required for all the members entering after the age
of 50 years. A person also needs to undergo this pre-acceptance medical check-up if he
has an adverse medical history or if the health condition of the person/s to be Insured is
such that the office in-charge feels that he / she be subjected to a medical examination.
The cost of this check-up will be borne by the proposer. But if the proposal is accepted,
then 50% of the cost of this check-up will be reimbursed to the proposer.

Note: Adverse Medical History means a person:

a) Who has undergone more than one Hospitalisation in previous two years,
b) Who is suffering from Critical Illness, Recurring Illness or Chronic Illness.
c) Is Suffering from Hypertension / Diabetes.
d) Is not in good health and free from Physical and mental diseases or infirmity
or medical complaints.

6. IS HOSPITALISATION ALWAYS NECESSARY TO GET A CLAIM?

Yes. Unless the Insured Person is Hospitalised for a condition warranting Hospitalisation,
no claim is payable under the Policy. The Policy does not cover outpatient treatments.

7. HOW LONG DOES THE INSURED PERSON NEED TO BE HOSPITALISED?

The Policy pays only where the Hospitalisation is for more than twenty four hours. But
for certain treatments specified in the Policy, period of stay at the Hospital could be less
than twenty four hours. Please refer to Clause 2.17 of the Policy for details.

8. WHAT DO I NEED TO DO AFTER I GET HOSPITALISED?

Immediately on Hospitalisation or within twenty four hours of such Hospitalisation,
please intimate the TPA of this fact, with details of Your Policy Number, Name of the
Hospital and treatment undertaken. This is an important condition of the Policy that you
need to comply with.

9. IS PAYMENT AVAILABLE FOR EXPENSES INCURRED BEFORE HOSPITALISATION?

Yes. Relevant medical expenses incurred before hospitalization for a period of THIRTY
days prior to the date of Hospitalisation are payable. Relevant medical expenses means
expenses related to the treatment of the disease for which the insured is Hospitalised.

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 10. IS PAYMENT AVAILABLE FOR EXPENSES INCURRED AFTER HOSPITALISATION?
Yes. Relevant medical expenses incurred after Discharge from the Hospital for a period
of SIXTY days after the date of discharge are payable. Relevant medical expenses means
expenses related to the treatment of the disease for which the insured is Hospitalised.

11. CAN I GET TREATED ANYWHERE?

Yes, the Policy covers treatment and/or services rendered only in India.

12. IS THERE A LIMIT TO WHAT THE COMPANY WILL PAY FOR HOSPITALISATION?
Yes. We will pay Hospitalisation expenses up to a limit, known as Sum Insured. In cases
where the Insured Person was Hospitalised more than once, the total of all amounts
paid

a) for all cases of Hospitalisation,

b) expenses paid for medical expenses prior to Hospitalisation,
c) expenses paid for medical expenses after discharge from hospital, and
d) any other payment made under the Policy

shall not exceed the Sum Insured as mentioned in the Schedule.

13. WHAT SUM INSURED SHOULD I CHOOSE?

You are free to choose any Sum Insured ranging from Rs. One Lakh to Fifteen Lakhs. The
Premium You pay depends upon Your Age and the Sum Insured chosen. You are free to
choose any Sum Insured available in the range specified above. But it is in your own
interest to choose the Sum Insured which could satisfy your present as well as future
needs, as explained in Point 15 below. Sum Insured of Rs. 4 lakh, 6 lakh and 7 lakh are
not available for a fresh Policy and is only available in case of renewal with same Sum
insured.

14. HOW LONG IS THE POLICY VALID?

The Policy is valid during the Period of Insurance stated in the Schedule attached to the
Policy. It is usually valid for a period of one year from the date of beginning of insurance.

15. IN CASE OF AYURVEDIC TREATMENT, WILL THE ENTIRE AMOUNT BE PAID?

The liability of the company in case of Ayurvedic / Homoeopathic / Unani treatment will
be 25% of the Sum Insured provided the treatment is taken in a government Hospital or in
any institute recognized by government or accredited by Quality Council Of India or National
Accreditation Board on Health, excluding centers for spas, massage and health rejuvenation
procedures

16. CAN THE POLICY BE RENEWED WHEN THE PRESENT POLICY EXPIRES?
Yes. You can, and to get all Continuity benefits under the Policy, you should renew the
Policy before the expiry of the present policy. For instance, if Your Policy commences
from 2nd October, 2016 date of expiry is usually on 1st October, 2017. You should
renew Your Policy by paying the Renewal Premium on or before 1st October 2017.

17. WHAT IS CONTINUITY BENEFIT?

There are certain treatments which are payable only after the Insured Person is
continuously covered for a specified period. For example, Cataract is covered only after
twenty four months of continuous insurance. If an Insured took a Policy in October,

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 2008, does not renew it on time and takes a Policy only in December 2009, and renewed
it on time in December 2010, any claim for Cataract would not become payable,
because the Insured person was not continuously covered for twenty four months. If, he
had renewed the Policy in time in October 2009 and then in October 2010, then he
would have been continuously covered for twenty four months and therefore his claim
for Cataract in the Policy beginning from October 2010 would be payable. For other
benefits under the Policy such as cost of health checkup, continuous Insurance is
necessary. Therefore, You should always ensure that you pay Your renewal Premium
before Your Policy expires.

18. WHAT IS CUMULATIVE BONUS BUFFER?

The Cumulative Bonus Buffer accrued to your Mediclaim 2012 Policy, on migration to
New India Mediclaim is protected. But for claim free renewal after migration to New
India Mediclaim No accrual would be made to the Cumulative Bonus Buffer. The
Cumulative Bonus Buffer will be available until it is completely used.

19. IS THERE ANY GRACE PERIOD FOR RENEWAL OF THE POLICY?

Yes. If Your Policy is renewed within thirty days of the expiry of the previous Policy, then
the Continuity Benefits would not be affected. But even if You renew Your Policy within
thirty days of expiry of previous Policy, any disease contracted or injuries sustained or
Hospitalisation commencing during the break in insurance is not covered. Therefore it is
in Your own interest to see that You renew the Policy before it expires.

20. CAN THE SUM INSURED BE INCREASED AT THE TIME OF RENEWAL?

We may agree for a request for increase in Sum Insured at the time of renewal. But We
are not obliged to agree to this request, if we feel the Person is not in good health.
Moreover, for persons aged over 60, such a request could entail subjecting the Person
for Medical Examination and other Medical tests. (In case the risk is accepted, 50% of
the reasonable cost of Medical Examination would be reimbursed).

Enhancement of Sum Insured is subject to the limits mentioned below:

Age <= 50 years Up to Sum Insured of 15 lakhs without Medical Examination.

Age 51-60 Years By two slabs without Medical Examination
Age 61 – 65 Years By one slab with Medical Examination

Enhancement of Sum Insured will not be considered for:

1) Any Insured Person over 65 years of age.

2) Any Insured Person who had undergone more than one Hospitalisation in the
preceding two years.
3) Any Insured Person suffering from one or more of the following Illnesses /
Conditions:
a) Any chronic Illness b)
Any recurring Illness c)
Any Critical Illness

In respect of any enhancement of Sum Insured, exclusions 4.1, 4.2 and 4.3 would apply
to the additional Sum Insured from such date.

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 21. IS THERE AN AGE LIMIT UPTO WHICH THE POLICY WOULD BE RENEWED?
No. Your Policy can be renewed, as long as You pay the Renewal Premium before the
date of expiry of the Policy. There is an age limit for taking a fresh Policy, but there is no
age limit for renewal. However, if You do not renew Your Policy before the date of
expiry or within thirty days of the date of expiry, the Policy may not be renewed, and
only a fresh Policy could be issued, subject to Our underwriting rules. In such cases, it is
possible that a fresh Policy could not be issued by Us. It is therefore in Your interest to
ensure that Your Policy is renewed before expiry.

22. CAN THE INSURANCE COMPANY REFUSE TO RENEW THE POLICY?

We may refuse to renew the Policy only on rare occasions such as fraud,
misrepresentation or suppression or non-cooperation being committed by You or any
one acting on Your behalf in obtaining insurance or subsequently in relation thereto. If
We discontinue selling this Policy, it might not be possible to renew this Policy on the
same terms and conditions. In such a case You shall however have the option for
renewal under any similar Policy being issued by the Company, provided the benefits
payable shall be subject to the terms contained in such other Policy.

In case of revision or modification or withdrawal of the Policy a notice will be provided

to You 90 days before such revision or modification or withdrawal.

Renewal can also be refused if the Policy is not renewed before expiry of the Policy or
within the Grace Period.

23. CAN I MAKE A CLAIM IMMEDIATELY AFTER TAKING A POLICY?

Claims for Illnesses cannot be made during the first thirty days of a fresh Insurance
policy. However, claims for Hospitalization due to accidents occurring during the first
thirty days are payable. There are certain treatments where the waiting period is two
years or four years. Please see Conditions 4.3.1, 4.3.2 and 4.4.7 of the Policy.

24. WHAT IS THIRD PARTY ADMINISTRATOR (TPA)?

Third Party Administrator (TPA) is a service provider to facilitate service to You for
providing Cashless facility for all hospitalizations that come under the scope of Your
policy. The TPA also settles reimbursement claims within the scope of the Policy.

25. WHAT IS CASHLESS HOSPITALIZATION?

Cashless hospitalization is service provided by the TPA on Our behalf whereby you are
not required to settle the hospitalization expenses at the time of discharge from
hospital. The settlement is done directly by the TPA on Our behalf. However those
expenses which are not admissible under the Policy would not be paid, and You would
have to pay such inadmissible expenses to the Hospital. Cashless facility is available only
in Networked Hospitals. Prior approval is required from the TPA before the patient is
admitted into the Network Hospital. You may visit our Website at
http://newindia.co.in/listofhospitals.aspx The list of Network Hospitals can also be
obtained from the TPA or from their website. You will have full freedom to choose the
hospitals from the Network Hospitals and avail Cashless facility on production of proof
of Insurance and Your identity, subject to the claim being admissible. The TPA might not
agree to provide Cashless facility at a Hospital which is not a Network Hospital. In such
cases You may avail treatment at any Hospital of Your choice and seek reimbursement
of the claim subject to the terms and conditions of the Policy. In cases where the
admissibility of the claim could not be determined with the available documents, even if
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 the treatment is at a Network Hospital, the TPA may refuse to provide Cashless facility.
Such refusal may not necessarily mean denial of the claim. You may seek
reimbursement of the expenses incurred by producing all relevant documents and the
TPA may pay the claim, if it is admissible under the terms and conditions of the Policy.

26. CAN I CHANGE HOSPITALS DURING THE COURSE OF MY TREATMENT?

Yes it is possible to shift to another hospital for reasons of requirement of better
medical procedure. However, this will be evaluated by the TPA on the merits of the case
and as per policy terms and conditions.

27. HOW TO GET REIMBURSEMENTS IN CASE OF TREATMENT IN NON-NETWORK

HOSPITALS OR DENIAL OF CASHLESS FACILITY?
In case of treatment in a non-Network Hospital, TPA will reimburse You the amount of
bills subject to the conditions of the Policy. You must ensure that the Hospital where
treatment is taken fulfills the conditions of definition of Hospital in the Policy. Within
twenty four hours of Hospitalisation the TPA should be intimated. The following
documents in original should be submitted to the TPA within seven days from the date
of Discharge from the Hospital:

 • Claim Form duly filled and signed by the claimant

• Discharge Certificate from the hospital

• All documents pertaining to the illness starting from the date it was first detected
 i.e. Doctor's consultation reports/history
 • Bills, Receipts, Cash Memos from hospital supported by proper prescription
• Receipt and diagnostic test report supported by a note from the attending medical
 practitioner/surgeon justifying such diagnostics.
• Surgeon's certificate stating the nature of the operation performed and surgeon's
 bill and receipt
• Attending doctor's / consultant's / specialist's / anesthetist's bill and receipt, and
 certificate regarding diagnosis
• Details of previous policies if the details are not already with TPA or any other
information needed by the TPA for considering the claim.

28. HOW TO GET REIMBURSEMENT FOR PRE AND POST HOSPITALIZATION EXPENSES?
The Policy allows reimbursement of medical expenses incurred before and after
admissible Hospitalisation up to a certain number of days. For reimbursement, send all
bills in original with supporting documents along with a copy of the discharge summary
and a copy of the authorization letter to your TPA. The bills must be sent to the TPA
within 7 days from the date of completion of treatment. You must also provide the TPA
with additional information and assistance as may be required by the company/TPA in
dealing with the claim.

29. WILL THE ENTIRE AMOUNT OF THE CLAIMED EXPENSES BE PAID?

The entire amount of the claim is payable, if it is within the Sum Insured and is related
with the Hospitalization as per Policy conditions and is supported by proper documents,
except the expenses which are excluded.

30. HOW MUCH WE WILL REIMBURSE?

Our liability for all claims admitted during the Period of Insurance will be only up to Sum
Insured for which the Insured Person is covered as mentioned in the Schedule. In
respect of those Insured Persons with Cumulative Bonus Buffer, Our liability for claims
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 admitted under this Policy shall not exceed the aggregate of the Sum Insured and the
Cumulative Bonus Buffer. Subject to this, We will reimburse the following Reasonable
and Customary, and Medically Necessary Expenses admissible as per the terms and
conditions of the Policy:

Room Rent, boarding and nursing expenses as provided by the Hospital not
3.1 (a)
exceeding 1.0 % of the Sum Insured per day
Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses not
3.1 (b)
exceeding 2.0 % of the Sum Insured per day
3.1 (c) Surgeon, Anesthetist, Medical Practitioner, Consultants’ Specialist fees.
Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances,
Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs,
3.1 (d) Cost of Prosthetic devices implanted during Surgery like pacemaker,
Relevant Laboratory/Diagnostic test, X-Ray and other medical expenses
related to the treatment.
3.1 (e) Pre-Hospitalization Medical expenses
3.1 (f) Post-Hospitalization Medical expenses

PROPORTIONATE DEDUCTION
Reimbursement/payment of Room Rent, boarding and nursing expenses incurred at the
Hospital shall not exceed 1% of the Sum Insured per day. In case of admission to
Intensive Care Unit or Intensive Cardiac Care Unit, reimbursement or payment of such
expenses shall not exceed 2% of the Sum Insured per day. In case of admission to a
room/ICU/ICCU at rates exceeding the aforesaid limits, the reimbursement/payment of
all other expenses incurred at the Hospital, with the exception of cost of medicines,
shall be effected in the same proportion as the admissible rate per day bears to the
actual rate per day of Room Rent/ICU/ICCU charges.

LIMIT ON PAYMENT FOR CATARACT

Our liability for payment of any claim relating to Cataract, for each eye, shall not exceed
20% of the Sum Insured subject to a maximum of Rs. 50,000. The said limit shall be
applicable per event for all the Policies of Our Company including Group Policies. Even if
two or more Policies of New India are invoked, sublimit of the Policy chosen by Insured
shall prevail and our liability is restricted to stated sublimit.

HOSPITAL CASH
For those Insured Persons, whose Sum Insured is more than or equal to Rs. three lakhs,
we will pay Hospital Cash at the rate of 0.1% of the Sum Insured, for each day of
Hospitalisation admissible under the Policy. The payment under this Clause for Any One
Illness shall not exceed 1% of the Sum Insured. The payment under this Clause is
applicable only where the period of Hospitalisation exceeds twenty four consecutive
hours. Payment under this clause shall reduce the Sum Insured.

Hospital Cash will be payable for completion of every twenty four hours and not part
thereof.

ADDITIONAL BENEFIT - HEALTH CHECK-UP

The Insured Person shall be entitled for reimbursement of the cost of Medical check-up
at the end of a block of every three Claim Free Years. Such payment shall be restricted

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NEW INDIA MEDICLAIM POLICY
 to Rs. 5,000 or 1% of the average Sum Insured of the Insured Person in the preceding
three years, whichever is less. This benefit is available only once in three years.

Any payment made under this clause shall not be considered as a claim for the purpose
of Clauses 5.11 of this Policy.

PAYMENT OF AMBULANCE CHARGES

We will pay You the charges for Ambulance services not exceeding 1% of the Sum
Insured, Reasonably and Medically Necessarily incurred for shifting any Insured Person
to Hospital for admission in Emergency Ward or ICU, or from one Hospital to another
Hospitalfor better medical facilities.

PAYMENTS ONLY IF INCLUDED IN HOSPITAL BILL

No payment shall be made for any Hospitalisation expenses incurred, unless they form
part of the Hospital Bill. However, the bills raised by Surgeon, Anaesthetist directly and
not included in the Hospital Bill shall be paid provided a numbered Bill is produced in
support thereof, for an amount not exceeding Rs. Ten thousand, where such payment is
made in cash and for an amount not exceeding Rs. Twenty thousand, where such
payment is made by cheque.

MEDICAL EXPENSES FOR ORGAN TRANSPLANT:

If treatment involves Organ Transplant to Insured Person, then We will also pay
Hospitalisation Expenses (excluding cost of organ) incurred on the donor, provided Our
liability towards expenses incurred on the donor and the insured recipient shall not
exceed the aggregate of the Sum Insured and Cumulative Bonus Buffer, if any, of the
Insured Person receiving the organ.

DAY ONE BABY COVER

A New Born Baby is covered for any Illness or Injury from the date of birth till the expiry
of this Policy, within the terms of this Policy. Any expense incurred towards post natal
care, pre-term or pre-mature care or any such expense incurred in connection with
delivery of such New Born Baby would not be covered. Congenital External Anomaly of
the New Born Baby is also not covered under the policy.

No coverage for the New Born Baby would be available during subsequent renewals
unless the child is declared for insurance and covered as an Insured Person.

MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS

If the claim event falls within two policy periods, the claims shall be paid taking into
consideration the available Sum Insured of the expiring Policy only. Sum Insured of the
Renewed Policy will not be available for the Hospitalisation (including Pre & Post
Hospitalisation Expenses), which has commenced in the expiring Policy. Claim shall be
settled on per event basis.

31. WHAT ARE THE OPTIONAL COVERS AVAILABLE IN THE POLICY?

Following are the optional covers available in the Policy.

OPTIONAL COVER I: NO PROPORTIONATE DEDUCTION

This cover can be opted by the Insured Person whose Sum Insured is Rs. 2,00,000 and
above.

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 On payment of additional Premium for each Insured Person, Proportionate deduction as
mentioned in Clause 3.2 of Policy Document will be deleted for such members opting for
such cover.

Policy holder shall continue to bear the differential between actual and eligible Room
Rent.

Premium will be charged separately for each Insured Person opting for this cover.

OPTIONAL COVER II: MATERNITY EXPENSES BENEFIT

This cover can be opted by the Insured Person whose Sum Insured is Rs. 5,00,000 and
above.

On the payment of additional Premium, Clause 4.4.14 of Policy Document or sub point
4.14 of Q. 33 below, shall be deleted for the members opting for Maternity Cover. Our
liability for claim admitted for Maternity shall not exceed 10% of the average Sum
Insured of the Insured Person in the preceding three years.

Special conditions applicable to Maternity Expenses Benefit:

1. These Benefits are admissible only if the expenses are incurred in Hospital as
inpatients in India.
2. A waiting period of thirty six months is applicable, from the date of opting this
cover, for payment of any claim relating to normal delivery or caesarian section
or abdominal operation for extra uterine pregnancy. The waiting period may be
relaxed only in case of delivery miscarriage or abortion induced by accident or
other medical emergency.
3. Claim in respect of delivery for only first two children and / or surgeries
associated therewith will be considered in respect of any one Insured Person
covered under the Policy or any renewal thereof.
4. Expenses incurred in connection with voluntary medical termination of
pregnancy during the first 12 weeks from the date of conception are not
covered.

Pre-natal and post-natal expenses are not covered unless admitted in Hospital and
treatment is taken there.

The maternity limit mentioned above shall be applicable per event for all the Policies of
Our Company including Group Policies. Even if two or more Policies of New India are
invoked, sublimit of the Policy chosen by Insured shall prevail and our liability is
restricted to stated sublimit.

Premium will be charged separately for each Insured Person opting for this cover.

OPTIONAL COVER III: REVISION IN LIMIT OF CATARACT

This cover can be opted by the Insured Person whose Sum Insured is Rs. 8,00,000 and
above.

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 On payment of additional Premium as mentioned in Schedule, it is declared and agreed
that following additional amount for Cataract shall become payable but not exceeding
the actual expenses incurred:

Sum Insured Revised Cataract Limit

Rs. 8,00,000 Rs. 80,000
Rs. 10,00,000 Rs. 1,00,000
Rs. 12,00,000 Rs. 1,20,000
Rs. 15,00,000 Rs. 1,50,000

Benefit of this cover will be available after the expiry of thirty six months from the date of opting
this cover. Premium will be charged separately for each Insured Person opting for this
cover.

OPTIONAL COVER IV: VOLUNTARY CO-PAY

If the Insured person opts for voluntary co-pay of 20%, a discount of 15% shall be of
given on the premium payable for the Insured Person.

32. WHAT WILL HAPPEN WHEN MY SUM INSURED IS EXHAUSTED DURING POLICY
PERIOD?
If during the Policy period the Sum Insured is exhausted for any Insured, then the Sum
Insured shall be reinstated back to the original Sum Insured chosen by the Insured,
provided our liability under the Reinstated Sum Insured shall be subject to the following
conditions:

1. Such Reinstatement of Sum Insured shall be effected only where the Sum
Insured is Rs. Five Lakhs or more.
2. Such Reinstatement shall take effect only after the Date of Discharge from the
Hospital for that claim which resulted in exhaustion of the Sum Insured.
3. No Illness or Injury, for a Hospitalisation occurring during the Period of Insurance
till the Date of Reinstatement, for which a Claim is paid or admissible, shall be
considered under the Reinstated Sum Insured.

Reinstatement shall be available only once for any Insured during a Policy Period.

33. CAN ANY CLAIM BE REJECTED OR REFUSED?

Yes, a claim, which is not covered under the Policy conditions, can be rejected. In case
You are not satisfied by the reasons for rejection, you can represent to Us within 15
days of such denial. If You do not receive a response to Your representation or if You are
not satisfied with the response, You may write to our Grievance Cell, the details of
which are provided at our website at http://newindia.co.in/public.asp. You may also call
our Call Centre at the Toll free number 1800-209-1415, which is available 24x7.

You also have the right to represent your case to the Insurance Ombudsman. The
contact details of the office of the Insurance Ombudsman could be obtained from
http://www.irda.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo234&
mid=7.2

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 34. CAN I CANCEL THE POLICY?
Yes, You can. You will be allowed a period of fifteen days from the date of receipt of the
Policy to review the terms and conditions of the Policy and to return the same if not
acceptable.

If You have not made any claim during the free look period, You shall be entitled to:

1. A refund of the premium paid less any expenses incurred by Us on medical

examination and the stamp duty charges or;
2. where the risk has already commenced and the option of return of the policy is
exercised by You, a deduction towards the proportionate risk premium for
period on cover or;
3. Where only a part of the risk has commenced, such proportionate risk premium
commensurate with the risk covered during such period.

If you choose to cancel the policy after expiry of Free Look Period, the refund would be
at our Short Period rate table given below:

Up to one month 1/4th of the annual rate

Up to three months 1/2 of the annual rate
Up to six months 3/4th of the annual rate
Exceeding six months Full annual rate

The refund would be made only if no claim has been made or paid under the Policy

We may also at any time cancel the Policy on grounds of misrepresentation, fraud, non-
disclosure of material fact or non-cooperation by You by sending fifteen days’ notice in
writing by Registered A/D to You at the address stated in the Policy. Even if there are
several insured persons, notice will be sent to You.

On such cancellation, premium corresponding to the unexpired period of Insurance will

be refunded, if no claim has been made or paid under the Policy.

35. IS THERE ANY BENEFIT UNDER THE INCOME TAX ACT FOR THE PREMIUM PAID FOR
THIS INSURANCE?
Yes. Payments made for health insurance in any mode other than cash are eligible for
deduction from taxable income as per Section 80 D of the Income Tax Act, 1961. For
details, please refer to the relevant Section of the Income Tax Act.

36. WHAT ARE EXCLUDED UNDER THIS POLICY

No claim will be payable under this Policy for the following:

1 Treatment of any Pre-Existing Condition/Disease, until forty eight months of Continuous

Coverage of such Insured Person have elapsed, from the Date of inception of his/her first
Policy with Us as mentioned in the Schedule.

2 Any Illness contracted by the Insured person (except Injury) during the first 30 days of the
commencement date of this Policy. This exclusion shall not however, apply if the Insured
person has Continuous Coverage for more than twelve months.

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 3.1 Unless the Insured Person has Continuous Coverage in excess of twenty four months with Us,
expenses on treatment of the following Illnesses are not payable:

1. All internal and external benign tumors, cysts, polyps of any kind, including benign
breast lumps
2. Benign ear, nose, throat disorders
3. Benign prostate hypertrophy
4. Cataract and age related eye ailments
5. Gastric/ Duodenal Ulcer
6. Gout and Rheumatism
7. Hernia of all types
8. Hydrocele
9. Infective Arthritis
10. Piles, Fissures and Fistula in anus
11. Pilonidal sinus, Sinusitis and related disorders
12. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from Accident
13. Skin Disorders
14. Stone in Gall Bladder and Bile duct, excluding malignancy
15. Stones in Urinary system
16. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus
17. Varicose Veins and Varicose Ulcers
18. Renal Failure

Note: Even after twenty four months of Continuous Coverage, the above Illnesses will not be
covered if they arise from a Pre-existing Condition, until 48 months of Continuous Coverage
have elapsed since inception of the first Policy with the Company.

3.2 Unless the Insured Person has Continuous Coverage in excess of forty eight months with Us,
the expenses related to treatment of

1. Joint Replacement due to Degenerative Condition,

2. Age-related Osteoarthritis & Osteoporosis

are not payable.

4.1 Injury / Illness directly or indirectly caused by or arising from or attributable to War, invasion,
Act of Foreign enemy, War like operations (whether war be declared or not), nuclear weapon/
ionising radiation, contamination by Radioactive material, nuclear fuel or nuclear waste or
from the combustion of nuclear fuel.

4.2 a. Circumcision unless Medically Necessary for treatment of an Illness not excluded hereunder
or as may be necessitated due to an Accident
b. Change of life/sex change or cosmetic or aesthetic treatment (except for burns/Injury) of
any description such as correction of eyesight, etc.
c. Plastic Surgery other than as may be necessitated due to an Accident or as a part of any
Illness.

4.3 Vaccination and/or inoculation.

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 4.4 Cost of braces, equipment or external prosthetic devices, non-durable implants, eyeglasses,
Cost of spectacles and contact lenses, hearing aids including cochlear implants, durable
medical equipment.

4.5 Dental treatment or Surgery of any kind unless necessitated by Accident and requiring
Hospitalisation.

4.6 Convalescence, general debility, 'Run-down' condition or rest cure, obesity treatment and its
complications, treatment relating to all psychiatric and psychosomatic disorders, infertility,
sterility, Venereal disease, intentional self-Injury and Illness or Injury caused by the use of
intoxicating drugs/alcohol.

4.7 Congenital Internal and External Disease or Defects or anomalies.

However, the exclusion for Congenital Internal Disease or Defects or anomalies shall not apply
after twenty four months of Continuous Coverage, if it was unknown to You or to the Insured
Person at the commencement of such Continuous Coverage. Exclusion for Congenital Internal
Disease or Defects or Anomalies would not apply to a New Born Baby during the year of Birth
and also subsequent renewals, if Premium is paid for such New Born Baby and the renewals
are effected before or within thirty days of expiry of the Policy.

The exclusion for Congenital External Disease or Defects or anomalies shall not apply after
thirty six months of Continuous Coverage, but such cover for Congenital External Disease or
Defects or anomalies shall be limited to 10% of the average Sum Insured of the Insured Person
in the preceding four years.

4.8 Bodily Injury due to willful or deliberate exposure to danger (except in an attempt to save
human life), intentional self-inflicted Injury, attempted suicide, Illness arising out of non-
adherence to medical advice.

4.9 Treatment of any Bodily Injury or Illness sustained whilst or as a result of active participation in
any hazardous sports of any kind.

4.10 Treatment of any Injury or Illness sustained whilst or as a result of participating in any criminal
act.

4.11 Sexually Transmitted Diseases, any condition directly or indirectly caused to or associated with
Human T-Cell Lymphotropic Virus Type III (HTLB - III) or lymphadenopathy Associated Virus
(LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or
condition of a similar kind commonly referred to as AIDS.

4.12 Charges incurred at Hospital primarily for diagnosis, x-ray or Laboratory examinations or other
diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive
existence or presence of any Illness or Injury for which confinement is required at a Hospital

4.13 Expenses on vitamins and tonics unless forming part of treatment for Injury or Illness as
certified by the attending Medical Practitioner.

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 4.14 Maternity Expenses, except abdominal operation for extra uterine pregnancy (Ectopic
Pregnancy), which is proved by submission of Ultra Sonographic Report and Certification by
Gynaecologist that it is life threatening one if left untreated.

4.15 Naturopathy and Siddha Treatment

4.16 External and or durable Medical / Non-medical equipment of any kind used for diagnosis and
or treatment including CPAP (Continuous Positive Airway Pressure), CPAD (Continuous
Peritoneal Ambulatory Dialysis), Oxygen Concentrator for Bronchial Asthmatic condition,
Infusion pump etc. Ambulatory devices i.e., walker, crutches, Collars, Caps, Splints, Elasto crepe
bandages, external orthopaedic pads, sub cutaneous insulin pump, Diabetic foot wear,
Glucometer / Thermometer and similar related items etc., and also any medical equipment,
which is subsequently used at home and outlives the use and life of the Insured Person.

4.17 Any expenses relating to cost of items detailed in Annexure II (of policy document).

4.18 Genetic disorders and stem cell implantation/Surgery.

4.19 Domiciliary Hospitalisation.

4.20 Acupressure, acupuncture, magnetic therapies

4.21 Experimental or unproven treatments/ therapies.

4.22 Any kind of Service charges, Surcharges, Luxury Tax and similar charges levied by the Hospital.

4.23 Treatment for Age Related Macular Degeneration (ARMD) , treatments such as Rotational Field
Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External
Counter Pulsation (EECP), Hyperbaric Oxygen Therapy

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