03-12-2021 Micro Insurance Policy - 2013-2014

Registered Office: 101, 201, 301, Natraj,
Junction of Western Express Highway &

Andheri - Kurla Road, Andheri East,
Mumbai -400069
Micro Insurance Policy
WHEREAS THE Insured named designated in the Schedule hereto has by a Proposal and declaration
which shall be the basis of this contract and is deemed to be incorporated herein, has applied to SBI
General Insurance Company Limited (hereinafter called “the Company”) for the insurance
hereinafter set forth in respect of the INSURED PERSONS and has paid premium as consideration for
such insurance.
The Company hereby agrees subject to the terms and conditions contained herein or endorsed or
otherwise expressed hereon, to indemnify, compensate, pay and/or reimburse the Insured/Insured
Person, his/her nominee or the legal heirs, as the case may be, in respect of insured events occurring
during the period of insurance stated in the Schedule, in the manner and to the extent set forth in
this Policy.
DEFINTIONS
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:
Accident means a sudden, unforeseen and involuntary event caused by external, visible and
violent means.
Age means completed years as at the commencement date of the Policy as Specified in the
schedule.
Alternative treatments mean forms of treatments other than treatment "Allopathy" or "modem
medicine" and includes Ayurveda, Unani, Sidha and Homeopathy in the Indian context.
Burglary and Housebreaking means an actual, forcible and violent entry to or exit from the
insured premises with the intent to steal contents there from.
Critical Illness means an illness, sickness or a disease or a corrective measure like Cancer of
specified severity, Open Chest Bag, Aorta Graft Surgery, Open Heart Replacement or Repair of
Heart Valves, Stroke Resulting in Permanent Symptoms, First Heart Attack – Of Specified
Severity, Kidney Failure Requiring Regular Dialysis, Primary Pulmonary Arterial Hypertension,
Major Organ/ Bone Marrow Transplant, Multiple Sclerosis with Persisting Symptoms, Coma of
Specified Severity, Total Blindness and Permanent Paralysis of Limbs all as defined in Scope of
Cover & Benefits section of this Policy.
Critical Illness Benefit means the amount specified in the Schedule, which is the maximum
amount for which Insurer may be liable to make payment for any or all Critical Illnesses covered
subject to terms & conditions under this Policy.
Condition Precedent means a policy term or condition upon which the Insurer's liability under
the policy is conditional upon.
SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)
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Congenital Anomaly Congenital Anomaly refers to a condition(s) which is present since birth,
and which is abnormal with reference to form, structure or position.
a. Internal Congenital Anomaly - Congenital anomaly which is not in the visible and
accessible parts of the body.
b. External Congenital Anomaly - Congenital anomaly which is in the visible and
Day care Treatment refers to medical treatment, and/or surgical procedure which is:
a. undertaken under General or Local Anesthesia in a Hospital/Day care centre in less
than 24 hrs because of technological advancement, and
b. which would have otherwise required a Hospitalisation of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this
definition.
“Day Care Hospital/Centre” means any institution established for day care treatment of illness and
/ or injuries or a medical setup within a hospital and which has been registered with the local
authorities, wherever applicable, and is under the supervision of a registered and qualified medical
practitioner AND must comply with all minimum criteria as under
a. has qualified nursing staff under its employment

b. has qualified medical practitioner (s) in charge
c. has a fully equipped operation theatre of its own where surgical procedures
are carried out
d. maintains daily records of patients and will make these accessible to the
insurance company’s authorized personnel.
Deductible means a cost-sharing requirement under a health insurance policy that provides that
the Insurer will not be liable for a specified rupee amount in case of indemnity policies and for a
specified number of days/hours in case of hospital cash policies which will apply before any
benefits are payable by the insurer. A deductible does not reduce the sum insured.
Dependent Child or Dependent Children means children who are aged between 6 months and 23
years of age and who are/is unmarried and financially dependent on the Insured
Dental treatment means treatment carried out by a dental practitioner including examinations,
fillings (where appropriate), crowns, extractions and surgery excluding any form of cosmetic
surgery/implants.
Disease / 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 by a medical practitioner.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to
respond quickly to treatment which aims to return the person to his or her state of
health immediately before suffering the disease/illness/injury which leads to full
recovery.
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that
has one or more of the following characteristics
i. it needs ongoing or long-term monitoring through consultations,
examinations, check-ups, and / or tests
ii. it needs ongoing or long-term control or relief of symptoms
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iii. it requires your rehabilitation or for you to be specially trained to cope with
it
iv. it continues indefinitely
v. it comes back or is likely to come back.
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.
Dwelling means a structure of pucca or kuttcha construction used as Insured’s residence.
Family means and includes Insured, Insured’s legal spouse and Insured’s dependent children.
Grace Period means the specified period of time immediately following the premium due date
during which a payment can be made to renew or continue a Policy in force without loss of
continuity benefits such as waiting periods and coverage of Pre-existing Diseases. Coverage is
not available for the period for which no premium is received.
Hospital means any institution established for inpatient care and day care treatment of illness
and / or injuries and which has been registered as a hospital with the local authorities, under the
Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments
specified under the Schedule of Section 56(1) of the said Act OR complies with all minimum
criteria as under:
a. has qualified nursing staff under its employment round the clock;
b. has at least 10 in-patient beds, in - towns having a population of less than 10,00,000
and at least 15 inpatient beds in all other places;
c. has qualified medical practitioner (s) in charge round the clock;
d. has a fully equipped operation theatre of its own where surgical procedures are
carried out;
e. maintains daily records of patients and makes these accessible to the insurance
company’s authorized personnel.
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 24 consecutive hours.
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.
Inpatient Care means treatment for which the insured person has to stay in a hospital for more
than 24 hours for a covered event.
Insured means the person named in the Schedule, who is a citizen and resident of India and for
whom the insurance is proposed and appropriate premium paid.
Insured Person means the persons named as such in the schedule of the policy.
Insurer means Us/Our/We SBI General Insurance Company Limited.

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Internal Congenital Anomaly means Congenital anomaly which is not in the visible and
Market value means Replacement value less depreciation.
Medical Advise means any consultation or advice from a Medical Practitioner including the issue
of any prescription or repeat prescription.
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.
Medical Practitioner means a person who holds a valid registration from the Medical Council of
any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by
the Government of India or a State Government and is thereby entitled to practice medicine
within its jurisdiction; and is acting within the scope and jurisdiction of license. The registered
practitioner should not be the Insured or close family members.
Medically Necessary Medically necessary treatment is defined as any treatment, tests,

medication, or stay in hospital or part of a stay in hospital which
a. is required for the medical management of the illness or injury suffered by the
insured;
b. must not exceed the level of care necessary to provide safe, adequate and
appropriate medical care in scope, duration, or intensity;
c. must have been prescribed by a medical practitioner,
d. must conform to the professional standards widely accepted in international medical
practice or by the medical community in India.
Notification of claim means the process of notifying a claim to the insurer or TPA by specifying
the timelines as well as the address / telephone number to which it should be notified.
OPD treatment means a treatment 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.
Pre-hospitalization Medical Expenses means Medical Expenses incurred immediately before the
Insured Person is Hospitalised, provided that:
a. Such Medical Expenses are incurred for the same condition for which the Insured
Person’s Hospitalisation was required, and
b. The In-patient Hospitalization claim for such Hospitalization is admissible by the
insurance company.

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Post-hospitalization Medical Expenses means medical Expenses incurred immediately after the
Insured Person is discharged from the hospital, provided that:
a. Such Medical Expenses are incurred for the same condition for which the Insured
Person’s Hospitalisation was required, and
b. The In-patient Hospitalization claim for such Hospitalization is admissible by the
insurance company.
Policy means statements made in the Proposal form, this Policy wording (including
endorsements, if any) and the Schedule.
Pre-existing Disease 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 to prior to the first Policy issued by the Insurer.
Qualified Nurse means a person who holds a valid registration from the Nursing Council of India
or the Nursing Council of any state in India.
Renewal means the terms on which the contract of insurance can be renewed on mutual consent
with a provision of grace period for treating the renewal continuous for the purpose of all waiting
periods.
Sum Insured means, in respect of each Benefit, the sum shown in the Schedule against that
Benefit and such sum represents the Company’s maximum liability for each Insured Person for
any and all claims made during the Policy period under that Benefit.
Surgery/Surgical Operation means manual and/or operative procedures required for treatment
of an Illness or Accidental Bodily Injury, correction of deformities and defects, diagnosis and cure
of Diseases, relief of suffering or prolongation of life, performed in a Hospital or day care centre
by a Medical Practitioner.
Unproven/Experimental treatment means Treatment including drug experimental therapy which

is not based on established medical practice in India, is treatment experimental or unproven.

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BENEFITS COVERED UNDER THE POLICY
Compulsory Cover
Section I – Personal Accident
Optional Covers
Section II A – Critical Illness Cover
Section II B – Hospital daily Cash
Section II C – Asset Insurance
Section II D – Burglary and Housebreaking
Section I - PERSONAL ACCIDENT COVER:

If the Insured/Insured Person shall sustain any bodily injury resulting solely and directly from an Accident
caused by violent and visible means then the Company shall pay to the Insured/Insured Person the sum or
sums as set forth in the Table of Benefits below
Table of Benefits Percentage of Sum Insured

as per Schedule
1. Death 100%
2. Total and irrecoverable loss of
i) Sight of both eyes or
ii) the actual loss by physical separation of two entire hands
or two entire feet or one entire hand and one entire foot 100%
or
iii) of such loss of sight of one eye and such loss of the one
entire hand or one entire foot.
3. Total and irrecoverable loss of
i) the sight of one eye or the actual loss by physical
separation of one entire hand or one entire foot. 50 %
In the above :
a) Physical separation of hand or leg means, a hand at or above the wrist or a foot above
the ankle.
Exclusions: The Company shall not be liable for any claim or claims under this Policy arising from
1. Payment of compensation in respect of injury or disablement directly or indirectly arising
out of or contributed to by or traceable to any disability existing on the date of issue of this
Policy.
2. Serving in any branch of the Military or Armed Forces of any country, whether in peace or
War
3. Infections (except pyogenic infections which shall occur through an Accidental cut or wound)
or any other kind of Disease
Provided also that due observance and fulfilment of the terms and conditions of this Policy (which conditions
and all endorsements hereon are to be read as part of this Policy) shall so far as they relate to anything to be
done or not to be done by the Insured/Insured Person be a condition precedent to any liability of the
Company under this Policy.
Terms and Conditions:

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1. The maximum amount payable under the Policy for all the benefits put together for the entire
Policy period is the Sum Insured for Accidental Death benefit provided under the policy.
2. Upon happening of any event which may give rise to a claim under this Policy, written notice
with all particulars must be given to the Company immediately. In case of death, written notice
must be given immediately, and such notice is to be given before internment or cremation and
in any case not later than 30 days from the date of death. In the event of loss of sight or
amputation of limbs, written notice thereof must also be given immediately but not later than
30 days after such loss of sight or amputation.
3. Proof satisfactory to the Company shall be furnished of all matters upon which a claim is based.
Any Medical or authorised representative of the Company shall be allowed to examine the
Insured/Insured Person on the occasion of any alleged injury or disablement as may reasonably
be required on behalf of the Company. In event of accidental death which is covered under the
policy, immediate intimation should be given to the police authorities and also submit post
mortem examination of the body of the Insured/Insured Person if available with claimant.
4. Such evidence as the Company may require from time to time shall be furnished including the
post-mortem report, if available with claimant) , if necessary within 14 days after demand in
writing. Requirement of all or any of the following indicative documents will depend on the
nature of claim.
i. Claim form duly signed
ii. Policy copy
iii. Claim Intimation
iv. FIR / MLC Copy /Spot Panchnama / Inquest Panchnama
v. Death Certificate
vi. Post Mortem Report (If conducted)
vii. Final Police Report
viii. Affidavit from the legal heirs of the deceased (in case nomination has not
been filed by deceased)
ix. Investigation reports
x. Medical certificate
xi. Disability Certificate
xii. Photograph of the injured with reflecting disablement
xiii. Discharge card
xiv. Education ID card
xv. Doctor certificate for person’s residential accommodation and/or vehicle
xvi. Receipt of ambulance usage
Section II A - Critical Illness Insurance

During the period of insurance as stated in the Schedule to this Policy, the Insured / Insured Person
shall contract any of the specified diseases, illnesses or sustain any injury leading to such specified
illness which are termed as an Insured Event, the Company hereby agrees subject to the terms,
conditions and exclusions herein contained, to pay to the extent of the Sum Insured as specified in
the Schedule to this Policy.
Insured Event in relation to the Insured/Insured Person, shall mean any illness, medical event or
surgical procedure as specifically defined below whose signs, symptoms & diagnosis occurs for the
first time after 90 days after the commencement of Period of Insurance and shall only include -
A. First diagnosis of the below-mentioned Illnesses more specifically described below:
1. Cancer of Specified Severity
2. Kidney Failure Requiring Regular Dialysis
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3. Primary Pulmonary Arterial Hypertension
4. Multiple Sclerosis With Persisting Symptoms
B. Undergoing for the first time of the following surgical procedures, more specifically
described below:
1. Major Organ/ Bone Marrow Transplant
2. Open Chest Bag
3. Aorta Graft Surgery
4. Open Heart Replacement or Repair of Heart Valves
C. Occurrence for the first time of the following medical events more specifically
described below:
1. Stroke Resulting in Permanent Symptoms
2. First Heart Attack of Specified Severity
3. Coma of Specified Severity
4. Total blindness
5. Permanent Paralysis of Limbs
Only one Critical Illness claim can be allowed by the Company during the lifetime of the
Insured/Insured Person. Without prejudice to the provisions relating to the termination of the
Policy mentioned elsewhere, Section IIA Critical Illness cover terminates immediately on the
payment of first Critical Illness benefit under the Policy.
The Insured Event under this Section and the conditions applicable to the same are more particularly
defined below:
Cancer of Specified Severity
a. A malignant tumour characterised by the uncontrolled growth & spread of malignant cells with
invasion & destruction of normal tissues. This diagnosis must be supported by histological
evidence of malignancy & confirmed by a pathologist. The term cancer includes leukemia,
lymphoma and sarcoma.
b. The following are excluded -
i. Tumours showing the malignant changes of carcinoma in situ & tumours which are
histologically described as premalignant or non invasive, including but not limited to:
Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 & CIN-3.
ii. Any skin cancer other than invasive malignant melanoma
iii. All tumours of the prostate unless histologically classified as having a Gleason score
greater than 6 or having progressed to at least clinical TNM classification
T2N0M0.........
iv. Papillary micro - carcinoma of the thyroid less than 1 cm in diameter
v. Chronic lymphocyctic leukaemia less than RAI stage 3
vi. Microcarcinoma of the bladder
vii. All tumours in the presence of HIV infection.
Kidney Failure Requiring Regular Dialysis

End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a
result of which either regular renal dialysis (hemodialysis or peritoneal dialysis) is instituted or renal
transplantation is carried out. Diagnosis has to be confirmed by a specialist medical practitioner.
Primary Pulmonary Arterial Hypertension:

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Primary Pulmonary Hypertension is characterized by elevated pulmonary artery pressure with no
apparent cause and substantial right ventricular enlargement confirmed by a Cardiologist with the
help of investigations including Cardiac Catheterization (cardiac catheterization proving the
pulmonary pressure to be above 30 mm of Hg), resulting in permanent irreversible physical
impairment of at least Class IV of the New York Heart Association (NYHA) Classification of Cardiac
Impairment and resulting in the Insured being unable to perform his / her usual occupation.
The NYHA Classification of Cardiac Impairment:
Class I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue,
dyspnoea, or angina pain.
Class II: Slight limitation of physical activity. Ordinary physical activity results in symptoms.
Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity
causes symptoms.
Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present
even at rest.
Multiple Sclerosis with Persisting Symptoms

a. The definite occurrence of multiple sclerosis. The diagnosis must be supported by all of the
following:
i. investigations including typical MRI and CSF findings, which unequivocally confirm
the diagnosis to be multiple sclerosis;
ii. there must be current clinical impairment of motor or sensory function, which must
have persisted for a continuous period of at least 6 months, and
iii. well documented clinical history of exacerbations and remissions of said
symptoms or neurological deficits with at least two clinically documented
episodes at least one month apart.
b. Other causes of neurological damage such as SLE and HIV are excluded.
Major Organ/ Bone Marrow Transplant

a. The actual undergoing of a transplant of:
i. One of the following human organs: heart, lung, liver, kidney, pancreas, that resulted
from irreversible end-stage failure of the relevant organ, or
ii. Human bone marrow using haematopoietic stem cells. The undergoing of a
transplant has to be confirmed by a specialist medical practitioner.
b. The following are excluded:

i. Other stem-cell transplants
ii. Where only islets of langerhans are transplanted
Open Chest Bag

a. The actual undergoing of open chest surgery for the correction of one or more coronary
arteries, which is/are narrowed or blocked, by coronary artery bypass graft (CABG). The
diagnosis must be supported by a coronary angiography and the realization of surgery
has to be confirmed by a specialist medical practitioner.

i. Angioplasty and/or any other intra-arterial procedures
ii. any key-hole or laser surgery.
Aorta Graft Surgery:

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The actual undergoing of surgery for disease of the aorta needing excision and surgical replacement
of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and
abdominal aorta but not its branches.
Surgery following traumatic injury to the aorta is not covered. Surgery to treat peripheral vascular
disease of the aortic branches is excluded even if a portion of the aorta is removed during the
operative procedures. Surgery performed using only minimally invasive or intra-arterial techniques
such as percutaneous endovascular aneurysm with insertion of a stent graft are excluded.
Open Heart Replacement or Repair of Heart Valves

The actual undergoing of open-heart valve surgery is to replace or repair one or more heart valves,
as a consequence of defects in, abnormalities of, or disease-affected cardiac valve(s). The diagnosis
of the valve abnormality must be supported by an echocardiography and the realization of surgery
has to be confirmed by a specialist medical practitioner. Catheter based techniques including but not
limited to, balloon valvotomy/valvuloplasty are excluded.
Stroke Resulting in Permanent Symptoms

a. Any cerebrovascular incident producing permanent neurological sequelae.This includes
infarction of brain tissue, thrombosis in an intracranial vessel, haemorrhage and embolisation
from an extracranial source. Diagnosis has to be confirmed by a specialist medical practitioner
and evidenced by typical clinical symptoms as well as typical findings in CT Scan or MRI of the
brain. Evidence of permanent neurological deficit lasting for at least 3 months has to be
produced.
i. Transient ischemic attacks (TIA)
ii. Traumatic injury of the brain
iii. Vascular disease affecting only the eye or optic nerve or vestibular functions.
First Heart Attack – Of Specified Severity

a. The first occurrence of myocardial infarction which means the death of a portion of the heart
muscle as a result of inadequate blood supply to the relevant area. The diagnosis for this will be
evidenced by all of the following criteria:
i. a history of typical clinical symptoms consistent with the diagnosis of Acute
Myocardial Infarction (for e.g. typical chest pain)
ii. new characteristic electrocardiogram changes
iii. elevation of infarction specific enzymes, Troponins or other specific biochemical
markers.
i. Non-ST-segment elevation myocardial infarction (NSTEMI) with elevation of
Troponin I or T
ii. Other acute Coronary Syndromes
iii. Any type of angina pectoris.
Coma of Specified Severity

a. A state of unconsciousness with no reaction or response to external stimuli or
internal needs. This diagnosis must be supported by evidence of all of the following:
i. no response to external stimuli continuously for at least 96 hours;
ii. life support measures are necessary to sustain life; and
iii. permanent neurological deficit which must be assessed at least 30 days after the
onset of the coma.

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b. The condition has to be confirmed by a specialist medical practitioner. Coma
resulting directly from alcohol or drug abuse is excluded.
Total Blindness:
Total, permanent and irreversible loss of all sight in both eyes as a result of sickness or accident.
Diagnosis has to be confirmed by a specialist (best by an ophthalmologist) and evidenced by specific
test results.
Permanent Paralysis of Limbs

Total and irreversible loss of use of two or more limbs as a result of injury or disease of the brain or
spinal cord. A specialist medical practitioner must be of the opinion that the paralysis will be
permanent with no hope of recovery and must be present for more than 3 months.
General Conditions:
1. The benefit covered under this section shall be payable only if the Insured/Insured Person is
first diagnosed as suffering from a defined Critical Illness after 90 days of the
commencement of the Policy Period and survives for at least 28 days following such
diagnosis and/or also subject to survival of the Insured/Insured Person for the minimum
assessment periods for covered Critical Illnesses as provided under the descriptions for each
of the Critical Illness. However, if the Policy is a continuous renewal of our own
MicroInsurance policy without any break in insurance, then the condition of 90 days of the
commencement of Policy period referred above will not be applicable.
2. Insured must provide intimation to Insurer immediately and in any event within 60 days of
the aforesaid Illness/ condition/ surgical event, if admissible under the Policy
3. Insured will need to submit the below mentioned documents for the processing of Critical
Illness Claim:
- Identity proof of the claimant

- Dully filled Claim form
- Hospital summary/Discharge card/treatment advise / medical reference
- Medical reports/records
- Investigation reports
- Doctor’s certificate
- Any other relevant document as requested by the Insurer.
4. In the event of death of the Insured post the survival period, the immediate family
member/relative of the Insured and claiming on Insured’s behalf must inform Insurer in
writing immediately and send Insurer a copy of all the required documents to prove the
cause of death within 14 days. Insurer upon acceptance of the admission of claim under the
Policy shall make payment to the Insured or Nominee/legal heirs of the Insured, in case of
the death of the Insured post the survival period.
Exclusions:
No benefit shall be paid for the following circumstances, for the following conditions/ tests/
treatments and/or any Critical Illness directly or indirectly arising thereof or there from:
1. Benefits will not be available for Any condition, whether diagnosed or not, ailment or injury
or related condition(s) for which Insured has been diagnosed, received medical treatment,
had signs and / or symptoms, prior to inception of Insured’s first Policy, until 48 consecutive
months have elapsed, after the date of inception of the first Policy with Insurer. It would also
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mean any direct or indirect complications arising out of pre-existing conditions whether
known or unknown to the Insured.
2. This Exclusion shall cease to apply if Insured has maintained the Health Insurance Policy with
Insurer for a continuous period of a full 4 years without break from the date of Insured’s first
Health Insurance Policy with Insurer.
3. Any covered Critical Illness arising from Birth control procedures and/or hormone
replacement therapy and any complications arising thereof from.
4. Any treatment/surgery for change of sex or any cosmetic surgery or treatment/surgery
/complications/illness arising as a consequence thereof.
5. Any covered Critical Illness arising from treatment by a family member and self-medication
or any treatment that is NOT scientifically recognized and any complications arising thereof /
there from.
6. Any covered Critical Illness arising from treatment with alternative medicines like Ayurvedic,
Homeopathy & Unani, acupuncture, acupressure, osteopath, naturopathy, chiropractic,
reflexology, aromatherapy and like and any complications arising thereof / there from.
7. Any diseases causing the death of the Insured within the stipulated Survival Period,
measured from the date of incidence of the illness.
Section II B - HOSPITAL DAILY CASH COVER

In the event of Accidental Bodily Injury or Sickness first occurring or manifesting itself during the
period of insurance as stated in the schedule of the policy and causing the Insured/Insured Person
Hospitalisation, a hospitalization benefit equivalent to an amount obtained by multiplying the
number of days of such completed period of hospitalisation (a completed period of 24 hours
deemed as 1 day) with the per day benefit payable as reflected in the Schedule will be paid subject
to a Deductible of first 24 hours of such Hospitalization for each and every claim.
This section does not provide benefits for any loss resulting in whole or in part from, or expenses
incurred, directly or indirectly in respect of
1. Benefits will not be available for Any condition, whether diagnosed or not, ailment or
injury or related condition(s) for which Insured has been diagnosed, received medical
treatment, had signs and / or symptoms, prior to inception of Insured’s first Policy, until 48
consecutive months have elapsed, after the date of inception of the first Policy with Insurer.
It would also mean any direct or indirect complications arising out of pre-existing conditions
whether known or unknown to the Insured.
This Exclusion shall cease to apply if Insured has maintained the Health Insurance Policy with
Insurer for a continuous period of a full 4 years without break from the date of Insured’s first
Health Insurance Policy with Insurer.
2. The Company shall not be liable to make any payment under this Policy in connection with
or in respect of Insured/Insured Person hospitalisation due to sickness / illness, as stated in
this Section, occurring before the commencement of Period of Insurance or arising within
the first 30 days of the commencement of the Period of Insurance. However this exclusion
would not applicable for hospitalisation due to Accidental Bodily Injury within first 30 days of
commencement of cover.
3. Exclusions applicable to first year of cover from commencement of the Policy, from the
following Diseases / Illness and its related complications:

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Any types of gastric or duodenal ulcers, Tonsillectomy, Adenoidectomy, Mastoidectomy,
Tympanoplasty, All internal or external tumor /cysts/nodules/polyps of any kind including
breast lumps, All types of Hernia and Hydrocele, Anal Fissures, Fistula and Piles.
4. Exclusions applicable to first two years of cover from commencement of the Policy, from the
following Diseases / Illness and its related complications:
Cataract, Benign Prostatic Hypertrophy, Hysterectomy/ myomectomy for menorrhagia or
fibromyoma or prolapse of uterus, Hypertension, Heart Disease and related complications,
Diabetes and related complications, Non infective Arthritis, Treatment of Spondylosis /
Spondilytis, Gout & Rheumatism, Surgery of Genitourinary tract, Calculus Diseases, Sinusitis,
nasal disorders and related disorders, Surgery for prolapsed intervertebral disc unless arising
from accident, Vertebro-spinal disorders (including disc) and knee conditions; Surgery of
varicose veins and varicose ulcers, Chronic Renal failure, Joint replacement surgery due to
degenerative condition, age related osteoarthritis and osteoporosis unless such joint
replacement surgery is necessitated by Accidental Bodily Injury.
Exclusions:
1. Convalescence, general debility, “Run-down” condition, rest cure, Congenital Internal and
/or external illness/disease/defect.
2. Venereal disease or any sexually transmitted disease or sickness.
3. Treatment for any mental disease / illness, psychiatric or psychological disorders.
4. Outpatient diagnostic, medical and surgical procedures or treatments, non-prescribed drugs
and medical supplies, hormone replacement therapy, sex change or treatment which
results from or is in any way related to sex change.
5. Hospitalization primarily for investigation purposes, diagnosis, x-ray examination, general or
routine physical or medical examinations, not incidental to treatment or diagnosis of a
covered Disease or Illness or any treatment or any preventive treatments, or examinations
carried out by a Medical Practitioner which are not medically necessary and which would
necessarily not warrant hospitalization and the line of treatment is such that could be
carried out on an outpatient basis.
6. Any fertility, sub fertility or assisted conception operation or sterilization procedure and
related treatment.
7. Epidemics recognized by WHO or/and Indian state / central government/state govt.
8. Circumcision unless necessary for treatment of a disease, illness or injury not excluded
hereunder, or, as may be necessitated due to an accident
9. Cosmetic or aesthetic treatments of any description, treatment or surgery for change of
life/gender, Lasik treatment, or similar type of corrective procedures for refractive error. Any
form of plastic surgery (unless necessary for the treatment of an Illness or Accidental Bodily
Injury).
10. Prostheses, corrective devices, spectacles, contact lenses, hearing aid, medical appliances,
external medical equipment of any kind used at home as post hospitalisation care including
cost of instrument used in the treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous
Peritoneal Ambulatory Dialysis (C.P.A.D) and Oxygen concentrator for Bronchial Asthmatic
condition.
11. Dental treatment or surgery of any kind unless required as a result of Accidental Bodily
Injury to natural teeth requiring hospitalization treatment.
12. Ailments requiring treatment due to use or abuse of any substance, drug or alcohol and
treatment for de-addiction.
13. Treatment arising from or traceable to pregnancy childbirth, miscarriage, abortion or
complications of any of this, including caesarian section. However, this exclusion will not
apply to abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is
13 Page 13 of 28
proved by submission of Ultra Sonographic Report and certification by Gynecologist that it is
life threatening
14. Vaccination or inoculation except as post bite treatment for animal bite
15. Surgery to correct deviated septum and hypertrophied turbinate unless necessitated by
accidental bodily injury and proved to our satisfaction that the condition is a result of an
accidental injury.
16. Treatments in health hydro, spas, nature care clinics and the like.
17. Hospitalization for donation of any body organs by an Insured including complications
arising from the donation of organs.
18. Treatment for obesity, weight reduction or weight management.
1. Terms & Conditions: Insured must provide intimation to Insurer immediately and in any
event within 48 hours upon discharge from hospital. However the Insurer at his sole
discretion may relax this condition subject to satisfactory proof/evidence being produced on
the reasons for such a delay beyond the stipulated 48 hours upto a maximum period of 7
days.
2. Insured will need to submit the below mentioned documents for the processing of Hospital
Daily Cash Claims within 7 days from the date of discharge from the hospital, However the
Insurer at his sole discretion may relax this condition subject to a satisfactory proof/evidence
being produced on the reasons for such a delay beyond the stipulated 7 days upto a
maximum period of 14 days.:
- Claim form duly signed
- Copy of attested Hospital summary / Discharge Summary
- Copy of Medical reports / records
- Doctor’s certificate
- Copy of Hospital Paid Bill and receipt.
- Valid Photo identity Card
- Any other relevant document as required by the company
3. If Insured suffers a relapse within 45 days of the discharge from Hospital when Insured last
obtained medical treatment or consulted a Doctor and for which a claim has been made, then
such relapse shall be deemed to be part of the same claim, as long as the relapse occurs
within the Policy Period
Section II C - ASSET INSURANCE
Coverage for Dwellings and / or Contents and / or Tools and implements and / or stocks of farm
produce:
The Company will indemnify the Insured in respect of loss or damage to the Insured Dwelling and /
or Contents and / or Tools and implements and / or stocks of farm produce arising due to the perils
described herein below subject to the terms and conditions contained herein.
I Fire - Excluding destruction or damage caused to the property insured by

(i) Its own fermentation, natural heating or spontaneous combustion.
(ii) It’s undergoing any heating or drying process.
(iii) Burning of property insured by order of any Public Authority.
II Lightning
14 Page 14 of 28
III Explosion/Implosion - Excluding loss, destruction of or damage
(a) to boilers (other than domestic boilers), economizers or other vessels, machinery or apparatus
(in which steam is generated) or their contents resulting from their own explosion/implosion,
(b) caused by centrifugal forces.
IV Aircraft Damage - Loss, destruction or damage caused by Aircraft other aerial or space devices
and articles dropped there from excluding those caused by pressure waves.
V Riot, Strike, Malicious Damage - Loss of or visible physical damage or destruction by external
violent means directly caused to the property insured but excluding those caused by
(a) Total or partial cessation of work or the retardation or interruption or cessation of any
process or operations or omissions of any kind.
(b) Permanent or temporary dispossession resulting from confiscation, commandeering,
requisition or destruction by order of the Government or any lawfully constituted Authority.
(c) Permanent or Temporary dispossession of any building or plant or unit or machinery
resulting from the unlawful occupation by any person of such building or plant or unit or
machinery or prevention of access to the same.
(d) Burglary, housebreaking, theft, larceny, or any such attempt or any omission of any
kind of any person (whether or not such act is committed in the course of a disturbance of
public peace) in any malicious act.
VI Storm, Cyclone, Typhoon, Tempest, Hurricane, Tornado, Flood and Inundation: Loss,
destruction or damage directly caused by Storm, Cyclone, Typhoon, Tempest, Hurricane, Tornado,
Flood or Inundation excluding those resulting from earthquake, Volcanic eruption or other
convulsions of nature. (Wherever earthquake cover is given as an “add on cover” the words
“excluding those resulting from earthquake volcanic eruption or other convulsions of nature” shall
stand deleted).
VII Impact Damage - Loss of or visible physical damage or destruction caused to the property
insured due to impact by any Rail/Road vehicle or animal by direct contact not belonging to or
owned by
(a) the Insured or any occupier of the premises or
(b) their employees while acting in the course of their employment.
VIII Subsidence and Landslide including Rock slide - Loss, destruction or damage directly caused by
Subsidence of part of the site on which the property stands or Land slide/Rock slide excluding:
(a) the normal cracking, settlement or bedding down of new structures
(b) the settlement or movement of made up ground
(c) coastal or river erosion
(d) defective design or workmanship or use of defective materials
(e) demolition, construction, structural alterations or repair of any property or groundwork
or excavations.
IX Bursting and/or overflowing of Water Tanks, Apparatus and Pipes
X Missile testing operations
XI Leakage from Automatic Sprinkler Installations - Excluding loss, destruction or damage caused
by
(a) repairs of alterations to the buildings or premises
(b) repairs, removal or extension of the sprinkler installation
XII Bush Fire - Excluding loss, destruction or damage caused by Forest Fire.
PROVIDED that the liability of the Company shall in no case exceed in respect of each item the sum
15 Page 15 of 28
expressed in the said Schedule to be insured thereon or in the whole the total Sum Insured hereby
or such other sum or sums as may be substituted therefore by memorandum hereon or attached
hereto signed by or on behalf of the Company.
XIII: Earthquake (Fire and Shock)
(A) GENERAL EXCLUSIONS

1. Loss, destruction or damage caused by war, invasion, act of foreign enemy hostilities or war
like operations (whether war be declared or not), civil war, mutiny, civil commotion
assuming the proportions of or amounting to popular rising, military rising, rebellion,
revolution, insurrection or military or usurped power.
2. Loss, destruction or damage directly or indirectly caused to the property insured by
a. Ionising radiations or contamination by radioactivity from any nuclear fuel or
from any nuclear waste from the combustion of nuclear fuel.
b. The radio active toxic, explosives or other hazardous properties of any explosive
nuclear assembly or nuclear component thereof.
3. Loss, destruction or damage caused to the insured property by pollution or contamination
excluding
a. Pollution or contamination which itself results from a peril hereby insured
against.
b. Any peril hereby insured against which itself results from pollution or
contamination.
4. Loss, destruction or damage to bullion or unset precious stones, any curios or works of art
for an amount exceeding Rs. 10000/-, goods held in trust or on commission, manuscripts,
plans, drawings, securities, obligations or documents of any kind, stamps, coins, or paper
money, cheques, books of accounts or other business books, compute systems records,
explosives unless otherwise expressly stated in the Policy.
5. Loss, destruction or damage to any electrical machine, apparatus, fixture, or fitting arising
from or occasioned by over-running, excessive pressure, short circuiting, arcing, self heating
or leakage of electricity from whatever caused (lightning included) provided that this
exclusion shall apply only to the particular electrical machine, apparatus, fixture or fitting so
affected and not to other machines, apparatus, fixtures or fittings which may be destroyed
or damaged by fire so set up.
6. Expenses necessarily incurred on (i) Architects, Surveyors and Consulting Engineer’s Fees
and (ii) Debris Removal by the Insured following a loss, destruction or damage to the
property insured by an insured peril in excess of 3% and 1% of the claim amount
respectively.
7. Loss of earnings, loss by delay, loss of market or other consequential or indirect loss or
damage of any kind or description whatsoever.
8. Loss or damage by spoilage resulting from the retardation or interruption or cessation of any
process or operation caused by operation of any of the perils covered.
9. Loss by theft during or after the occurrence of any insured peril except as provided under
Riot, Strike, Malicious and Terrorism Damage cover.
10. Loss or damage to property insured if removed to any building or place other than in which
it is herein stated to be insured, except machinery and equipment temporarily removed for
repairs, cleaning, renovation or other similar purposes for a period not exceeding 60 days.
16 Page 16 of 28
(B) GENERAL CONDITIONS
1. All insurances under this Policy shall cease on expiry of seven days from the date of fall or
displacement of any building or part thereof or of the whole or any part of any range of
buildings or of any structure of which such building forms part.
PROVIDED such a fall or displacement is not caused by insured peril, loss or damage which is
covered by this Policy or would be covered if such building, range of buildings or structure
were insured under this Policy.
Notwithstanding the above, the Company subject to an express notice being given as soon
as possible but not later than seven days of any such fall or displacement may agree to
continue the insurance subject to revised rates, terms and conditions as may be decided by
it and confirmed in writing to this effect.
2. Under any of the following circumstances the insurance ceases to attach as regards the
property effected unless the Insured, before the occurrence of any loss or damage, obtains
the sanction of the Company signified by endorsement upon the Policy by or on behalf of
the Company:-
a. If the trade or manufacture carried on be altered, or if the nature of the occupation
of or other circumstances affecting the building insured or containing the insured
property be changed in such a way as to increase the risk of loss or damage by
Insured Perils.
b. If the building insured or containing the insured property becomes unoccupied and
so remains for a period of more than 30 days (to be deleted in case of dwellings)
c. If the interest in the property passes from the Insured otherwise than by will or
operation of law.
3. This insurance does not cover any loss or damage to property which, at the time of the
happening of such loss or damage, is insured by or would, but for the existence of this
policy, be insured by any marine policy or policies except in respect of any excess beyond
the amount which would have been payable under the marine policy or policies had this
insurance not been effected.
4. This insurance may be terminated at any time at the request of the Insured, in which case
the Company will retain the premium at customary short period rate for the time the Policy
has been in force. This insurance may also at any time be terminated at the option of the
Company, on 15days’ notice to that effect being given to the Insured, in which case the
Company shall be liable to repay on demand a rateable proportion of the premium for the
unexpired term from the date of the cancellation.
5. (i) On the happening of any loss or damage, the Insured shall forthwith give notice thereof to
the Company and shall within 15 days after the loss or damage, or such further time as the
Company may in writing allow in that behalf, deliver to the Company.
a. A claim in writing for the loss or damage containing in particular an account
as may be reasonably practicable of all the several articles or items or
property damaged or destroyed, and of the amount of the loss or damage
thereto respectively, having regard to their value at the time of the loss
or damage not including profit of any kind.
b.Particulars of all other insurance, if any
The Insured shall also at all times at his own expense produce, procure and give to the
Company all such further particulars, plans, specification books, vouchers, invoices, and
17 Page 17 of 28
duplicates or copies thereof, documents, investigation reports (internal/external), proofs
and information with respect to the claim and the origin and cause of the loss and the
circumstances under which the loss or damage occurred, and any matter touching the
liability or the amount of the liability or the amount of the liability of the Company as may
be reasonable required by or on behalf of the Company together with a declaration on oath
or in other legal form of the truth of the claim and of any matters connected therewith.
No claim under this Policy shall be payable unless the terms of this condition have been
complied with.
(ii) In no case whatsoever shall the Company be liable for any loss or damage after the
expiry of 12 months from the happening of the loss or damage unless the claim is the
subject of pending action or arbitration; it being expressly agreed and declared that if the
Company shall disclaim liability for any claim hereunder and such claim shall not within 12
calendar months from the date of the disclaimer have been made the subject matter of a
suit in a court of law then the claim shall for all purposes be deemed to have been
abandoned and shall not thereafter be recoverable hereunder.
6. On the happening of loss or damage to any of the property insured by this Policy, the
Company may
a. Enter and take and keep possession of the building or premises where the loss or
damage has happened.
b. Take possession of or require to be delivered to it any property of the Insured in the
building or on the premises at the time of the loss or damage.
c. Keep possession of any such property and examine, sort, arrange, remove or
otherwise deal with the same.
d. Sell any such property or dispose of the same for account of whom it may concern.
The powers conferred by this condition shall be exercisable by the Company at any time
until notice in writing is given by the Insured that he makes no claim under the Policy, or if
any claim is made, until such claim is finally determined or withdrawn, and the Company
shall not by any act done in the exercise or purported exercise of its powers hereunder,
incur any liability to the Insured or diminish its rights to rely upon any of the conditions of
this Policy in answer to any claim. If the Insured or any person on his behalf shall not
comply with the requirements of the Company or shall hinder or obstruct the Company, in
the exercise of its powers hereunder, all benefits under this Policy shall be forfeited. The
Insured shall not in any case be entitled to abandon any property to the Company whether
taken possession of by the Company or not.
7. If the Company at its option, reinstates or replaces the property damaged or destroyed, or
any part thereof, instead of paying the amount of the loss or damage, or join with any other
Company or Insurer(s) in so doing the Company shall not be bound to reinstate exactly or
completely but only as circumstances permit and in reasonably sufficient manner, and in no
case shall the Company be bound to expend more in reinstatement than it would have cost
to reinstate such property as it was at the time of the occurrence of such loss or damage nor
more than the Sum Insured by the Company thereon. If the Company so elects to reinstate
or replace any property the Insured shall at his own expense furnish the Company with such
plans, specification, measurements, quantities and such other particulars as the Company
may require, and no acts done, or caused to be done, by the Company with a view to
reinstatement or replacement shall be deemed an election by the Company to reinstate or
18 Page 18 of 28
replace. If in any case the Company shall be unable to reinstate or repair the property
hereby insured, because of any municipal or other regulations in force affecting the
alignment of streets or the construction of buildings or otherwise, the Company shall, in
every such case, only be liable to pay such sum as would be requisite to reinstate or repair
such property if the same could lawfully be reinstated to its former condition.
8. If the property hereby insured shall at the breaking out of any fire or at the commencement
of any destruction of or damage to the property by any other peril hereby insured against be
collectively of greater value than the Sum Insured thereon, then the Insured shall be
considered as being his own insurer for the difference and shall bear a rateable proportion
of the loss accordingly. Every item, if more than one, of the Policy shall be separately
subject to this condition.
9. If at the time of any loss or damage happening to any property hereby insured there be any
other subsisting insurance or insurances, whether effected by the Insured or by any other
person or persons covering the same property, this Company shall not be liable to pay or
contribute more than its rateable proportion of such loss or damage.
10. At all times during the period of insurance of the Policy the insurance cover will be
maintained to the full extent of the respective Sum Insured in consideration of which upon
the settlement of any loss under this Policy, pro-rata premium for the unexpired period from
the date of such loss to the expiry of period of insurance for the amount of such loss shall be
payable by the Insured to the Company. The additional premium referred above shall be
deducted from the net claim amount payable under the Policy. This continuous cover to the
full extent will be available notwithstanding any previous loss for which the Company may
have paid hereunder and irrespective of the fact whether the additional premium as
mentioned above has been actually paid or not following such loss. The intention of this
condition is to ensure continuity of the cover to the Insured subject only to the right of the
Company for deduction from the claim amount, when settled, of pro-rata premium to be
calculated from the date of loss till expiry of the Policy. Notwithstanding what is stated
above, the Sum Insured shall stand reduced by the amount of loss in case the Insured
immediately on occurrence of the loss exercises his option not to reinstate the Sum Insured
as above.
Section II D - Burglary and Housebreaking

The Company will indemnify the Insured in respect of loss or damage to the contents, tools or
implements or other named assets and stock of farm produce whilst contained in the Insured
premises by Burglary and Housebreaking as defined in the policy. In such an event the Company will
subject to the terms exceptions and conditions contained herein pay or make good to the Insured
such loss to the extent of the intrinsic value of the property so lost or such damage to the amount so
sustained. Provided that the liability of the Company, shall in no case exceed in respect of each item
the sum expressed in the Schedule hereto to be insured thereon or in the whole the total Sum
Insured hereby.
Exclusions
This Policy does not cover the following unless specially mentioned in the Schedule and expressly
insured by the Policy

19 Page 19 of 28
a) Loss or damage where any inmate or member of the Insured’s household or of his business
staff or any other person lawfully in the premises is concerned in the actual theft of or
damage to any of the articles or premises or where such loss or damage has been expedited
or in any way assisted or brought about by any such person or persons.
b) Loss or damage caused by wear and tear or gradual deterioration.
c) Consequential loss or damage or legal liability of any kind.
d) Livestock, motor vehicles and pedal cycles.
e) Money, securities for money, stamps, gold or silver articles, precious stones, promissory
notes and documents of like nature.
f) 5% of the claim amount subject to a minimum of Rs.500/- for each and every claim.
Conditions
1. Claim Notification and Proof of Loss
On the happening of any loss or damage the Insured shall forthwith give notice thereof in
writing to the Police and also to the Company detailing the circumstances of the case and
shall within seven days after such loss or damage shall have come to the Insured's
knowledge and at the Insured's own expense deliver to the Company a claim in writing and
containing in particular an account as may be reasonably practicable of all the property lost
or damaged and of the amount of the loss or damage in respect thereof respectively having
regard to its value at the time of the loss or damage and also of the damage (if any) to the
premises.
The Insured shall also produce and give to the Company when where and to whom and in a
manner required by the Company and at the Insured's own expense all such books of
account, vouchers, invoices, documents, proofs and information as may be reasonably
required and the Insured shall be bound to satisfy the Company by such reasonable
evidence as the Company may require that the loss or damage claimed for has actually
arisen from one of the causes insured against and that the property in respect of which a
claim is made is not merely mislaid or missing.
2. Reinstatement and Repair
The Company at any time before payment of a claim and notwithstanding that an offer of
settlement has been made instead of paying the amount of the loss or damage in respect of
any property or the premises may make it good by reinstating or replacing any of the
property stolen or repairing the premises damaged or such items or part thereof as the
Company may think fit and paying the amount of the loss or damage in respect of the
residue of such property or premises. Provided that if the Company elects to replace any
property or reinstate any premises the Company in making good the loss or damage shall
not be bound to replace or reinstate such property or premises exactly and completely but
only to do so substantially as nearly as circumstances permit and in a reasonably sufficient
manner. In case where any of the property or premises are insured elsewhere the Company
may join with any other insurance company or insurers in replacing or reinstating the same.
3. Underinsurance
If the property hereby insured shall at the time of happening of any loss destruction or
damage be collectively of greater value than 85% of the Sum Insured thereon then the
20 Page 20 of 28
Insured shall be considered as being his own insurer for the difference and shall bear
rateable proportion of the loss accordingly. Every item if more than one of the Policy shall
be separately subject to this Condition.
4. Occupation of premises
The Company may at any time after the occurrence of damage to the property insured enter
upon the premises and take and keep possession of the property concerned and deal with
the salvage and this Policy shall be proof of leave and licence for such purpose, and if the
Insured or anyone acting on his behalf shall obstruct or prevent the Company from so doing,
all benefit under this Policy shall be forfeited.
Upon payment of any claim for loss under this Policy, the property in respect of which the
payment is made shall belong to the Company. No property may be abandoned to the
Company.
5. Reinstatement after settlement of a claim
All sums which may from time to time be paid by way of indemnity under this Policy in any
one Period of Insurance shall be accounted in diminution of the total Sum Insured so that in
case of any subsequent event giving rise to a claim occurring during the same period the
total amount payable during that period by the Company shall not in any case exceed the
total Sum Insured. In the event of the property lost, destroyed or damaged being replaced
by other property, the Company will at the Insured’s request extend this insurance by
endorsement to include such property upon payment of the appropriate pro-rata additional
premium. Such reinstatement will be automatic only once during any one period of
insurance.
General Exclusions applicable to all coverages except Asset Insurance under the Policy:
1. Payment of compensation in respect of death of or bodily injury to the Insured directly or
indirectly caused by or contributed to by or arising from or traceable to ionizing radiation or
contamination by radioactivity from any source whatsoever, or from nuclear weapons
material.
2. War, invasion, act of foreign enemy, hostilities (whether war be declared or not), armed or
unarmed truce, civil war, mutiny, rebellion, revolution, insurrection, military or usurped
power, riot or civil commotion, strikes
3. Participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba
diving, mountain climbing (where ropes or guides are customarily used), riding or driving in
races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or
equestrian activities, skin diving or other underwater activity, rafting or canoeing involving
white water rapids, yachting or boating outside coastal waters (2 miles), participation in any
Professional Sports, bull fights (Jalli Kattu), cart racing, boat racing, bull racing and yoked bull
racing/ water buffalo racing (Kala Pootu/Maramadi/Kambala), horse or camel or donkey or
any other animal racing/riding or racing in unsaddled animals, participation in contact sports
like Mal Yutham and any martial arts training, sword fights and demonstration of skills in
using such weapons (like Kalari Payattu and Gatka) or other such weapon fights including but
not limited to canes and sticks, shields, chains, guns, explosive weapons etc any bodily
21 Page 21 of 28
contact sport or any other hazardous or potentially dangerous sport for which Insured is
untrained;
4. Genetic disorders and stem cell implantation / surgery/storage.
5. Payment of compensation in respect of death, injury or disablement of the Insured from (a)
intentional self injury, suicide or attempted suicide. (b) whilst under the influence of
intoxicating liquor or drug. (c) directly or indirectly caused by insanity. (d) arising or resulting
from the insured committing any breach of the law with criminal intent.
6. Sexually transmitted conditions, mental or nervous disorder, , Acquired Immune Deficiency
Syndrome (AIDS), Human Immune deficiency Virus (HIV) infection
7. Use/Abuse of drugs, alcohol, or other intoxicants or hallucinogens unless properly
prescribed by a Medical Practitioner and taken as prescribed
8. Any congenital Illness/Conditions.
9. Treatments taken at any institution which is primarily a rest home or convalescent facility, a
place for custodial care, a facility for the aged or alcoholic or drug addicts or for the
treatment of psychiatric or mental disorders; even if the institution has been registered as a
hospital with the Appropriate Authorities
10. Treatment with alternative medicines like Ayurvedic, Homeopathic, acupuncture,
acupressure, osteopath, naturopathy, chiropractic, reflexology and aromatherapy.
11. Experimental, unproven or any other treatment that is not scientifically recognized
12. Any medical procedure or treatment, which is not medically necessary or not performed by
a Medical Practitioner.
13. Failure to seek or follow medical advice following the diagnosis of any illness/disease/injury.
14. Serving in any branch of the Military or Armed Forces of any country, whether in peace or
War
15. In the event of coverage being provided to members of NGOs and SHGs, coverage will cease
if members are no longer associated with the NGO/SHG
General Conditions applicable to all coverages under the Policy:
1. Cancellation: The Policy can be cancelled at the option of the Company in the event of fraud,
misrepresentation or suppression of any of the information that was sought in the proposal
form or any other communication by giving the Insured 15 days notice by registered letter,
at the Insured's last known address. In such an event Company will refund to the Insured a
pro-rata' premium for unexpired period of Insurance subject to no claim has occurred up to
date of cancellation. Company shall, however, remain liable for any claim which arose prior
to the date of cancellation.
Also, the Insured may at any time cancel this Policy by giving a written notice to the
Company and in such event Company shall allow refund of premium at Insured’s short
period rate only (table given here below) provided no claim has occurred up to the date of
cancellation.
Period on risk Rate of premium refunded
Up to one month 75% of annual rate
Up to three months 50%of annual rate
Up to six months 25% of annual rate
Exceeding six months Nil

22 Page 22 of 28
2. Renewal: This Policy may be renewed by mutual consent every year and in such event, the
renewal premium shall be paid to Company on or before the date of expiry of the Policy or
of the subsequent renewal thereof. However Company shall not be bound to give notice
that such renewal premium is due. Also Company may exercise option not to renew the
policy on grounds of fraud misrepresentation, or suppression of any material fact either at
the time taking the Policy or any time during the currency of the earlier policies.
A Grace Period of 30 days is allowed for renewal of the Policy. This will be counted from the
day immediately following the premium due date during which a payment can be made to
renew or continue the Micro Insurance Policy in force without loss of continuity benefits
such as waiting periods and coverage of Pre-existing condition / Diseases. The continuity of
coverage for all the covers under the expiring policy will be subject to receiving appropriate
premium for the same. Coverage is not available for the period for which no premium is
received and Company has no liability for the claims arising during this period.
3. Termination of Policy - This Policy terminates on earliest of the following events-

a. Cancellation of policy by as per the cancellation provision.
b. On the policy expiry date.
Following sections terminate on event giving rise to claim under respective section however
rest of the policy remains in force.
 Critical Illness Section
 Death/ permanent total disablement under Personal Accident
Section
4. Nomination and Assignment: This Policy is not assignable and no person(s) other than
Insured or Insured’s nominee(s) as mentioned in the schedule or legal representatives,
wherever is applicable, can claim or sue the Insurer under this policy.
The payment by the Insurer to the Insured, his/her nominee or legal representative of any
compensation or benefit under the policy shall in all cases be an effectual discharge to the
Insurer.
5. Withdrawal of Product: In case of withdrawal of this product insurer will communicate to

Insured at least 3 months prior to the withdrawal. Existing policy will continue to remain in
force till its expiry, and at the time of renewal, Insured will have option to migrate to
insurer’s micro insurance products available at that time with continuity benefit, if any.
6. Arbitration: If any dispute or difference shall arise as to the quantum to be paid under the
Policy (liability being otherwise admitted) such difference shall independently of all other
questions be referred to the decision of a sole arbitrator to be appointed in writing by the
parties or if they cannot agree upon a single arbitrator within 30 days of any party invoking
arbitration, the same shall be referred to a panel of three arbitrators, comprising of two
arbitrators, one to be appointed by each of the parties to the dispute/difference and the
third arbitrator to be appointed by such two arbitrators and such arbitration shall be
conducted under and in accordance with the provisions of the Arbitration and Conciliation
Act, 1996.
It is clearly agreed and understood that no difference or dispute shall be referable to

arbitration as herein before, if the Company has disputed or not accepted liability under or
in respect of this Policy.

23 Page 23 of 28
It is also hereby further expressly agreed and declared that if the Company shall disclaim
liability to the Insured for any claim hereunder and such claim shall not within 12 calendar
months from the date of such disclaimer have been made the subject matter of a suit in a
court of Law, the claim shall for all purposes be deemed to have been abandoned and shall
not thereafter be recoverable hereunder.
7. The Company shall not be liable to make any payment under this Policy, in respect of any
claim if such claim be in any manner fraudulent or supported by any fraudulent statement or
device whether by the Insured/Insured Person or by any person on behalf of the
Insured/Insured Person.
8. It is also hereby further expressly agreed and declared that if the Company disclaim liability
to the Insured/Insured Person for any claim hereunder and such claim shall not within 12
calendar months from the date of such disclaimer have been made the subject of a suit in a
court of law, then the claim shall for all purposes be deemed to have been abandoned and
shall not thereafter be recoverable hereunder.
9. Payment of Claims:
a) Insurer shall make payment in India in Indian Rupees only.
b) if admissible under the Policy ,claim can be received from Insured through various
modes like email / telephone/ fax/ in person or may be via letter or any other suitable
mode. Upon receipt of information Insurer will register the claim under a unique claim
number.
c) On receipt of claim documents from Insured, Insurer shall assess the admissibility of
claim as per Policy terms and conditions. Upon satisfactory completion of assessment
and admission of claim, the Insurer will make the payment of benefit as per the
contract. In case if the claim is repudiated Insurer will inform the Insured about the
same in writing with reason for repudiation. Lack of documents or medical certificates
confirming the diagnosis of illness or undergoing of medical/surgical procedure will
result in forfeiture of the claim.
d) Penal Interest Provision: Upon acceptance of an offer of settlement by the insured, the
payment of the amount due shall be made within 7 days from the date of acceptance of
the offer by the insured. In the cases of delay in the payment, the insurer shall be liable
to 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 it.
e) No Sum Payable under this Policy shall carry interest except as provided by IRDA
(Protection of Policy Holders Interest) Regulation, 2002.

24 Page 24 of 28
10. GRIEVANCE REDRESSAL PROCEDURE
In view of our commitment to provide you with the best services, we would like to inform
you that if you have any queries / clarifications or grievances under your Policy, please get
in touch with our local office at the address mentioned in the Policy. Kindly quote your
Policy number in all communication with us. This will help us to deal with the matter
faster. In case of non-availability of the policy number, we request you to contact our
Insurance advisor or our local Office for the same.
The Company will settle the claims under this Policy within 30 days from the date of
receipt of necessary documents required for assessing the claim. In the event that the
Company decides to reject a claim made under this Policy, the Company shall do so within
a period of thirty days of the Survey Report or the additional Survey Report, as the case
may be, in accordance with the provisions of Protection of Policyholders’ Interest
Regulations 2002.
Our Endeavour would be to resolve your queries / clarifications or grievances, at the first
instance itself. But if you feel that the matter was not handled to your satisfaction, we
request you to get in touch with our Customer Service Cell at the below mentioned
address-
Customer Service Cell / Grievance Redressal Officer

SBI General Insurance Company Ltd.
101-201-301, Nataraj,
Junction of Andheri Kurla Road and Western Express Highway,
Andheri East, Mumbai – 400069
Email – customer.care@sbigeneral.in
Telephone- 022 XXXXXXXXXXXXX
Fax No.: 022 XXXXXXXXXXXXX
It is our commitment to resolve your queries / clarifications or grievances at the earliest. The
Insurance Ombudsman is an organization set up by the IRDA to address grievances that are not
settled to your satisfaction. Below mentioned are the addresses of these offices that you may get in
touch with
CONTACT DETAILS JURISDICTION
AHMEDABAD - Shri. / Smt. State of Gujarat and Union Territories of Dadra

Office of the Insurance Ombudsman, & Nagar Haveli and Daman and Diu.
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Ahmedabad – 380 014.
Tel.: 079 - 27546150 / 27546139
Fax: 079 - 27546142
Email: ins.omb@rediffmail.com
BENGALURU - Shri. M. Parshad New Centre.

Office of the Insurance Ombudsman,
Jeevan Mangal Bldg., 2nd Floor,
25 Page 25 of 28
SB I General
INSURANCE
Behind Canara Mutual Bldgs.,
No.4, Residency Road,
Bengaluru – 560 025.
Tel.: 080 - 22222049
Fax: 080 -
Email: insombudbng@gmail.com
BHOPAL - Shri. Raj Kumar Srivastava States of Madhya Pradesh and Chattisgarh.
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpalbhopal@gmail.com
BHUBANESHWAR - Shri. B. N. Mishra State of Orissa.

62, Forest park,
Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: ioobbsr@dataone.in
CHANDIGARH - Shri. Manik B. Sonawane States of Punjab, Haryana, Himachal Pradesh,

Office of the Insurance Ombudsman, Jammu & Kashmir and Union territory of
S.C.O. No. 101, 102 & 103, 2nd Floor, Chandigarh.
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274
Email: ombchd@yahoo.co.in
CHENNAI - Shri Virander Kumar State of Tamil Nadu and Union Territories -
Office of the Insurance Ombudsman, Pondicherry Town and Karaikal (which are part
Fatima Akhtar Court, of Union Territory of Pondicherry).
4th Floor, 453 (old 312),
Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: chennaiinsuranceombudsman@gmail.com
DELHI - Smt. Sandhya Baliga States of Delhi and Rajasthan.

2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
26 Page 26 of 28
SB I General
INSURANCE
Tel.: 011 - 23239633 / 23237539
Fax: 011 - 23230858
Email: iobdelraj@rediffmail.com
GUWAHATI - Sh. / Smt. States of Assam, Meghalaya, Manipur, Mizoram,

Office of the Insurance Ombudsman, Arunachal Pradesh, Nagaland and Tripura.
Jeevan Nivesh, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2132204 / 2132205
Fax: 0361 - 2732937
Email: ombudsmanghy@rediffmail.com
HYDERABAD - Shri. G. Rajeswara Rao States of Andhra Pradesh, Karnataka and Union
Office of the Insurance Ombudsman, Territory of Yanam - a part of the Union
6-2-46, 1st floor, "Moin Court", Territory of Pondicherry.
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.: 040 - 65504123 / 23312122
Fax: 040 - 23376599
Email: insombudhyd@gmail.com
Jaipur - Shri. Ashok K. Jain New Centre.

Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 -
Fax: 0141 -
Email:
KOCHI - Shri. P. K. Vijay Kumar State of Kerala and Union Territory of (a)
Office of the Insurance Ombudsman, Lakshadweep (b) Mahe-a part of Union Territory
2nd Floor, Pulinat Bldg., of Pondicherry.
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: iokochi@asianetindia.com
KOLKATA - Shri. K. B. Saha States of West Bengal, Bihar, Sikkim, Jharkhand

Office of the Insurance Ombudsman, and Union Territories of Andaman and Nicobar
Hindustan Bldg. Annexe, 4th Floor, Islands.
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341

27 Page 27 of 28
SB I General
INSURANCE
Email: insombudsmankolkata@gmail.com
LUCKNOW - Shri. N. P. Bhagat States of Uttar Pradesh and Uttaranchal.

6th Floor, Jeevan Bhawan, Phase-II,
Nawal Kishore Road, Hazratganj,
Lucknow - 226 001.
Tel.: 0522 - 2231330 / 2231331
Fax: 0522 - 2231310
Email: insombudsman@rediffmail.com
MUMBAI - Shri. A. K. Dasgupta States of Maharashtra and Goa.

3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
Email: ombudsmanmumbai@gmail.com
Pune - Shri. A. K. Sahoo New Centre.

Jeevan Darshan Bldg., 2nd Floor,
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020 -
Fax: 020 -
Email:
STATUTORY NOTICE: INSURANCE IS THE SUBJECT MATTER OF SOLICITATION

28 Page 28 of 28

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Registered Office: 101, 201, 301, Natraj,

Junction of Western Express Highway &

a. has qualified nursing staff under its employment

Disease / Illness means a sickness or a disease or pathological condition leading to the

Dwelling means a structure of pucca or kuttcha construction used as Insured’s residence.

Hospitalisation means admission in a Hospital for a minimum period of 24 In patient care

Insurer means Us/Our/We SBI General Insurance Company Limited.

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Market value means Replacement value less depreciation.

Medically Necessary Medically necessary treatment is defined as any treatment, tests,

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Unproven/Experimental treatment means Treatment including drug experimental therapy which

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Section I - PERSONAL ACCIDENT COVER:

Table of Benefits Percentage of Sum Insured

Terms and Conditions:

Section II A - Critical Illness Insurance

Kidney Failure Requiring Regular Dialysis

Primary Pulmonary Arterial Hypertension:

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Multiple Sclerosis with Persisting Symptoms

Major Organ/ Bone Marrow Transplant

b. The following are excluded:

Open Chest Bag

b. The following are excluded:

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Open Heart Replacement or Repair of Heart Valves

Stroke Resulting in Permanent Symptoms

First Heart Attack – Of Specified Severity

Coma of Specified Severity

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Permanent Paralysis of Limbs

- Identity proof of the claimant

Section II B - HOSPITAL DAILY CASH COVER

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Section II C - ASSET INSURANCE

I Fire - Excluding destruction or damage caused to the property insured by

(A) GENERAL EXCLUSIONS

Section II D - Burglary and Housebreaking

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

2. Reinstatement and Repair

5. Reinstatement after settlement of a claim

General Conditions applicable to all coverages under the Policy:

Up to one month 75% of annual rate

Up to three months 50%of annual rate

Up to six months 25% of annual rate

Exceeding six months Nil

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

3. Termination of Policy - This Policy terminates on earliest of the following events-

5. Withdrawal of Product: In case of withdrawal of this product insurer will communicate to

It is clearly agreed and understood that no difference or dispute shall be referable to

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

SBI General Insurance Company Limited Micro Insurance Policy (IRDA/NL-HLT/SBIGI/P-H/V.1/43/13-14)

Customer Service Cell / Grievance Redressal Officer

CONTACT DETAILS JURISDICTION

AHMEDABAD - Shri. / Smt. State of Gujarat and Union Territories of Dadra

BENGALURU - Shri. M. Parshad New Centre.

BHUBANESHWAR - Shri. B. N. Mishra State of Orissa.

CHANDIGARH - Shri. Manik B. Sonawane States of Punjab, Haryana, Himachal Pradesh,