Aspire Policy Wordings

ASPIRE- POLICY WORDINGS
1. Preamble
You are a global citizen and the world is your playground. This Policy covers Allopathic treatments anywhere in the world.
AYUSH treatments are covered in India only. After all, the world comes to us for the best of AYUSH.
2. Definitions
It is IMPORTANT You should go through the definition of some words used in the policy. Definition of these may vary from the
common understanding and colloquial meaning. If a word is not specifically defined in the following section, it’s common
meaning will apply.
2.1. Standard Definitions:

2.1.1. Accident or Accidental means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
2.1.2. AYUSH Hospital is a healthcare facility wherein medical / surgical / para-surgical treatment procedures and interventions are
carried out by AYUSH Medical Practitioner(s) comprising of any of the following:
a. Central or state government AYUSH Hospital; or
b. Teaching Hospital attached to AYUSH college recognized by the Central Government / Central Council of Indian Medicine /
Central Council of Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine,
registered with the local authorities, wherever applicable and is under the supervision of a qualified registered AYUSH
Medical Practitioner and must comply with all the following criterion:
i. Having at least five in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures
are to be carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized
representative.
AYUSH Hospitals referred above shall also obtain either pre-entry level certificate (or higher level of certificate) issued by
National Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or higher level of
certificate) under National Quality Assurance Standards (NQAS), issued by National Health Systems Resources Centre (NHSRC).
2.1.3. AYUSH Treatment refers to the medical and / or hospitalization treatments given under Ayurveda, Yoga and
Naturopathy, Unani, Sidha and Homeopathy systems.
2.1.4. Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment
undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by
the insurer to the extent pre-authorization is approved.
2.1.5. Congenital Anomaly means a condition which is present since birth, and which is abnormal with reference to form, structure
or position.
a. Internal Congenital Anomaly: Congenital Anomaly which is not in the visible and accessible parts of the body.
b. External Congenital Anomaly: Congenital Anomaly which is in the visible and accessible parts of the body.
2.1.6. Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured
will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured.
2.1.7. Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer without an associated increase
in premium.
2.1.8. Day Care Centre means any institution established for Day Care Treatment of Illness and/or Injuries or a medical set-up with
a Hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a
registered and qualified Medical Practitioner AND must comply with all minimum criterion as under:
a. has Qualified Nursing staff under its employment;
b. has qualified Medical Practitioner(s) in charge;
c. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
d. maintains daily records of patients and will make these accessible to the insurance company’s authorized personnel.
2.1.9. Day Care Treatment refers to medical treatment, and/or Surgical Procedure which is:
a. undertaken under General or Local Anaesthesia in a Hospital/Day Care Centre in less than 24 hrs because of
technological advancement, and
b. which would have otherwise required a Hospitalization of more than 24 hours.
Treatment normally taken on an out patient basis is not included in the scope of this definition.
2.1.10. 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.
2.1.11. Dental Treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings
(where appropriate), crowns, extractions and Surgery.
Product Name: Aspire | Product UIN: NBHHLIP24129V012324

2.1.12. Domiciliary Hospitalization means medical treatment for an Illness/disease/Injury which in the normal course would
require care and treatment at a Hospital but is actually taken while confined at home under any of the following
circumstances:
a. the condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or
b. the patient takes treatment at home on account of non availability of room in a Hospital.
2.1.13. Emergency care means management for an Illness or Injury which results in symptoms which occur suddenly and
unexpectedly, and requires immediate care by a Medical Practitioner to prevent death or serious long term impairment of
the Insured Person’s health.
2.1.14. Grace Period means the specified period of time, immediately following the premium due date during which premium
payment can be made to renew or continue a policy in force without loss of continuity benefits pertaining to waiting
periods and coverage of pre-existing diseases. Coverage need not be available during the period for which no premium is
received. The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where
premium payment mode is monthly and thirty days in all other cases.
Provided the insurers shall offer coverage during the grace period, if the premium is paid in instalments during the policy
period.
2.1.15. Hospital means any institution established for Inpatient Care and Day Care Treatment of Illness and / or Injuries and
which has been registered as a Hospital with the local authorities under the Clinical Establishments (Registration and
Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act OR complies
with all minimum criteria as under:
a. has Qualified Nursing staff under its employment round the clock;
b. has at least 10 Inpatient beds in towns having a population of less than 10,00,000 and at least 15 Inpatient beds in all other
places;
c. has qualified Medical Practitioner(s) in charge round the clock;
d. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
e. maintains daily records of patients and makes these accessible to the Insurance company’s authorized personnel.
2.1.16. Hospitalization means admission in a Hospital for a minimum period of 24 consecutive ‘In-patient Care’ hours except for
specified procedures/treatments, where such admission could be for a period of less than 24 consecutive hours.
2.1.17. Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function
and requires medical treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to
return the person to his or her state of health immediately before suffering the disease/ illness/ injury which leads to full
recovery
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the following
characteristics:
a. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
b. it needs ongoing or long-term control or relief of symptoms
c. it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
d. it continues indefinitely
e. it recurs or is likely to recur
2.1.18. 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.
2.1.19. In-patient Care means treatment for which the Insured Person has to stay in a Hospital for more than 24 hours for a
covered event.
2.1.20. Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a
dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of
patients who are in a critical condition, or require life support facilities and where the level of care and supervision is
considerable more sophisticated and intensive than in the ordinary and other wards.
2.1.21. ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses on a per day basis
which shall include the expenses for ICU bed, general medical support services provided to any ICU patient including
monitoring devices, critical care nursing and intensivist charges.
2.1.22. Maternity Expenses shall include:
a. Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections
incurred during Hospitalization)
b. Expenses towards lawful medical termination of pregnancy during Policy Period.
2.1.23. Medical Advice means any consultation or advice from a Medical Practitioner including the issuance of any prescription or
follow-up prescription.
2.1.24. 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.
2.1.25. Medical Practitioner means a person who holds a valid registration from the Medical Council of any State or Medical
Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State

Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and
jurisdiction of his licence.
2.1.26. Medically Necessary Treatment means any treatment, tests, medication, or stay in Hospital or part of a stay in Hospital
which:
a. is required for the medical management of the Illness or Injury suffered by the insured;
b. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or
intensity;
c. must have been prescribed by a Medical Practitioner;
d. must conform to the professional standards widely accepted in international medical practice or by the medical
community in India.
2.1.27. Migration means a facility provided to policyholders (including all members under family cover and group policies), to
transfer the credit gained for pre-existing conditions and specific waiting periods from one health insurance policy to
another with the same insurer.
2.1.28. Network Provider means Hospital enlisted by an insurer, TPA or jointly by an insurer and TPA to provide medical services
to an insured by a Cashless Facility.
2.1.29. New Born Baby means baby born during the policy period and is aged up to 90 days.
2.1.30. Non-Network Provider means any Hospital, Day Care Centre or other provider that is not part of the network.
2.1.31. Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes
of communication
2.1.32. OPD Treatment means the one in which the Insured visits a clinic / Hospital or associated facility like a consultation room
for diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day care or In-
patient.
2.1.33. Pre-existing Disease means any condition, ailment, injury or disease
a. That is/are diagnosed by a physician not more than 36 months prior to the date of commencement of the policy issued by
the insurer, or
b. For which medical advice or treatment was recommended by, or received from, a physician , not more than 36 months prior
to the date of commencement of the policy.
2.1.34. Pre-hospitalization Medical Expenses means medical expenses incurred during pre-defined number of days preceding the
hospitalization of the Insured Person, provided that:
a. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
2.1.35. Post-hospitalization Medical Expenses means medical expenses incurred during pre-defined number of days immediately
after the Insured Person is discharged from the Hospital, provided that:
a. Such Medical Expenses are for the same condition for which the Insured Person’s Hospitalization was required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
2.1.36. Portability means a facility provided to the health insurance policyholders (including all members under family cover), to
transfer the credits gained for, pre-existing disease and specific waiting periods from one insurer to another.
2.1.37. Reasonable and Customary Charges means the charges for services or supplies, which are the standard charges for the
specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking
into account the nature of the Illness / Injury involved.
2.1.38. Renewal means the terms on which the contract of insurance can be renewed on mutual consent with a provision of
Grace Period for treating the renewal continuous for the purpose of gaining credit for pre-existing diseases, time bound
exclusions and for all Waiting Periods.
2.1.39. Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the
associated medical expenses.
2.1.40. Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an Illness or
Injury, correction of deformities and defects, diagnosis and cure of diseases, relief from suffering or prolongation of life,
performed in a Hospital or Day Care Centre by a Medical Practitioner.
2.1.41. Unproven/Experimental treatment means the treatment including drug experimental therapy which is not based on
established medical practice in India, is treatment experimental or unproven
2.2. Specific Definitions

2.2.1. Base Sum Insured means the coverage amount for which the premium is computed and charged for this policy.
2.2.2. Biological mother means a woman whose ovum was fertilized and became a foetus.
2.2.3. Partner Network means Hospital, Diagnostic Centers, Clinics, Doctors, Health Care Workers, empanelled by the Insurer
and/or by a consolidated organization to provide health related medical services.
2.2.4. Insured Person is the one for whom the company has received full premium (including additional premium if any),
completed the risk assessment and issued the policy. The names of the Insured persons covered in the policy are specified in
the policy document, who are also referred as You/Your/Policyholder in this policy.
2.2.5. Policy Year means the period of one year from the date of commencement of the policy.
3. Sum Insured(s)

The product offers you so much more! More benefits, More options and More Sum Insured. Sum Insured will be utilized as per
following sequence in event of any claim:
1. Base Sum Insured

2. Booster+ Sum Insured
3. Safeguard/Safeguard+ Sum Insured
4. ReAssure+/ReAssureX
4. Benefits available under the policy.

Different benefits have different limits or Sum Insured. A limit or Sum Insured is our maximum liability (basically this is the
maximum claim we will pay) under the benefit. These limits & Sum Insured will be mentioned in your Policy Schedule.
4.1.1. Expenses in reaching a Hospital

a. Road Ambulance: We will pay you up to Base Sum Insured
b. Air Ambulance: Only in case of Emergency. We will pay up to Base Sum Insured.
Note: This will be paid only if claim for hospitalization is paid by us. You must always use a registered ambulance /
air ambulance provider.
4.1.2. Expenses during Hospitalization

a. We will pay the expenses incurred by you on treatment (Naturally this excludes expenses not linked to treatment like food, beverage,
toiletries and cosmetics). We don’t limit your choice. Choose the room you like, but choose judiciously to protect your Sum Insured.
• Hospitalized for 2 hours or more (minimum 24 hours for AYUSH treatment in a AYUSH Hospital). This means that all Day Care
Treatments will also be covered.
Note:
 We will NOT pay, even if you were Hospitalized, if there was no treatment and only investigations were done. Examples:
MRI, CT Scan, Endoscopy, Colonoscopy etc.
 We will NOT pay for Automation machine for peritoneal dialysis
b. We pay for Modern treatments, up to Base Sum Insured for the list as specified below:
1. Uterine Artery 2. Immunotherapy- 3. Vaporisation of the 4. Stem cell therapy: Hematopoietic

Embolization and HIFU Monoclonal Antibody to prostrate (Green laser stem cells for bone marrow
(High intensity focused be given as injection treatment or holmium transplant for haematological
ultrasound) laser treatment) conditions
5. Balloon Sinuplasty 6. Oral Chemotherapy 7. Robotic surgeries 8. Stereotactic radio Surgeries
9. Deep Brain stimulation 10. Intra vitreal 11. Bronchical 12. IONM - (Intra Operative
injections Thermoplasty Neuro Monitoring)
4.1.3. Expenses before and after hospitalization (Pre & Post hospitalization)
We will pay expenses incurred on consultations, medicines, physiotherapy, diagnostic tests for 60 days before the date of admission and 180
days after date of discharge IF these are related to the condition for which hospitalization claim is paid.
4.1.4. Home Care / Domiciliary Treatment

Home Care Treatment means treatment availed by the insured person at home which in normal course would require care and treatment at
a hospital but is actually taken at home provided that:
a. The medical practitioner advices the insured person to undergo treatment at home
b. There is continuous active line of treatment with monitoring of health status by a medical practitioner for each day through the duration
of the home care treatment
c. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained
Note:
 We will pay for Pre & Post hospitalization benefit as per section 4.1.3 for Home Care / Domiciliary Treatment.
 We pay for peritoneal dialysis, Chemotherapy taken at home.
 We do NOT pay for any Medical & ambulatory devices used at home (like Pulse Oxymeter, BP monitors, Sugar monitors, automation
device for peritoneal dialysis, CPAP, BiPAP, Crutches, wheel chair etc.)
4.1.5. Organ donor

If you ever undergo an organ transplant, we will pay the hospitalization expenses of the donor for harvesting the organ, ONLY when your
Hospitalization claim is paid.
If you donate any of your organs, we will pay for the expenses for harvesting the organ from you. We respect this noble deed. Remember,
organ donation saves many lives.
4.1.6. Annual Health Checkup

Available once every Policy Year, from day 1 of the policy. You can choose any test(s) from the list specified below. The tests MUST be booked
through digital assets (e.g. Mobile App). This benefit is available ONLY on cashless basis and no reimbursement is allowed.
List of tests covered:

Complete blood count (CBC) Complete Physical Examination by Physician Serum Electrolytes
Urine Routine & Microscopic Post prandial/lunch blood sugar (PPBS / PLBS) HbA1C
Erythrocyte Sedimentation Rate (ESR) Uric Acid Thyroid function test
Fasting Blood sugar (FBS) Lipid Profile Liver Function Test (LFT)
Electrocardiogram (ECG) Kidney function test Treadmill test (TMT) OR 2 D ECHO
X Ray chest Serum Vitamin D Ultrasound test (USG)
Mammogram Colonoscopy (for >50 year olds) Serum calcium
PAP smear
Note:
If you undergo multiple tests, make sure that all these are done within 7 days.
4.1.7. ReAssure+
4.1.7.1. ReAssure “Forever”: Enjoy unlimited Sum Insured. The first paid claim in the life of the policy triggers ReAssure “Forever”. Once
Triggered it stays for life, provided that the policy is renewed without break.
Note:
a. Maximum amount ReAssure+ pays for any single claim is up to Base Sum Insured.
b. We will consider a claim, if it is paid under the following: Expenses in reaching a Hospital, Expenses during
Hospitalization, Expenses before and after hospitalization, Home Care / Domiciliary Treatment, Organ Donor,
Borderless.
c. Expenses in reaching a Hospital and Expenses before and after hospitalization for the 1st ever hospitalization will be
treated as the 1st claim itself.
Illustration:
Year 1: Once the Policy is bought.
Base Sum 1st paid ReAssure+ is Balance 2nd Claim amount Balance 3rd Payable Claim amount
Insured Claim triggered Base Sum payable paid Base Sum claim paid
(Equal to Base Insured claim Insured
10 Lakh 7 Lakh Sum Insured) 3 Lakh 12 Lakh 12 Lakh Nil 11 Lakh 10 Lakh from
(3 Lakh from ReAssure+
Base Sum
Insured and 9
Lakh from
ReAssure+
Year 2: Once the policy is renewed:

ReAssure+ is Balance 2nd Balance
Base Sum 1st Claim Claim 3rd Payable Claim
already Base Sum payable Base Sum
Insured Paid amount paid claim amount paid
triggered Insured claim Insured
10 Lakh 10 Lakh 15 Lakh Nil 12 Lakh 10 Lakh Nil 10 Lakh 10 Lakh from
ReAssure+
10 Lakhs
from Base (this 10 Lakh
Sum Insured will trigger
ReAssure+ ReAssure+
and 5 Lakhs unlimited
from times)
ReAssure+
4.1.7.2. Lock the Clock: Your age is locked at entry when you buy the policy, till a claim is paid.

E.g. if you buy the policy at 25 years, you will keep paying the premium applicable for 25-year-old at each renewal, till a claim is paid in
the policy. Post the claim is paid, the premium charged will be as per your current age and will continue to change as per the age slabs at
each renewal.
4.1.7.3. Lock the Clock+: Your age is locked at entry when you buy the policy, till a claim is paid. Even if a claim is paid for the M-iracle benefit, the
age lock will not break.
E.g. if you buy the policy at 25 years, you will keep paying the premium applicable for a 25 year old at each renewal, till a claim is paid in
the policy. Even if a claim is paid under the M-iracle benefit (provided that no other claim is paid) you will keep paying the premium
applicable for 25 year old at each renewal.
If any other claim is paid, then the premium charged will be as per your current age and will continue to change as per the age slabs at
each renewal.
Note (Lock the Clock & Lock the Clock+)

b) In case of multi tenure policies, the premium for the entire tenure will be charged as per the entry age. No additional premium will
be charged In the middle of the tenure in case of claims.
At the time of renewal (in case of a claim), the premium will be charged as per the current age of the consumer at renewal.
c) If you add a member to the floater plan, then the premiums will be charged as per the entry age of the eldest
member and will lock the premium at that age, till a claim is paid.
d) If you add a member to an individual plan and convert it into a Floater plan, then the premiums will be charged as per the entry age
of the eldest member and will lock the premium at that age, till a claim is paid.
e) If the eldest member is no longer part of the Floater plan, then the Floater premium will be calculated as per the original entry age
of the eldest member in the policy amongst the remaining members and lock at that age, till a claim is paid.
f) If a floater plan, splits into multiple policies, then we will carry forward the locked age at which the floater policies were taken by
individuals (as per the claim history) in the policies carried forward, till a claim is paid.
g) In a multi individual policy, the age will unlock only for the individuals who claim.
h) In a floater policy, if a claim is paid for anyone in the plan then we will unlock the age for the entire policy.
i) We will consider a claim, if a claim is paid under the following: Expenses in reaching a Hospital, Expenses during Hospitalization,
Expenses before and after hospitalization, Home Care / Domiciliary Treatment, Organ Donor, Borderless, M-iracle.
j) Claim paid under the M-iracle benefit will not impact Lock the Clock +
4.1.8. ReAssureX
Enjoy unlimited Sum Insured. The first paid claim in the life of the policy triggers ReAssure “Forever”. Once Triggered it stays for life,
provided that the Policy is renewed without break.
Note:
a. Maximum amount ReAssureX pays for any single claim is up to Base Sum Insured.
b. We will consider a claim, if it is paid under the following: Expenses in reaching a Hospital, Expenses during
Hospitalization, Expenses before and after hospitalization, Home Care / Domiciliary Treatment, Organ Donor,
Borderless.
c. Expenses in reaching a Hospital and Expenses before and after hospitalization for the 1st ever hospitalization will be
treated as the 1st claim itself.
Illustration:
Year 1: Once the Policy is bought.
Base Sum 1st paid Balance 2nd Claim amount Balance 3rd Payable Claim amount
Insured Claim Base Sum payable paid Base Sum claim paid
Insured claim Insured
10 Lakh 7 Lakh ReAssureX is 3 Lakh 12 Lakh 12 Lakh Nil 11 Lakh 10 Lakh from
triggered ReAssureX
(Equal to Base (3 Lakh from
Sum Insured) Base Sum
Insured and 9
Lakh from
ReAssureX
Year 2: Once the policy is renewed:

Balance 2nd Balance
Base Sum ReAssureX 1st Claim Claim 3rd Payable Claim
Base Sum payable Base Sum
Insured Sum Insured Paid amount paid claim amount paid
Insured claim Insured
10 Lakh 10 Lakh 15 Lakh Nil 12 Lakh 10 Lakh Nil 10 Lakh 10 Lakh from
10 Lakhs ReAssureX
from Base
Sum Insured (this 10 Lakh
ReAssureX ReAssureX will trigger
and 5 Lakhs
from unlimited
ReAssureX times)
Either ReAssure+ or ReAssureX can be offered in a single policy.
4.1.9. Booster+
Don’t lose what you don’t use.
Unutilized Base Sum Insured carries forward. Maximum it will accumulate up to 10 times of the Base Sum Insured, based on variant chosen
and your entry age into this plan.
Example: If you are 25-year-old at the time of buying the policy and have opted for Titanium+ Variant of 10 Lakh base sum insured, then at
the end of 10 years (if no claim is paid in these years) you will have INR 1.10 Crore Sum Insured (that is INR 10 Lakh base + INR 1 Crore
Booster+).
Don’t forget that you would have the Safeguard / Safeguard+ (this is a great benefit. You must choose it) and ReAssure “Forever” (in case
of claim) over and above the INR 1.10 Crore.
That’s 11 times more sum insured than what you paid for.
Note:
a) If you convert an Individual Sum Insured policy in any manner, into a floater plan, then the least of the Booster+ Sum Insured of
individual insured members will be carried forward to the floater plan.
b) If a floater plan, splits into multiple policies, then the Booster+ Sum Insured of floater plan will be carried forward to the split
policies, provided the Base Sum Insured is not reduced.
c) If you reduce the Base Sum Insured, Booster+ Sum Insured will be proportionately reduced. Let’s say if you reduce the current INR
10 lakh Sum Insured to INR 5 lakh, your Booster+ Sum Insured will be halved.
d) You can and should regularly increase Sum Insured of your Health insurance policy. Medical inflation is a reality and current Sum
Insured will fall short in future for advanced treatments. When you enhance your Sum Insured, the accumulated Booster+ Sum
Insured will continue and grow even more (remember Booster+ is up to maximum 10 times (based on the entry age and plan you
have chosen) of the Base Sum Insured. Higher the Base Sum insured higher the Booster+ Sum Insured .
4.1.10. M-iracle
Celebrating Parenthood!
A baby adds new meaning to life, new meaning to family. All that goes in to planning for, welcoming and bringing up the little ones are the
most beautiful times in life.
 Antenatal check-ups. Those Gynecologist consultations, Sonograms, blood and other tests You would need
 Vaccines for the expecting mother
 Delivery. Normal or Caesarian section
 Surrogacy & Delivery by surrogate mother
 Assisted reproduction like In vitro fertilization (IVF), Gamete intrafallopian transfer (GIFT), Zygote intrafallopian transfer (ZIFT),
Intracytoplasmic Sperm Injection (ICSI)
 (Medical) termination of pregnancy
 Treatment for infertility
 Charges for legally adopting a child.
Note: The maximum charges per adoption is fixed by central adoption resource authority (CARA) and we will pay that.
 Up to INR 10,000 will be paid for tests conducted on the child, at the time of adoption. These will be paid post the child is legally
adopted.
 The New Born will be covered from Day 1 in the policy. (Excl 5.2.3 will not apply for New Born Babies added)

We know You want to give the baby the best the world can offer. You have made so many plans. We understand that. Your M-iracle Sum
Insured too works like Booster+. Unutilized part of Your M-iracle Sum Insured carries forward. The maximum You can accumulate depends on
the age when you first purchased this Policy and the Plan chosen. Earlier the better.
Example: If you are 25-year-old at the time of buying the policy and have opted for Titanium+ Variant of 20 Lakh base sum insured, then at
the end of 10 years (if no claim is paid under the M-iracle benefit in these years) you will have INR 2.2 Lakh sum insured (that is INR 20,000
M-iracle Base Sum Insured + INR 2 Lakh “M-iracle Booster+).
Don’t forget that this is over and above your Base Sum Insured, Booster+ on Base Sum Insured and ReAssure+/ReAssureX.
Note:
 M-iracle Sum Insured and Waiting Period is as per the Variant you have chosen
 Ectopic pregnancy is covered under the Hospitalization benefit.
 The Biological mother MUST be insured under the policy except when a child is born through Surrogacy or is legally adopted.
 This benefit is applicable only in India.
 All complications related to Maternity will be paid from M-iracle Sum Insured only.
 Vaccines that will be covered are Tdap (Tetanus, Diphtheria, Pertussis), Td (Tetanus, Diphtheria), Flu Shot, Hepatitis A, Hepatitis B.
Note: You can add your spouse in to the running policy if you get married after purchase of this policy. However, if you are already married,
you can add Your spouse ONLY at renewal.
4.1.11. Live Healthy
Simply walk and earn up to 30% discount at renewal, by downloading the recommended mobile App and get your Health points. 1000 steps
will help you earn one health point!
Note: Discount is on the individual’s premium in Individual plan and on Floater Policy Premium in Floater plans. Discount will be considered
only for Insured’s 18 years and above.
Renewal discount is computed based on the health score on 90 days before the due date of renewal. These points are not lost and will be
considered for the next policy year.
Policy Period: 1 year

Policy End of 9 months Points at the end of Points in next Total points Discount on renewal premium
Start Date 9 months (A) 3 months (B) considered for (Renewal policy start date 1st
This will be discount (A + B) April 2024)
considered for from 2nd Policy
discount on the Period onwards NOTE: Discount applicable on the
first renewal. member’s premium in Individual
sum insured policies and on the
Policy premium in case of Floater
Individual sum Floater
insured policy policies with
and Floater more than 1
policies with 1 Adult
Adult
1 April 31st December Up to 1500 0% 0%
2023 2023
1501 –2250 5% 2.5%
2251 – 3000 15% 7.5%
3001 – 3750 20% 10%
>=3751 30% 15%
Policy Period: 2 years

Start Date 21 months (A) 3 months (B) considered for (Renewal policy start date 1st April
This will be discount (A + B) 2025)

Adult
2023 2024
3001 – 4500 5% 2.5%
4501 – 6000 15% 7.5%
6001 – 7500 20% 10%
>=7501 30% 15%
Policy Period: 3 years

Start Date 33 months (A) 3 months (B) considered for (Renewal policy start date 1st April
This will be discount (A + B) 2026)
Adult
2023 2025
4501 – 6750 5% 2.5%
6751 – 9000 15% 7.5%
9001 – 11250 20% 10%
>=11251 30% 15%
4.1.12. Second Medical Opinion

Unlimited times in a Policy year, you can choose to take a second medical opinion from any Medical Practitioner for which we have paid a
claim under expenses during hospitalization. Through our partners we can help you get a second opinion from some of the most reputed
doctors in the country.
4.1.13. e-consultation
You can take unlimited e-consultations from our Partner Network.
Optional Benefit:
4.1.14. Annual Aggregate Deductible

This is an aggregate amount in a year that is incurred by you on Expenses in reaching a Hospital, Expenses during Hospitalization, Expenses
before and after hospitalization, Home Care / Domiciliary Treatment, Organ Donor, which we will NOT pay. Once the total expense exceeds
this amount, balance we will pay.
Note:
a. Deductible amount borne by you should also be payable as per policy terms and conditions.
b. Deductible will NOT apply to M-iracle, Cash-Bag, WellConsult (OPD), Annual Health Check-up, Live Healthy, Second Medical Opinion, e-
consultation, Personal Accident, Hospital Daily Cash, Borderless benefits.
4.1.15. Hospital Cash:

We will pay for an Insured, an additional fixed amount for each day’s hospitalization for maximum up to 30 days. One day is considered as 24
continuous hours of hospitalization.
4.1.16. Co-Payment:
It is the percentage of admissible claim amount You would have to bear for every claim, Rest we will pay.

Note: Co-payment will NOT apply to M-iracle, Cash-Bag, WellConsult (OPD), Annual Health Check-up, Live Healthy, Second Medical Opinion,
e-consultation, Personal Accident, Hospital Daily Cash, Borderless benefits.
Note: Co-Payment & Annual Aggregate Deductible cannot be opted together.
4.1.17. Pre-Existing Disease Waiting Time Modification

You can choose to reduce or increase the Pre-Existing Disease waiting time.
Note: This can only available at the time of buying the policy and cannot be opted/modified/removed at renewal
4.1.18. Room Type Modification

You can as per your lifestyle, choose to change the room category we are offering, and opt for what suits you best!
You can choose between a Standard Single Room and a Shared Room up to Sum Insured. Irrespective of the Room type you choose, ICU
admission will always be paid up to Sum Insured.
Note: You will have to bear additional co-payment IF treatment is taken in a higher room category than the eligible room category
Category Available in the Base Plan Category Claimed for Co-Payment Percentage
Shared Room Standard Single Room 10%
Shared Room Deluxe/Suite Room 25%
Standard Single Room Deluxe/Suite Room 15%
4.1.19. Personal Accident

4.1.19.1. Accidental Death (AD)
In event of unfortunate demise of the insured within 365 days from the date of the Accident, within the Policy Period, we will pay the
Sum Insured.
The Personal accident benefit will terminate after the Accidental Death benefit is paid for.
4.1.19.2. Permanent Total Disability

If the Insured Person suffers Permanent Total Disability, within 365 days from the date of the Accident, within the Policy Period, we will
pay the benefit as per the below Table
Condition for Permanent Total Disability % of Accidental Death Sum Insured

Complete & Irrecoverable loss of :
 Any 2 Limbs
 Sight of both eyes 125%
 Speech & hearing of both Ears
 Combination of One Limb & Sight of One Eye
Complete & Irrecoverable loss of :
 1 Limb 50%
 Sight of 1 Eye
c. Complete & Irrecoverable loss of limb means physical separation or complete loss of functionality of the limb, within 365 days from the
date of the Accident. This will include Paralysis including Paraplegia, Quadriplegia with loss of functional use of limb.
The Personal accident benefit will terminate after the Permanent Total Disability benefit is paid for.
4.1.19.3. Permanent Partial Disability

If the Insured Person suffers a Permanent Partial Disability, within 365 days from the date of the Accident, within the Policy Period, we will
pay the benefit as per the below Table.
Condition for Permanent Partial Disability % of Accidental Death Sum Insured
Each arm at the shoulder joint 70%

Each arm to a point above elbow joint 65%
Each arm below elbow joint 50%
Each hand at the wrist 50%
Each Thumb 20%
Each Index Finger 10%
Each other Finger 5%

Each leg above center of the femur 70%
Each leg up to a point below the femur 65%
Each leg to a point below the knee 50%
Each foot at the ankle 40%
Each big toe 5%
Each other toe 2%
Each eye 50%
Hearing in each ear 30%
Sense of smell 10%
Sense of taste 5%
a. If a Permanent Partial Disability loss is not mentioned in the table above, then we will internally assess the degree of disablement
and determine the amount of payment to be made.
b. If there is more than one Permanent Partial Disability loss, then the total claim amount put together for all losses will not exceed
the total Accidental Death Sum Insured opted. Once Total Sum Insured is paid, the policy will lapse.
4.1.20. Safeguard
4.1.20.1.1. Claim Safeguard: We will cover non-payable items mentioned in ‘List I – Expenses not covered’ of Annexure I’. Clause
2.1.37 for Reasonable and Customary Charges will still apply.
4.1.20.1.2. Booster+ Safeguard: Booster+ will not be impacted if the total claim in a policy year is up to INR 50,000
4.1.20.1.3. Sum Insured Safeguard: Preserves the value of Sum Insured. Safeguards it against inflation. We will increase the Base Sum
Insured on cumulative basis at each renewal by the rate of inflation in the previous year. Inflation rate would be the average
consumer price index (CPI) of the entire calendar year published by the Central Statistical Organization (CSO).
Note: You will lose all accumulated Sum Insured Safeguard if you opt out of this benefit at any point in time.
4.1.21. Safeguard+
4.1.21.1. Claim Safeguard+: We will cover non-payable items mentioned in ‘List I,II,III,IV of Annexure I’. Clause 2.1.37 for Reasonable
and Customary Charges will still apply.
4.1.21.2. Booster+ Safeguard+: Booster+ will not be impacted if the total claim in a policy year is up to INR 1,00,000.
4.1.21.3. Sum Insured Safeguard+: Preserves the value of Sum Insured. Safeguards it against inflation. We will increase the Base Sum Insured
on cumulative basis at each renewal by the rate of inflation in the previous year. Inflation rate would be the average consumer price
index (CPI) of the entire calendar year published by the Central Statistical Organization (CSO).
Note: You will lose all accumulated Sum Insured Safeguard+ if you opt out of this benefit at any point in time.
Note: You can either choose Safeguard or Safeguard+ at a given point in time.
4.1.22. Future Ready

Add your Future Spouse to the plan, and all waiting periods (Initial Waiting Period, Pre-Existing Disease, specified disease/procedure, M-
iracle Waiting Periods) completed by you will be passed on to your Future Spouse, when they are added in the policy.
Note:
 This Optional Benefit can be opted at the time of new policy inception or at any renewal.
 You can ONLY add your newly married spouse to the plan.
 We will NEED the marriage certificate to add the spouse. The spouse can be added anytime during the policy tenure or at
Renewal.
 Newly Married spouse MUST be added within 90 days of the marriage.
4.1.23. Borderless
Get emergency or planned treatments anywhere in the world. Choose from a range of co-payments options 0%, 20%, 30%, 40% & 50%
Note:
 The consumer can be diagnosed anywhere in the world and can go for treatments anywhere in the world. This benefit is also available
under cashless and reimbursement.
 The Sum Insured will be same as the Policy Sum Insured.

 The following benefits will be considered for Borderless also: Expenses in reaching a Hospital, Expenses during Hospitalization,
Expenses before and after hospitalization, Organ Donor.
 This optional benefit is not available to Non-Indian citizens & people who are not permanent residents of India.
4.1.24. Cash-Bag:
. For each claim free year get an amount equal to 10% of the premium to be paid on 1st Renewal and 5% thereafter on each renewal from
2nd renewal onwards. Accumulate this amount and use the amount for OPD, pay for deductibles, pay for co-payment, Non-payable items
and pay premiums. This optional benefit can be accessed through our Mobile App.
Note:
 Deductibles, Co-Payments can only be paid for claims under Aspire Product.
 Only Aspire Product premium can be paid for using this Cash-Bag
 Claims under Cash-Bag will not impact Booster+, Lock the Clock/Lock the Clock+
4.1.25. WellConsult (OPD):
Opt for complete wellness and OPD benefits.
4.1.25.1. Tele/Video Consultation on our network.

4.1.25.2. Physical Consultations with Specialists & General Practitioner on our network. Flat 20% co-payment in case of re-
imbursement.
4.1.25.3. Prescribed Diagnostics on our Partner network. Flat 20% co-payment in case of re-imbursement.
4.1.25.4. Prescribed Pharmacy on our Partner network. Flat 20% co-payment in case of re-imbursement.
4.1.25.5. Online sessions on Emotional Wellness. Can be availed only through our Partner network.
4.1.25.6. Diet and Nutrition Coaching. Can be availed only through our Partner network.
4.1.25.7. Artificial Intelligence lead Smart Fitness Coaching. Can be availed only through our Partner network.
4.1.25.8. Access to Global online content on wellness through our Partner network
4.1.25.9. Access to Gym memberships on our Partner network.
Note:
 All benefits are as per limits mentioned in your policy schedule.
 Claims under WellConsult (OPD) will not impact Booster+, Lock the Clock/Lock the Clock+
 We will not pay for Dental and ophthalmological consultations, diagnostics and pharmacy under this benefit.
 This benefit is applicable only in India.
5. Exclusions
5.1. Standard Exclusions
5.1.1. Pre-existing Diseases (Code–Excl01):
a. Expenses related to the treatment of a Pre-existing Disease (PED) and its direct complications shall be excluded until the
expiry of 12months/24 months/ 36 months (as per Variant selected) of continuous coverage after the date of inception of
the first Policy.
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the
extent of Sum Insured increase.
c. If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI
(Insurance Products) Regulations, 2024, then waiting period for the same would be reduced to the extent of prior
coverage.
d. Coverage under the Policy after the expiry of 12months/24 months/ 36 months (as per Variant selected) for any Pre-
existing Disease is subject to the same being declared at the time of application and accepted by Us.
5.1.2. Specified disease/procedure waiting period (Code- Excl02)

a. Expenses related to the treatment of the listed conditions, surgeries/treatments shall be excluded until the expiry of 24
months/12 months (as per Variant Selected) of continuous coverage after the date of inception of the first Policy. This
exclusion shall not be applicable for claims arising due to an Accident (covered from day 1) or Cancer (covered after 30-day
waiting period).
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. If any of the specified disease/procedure falls under the waiting period specified for pre-Existing diseases, then the longer
of the two waiting periods shall apply.

d. The waiting period for listed conditions shall apply even if contracted after the Policy or declared and accepted without a
specific exclusion.
e. If the Insured Person is continuously covered without any break as defined under the applicable norms on portability
stipulated by IRDAI then waiting period for the same would be reduced to the extent of prior coverage.
f. List of specific diseases/procedures:
i. Pancreatitis and stones in biliary and urinary system
ii. Cataract, glaucoma and retinal detachment
iii. Hyperplasia of prostate, hydrocele and spermatocele
iv. Prolapse uterus or cervix, endometriosis, Fibroids, Polycystic ovarian disease (PCOD), hysterectomy (unless
necessitated by Malignancy)
v. Hemorrhoids, fissure, fistula or abscess of anal and rectal region
vi. Hernia of any site or type,
vii. Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies,
Rheumatoid Arthritis, gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair
viii. Varicose veins of lower extremities
ix. All internal or external benign neoplasms/ tumours, cyst, sinus, polyps, nodules, mass or lump
x. Ulcer, erosion or varices of gastro intestinal tract
xi. Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of
tympanic membrane), Tonsils and adenoids, nasal septum and nasal sinuses
5.1.3. 30-day waiting period (Code- Excl03):

a. Expenses related to the treatment of any Illness within 30 days from the first Policy commencement date shall be excluded
except claims arising due to an Accident, provided the same are covered.
b. This exclusion shall not, however, apply if the Insured Person has continuous coverage for more than twelve months
c. The within referred waiting period is made applicable to the enhanced Sum Insured in the event of granting higher Sum
Insured subsequently.
5.1.4. Investigation & Evaluation (Code-Excl04)

a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
5.1.5. Rest Cure, rehabilitation and respite care (Code-Excl05)

Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
a. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as
bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
b. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
5.1.6. Obesity/ Weight Control (Code-Excl06)

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Doctor.
b. The surgery/Procedure conducted should be supported by clinical protocols.
c. The member has to be 18 years of age or older and;
d. Body Mass Index (BMI);
i. greater than or equal to 40 or
ii. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
1. Obesity-related cardiomyopathy
2. Coronary heart disease
3. Severe Sleep Apnea
4. Uncontrolled Type2 Diabetes
5.1.7. Cosmetic or plastic Surgery (Code-Excl08)

Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an
Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to
the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
5.1.8. Hazardous or Adventure sports (Code-Excl09)

Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports,
including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba
diving, hand gliding, sky diving, deep-sea diving.
5.1.9. Breach of law (Code-Excl10)

Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit
a breach of law with criminal intent.
5.1.10. Excluded Providers (Code-Excl11)

Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically
excluded by Us and disclosed in Our website / notified to the Policyholders are not admissible. However, in case of life
threatening situations or following an Accident, expenses up to the stage of stabilization are payable but not the complete
claim.
The complete list of excluded providers can be referred to on our website.
5.1.11. Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12)
5.1.12. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a
nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
(Code-Excl13)
5.1.13. Refractive Error (Code-Excl15)

Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
Note: Less than 7.5 Diopter means a power of eye either >7.5 Dioptre for Hypermetropia or far sightedness (say +7.75
Dioptre) or < 7.5 Dioptre for Myopia or near sightedness (say -7.75 Dioptre).
5.1.14. Unproven Treatments (Code-Excl16)

Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven
treatments are treatments, procedures or supplies that lack significant medical documentation to support their
effectiveness.
5.2. Specific Exclusions

5.2.1. Personal Waiting Period
Conditions specified for an Insured Person under Personal Waiting Period will be subject to a Waiting Period of up to 48
months from the inception of the First Policy with Us.
5.2.2. Conflict & Disaster:

Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations
(whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
5.2.3. External Congenital Anomaly:

Screening, counseling or treatment related to external Congenital Anomaly.
5.2.4. Dental treatment:

All dental treatments other than due to accidents and cancers.
5.2.5. Unrecognized Physician or Hospital:

a. Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by
Central Council of Indian Medicine or by Central council of Homeopathy.
b. Treatment provided by anyone with the same residence as an Insured Person or who is a member of the Insured Person’s
immediate family or relatives.
c. Treatment provided by Hospital or health facility that is not recognized by the relevant authorities in India.
5.2.6. Costs which are not Reasonable and Customary and treatments which are not Medically Necessary. Refer Definition
2.1.37 for Reasonable and Customary Charges.
5.2.7. Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state
6. General Terms and Clauses

6.1 Standard General Terms and Clauses Simplified for you
6.1.1 Free Look Period
The Free Look Period shall be applicable on individual health insurance policies and not on renewals. Free look is a 30 days
period during which you
The insured person shall be allowed free look period of thirty days from date of receipt of the policy can return back your
document to review the terms and conditions of the policy.. If he/she is not satisfied with any of the terms policy, if you don’t like
and conditions , he/she has the option to cancel his/her policy. what you have purchased.

In the event the policyholder disagrees to any of the policy terms or conditions, or otherwise and has not
made any claim, he/she shall have the option to retun the policy to the insurer for cancellation, stating
the reasons for the same.
i. Irrespective of the reasons mentioned, the policyholder shall be entitled to a refund of the
premium paid subject only to a deduction of a proportionate risk premium for the period of cover
and the expenses, if any, incurred by the insurer on medical examination of the proposer and
stamp duty charges.
6.1.2 Cancellation Simplified for you

The policy holder may cancel his/her policy at any time during the term, by giving 7 days’ notice in You can cancel your policy
writing. The insurer shall: whenever you wish.
Note: We will NOT refund
a. Refund proportionate premium for unexpired policy period, if the term of the policy upto one any premium if we have
year and there is no claim(s) made during the policy period. paid a claim.
b. Refund premium for the unexpired policy period, in respect of policies with term more than 1
year and risk coverage for such policy years are not commenced. We will refund part of the
premium depending on
how many days your
6.1.3 Renewal of Policy policy has been running
A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure for, if there is no claim.
or misrepresentation by the insured.
An insurer shall not deny the renewal of a health insurance policy on the ground that the insured had
made a claim or claims in the preceding policy years, except for benefit based policies where the policy
terminates following payment of the benefit covered under the policy.
a. Request for renewal along with requisite premium shall be received by the Company
before the end of the policy period.
b. At the end of the policy period, the policy shall terminate and can be renewed within the
Grace Period of 30 days (annual installment) to maintain continuity of benefits without
break in policy.
c. Coverage is available during the grace period.
d. No loading shall apply on renewals based on individual claims experience. However,
discount in premium may be provided by insurers to individual policyholders for good
claims experience.
e. Insurer shall not resort to fresh underwriting by calling for medical examination, fresh
proposal form etc at renewal stage where there is no change in sum insured offered. In
case increase in sum insured is requested by the policyholder, the Insurer may
underwrite only to the extent of increased sum insured
6.1.4 Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy including the
premium rates. The Insured Person shall be notified three months before the changes are effected.
6.1.5 Nomination
The policyholder is required at the inception of the policy to make a nomination for the purpose of
payment of claims under the policy in the event of death of the policyholder. Any change of nomination
shall be communicated to the company in writing and such change shall be effective only when an
endorsement on the policy is made. ln the event of death of the policyholder, the Company will pay the
nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is
no subsisting nominee, to the legal heirs or legal representatives of the policyholder whose discharge
shall be treated as full and final discharge of its liability under the policy. The insurer shall obtain
nomination at the time of new business and at the time of renewal for existing policies.
6.1.6 Fraud
lf any claim made by the insured person, is in any respect fraudulent, or if any false statement, or
declaration is made or used in support thereof, or if any fraudulent means or devices are used by the
insured person or anyone acting on his/her behalf to obtain any benefit under this policy, all benefits
under this policy and the premium paid shall be forfeited.

Any amount already paid against claims made under this policy but which are found fraudulent later
shall be repaid by all recipient(s)/policyholder(s), who has made that particular claim, who shall be
jointly and severally liable for such repayment to the insurer. Simplified for you
If we ever cancel your
For the purpose of this clause, the expression "fraud" means any of the following acts committed by the policy, it will be for Fraud
insured person or by his agent or the hospital/doctor/any other party acting on behalf of the insured or Non disclosure only.
person, with intent to deceive the insurer or to induce the insurer to issue an insurance policy: a) the Insurance contract is a
suggestion, as a fact of that which is not true and which the insured person does not believe to be true; legal contract too and it’s
b) the active concealment of a fact by the insured person having knowledge or belief of the fact; c) any based on trust.
other act fitted to deceive; and d) any such act or omission as the law specially declares to be fraudulent Fraud is an action by you
or anyone acting on your
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of Fraud, if behalf where you receive
the insured person / beneficiary can prove that the misstatement was true to the best of his knowledge benefits, financial or
and there was no deliberate intention to suppress the fact or that such misstatement of or suppression otherwise, for which you
of material fact are within the knowledge of the insurer. are either not eligible at
all or not to the extent
6.1.7 Withdrawal of Policy under the policy.
i. ln the likelihood of this product being withdrawn in future, the Company will intimate the insured
person about the same 90 days prior to expiry of the policy. Pay your renewal
ii. lnsured Person will have the option to either renew (up to 90 days from renewal date) same premium before end of
product or to migrate to similar a health insurance product available with the Company at the time policy period to maintain
of renewal with all the accrued continuity benefits such as cumulative bonus, waiver of waiting continuity of benefits. A
period as per IRDAI guidelines, provided the policy has been maintained without a break. grace period is also
4.2. available to pay the
6.1.8 Redressal of Grievance: premium after policy
ln case of any grievance the insured person may contact the company through: expiry.
Website: www.nivabupa.com Note: You are NOT
insured during the grace
Toll- Free: 1860-500-8888 period.
E-mail: Email us through our service platform https://rules.nivabupa.com/customer-
service/
Simplified for you
(Senior citizens may write to us at: seniorcitizensupport@nivabupa.com) We will cancel your policy,
Fax : 011-41743397 will not pay any claim, will
not refund any premium
Courier: Customer Services Department
paid and have right to
Niva Bupa Health Insurance Company Limited take all possible legal
D-5, 2nd Floor, Logix Infotech Park action against you
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301 including for recovery of
benefits paid earlier, if
lnsured person may also approach the grievance cell at any of the company's branches with the details  You withheld any
information from us,
of grievance. If lnsured person is not satisfied with the redressal of grievance through one of the above
whole or part that
methods, insured person may contact the grievance officer at: would have invited
Head – Customer Services any decision other
Niva Bupa Health Insurance Company Limited than a ‘standard
D-5, 2nd Floor, Logix Infotech Park acceptance’ of your
application for
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301
insurance.
Contact No: 1860-500-8888 Note: Non standard
Fax No.: 011-41743397 decisions are:
Email ID: Email our Grievance officer through our Grievance Redressal platform https:// o Loading – We ask for
additional premium
transactions.nivabupa.com/pages/grievance-redressal.aspx o Exclusions – We apply
For updated details of grievance officer, kindly refer the link a additional waiting
https://www.nivabupa.com/customer-care/health-services/grievance-redressal.aspx period for health
conditions or
treatments
If the Insured person is not satisfied with the above, they can escalate to GRO@nivabupa.com. o Rejection – We hate
to do this. But
sometimes are

lf lnsured person is not satisfied with the redressal of grievance through above methods, the insured compelled to say no
to a customer
person may also approach the office of lnsurance Ombudsman of the respective area/region for
redressal of grievance as per lnsurance Ombudsman Rules 2017 ( at the addresses given in Annexure II). IMPORTANT: We
understand you may not
Grievance may also be lodged at IRDAI integrated Grievance Management System – know how important is
www.bimabharosa.irdai.gov.in the information on your
4.3. health and it’s impact on
6.1.9 Claim settlement (Provision for Penal interest) your policy. Hence it’s
I. The Company shall settle or reject a claim, as the case may be, within 15 days from the claim very important that you
submission date. disclose all health
II. ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the information and we
would decide how
policyholder from the date of receipt of claim intimation till the date of payment of claim at a rate
important (we call it
of 2% above the bank rate.
‘material’) it is.
(Explanation: "Bank rate" shall mean the rate fixed by the Reserve Bank of lndia (RBl) at the beginning of  Cause fraud of any kind
the financial year in which claim has fallen due)
4.4.
6.1.10 Moratorium Period
After completion of sixty continuous months of coverage (including portability and migration) in health
insurance policy, no policy and claim shall be contestable by the insurer on the grounds of non-disclosure,
misrepresentation, except on grounds of established fraud. The period of sixty continuous months is
called as moratorium period. The moratorium will be applicable for the sums insured of the first policy.
Simplified for you
Wherever, the sum insured is enhanced, completion of sixty continuous months would applicable from
We will provide our
the date of enhancement of sums insured only on the enhanced limits.
decision on claim within
15 days from submission
The policies would however be subject to all limits, sub limits, co-payments, deductibles as per the Policy
of all necessary claim
contract.
documents. For any delay
in payment of claim, we
Note: the accrued credits gained under the ported and migrated policies shall be counted for the
will pay interest on the
purpose of calculating the Moratorium Period.
claim amount at a rate 2%
above bank rate.
6.1.11 Multiple Policies
A. Indemnity Based Policies:
Simplified for you
i. In case of multiple policies taken by an Insured Person during a period from one or more
After 5 years, no health
insurers to indemnify treatment costs, the Insured Person shall have the right to require insurance claim shall be
a settlement of his / her claim in terms of any of his / her policies. In all such cases the contestable except for
insurer chosen by the Policyholder shall be considered as the Primary Insurer and will be proven fraud and
obliged to settle the claim as long as the claim is within the limits of and according to the permanent exclusions.
terms of the chosen Policy
ii. If the amount to be claimed exceeds the available coverage of the said policy, then the
primary insurer shall seek the details of other available policies of the policyholder and
shall coordinate with other insurers to ensure settlement pf the balance amount as per
the policy conditions, without causing any hassles to the policy holder
B. Benefit Based Policies:
i. On occurrence of the insured event, the policy holder can claim from all Insurers under all
policies
6.1.12 Migration Simplified for you

In case of migration of one policy to another with the same Insurer, the policyholder (including all In case you have multiple
members under family cover and group insurance policies) can transfer the credits gained to the policies, you can choose
extent of the Sum Insured, No Claim Bonus, Specific Waiting periods, waiting period for pre- the policy from which you
existing diseases, Moratorium period etc. in the previous policy to the migrated policy. want to claim first.
If claim amount exceeds
The insurer may underwrite the proposal in case of migration, if the insured is not continuously the Sum Insured of first
covered for 36 months. policy you claim from;
then you can claim the
6.1.13 Portability balance amount from the
A Policyholder has the choice to port his/ her policies from one Insurer to another irrespective of second policy.
individual or group policy subject to the Board approved underwriting policy of the insurers.

The policyholder is entitled to transfer the credits gained to the extent of the Sum Insured, No Claim
Bonus, specific waiting periods, waiting period for pre-existing disease , Moratorium period etc.
from the Existing Insurer to the Acquiring Insurer in the previous policy.
6.1.14 Disclosure of Information

The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of
misrepresentation, mis-description or non-disclosure of any material fact by the policyholder.
(Explanation: “Material facts” for the purpose of this policy shall mean all relevant information sought
by the company in the proposal form and other connected documents to enable it to take informed Simplified for you
decision in the context of underwriting the risk) You can shift your policy
to any other health
6.1.15 Condition Precedent to Admission of Liability insurance product / plan
The terms and conditions of the policy must be fulfilled by the insured person for the Company to make offered by us as per
any payment for claim(s) arising under the policy. migration guidelines.
6.1.16 Complete Discharge

Any payment to the policyholder, insured person or his/ her nominees or his/ her legal representative
or assignee or to the Hospital, as the case may be, for any benefit under the policy shall be a valid
discharge towards payment of claim by the Company to the extent of that amount for the particular Simplified for you
claim. You can also shift your
policy to any other insurer
6.1.17 Premium Payment in Instalments as per portability
lf the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, guidelines.
Quarterly or Monthly, as mentioned in the policy Schedule/Certificate of insurance, the following
Conditions shall apply (notwithstanding any terms contrary elsewhere in the policy)
i. Grace Period of 30 days in all types of policies, and a period of 15 days in case of monthly
instalments
ii. For policies where premium is paid in instalments only, the coverage will be given during grace
period.
iii. The insured person will get the accrued continuity benefit in respect of the "Waiting Periods",
"Specific Waiting Periods" in the event of payment of premium within the stipulated grace Period.
iv. No interest will be charged lf the instalment premium is not paid on due date
v. ln case of instalment premium due not received within the grace period, the policy will get
canceled.
vi. ln the event of a claim, all subsequent premium instalments shall immediately become due and
payable.
6.2 Specific Terms and Clauses

6.2.1 Automatic Cancellation:
The Policy shall automatically terminate in the event of death of the all Insured Person(s). A refund in
accordance with the table in Section 6.1.2 shall be payable provided that no claim has been admitted or
lodged or not benefit has been availed by the insured person under the policy.
6.2.2 Additional premium (Risk Loading)

i. We may ask for additional premium after due risk evaluation (it’s what referred to as Underwriting)
based on all information provided by you. We will issue policy to you only after you pay us the
additional premium and provide us consent.
ii. We will never ask for more than 100% for any particular health condition and never more than
150% for any individual.
iii. Once applied, Risk loading continues even for all renewals. However, we offer discounts up to 30%
under LiveHealthy+ for maintenance and improvement in health
6.2.3 Other Renewal Conditions:

a. Renewal Premium:
Renewal premium will alter based on Age. For Floater plan, the age of eldest insured person will be
considered for calculating the premium.
b. Addition of Insured Persons on Renewal:

If a new member is added in the Policy, either by way of endorsement or at the time of Renewal,
the Pre-existing Disease clause, exclusions, loading (if any) and Waiting Periods will be applicable
afresh for that member.

c. Changes to Sum Insured on Renewal:
You may opt for enhancement of Sum Insured at the time of Renewal, subject to underwriting. All
Waiting Periods as defined in the Policy shall apply afresh for this enhanced limit from the effective
date of such enhancement.
6.2.4 Claims
a. Cashless claim facility is available at our network hospitals ONLY. As list of network hospitals is
dynamic, for the latest list, refer to our website www.nivabupa.com.
b. Documents required with claim form:
Hospital / Medical records:
• Original Discharge summary with first and subsequent consultation papers.
• Original Final Hospital bill with detailed break-up and payment receipt (including pharmacy
bills).
• Laboratory investigation reports with supporting prescriptions.
• MLC/First Information Report (FIR) (in accident cases).
Policyholder documents (Nominee in case of death of Policyholder):
• KYC documents
• Cancelled cheque
IMPORTANT:
• All documents MUST be submitted at the earliest possible time.
• For any delay in submission, You MUST provide the reasons in writing. We will condone such
delay on merits (i.e. reasons beyond your control).
• You MUST submit all claim related documents for expenses within the Deductible amount (if
applicable).
• We reserve the right to check and investigate the hospital / medical records from any doctor,
Hospital, clinic, individual or institution.
c. The expenses that are not covered or subsumed into room charges / procedure charges / costs of
treatment are placed as Annexure I.
d. If you opt for a Hospital room which is higher than the eligible room category as specified in your
Policy Schedule, then We will pay only a pro-rated portion of the total Associated Medical
Expenses (including surcharge or taxes thereon) as per the following formula:
(Eligible Room Rent limit / Room Rent actually incurred) * total Associated Medical Expenses
Associated Medical Expenses shall include Room Rent, nursing charges, Medical Practitioners’ fees
and operation theatre charges.
e. For any hospitalization, we will pay for items included in the bill by the Hospital during the duration
of hospitalization. Items not included in the bill will not be paid.
f. For any claim that is presented to us in any currency other than INR, we will use the Exchange rate
as on the date of Admission/Event of that claim.
g. All claims will be paid in INR only.
Please Note:
 Once the final authorization request is received for discharge, the same will be processed
within three hours from the final documents received. In case of delay from our end, any
additional amount charged by the hospital will be borne by us. This amount will be paid over
and above the policy limits.
 We offer Cashless Everywhere, even in hospitals which are not part of our network. For More
details and process please visit our website:
https://transactions.nivabupa.com/cashlessclaims/pages/intimation-claim.aspx
6.2.5 Policy Disputes

Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions
contained herein shall be governed by Indian law and shall be subject to the jurisdiction of the Indian
Courts.
4.5.
6.2.6 Territorial Jurisdiction
All claims shall be payable in India in Indian Rupees only.
4.6.
6.2.7 Alteration to the Policy
This Policy constitutes the complete contract of insurance. Any change in the Policy will only be
evidenced by a written endorsement signed and stamped by Us. No one except Us can within the
permission of the IRDAI change or vary this Policy.

6.2.8 Zonal pricing
For the purpose of calculating premium, the country has been divided into the following 4 zones:
i. Zone 1: Delhi NCR (Delhi NCR Includes Delhi, Baghpat, Bulandshahr, Gautam Buddh Nagar,
Ghaziabad, Hapur, Meerut, Muzaffarnagar, Shamli, Charkhi Dadri, Faridabad, Gurugram,
Jhajjar, Jind, Karnal, Mahendragarh, Nuh, Palwal, Panipat, Rewari, Rohtak, Sonipat, Aligarh,
Alwar, Hissar, Kaithal, Kurukshetra, Mathura, Saharanpur, Sirsa), Nasik, Surat, Vadodara
ii. Zone 2: Rest Of Gujarat, Kolkata, Mumbai, Palghar, Raigarh (MH), Thane
iii. Zone 3: Amritsar, Chennai, Hooghly, Hyderabad, Jaipur, K.V.Rangareddy, Kolkata Ext, Madhya
Pradesh, Rest Of Maharashtra, Rest Of Uttar Pradesh, Rest Of Haryana
iv. Zone 4: Rest of India (Including Bengaluru and Pune)
Your premium depends upon your residential city. Please inform us immediately in case of change in
your city.
6.2.9 Assignment
The Policy can be assigned subject to applicable laws.

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

1 BABY FOOD 24 ATTENDANT CHARGES 47 LUMBO SACRAL BELT
2 BABY UTILITIES CHARGES 25 EXTRA DIET OF PATIENT 48 NIMBUS BED OR WATER OR
(OTHER THAN THAT WHICH AIR BED CHARGES
FORMS PART OF BED CHARGE)
3 BEAUTY SERVICES 26 BIRTH CERTIFICATE 49 AMBULANCE COLLAR
4 BELTS/ BRACES 27 CERTIFICATE CHARGES 50 AMBULANCE EQUIPMENT
5 BUDS 28 COURIER CHARGES 51 ABDOMINAL BINDER
6 COLD PACK/HOT PACK 29 CONVEYANCE CHARGES 52 PRIVATE NURSES CHARGES-
SPECIAL NURSING CHARGES
7 CARRY BAGS 30 MEDICAL CERTIFICATE 53 SUGAR FREE Tablets
8 EMAIL / INTERNET CHARGES 31 MEDICAL RECORDS 54 CREAMS POWDERS LOTIONS
(Toiletries are not payable, only
prescribed medical
pharmaceuticals payable)
9 FOOD CHARGES (OTHER THAN 32 PHOTOCOPIES CHARGES 55 ECG ELECTRODES
PATIENT's DIET PROVIDED BY
HOSPITAL)
10 LEGGINGS 33 MORTUARY CHARGES 56 GLOVES
11 LAUNDRY CHARGES 34 WALKING AIDS CHARGES 57 NEBULISATION KIT
12 MINERAL WATER 35 OXYGEN CYLINDER (FOR USAGE 58 ANY KIT WITH NO DETAILS
OUTSIDE THE HOSPITAL) MENTIONED [DELIVERY KIT,
ORTHOKIT, RECOVERY KIT, ETC]
13 SANITARY PAD 36 SPACER 59 KIDNEY TRAY
14 TELEPHONE CHARGES 37 SPIROMETRE 60 MASK
15 GUEST SERVICES 38 NEBULIZER KIT 61 OUNCE GLASS
16 CREPE BANDAGE 39 STEAM INHALER 62 OXYGEN MASK
17 DIAPER OF ANY TYPE 40 ARMSLING 63 PELVIC TRACTION BELT
18 EYELET COLLAR 41 THERMOMETER 64 PAN CAN
19 SLINGS 42 CERVICAL COLLAR 65 TROLLY COVER
20 BLOOD GROUPING AND CROSS 43 SPLINT 66 UROMETER, URINE JUG
MATCHING OF DONORS
SAMPLES
21 SERVICE CHARGES WHERE 44 DIABETIC FOOT WEAR 67 AMBULANCE
NURSING CHARGE ALSO
CHARGED
22 TELEVISION CHARGES 45 KNEE BRACES (LONG/ SHORT/ 68 VASOFIX SAFETY
HINGED)
23 SURCHARGES 46 KNEE IMMOBILIZER/SHOULDER
IMMOBILIZER
List II – Items that are to be subsumed into Room Charges

1 BABY CHARGES (UNLESS 14 BED PAN 27 ADMISSION KIT
SPECIFIED/INDICATED)
2 HAND WASH 15 FACE MASK 28 DIABETIC CHART CHARGES
3 SHOE COVER 16 FLEXI MASK 29 DOCUMENTATION CHARGES
/ ADMINISTRATIVE
EXPENSES
4 CAPS 17 HAND HOLDER 30 DISCHARGE PROCEDURE
CHARGES
5 CRADLE CHARGES 18 SPUTUM CUP 31 DAILY CHART CHARGES
6 COMB 19 DISINFECTANT LOTIONS 32 ENTRANCE PASS / VISITORS
PASS CHARGES
7 EAU-DE-COLOGNE / ROOM 20 LUXURY TAX 33 EXPENSES RELATED TO
FRESHNERS PRESCRIPTION ON
DISCHARGE
8 FOOT COVER 21 HVAC 34 FILE OPENING CHARGES

9 GOWN 22 HOUSE KEEPING CHARGES 35 INCIDENTAL EXPENSES /
MISC. CHARGES (NOT
EXPLAINED)
10 SLIPPERS 23 AIR CONDITIONER CHARGES 36 PATIENT IDENTIFICATION
BAND / NAME TAG
11 TISSUE PAPER 24 IM IV INJECTION CHARGES 37 PULSEOXYMETER CHARGES
12 TOOTH PASTE 25 CLEAN SHEET
13 TOOTH BRUSH 26 BLANKET/WARMER
BLANKET
List III – Items that are to be subsumed into Procedure Charges

1 HAIR REMOVAL CREAM 9 WARD AND THEATRE BOOKING 17 BOYLES APPARATUS CHARGES
CHARGES
2 DISPOSABLES RAZORS 10 ARTHROSCOPY AND 18 COTTON
CHARGES (for site ENDOSCOPY INSTRUMENTS
preparations)
3 EYE PAD 11 MICROSCOPE COVER 19 COTTON BANDAGE
4 EYE SHEILD 12 SURGICAL BLADES, 20 SURGICAL TAPE
HARMONICSCALPEL,SHAVER
5 CAMERA COVER 13 SURGICAL DRILL 21 APRON
6 DVD, CD CHARGES 14 EYE KIT 22 TORNIQUET
7 GAUSE SOFT 15 EYE DRAPE 23 ORTHOBUNDLE, GYNAEC
BUNDLE
8 GAUZE 16 X-RAY FILM
List IV – Items that are to be subsumed into costs of treatment

1 ADMISSION/REGISTRATION 7 INFUSION PUMP– COST 13 MOUTH PAINT
CHARGES
2 HOSPITALISATION FOR 8 HYDROGEN 14 VACCINATION CHARGES
EVALUATION/ DIAGNOSTIC PEROXIDE\SPIRIT\
PURPOSE DISINFECTANTS ETC
3 URINE CONTAINER 9 NUTRITION PLANNING 15 ALCOHOL SWABES
CHARGES - DIETICIAN
CHARGES- DIET CHARGES
4 BLOOD RESERVATION 10 HIV KIT 16 SCRUB
CHARGES AND ANTE NATAL SOLUTION/STERILLIUM
BOOKING CHARGES
5 BIPAP MACHINE 11 ANTISEPTIC MOUTHWASH 17 GLUCOMETER & STRIPS
6 CPAP/ CAPD EQUIPMENTS 12 LOZENGES 18 URINE BAG
Annexure II - List of Insurance Ombudsmen

Jurisdiction of Office
Office Details
Union Territory, District)
AHMEDABAD
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor, Gujarat,
Tilak Marg, Relief Road, UT of Dadra & Nagar Haveli,
Ahmedabad – 380 001. Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
Karnataka.
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Madhya Pradesh
Near New Market,
Chhattisgarh.
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR
62, Forest park,
Bhubneshwar – 751 009. Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in
CHANDIGARH
Punjab,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Haryana (excluding Gurugram, Faridabad, Sonepat and
Batra Building, Sector 17 – D,
Bahadurgarh),
Chandigarh – 160 017.
Himachal Pradesh,
Tel.: 0172 - 2706196 / 2706468
UT of Jammu & Kashmir, Ladakh and Chandigarh.
Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI
Fatima Akhtar Court, 4th Floor, 453,
Tamil Nadu,UT-
Anna Salai, Teynampet,
Pondicherry Town and
CHENNAI – 600 018.
Karaikal (which are part of UT of Pondicherry).
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in

DELHI
2/2 A, Universal Insurance Building, Delhi &
Asaf Ali Road, Following Districts of Haryana - Gurugram, Faridabad,
New Delhi – 110 002. Sonepat & Bahadurgarh.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in
GUWAHATI
Assam,
Meghalaya,
Jeevan Nivesh, 5th Floor,
Manipur,
Nr. Panbazar over bridge, S.S. Road,
Mizoram,
Guwahati – 781001(ASSAM).
Arunachal Pradesh,
Tel.: 0361 - 2632204 / 2602205
Nagaland and Tripura.
Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD
6-2-46, 1st floor, "Moin Court",
Andhra Pradesh,
Lane Opp. Saleem Function Palace,
Telangana, UT of
A. C. Guards, Lakdi-Ka-Pool,
Yanam and
Hyderabad - 500 004.
part of UT of Pondicherry.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg, Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road, Kerala, UT of Lakshadweep, Mahe-a part of UT of
Ernakulam - 682 015. Pondicherry.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in
KOLKATA
Hindustan Bldg. Annexe, 4th Floor,
West Bengal,
4, C.R. Avenue,
Sikkim, UT of
KOLKATA - 700 072.
Andaman & Nicobar Islands.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in

Districts of Uttar Pradesh :
LUCKNOW Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
Office of the Insurance Ombudsman, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
6th Floor, Jeevan Bhawan, Phase-II, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow,
Nawal Kishore Road, Hazratganj, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki,
Lucknow - 226 001. Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi,
Tel.: 0522 - 2231330 / 2231331 Balrampur, Basti, Ambedkarnagar, Sultanpur,
Fax: 0522 - 2231310 Maharajgang, Santkabirnagar, Azamgarh, Kushinagar,
Email: bimalokpal.lucknow@cioins.co.in Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar.
MUMBAI
3rd Floor, Jeevan Seva Annexe,
Goa,
S. V. Road, Santacruz (W),
Mumbai Metropolitan Region
Mumbai - 400 054.
excluding Navi Mumbai & Thane.
Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in
NOIDA State of Uttaranchal and the following Districts of

Office of the Insurance Ombudsman, Uttar Pradesh:
Bhagwan Sahai Palace Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun,
4th Floor, Main Road, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut,
Naya Bans, Sector 15, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Distt: Gautam Buddh Nagar, U.P-201301. Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad,
Tel.: 0120-2514252 / 2514253 Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
Email: bimalokpal.noida@cioins.co.in Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
PATNA
1st Floor,Kalpana Arcade Building,,
Bihar,
Bazar Samiti Road,
Jharkhand.
Bahadurpur, Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@cioins.co.in
PUNE
Jeevan Darshan Bldg., 3rd Floor, Maharashtra,
C.T.S. No.s. 195 to 198, Area of Navi Mumbai and Thane
N.C. Kelkar Road, Narayan Peth, Pune – 411 030. excluding Mumbai Metropolitan Region.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in
EXECUTIVE COUNCIL OF INSURERS

3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 - 69038801/03/04/05/06/07/08/09
Email: inscoun@cioins.co.in
Shri B. C. Patnaik, Secretary General
Smt Poornima Gaitonde, Secretary
Ombudsmen details are subject to change. Please refer this link for the updated details: CIO (cioins.co.in)”

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ASPIRE- POLICY WORDINGS

2.1. Standard Definitions:

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

2.2. Specific Definitions

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

1. Base Sum Insured

4. Benefits available under the policy.

4.1.1. Expenses in reaching a Hospital

4.1.2. Expenses during Hospitalization

1. Uterine Artery 2. Immunotherapy- 3. Vaporisation of the 4. Stem cell therapy: Hematopoietic

4.1.4. Home Care / Domiciliary Treatment

4.1.5. Organ donor

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

4.1.6. Annual Health Checkup

List of tests covered:

Year 2: Once the policy is renewed:

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

Note (Lock the Clock & Lock the Clock+)

Year 2: Once the policy is renewed:

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

Either ReAssure+ or ReAssureX can be offered in a single policy.

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

4.1.11. Live Healthy

Policy Period: 1 year

Policy Period: 2 years

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

Policy Period: 3 years

4.1.12. Second Medical Opinion

4.1.14. Annual Aggregate Deductible

4.1.15. Hospital Cash:

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

Note: Co-Payment & Annual Aggregate Deductible cannot be opted together.

4.1.17. Pre-Existing Disease Waiting Time Modification

4.1.18. Room Type Modification

4.1.19. Personal Accident

4.1.19.2. Permanent Total Disability

Condition for Permanent Total Disability % of Accidental Death Sum Insured

4.1.19.3. Permanent Partial Disability

Condition for Permanent Partial Disability % of Accidental Death Sum Insured

Each arm at the shoulder joint 70%

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

4.1.22. Future Ready

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

4.1.25. WellConsult (OPD):

Opt for complete wellness and OPD benefits.

4.1.25.1. Tele/Video Consultation on our network.

5.1.2. Specified disease/procedure waiting period (Code- Excl02)

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

5.1.3. 30-day waiting period (Code- Excl03):

5.1.4. Investigation & Evaluation (Code-Excl04)

5.1.5. Rest Cure, rehabilitation and respite care (Code-Excl05)

5.1.6. Obesity/ Weight Control (Code-Excl06)

5.1.7. Cosmetic or plastic Surgery (Code-Excl08)

5.1.8. Hazardous or Adventure sports (Code-Excl09)

5.1.9. Breach of law (Code-Excl10)

Product Name: Aspire | Product UIN: NBHHLIP24129V012324

5.1.10. Excluded Providers (Code-Excl11)

5.1.13. Refractive Error (Code-Excl15)