Rakesh Kumar Agarwal

Date: 22/10/2024
Policy Number: 32057469202403

Customer ID: 2001590558
MR. RAKESH KUMAR AGARWAL

H.NO.-74, BRAHMANO KA MOHALLA,
MAHARKHURD, TEH. SHAHPURA,
JAIPUR RAJASTHAN,
JAIPUR,
RAJASTHAN - 303806
Mobile: XXXXXX9471
Subject : Niva Bupa Health Insurance Policy No. 32057469202403
Dear MR. RAKESH KUMAR AGARWAL,
Thank you for renewing your Niva Bupa health insurance policy. At Niva Bupa, we put your health first and are committed to provide you access to
the very best of healthcare, backed by the highest standards of service.
Please find enclosed your Niva Bupa Policy Kit which will help you understand your policy in detail and give you more information on
how to access our services easily. Your policy kit includes the following:
• Insurance Certificate: Confirming your specific policy details like date of commencement, persons covered and specific conditions related to
your plan.
• Premium Receipt: Receipt issued for the premium paid by you.
Do visit us online at www.nivabupa.com to view and download our updated list of network hospitals in your city, download claim forms and for other
useful information. You can register with us online using your policy number, date of birth & email id and access your policy details. In case of any
further assistance, call us at 1860-500-8888 (customer helpline number) or raise a request using our self-service platform, Insta Assist by clicking:
https://rules.nivabupa.com/customer-service/.
We request you to read your policy terms and conditions carefully so that you are fully aware of your policy benefits. For benefits related to section
80D, please consult your tax advisor.
Assuring you of our best services and wishing you and your loved ones good health always.
Yours Sincerely,
Director - Operations & Customer Service

For and on behalf of Niva Bupa Health Insurance Co. Ltd.
(Formerly known as Max Bupa Health Insurance Co. Ltd.)
Important - Please read this document and keep in a safe place.
Product Name: ReAssure 2.0 | Product UIN: NBHHLIP23169V012223, Add On Name: Smart Health+ | Add On UIN: NBHHLIA22164V012122
Turnaround Time*
POLICY SERVICING
(Calendar Days)
Post Policy issue service requests – from the date of receipt of service
7 Days
request
Proposal refund in case of cancellation – from the date of decision of the
7 Days
proposal
CLAIM SERVICING Turnaround Time*

(Calendar Days)
Settlement of Claims - From the date of submission of claim 15 Days
GRIEVANCE HANDLING Turnaround Time*

(Calendar Days)
Acknowledge a grievance – from the date of receipt of grievance Immediately
Resolve a grievance– from the date of receipt of grievance 14 Days
*Turnaround time will start from the date of receipt of complete documents at Niva Bupa Health Insurance Company Ltd.
ReAssure 2.0 Insurance Certificate
Policyholder Name: MR. RAKESH KUMAR AGARWAL Policy Number 32057469202403

Policyholder Address: Policy Commencement Date and Time From 24/11/2024 00:00
H.NO.-74, BRAHMANO KA MOHALLA, Policy Expiry Date and Time To 23/11/2025 23:59
MAHARKHURD, TEH. SHAHPURA, Base Sum Insured INR 10,00,000
JAIPUR RAJASTHAN, Variant Opted Titanium+
JAIPUR, Plan Opted Individual
RAJASTHAN - 303806 Policy Period 1 Year

Renewal / Payment Due Date 23/11/2025
Details of Electronic Insurance Account (eIA) Reported claims in the policy since 10
eIA Number None inception
Insurance Repository Name None
Cover Details
Name of the Insured Person(s) Base Sum Sum Insured Booster+ Sum Sum Insured Live Healthy Personal Accident
Insured Safeguard+ Insured (INR) (Base Sum Discount % opted
(INR) (INR) Insured + Sum
Insured
Safeguard+ +
Booster+ Sum
Insured) (INR)
Mr. Rakesh Kumar Agarwal 10,00,000 1,49,200 0 11,49,200 0.00 0

.
Premium Details
Net Integrated Central State/UT Goods Loading Gross Premium Gross Premium (INR)
Premium/Taxa Goods and Goods and and Service Tax (INR) (in words)
ble Value Service Tax Service Tax (9.00 %)
(INR) (18.00%) (9.00 %)
17,869.00 0.00 1,608.21 1,608.21 2,978.00 21,085.00 Twenty-One Thousand Eighty-Five
Only
Nominee Details
Nominee Name Relationship with the Policyholder
Prabhu Dayal Modi Father
Intermediary Details
Intermediary Name Intermediary Code Intermediary Contact No.

Seema Gupta JAI01104078 8952935575
Claim Administrator Servicing Branch Details
Niva Bupa Health Insurance Company Limited U6th Floor, KJ City Tower, E-2, Ashok Marg, Panch Batti, C Scheme, Ashok Nagar, Jaipur,
Rajasthan 302001
Optional Benefit/Feature Details
Particulars Details
Hospital Cash INR 2,000/day; for maximum up to 30 days
Safeguard Not opted
Safeguard+ Yes
Personal Accident Not Opted
Smart Health+ (Disease Management) Not Opted
Smart Health+ (Acute Care) Best Consult
Pre Existing Disease Waiting Time Modification Not Opted
Co-payment Not Opted
Room Type Modification Not Opted
Annual Aggregate Deductible Not Opted
Product Benefit Table1
Expenses in Reaching Hospital • Road Ambulance: Up to Sum Insured

• Air Ambulance: up to INR 2,50,000 per hospitalization
• Up to Sum Insured
Expenses During Hospitalization (Covers AYUSH) • Modern Treatments: Covered up to Sum Insured with sub-limit of Rs. 1L per
claim on few robotic surgeries
Expenses Before and After a Hospitalization 60 Days and 180 Days Respectively. Covered Up to Sum Insured
Home Care/Domiciliary Covered up to Sum Insured
Organ Donor Covered up to Sum Insured
Annual Health Check-up (Only Cashless) For defined list of tests; up to INR 5,000 Per Insured Person
• ReAssure "Forever": First claim paid triggers ReAssure, forever. It is unlimited.

ReAssure+ Each claim under ReAssure "Forever" will be up to Base Sum Insured.
• Lock the Clock: Pay premiums as per your entry age, till a claim is paid.
Booster+ Carry forward unutilized sum Insured Maximum up to10 times of Base Sum
Insured
Live Healthy Up to 30% Discount on Renewal premium basic steps taken.
Shared Accommodation Benefit INR 800 per day; Maximum INR 4,800
Second Medical Opinion Once for any condition in a Policy year.
e-consultation Unlimited e-consultation within our network
1
The details of the benefits will change depending upon the plan opted. All the benefits are on per Policy Year basis, if otherwise not mentioned.
Insured Person Details
Name of the Age Insured Gender Relationship Insured Additional Pre Existing Personal Waiting
Insured Person DOB with Sum Insured Condition# Period*
(s) Niva Bupa
(Since)
Mr. Rakesh 45 01/07/1979 Male Applicant 24/11/2021 0 1. Cataract None
Kumar Agarwal
(# -Pre existing Disease as disclosed by You / Insured Person or discovered by us during medical underwriting)
(* - Please refer to Policy terms & Conditions for details)
Permanent Exclusion (if any):
None
Pursuant to Notification no 13/2020- Central Tax and Notification no 14/2020- Central Tax both dated 21st March 2020 read with rule 54 (2) of
CGST Rules 2017, the provisions of E Invoicing & QR code are not applicable to an Insurance company, hence E Invoice number and QR code has not
been printed on this document. GST under RCM: NIL
GSTI No.: 08AAFCM7916H1Z8 SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 8 Customer State Code / Customer GSTI No.: 8 /NA
Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
Location: New Delhi Director - Operations & Customer Service

Date: 22/10/2024 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)
Premium Receipt - ReAssure 2.0
Dear MR. RAKESH KUMAR AGARWAL
H.NO.-74, BRAHMANO KA MOHALLA
MAHARKHURD, TEH. SHAHPURA
JAIPUR RAJASTHAN
JAIPUR
RAJASTHAN - 303806
We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policyholder Name Mr. Rakesh Kumar Agarwal Policy Number 32057469202403
Product Name ReAssure 2.0 Plan Opted Individual Base Sum Insured 10,00,000
Policy Commencement Date # 24/11/2024 Policy Expiry Date 23/11/2025
Premium Calculation:
Premium (Rs.) - Base Product 11,614.00
Premium (Rs.) - Hospital Cash 755.00
Premium (Rs.) - Safeguard+ 1,452.00
Premium (Rs.) - Smart Health+: Acute Care Add-on 1,070.00
Underwriting Loading (Rs.) 2,978.00
Net Premium / Taxable value (Rs.) 17,869.00
Integrated Goods and Service Tax (18.00 %) 0.00
Central Goods and Service Tax (9.00 %) 1,608.21
State/UT Goods and Service Tax (9.00 %) 1,608.21
Gross Premium (Rs.) 21,085.00

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

Name of Person Insured Age Gender Relationship**
Mr. Rakesh Kumar Agarwal 45 Male Applicant
For the purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax Act,1961 and any amendments made
thereafter. For your eligibility and deductions, please refer to provisions of Income Tax Act 1961 as modified and consult your tax consultant. In the
event of non-realization of premium, tax benefits cannot be obtained against this premium receipt.
Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void.
GSTI No.: 08AAFCM7916H1Z8 SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 8 Customer State Code / Customer GSTI No.: 8 /NA
Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
Location: New Delhi Director - Operations & Customer Service

Date: 22/10/2024 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)
List of Un-recognized Hospitals
Sr. State City Hospital Address
No.
1 Gujarat Surat Aakanksha Hospital 126, Aaradhnanagar Soc., B/H. Bhulkabhavan
School, Aanand-Mahal Rd., Adajan, Surat
2 Gujarat Surat Abhinav Hospital Harsh Apartment, Nr Jamna Nagar Bus Stop,
God Dod Road Surat
3 Gujarat Surat Adhar Ortho Hospital Dawer Chambers, Nr. Sub Jail, Ring Rd., Surat
4 Gujarat Surat Aris Care Hospital A 223-224, Mansarovar Soc, 60 Feet ,
Godadara Road, Surat
5 Gujarat Surat Arzoo Hospital Opp. L.B. Cinema, Bhatar Rd., Surat
6 Gujarat Surat Auc Hospital B-44 Gujarat Housing Board, Nandeshara
7 Gujarat Surat Dharamjivan General Hospital Karmayogi - 1, Plot No. 20/21, Near Piyush Point,
& Trauma Centre Pandesara
8 Gujarat Surat Dr. Santosh Basotia Hospital Bhatar Road, Surat
9 Gujarat Surat Ghevariya Dental Clinic 202, M K Complex, Variya Compound, Hirabag
Circal
10 Gujarat Surat God Father Hospital 344, Nandvan Soc., B/H. Matrushakti Soc.,
Puna Gam, Surat.
11 Gujarat Surat Govind-Prabha Arogya Opp. Ratna-Sagar Vidhyalaya, Kaji Medan,
Sankool Gopipura, Surat
12 Gujarat Surat Hari Milan Hospital L H Road
13 Gujarat Surat Jaldhi Ano-Rectal Hospital
Tadwadi, Surat
14 Gujarat Surat Jeevan Path Gen. Hospital 2nd. Fl., Dwarkesh Nagri, Nr. Laxmi Farsan,
Sayan, Surat.
15 Gujarat Surat Kalrav Children Hospital Yashkamal Complex, Nr. Jivan Jyot, Udhna
16 Gujarat Surat Kanchan General Surgical Plot No. 380, Ishwarnagar Soc, Bhamroli-Bhatar,
Hospital Pandesara Surat
17 Gujarat Surat Krishnavati General Hospital Bamroli Road
18 Gujarat Kutch Mantra Orthopaedic Hospital Dr. Bhavin N. Patel
Gandhidham(Kutch)
19 Gujarat Surat Niramayam Hosptial & Shraddha Raw House, Near Natures Park
Prasutigruah
20 Gujarat Surat Patna Hospital 25, Ashapuri Soc - 2, Bamroli Road, Surat
21 Gujarat Surat Poshia Children Hospital Harekrishan Shoping Complex 1St Floor, Varachha
Road, Surat
22 Gujarat Surat Prayosha Hospital A-102/103, Shagun Residency, Puna Bombay Mar-
ket Road, Puna, Surat, Gujarat
23 Gujarat Surat R.D Janseva Hospital 120 Feet Bamroli Road, Pandesara, Surat
24 Gujarat Surat Radha Hospital & Maternity 239/240 Bhagunagar Society, Opp Hans Society,
Home L H Road, Varachha Road
25 Gujarat Surat Santosh Hospital L H Road
26 Gujarat Surat Shaurya Hospital Udhna, Surat
27 Gujarat Surat Shikha General Hospital 14 – Umiya Nagar – 1, Navagam Dindoli Road,
- Changed Name To Sai Udhna
Hospital
28 Gujarat Surat Shishumangal Children Surat
Hospital
Product
Product Name:
Name: HealthReAssure
Companion2.0 | Product
| Product UIN:UIN: NBHHLIP23169V012223
NBHHLIP23007V052223
No.
29 Gujarat Surat Shree Ramdev General & 248,Shiv Nagar G.I.D.C. Road,Nr:Udhna Citizen
Surgical Hospital Co-Operative Bank,Pandasara
30 Gujarat Surat Shree Sai Hospital & Prasuti 14, Umiya Nagar-1, Navagam Dindoli Road, Udhna
Gruh
31 Gujarat Surat Shreyans Anorectal & Daycare 5Th Floor, Opp. Ayurvedic Collage,
Hospital Station Road, Surat
32 Gujarat Surat Shri Panchratna Hospital & Geetanagar, Near Dindoli Jakat Naka,
Prasutugruah Navagam, Udhna, Surat
33 Gujarat Surat Shubham General Hospital 2nd Floor, Nirmal Complex, Near Maruti Gaushala,
Opp. Bhagwati Rus
34 Gujarat Surat Siddhi Clinic & Nursing Home 33- Nandanvan Apt., Naginawadi, Surat
35 Gujarat Surat Sparsh Multy Specality G.I.D.C Road, Nr Udhana Citizan Co-Op.Bank
Hospital & Trauma Care
Center
36 Gujarat Surat Sree Uday Narayan General 193,Sukhi Nagar, Bamroli Road, Near New Bridge,
Hospital Pandesara, Surat
37 Gujarat Surat Tripathi Chartiable Hospital Geetanagar, Near Dindoli Jakat Naka, Navagam,
Udhna, Surat
38 Gujarat Ahmedabad Umiya Medical & Surgical 2Nd Floor, Centre Plaza, Sattadhar Char Rasta,
Hospital Sola Road
39 Gujarat Surat Varachha General Hospital 17-26, Samarth Park Near Archana School
40 Uttar Kushi Nagar Aastha Multispecialty Hospital Padrauna Road, Kushinagar, Up, Ph :
Pradesh 9598440966/9793196178
41 Maharashtra Thane Ashwini Nursing Home Prashanti, Ground Floor, Agarkar Road,
Dombivli East, Thane
42 Maharashtra Thane Asmita Nursing Home Prashanti, Ground Floor, Agarkar Road,
43 Maharashtra Thane Balaji Nursing Home Prashanti, Ground Floor, Agarkar Road,
44 Haryana Rohtak Channan Devi Memorial Plot No.952, Ward No.23, Lal Chand Colony Chowk,
Hopital Near Durga Mandir, Rohtak
45 Telangana Hyderabad Goodlife Hospitals #1-7-309, Hanuman Nagar, Opp. Jaginis Foodland,
Chaitanyapri X Roads, Dilskhnagar
46 Orissa Dhenkanal Jagannath Clinic & Nursing Durgabazar, Nuahata, Kantabania, Banarpal
Home
47 Uttar Allahabad Jeevan Jyoti Hospital 162, Bai Ka Bagh, Lowther Road, Allahabad, Up
Pradesh
48 Tamilnadu Mayiladuthurai Krishna Hospital No 8 Pattamangala Street Mayiladuthurai
49 Maharashtra Mumbai Mumtaz Nursing Home 3/299/3774, Opp. Choti Masjid, Tagore Nagar,
Near Hariyali Police Chowki, Vikhroli (E),
Mumbai-400083
50 Telangana Kesava Nagar Padmaja Hospital # 17-1- 386/1/18 Kesava Nagar Colony Champapet
Colony Hyderabad
51 Bihar Harnaut Pragya Nurshing Home Harnaut
52 Telangana Jeedimetla Ram Hospitals Shapur Nagar, Ida, Jeedimetla
53 Haryana Gurgaon Ramanarayan Hospital Vill Bass Hariya P.O Bass Lambi Ggn-122503
54 Maharashtra Mumbai Royal Nursing Home Plot No 7, Sector-1, Airoli,, Navi Mumbai-400708
55 Orrissa Cuttak Sabarmati General Hospital Mahanadi Vihar
56 Uttar Meerut Sahara Hospital Ajanta Colony, Garh Road
Pradesh
Product
ProductName:
Name:Health Companion
ReAssure 2.0 || Product
Product UIN:
UIN:NBHHLIP23007V052223
NBHHLIP23169V012223
No.
57 Maharashtra Mumbai Sb Nursing Home Powai
58 Uttar Meerut Shagun Hospital 24 Tyagi Market Tej Garhi
Pradesh
59 Haryana Gurgaon Shri Balaji Hospital & Trauma Gadoli, Pataudi Road, Gurgaon
Center
60 Telangana Hyderabad Sri Sai Thirumala Hospitals Kishan Kumar Complex, Durga Nagar, Karmanghat
Main Road
61 Madhya Bhopal Venus Hospital And Medical H. No-2,Pipal Square,Karond, Bhopal
Pradesh Research Centre
62 Telangana Vanasthali Vijaya Nursing Home Near Double Road, Vanasthali Puram
Puram
63 Uttar Allahabad Virendra Hospital 7 Stanley Road (Next To Mishra Bhavan)Civil Lines,
Pradesh Allahabad
64 Uttar Meerut Yog Nursing Home Near Tej Garhi, University Road
Pradesh
Note:
1. Claims whether Cashless or reimbursement pertaining to treatments taken at the above mentioned Hospitals shall not
be entertained, processed or paid by Niva Bupa.
2. The above list is only for the purpose of admissibility of claims with respect to any health insurance policies of Niva
Bupa Health Insurance Company Limited.
3. The above list is subject to be updated from time to time. For updated list please visit this site at www.nivabupa.com
or call our customer care at 1860 500 8888
Product Name:
Product Name:Health Companion
ReAssure 2.0 || Product
Product UIN:
UIN:NBHHLIP23007V052223
NBHHLIP23169V012223
Customer Information Sheet/ Know Your Policy
This document provides key information about your policy. You are advised to go
through your policy document
Policy
Sl.
Title Description Clause
No
Number
1 Name of ReAssure 2.0
Insurance
Product/ Policy
2 Policy Number 32057469202403
3 Type of Both Indemnity and Benefit
Insurance
Product/ Policy
4 Sum Insured Sum Insured Options are: 5 Lacs, 7.5Lacs, 10 Lacs,
15 Lacs, 20 Lacs, 25 Lacs, 50 Lacs, 75 Lacs, 100
Lacs
The Sum Insured opted by you is mentioned in the

Policy Schedule.
5 Policy Coverage Expenses in respect of:
Base Coverage:
 Expenses in reaching the hospital: Road
ambulance covered up to Sum Insured and Air 4.1
ambulance up to INR 2,50,000 per hospitalization
 Expenses during Hospitalization: 2 hours and 4.2.1
more covered (AYUSH covered for 24 hours and
more).
 Modern treatments like Robotic surgeries, oral 4.2.2
chemotherapy etc. are covered
 Expenses before and after hospitalization: 60 and 4.3
180 days respectively. Up to Sum Insured.
 Home Care/Domiciliary treatment covered up to 4.4
Sum Insured.
 Organ donor expenses covered up to Sum
Insured 4.5
 Annual Health Check-up can be availed from day
1 of the policy as per plan chosen by You 4.6
 ReAssure+ –
4.7
· ReAssure “Forever”: The first paid claim
triggers ReAssure “Forever”. Maximum
amount this benefit pays for any single
claim is up to Base Sum Insured.
Page 1 of 12
Product Name: ReAssure 2.0, Product UIN: NBHHLIP23169V012223

· Lock the Clock: Entry age is locked at the
time of buying the policy, till a claim is paid
 ReAssureX - The first paid claim triggers 4.8
ReAssure “Forever”. Maximum amount this
benefit pays for any for any single claim is up to
Base Sum Insured.
 Booster+ - carry forward unutilized sum insured 4.9
for maximum 10 times of Base Sum Insured.
 Live Healthy - discount on premium at renewal 4.10
 Shared accommodation Cash Benefit- additional 4.11
amount paid each day if shared room is opted.
 Second Medical opinion – choose to take a 4.12
second medical opinion once in a policy year.
 E-consultation- Unlimited e-consultation with our 4.13
partners.
Optional Coverage:
 Hospital Daily Cash 4.14
- Up to INR 5 Lakh Base Sum Insured: INR
1,000/day
- Between INR 7.5 Lakh to INR 15 Lakh Base
Sum Insured: INR 2,000/day
- Above 15 Lakh Base Sum Insured: INR
4,000/day
- Maximum coverage offered under this benefit
is for 30 days / policy year / insured person.
 Personal Accident
4.15
 Safeguard 4.16
 Safeguard+ 4.17
 Annual aggregate deductible 4.18
 Co-payment 4.19
 Pre-Existing Disease Waiting Time Modification 4.20
 Room Type Modification 4.21
6 Exclusions Standard Exclusions 5
 Pre-existing Diseases (Code–Excl01)
 Specified disease/procedure waiting period
(Code- Excl02)
 30-day waiting period (Code- Excl03)
 Investigation & Evaluation (Code-Excl04)
 Rest Cure, rehabilitation and respite care (Code-
Excl05)
 Obesity/ Weight Control (Code-Excl06)
 Cosmetic or plastic Surgery (Code-Excl08)
 Hazardous or Adventure sports (Code-Excl09)
Page 2 of 12

 Breach of law (Code-Excl10)
 Excluded Providers (Code-Excl11)
 Treatment for, alcoholism, drug or substance
abuse or any addictive condition and
consequences thereof. (Code-Excl12)
 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)
 Refractive Error (Code-Excl15)
 Unproven Treatments (Code-Excl16)
 Sterility and Infertility (Code-Excl17)
 Maternity Expenses (Code-Excl18)
Specific Exclusions
 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
 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.
 External Congenital Anomaly- Screening,
counseling or treatment related to external
Congenital Anomaly.
 Dental treatment- All dental treatments other than
due to accidents and cancers.
 Unrecognized Physician or Hospital-
- 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.
- 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.
Page 3 of 12

- Treatment provided by Hospital or health
facility that is not recognized by the relevant
authorities in India.
 Costs which are not Reasonable and Customary
and treatments which are not Medically
Necessary. Refer Definition 2.1.36 for Reasonable
and Customary Charges.
 Artificial life maintenance for the Insured Person
who has been declared brain dead or in vegetative
state
Waiting period  Initial Waiting Period (Excl03)- 30 days for all 5.1.3
 Time period illnesses (not applicable in case of continuous
during which renewal or accidents)
specified
diseases/trea  Specific Waiting Period (Not applicable for 5.1.2
tments are claims arising due to an accident) (Excl02): 24
not covered. months for all of the following conditions
 It is counted o Pancreatitis and stones in biliary and urinary
from the system
beginning of o Cataract, glaucoma and retinal detachment
the policy o Hyperplasia of prostate, hydrocele and
coverage. spermatocele
o Prolapse uterus or cervix, endometriosis,
Fibroids, Polycystic ovarian disease (PCOD),
hysterectomy (unless necessitated by
Malignancy)
o Hemorrhoids, fissure, fistula or abscess of
anal and rectal region
o Hernia of any site or type,
o Osteoarthritis, joint replacement,
osteoporosis, systemic connective tissue
disorders, inflammatory polyarthropathies,
Rheumatoid Arthritis, gout, intervertebral disc
disorders, arthroscopic surgeries for ligament
repair
o Varicose veins of lower extremities
o All internal or external benign neoplasms/
tumours, cyst, sinus, polyps, nodules, mass or
lump
o Ulcer, erosion or varices of gastro intestinal
tract
o 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
Page 4 of 12

 Pre-existing diseases (Excl01): Covered after 36
months of continuous coverage
5.1.1
 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 5.2.1
8 Financial Limits i. Sublimit

of Coverage A. Modern Treatments: Up to INR 1Lac on few 4.2.2
robotic surgeries
i. Sub-limit (It is B. Air Ambulance up to INR 2.5L per 4.1.2
a pre-defined hospitalization
limit and the C. Annual Health Check-up: 4.6
insurance a. Up to INR 500 for every INR 1 Lac
company will Base Sum Insured
not pay any b. Individual policy: maximum INR 5,000
amount in per Insured per Policy Year
excess of this c. Family Floater policy: maximum INR
limit) 10,000 per policy per Policy Year
D. Shared Accommodation: 4.11
a. For sum insured up to INR 15 Lacs:
INR 800 per day; maximum INR 4,800
b. For sum insured above INR 15 Lacs:
INR 1,000 per day; maximum up to INR
6,000
E. Hospital Cash: 4.14
a. Up to INR 5 Lakh Base Sum Insured:
INR 1,000/day
b. Between INR 10 Lakh to INR 15 Lakh
Base Sum Insured: INR 2,000/day
c. Above 15 Lakh Base Sum Insured: INR
4,000/day
d. Maximum coverage offered under this
benefit is for 30 days / policy year / insured
person.
F. Personal Accident: up to 5 times of Base 4.15
Sum Insured. Maximum up to INR 1 Crore.
G. Room Type Modification: optional benefit 4.21
with following options- Single Private Room
and a Sharing Room
Page 5 of 12

ii. Co-Payment (It ii. Co-payment- Optional benefit with following 4.19
is a specified options- 20%, 30%, 40% and 50%.
amount/
percentage of
the admissible
claim amount
to be paid by
policyholder/
insured)
iii. Annual Aggregate Deductible- Optional 4.18

iii. Deductible (It benefit with following options- INR 10,000/
is a specified 20,0000/ 30,000/ 50,000/ 1,00,000.
amount up to
which an
insurance
company will
not pay any
claim, and
which will be
deducted from
total claim
amount (if
claim amount
is more than
specified
amount)
iv. Any other limit

(as applicable)
9 Claims/ Claims Details of procedure to be followed for cashless 6.2.4
Procedure service as well as for reimbursement of claim
including pre and post hospitalization.
Turn Around Time (TAT) for claims settlement

- TAT for pre-authorization of cashless facility-
1 Hour
- TAT for cashless final bill authorization- grant
final authorization within three hours of the
receipt of discharge authorization request
from the hospital. In case of delay, any
additional amount charged by hospital, will be
borne by us
Network Hospital Details-

https://rules.nivabupa.com/hospital-network/
Page 6 of 12

5.2.5
Helpline No- 1860-500-8888
Downloading/ getting claim form-

https://transactions.nivabupa.com/pages/downloads.
aspx
Hospitals which are blacklisted or from where no

claim will be accepted by insurer-
https://rules.nivabupa.com/doc/Exclude_List.pdf
10 Policy Servicing  Call center no of Insurer- Contact No: 1860-500- 6.1.8
8888
 Details of Company Officials--
Website: www.nivabupa.com
Customer Services Department
Niva Bupa Health Insurance Company
Limited
D-5, 2nd Floor, Logix Infotech Park
opp. Metro Station, Sector 59, Noida, Uttar
Pradesh, 201301
Self-service platform, Insta Assist
https://rules.nivabupa.com/customer-service/
11 Grievances/Com Details of 6.1.8

plaints
 Grievance Redressal Officer of the insurer
Grievance Redressal Officer
Limited
Pradesh, 201301
For details of grievance officer, kindly refer the
link https://www.nivabupa.com/customer-
care/health-services/grievance-redressal.aspx
 Insurance company grievance portal/ Department

Customer Services Department
Limited
Page 7 of 12

Pradesh, 201301
Contact No: 1860-500-8888
Fax No.: 011-41743397
Self-service platform, Insta Assist
https://rules.nivabupa.com/customer-service/
Senior citizens may write to us at at:
seniorcitizensupport@nivabupa.com
lnsured person may also approach the
grievance cell at any of the company's
branches with the details of grievance
 IRDAI/(IGMS/Call Centre): Email ID:

www.igms.irdai.gov.in Ombudsman (Refer
Annexure II of policy document for List of
Insurance Ombudsmen)
12 Things to  Free Look cancellation: The Free Look Period 6.1.1
Remember shall be applicable on individual health insurance
policies and not on renewals.
The insured person shall be allowed free look

period of thirty days from date of receipt of the
policy document to review the terms and conditions
of the policy. If he/she is not satisfied with any of
the terms and conditions, he/she has the option to
cancel his/her policy.
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
return 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. 6.1.3
 Policy renewal: Except on grounds of fraud,

moral hazard or misrepresentation or non-
Page 8 of 12

cooperation, renewal of your policy shall not be 6.1.12 &
denied, provided the policy is not withdrawn. 6.1.13
 Migration and Portability: When your policy is

due for renewal, you may migrate to another
policy with us or port your policy to another
insurer.
You can contact Customer Service Department
(details provided above) for migration and
portability. 6.2.3.c
 Change in Sum Insured: Sum Insured can be

changed (increased/decreased) only at the time
of renewal or at any time, subject to underwriting
by the company. For increase in Sl, the waiting
period if any shall start afresh only for the 6.1.10
enhanced portion of the sum insured.
 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 sims insured
of the first policy. Wherever, the sum insured is
enhanced, completion of sixty continuous months
would applicable from the date of enhancement
of sums insured only on the enhanced limits.
13 Your Obligations Please disclose all pre-existing disease/s or 6.1.14
condition/s before buying a policy. Non-disclosure
may affect the claim settlement.
Disclosure of Information- The Policy shall be void

and all premium paid thereon shall be forfeited to the
Company in the event of misrepresentation, mis-
description or non-disclosure of any material fact by
the policyholder.
(Explanation: “Material facts” for the purpose of this
policy shall mean all relevant information sought by
the company in the proposal form and other
connected documents to enable it to take informed
decision in the context of underwriting the risk)
Page 9 of 12

Benefit Illustration
Benefit Illustration (5 Lac Sum Insured, Policy Term 1 year)

Age Coverage
of opted on
the individual
Coverage opted on
mem basis
individual basis covering Coverage opted on family
bers covering
multiple members of the floater basis with overall
insur each
family under a single Sum Insured (Only one Sum
ed member of
policy (Sum Insured is Insured is available for the
the family
available for each member entire family)
separately
of the family)
(at a single
point in
time)
Prem Sum Prem Disco Prem Sum Premiu Float Prem Sum
ium Insu ium unt, if ium Insu m or er ium Insu
(Rs.) red (Rs.) any after red Consoli disco after red
(Rs.) disc (Rs.) dated unt, disc (Rs.)
ount premiu if any ount
(Rs.) m for (Rs.)
all
membe
rs of
family
(Rs.)
Illustration 1
5,00, 5,00, 14,71 22,00 5,00,

7,787 7,787 7,787
18 000 779 7,008 000 6 5 000
5,00, 5,00,
7,787 7,787 7,787
21 000 779 7,008 000
5,00, 5,00,
9,761 9,761 9,761
39 000 976 8,785 000
11,38 5,00, 11,38 10,24 5,00,

11,386
45 6 000 6 1,139 7 000
Page 10 of 12

Total premium for all Total premium for all Total premium when the policy
members of the members of the family is is opted on floater basis is
family is Rs.36,721, Rs.33,049, when they are Rs.22,005.
when each member covered under a single
is covered policy. Sum Insured of Rs.500,000 is
separately. available for the entire family.
Sum Insured available for
Sum Insured each family member is
available for each Rs.500,000.
individual is
Rs.500,000.
Illustration 2
20,24 5,00, 20,24 18,22 5,00, 9,642 46,27 5,00,

20,244
55 4 000 4 2,024 0 000 5 000
35,67 5,00, 35,67 32,10 5,00,

35,673
63 3 000 3 3,567 6 000
members of the members of the family is is opted on floater basis is
family is Rs.55,917, Rs.50,325, when they are Rs.46,275.
individual is
Rs.500,000.
Illustration 3
35,67 5,00, 35,67 32,10 5,00, 20,67 60,60 5,00,

35,673
65 3 000 3 3,567 6 000 8 5 000
45,60 5,00, 45,60 41,04 5,00,

45,609
70 9 000 9 4,561 8 000
members of the members of the family is Rs. is opted on floater basis is
family is Rs.81,282, 73,154, when they are Rs.60,605.
Page 11 of 12

individual is
Rs.500,000.
Note: Premium rates specified in the above illustration are standard premium
rates without considering any loading. Also, the premium rates are exclusive of
taxes applicable.
Premium is considered for Platinum+ Variant and Zone 1
Page 12 of 12

Policy Wordings
1. Preamble
This Policy covers Allopathic and AYUSH treatments taken in India ONLY.
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 claim 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. Dental Treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings (where
appropriate), crowns, extractions and Surgery.
2.1.11. Deductible means a cost-sharing requirement under a health insurance policy that provides that the Insurer will not be
liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital
cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the Sum Insured.
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.
Internal
Policy Wordings
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;
Internal
Policy Wordings
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. Non-Network Provider means any Hospital, Day Care Centre or other provider that is not part of the network.
2.1.30. Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes
of communication
2.1.31. 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.
2.1.32. 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.
2.1.33. 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.
2.1.34. 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.
2.1.35. 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.
2.1.36. 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.
2.1.37. 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.
2.1.38. Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the associated
medical expenses.
2.1.39. 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.
2.1.40. Specific Waiting period means a period up to 36 months from the commencement of a health insurance policy during
which period specified diseases/treatments (except due to an accident) are not covered. On completion of the period,
diseases/treatments shall be covered provided the policy has been continuously renewed without any break
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. 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.
2.2.3. 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. 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
Internal
Policy Wordings
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. Expenses in reaching a Hospital
4.1.1. Road Ambulance: We will pay you up to Sum Insured.
4.1.2. Air Ambulance: Only in case of Emergency. Maximum INR 2,50,000 per hospitalization.
Note: This will be paid only if claim for hospitalization is paid by us. You must always use a
registered ambulance / air ambulance provider.
4.2. Expenses during Hospitalization

4.2.1. 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.
 Admitted for 2 hours or more (minimum 24 hours for AYUSH treatment in a AYUSH Hospital)
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
4.2.2. We pay for Modern treatments as specified below:
1. Uterine 2. Immunotherapy- 3. Vaporisation of 4. Stem cell

Artery Monoclonal the prostrate therapy:
Embolization Antibody to be (Green laser Hematopoietic
and HIFU given as treatment or stem cells for
(High injection holmium laser bone marrow
intensity treatment) transplant for
focused haematological
ultrasound) conditions
5. Balloon 6. Oral 7. Robotic surgeries 8. Stereotactic
Sinuplasty Chemotherapy radio Surgeries
9. Deep Brain 10. Intra 11. Bronchical 12. IONM -
stimulation vitreal injections Thermoplasty (Intra
Operative
Neuro
Monitoring)
NOTE: A limit of maximum INR 1,00,000 per claim will apply to all robotic surgeries, except for total radical
prostatectomy, cardiac surgeries, partial nephrectomy and surgeries for malignancies.
4.3. 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.
4.4. 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:
4.4.1. The medical practitioner advices the insured person to undergo treatment at home
4.4.2. 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
4.4.3. 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 4.3 for Home Care / Domiciliary Treatment.
Internal
Policy Wordings
 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.)
4.5. 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 Hospitalisation 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.
4.6. 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 up to your
eligibility limit. The tests MUST be booked through our digital assets (e.g. Mobile App). This benefit is available ONLY on
cashless and no re-imbursement is allowed
List of tests covered:

Complete Physical
Complete blood count (CBC) Serum Electrolytes
Examination by Physician
Post prandial/lunch blood
Urine Routine & Microscopic HbA1C
sugar (PPBS / PLBS)
Erythrocyte Sedimentation Rate
Uric Acid Thyroid function test
(ESR)
Liver Function Test
Fasting Blood sugar (FBS) Lipid Profile
(LFT)
Treadmill test (TMT) OR
Electrocardiogram (ECG) Kidney function test
2 D ECHO
X Ray chest Serum Vitamin D Ultrasound test (USG)
Colonoscopy (for >50 year
Mammogram Serum calcium
olds)
PAP smear
Note:
If you undergo multiple tests, make sure that all these are done within 7 days. Unutilized amount will not be carried forward
to next policy year.
4.7. ReAssure+
4.7.1. 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:
 Maximum amount ReAssure+ pays for any single claim is up to Base Sum Insured.
 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.
 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 1st ReAssure+ Balance 2nd Claim Balance 3rd Claim
Sum paid is Base payable amount Base Payable amount
Insured Claim triggered Sum claim paid Sum claim paid
(Equal to Insured Insured
10 Lakh 7 Base Sum 3 Lakh 12 Lakh 12 Lakh Nil 11 Lakh 10 Lakh
Lakh Insured) (3 Lakh from
from Base ReAssure+
Sum
Insured
and 9
Lakh from
ReAssure+
Internal
Policy Wordings
Year 2: Once the policy is renewed:

Balance Balance
Base ReAssure+ 2nd Claim 3rd Claim
1st Claim Base Base
Sum is already payable amount Payable amount
Paid Sum Sum
Insured triggered claim paid claim paid
Insured Insured
10 Lakh 10 Lakh 15 Lakh Nil 12 Lakh 10 Lakh Nil 10 Lakh 10 Lakh

from
10 Lakhs ReAssure+
from Base
Sum (this 10
Insured Lakh will
ReAssure+ ReAssure+
and 5 trigger
Lakhs unlimited
from times)
ReAssure+
4.7.2. 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 a 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.
Note:
 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.
 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.
 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.
 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.
 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.
 In a multi individual policy, the age will unlock only for the individuals who claim.
 In a floater policy, if a claim is paid for anyone in the plan then we will unlock the age for the entire policy.
 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
4.8. 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:
 Maximum amount ReAssureX pays for any single claim is up to Base Sum Insured.
 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.
 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 1st ReAssureX Balance 2nd Claim Balance 3rd Claim
Sum paid is Base payable amount Base Payable amount
Insured Claim triggered Sum claim paid Sum claim paid
(Equal to Insured Insured
Internal
Policy Wordings
10 Lakh 7 Base Sum 3 Lakh 12 Lakh 12 Lakh Nil 11 Lakh 10 Lakh

Lakh Insured) from
(3 Lakh ReAssureX
from Base
Sum
Insured
and 9 Lakh
from
ReAssureX
Year 2: Once the policy is renewed:

Balance Balance
Base ReAssureX 2nd Claim 3rd Claim
1st Claim Base Base
Sum Sum payable amount Payable amount
Paid Sum Sum
Insured Insured claim paid claim paid
Insured Insured
10 Lakh 10 Lakh 15 Lakh Nil 12 Lakh 10 Lakh Nil 10 Lakh 10 Lakh

from
10 Lakhs ReAssureX
from Base
Sum (this 10
Insured Lakh will
ReAssureX ReAssureX
and 5 trigger
Lakhs unlimited
from times)
ReAssureX
4.9. Booster+
Don’t lose what you don’t use.
Unutilized Base Sum Insured carries forward. Maximum it will accumulate up to 3/5/10 times (based on the plan you have
chosen) of the Base Sum Insured.
Example: If you have chosen Base Sum Insured of INR 10 lakh and Titanium+ Variant, then at the end of 10 years (if you
have made no claims in these years) you will have
1.10 Crore Sum Insured (that is 10 Lakh base + 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 1.10
Crore.
That’s 11 times of Sum Insured than what you paid for.
Note:
 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.
 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.
 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.
 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
3/5/10 times (based on the plan you have chosen) of the Base Sum Insured. Higher the Base Sum insured higher
the Booster+ Sum Insured ).
4.10. 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.
Internal
Policy Wordings
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 Points in Total points Discount on renewal premium
Start of 9 months (A) next 3 considered for (Renewal policy start date 1st
Date This will be months (B) discount (A + B) April 2024)
considered for from 2nd Policy
discount on the Period onwards NOTE: Discount applicable on
first renewal. the member’s premium in
Individual sum insured policies
and on the Policy premium in
case of Floater
Individual sum Floater
insured policy policies
and Floater with more
policies with 1 than 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

Policy End of 21 Points at the end Points in Total points Discount on renewal premium
Start months of 21 months (A) next 3 considered for (Renewal policy start date 1st
Individual sum insured
policies and on the Policy
premium in case of Floater
Adult Adult
2023 2024
3001 – 4500 5% 2.5%
4501 – 6000 15% 7.5%
6001 – 7500 20% 10%
>=7501 30% 15%
Policy Period: 3 years

Policy End of 33 Points at the end Points in Total points Discount on renewal premium
Start months of 33 months (A) next 3 considered for (Renewal policy start date 1st
Individual sum insured policies
and on the Policy premium in
case of Floater
Internal
Policy Wordings

Adult Adult
2023 2025
4501 – 6750 5% 2.5%
6751 – 9000 15% 7.5%
9001 – 11250 20% 10%
>=11251 30% 15%
4.11. Shared accommodation Cash Benefit

If you opt for a shared room (for which hospitalization claim is paid), we will pay an additional amount for each day’s
hospitalization. One day is considered as 24 continuous hours of hospitalization.
4.12. Second Medical Opinion

Once 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.
4.13. e-Consultation
You can take Unlimited e-consultations from our Partners.
Optional Benefit:
4.14. 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.
Note: we will pay if you were hospitalized for 48 hours or more continuously.
4.15. Personal Accident

4.15.1. 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.
4.15.2. 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
% of Accidental
Condition for Permanent Total Disability
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
a. 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.
4.15.3. Permanent Partial Disability

a. 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.
% of Accidental
Condition for Permanent Partial Disability
Death Sum Insured
Internal
Policy Wordings
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%
b. 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.
c. 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.
4.16. Safeguard
4.16.1. Claim Safeguard: We will cover non-payable items mentioned in ‘List I – Expenses not covered’ of
Annexure I’. Clause 2.1.36 for Reasonable and Customary Charges will still apply.
4.16.2. Booster+ Safeguard: Booster+ will not be impacted if the total claim in a policy year is up to INR 50,000
4.16.3. 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.
4.17. Safeguard+
4.17.1. Claim Safeguard+: We will cover non-payable items mentioned in ‘List I,II,III,IV of Annexure I’. Clause
2.1.36 for Reasonable and Customary Charges will still apply.
4.17.2. Booster+ Safeguard+: Booster+ will not be impacted if the total claim in a policy year is up to INR
1,00,000.
4.17.3. 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.
4.18. 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 Annual Health Check-up, Live Healthy, Second Medical Opinion, Shared Accommodation
Cash, e-consultation, Personal Accident, Hospital Daily Cash benefits.
4.19. Co-Payment:
It is the percentage of admissible claim amount You would have to bear, Rest we will pay.
Internal
Policy Wordings
Note: Co-payment will NOT apply to Annual Health Check-up, Live Healthy, Second Medical Opinion, Shared Accommodation
Cash, e-consultation, Personal Accident, Hospital Daily Cash benefits.
4.20. Pre-Existing Disease Waiting Time Modification

You can choose to reduce or increase the Pre-Existing Disease waiting time.
4.21. 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 Single Private Room and a Sharing Room. Irrespective of the Room type you choose, ICU
admission will always be paid up to Base Sum Insured.
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 36 months 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 36 months 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 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.
Internal
Policy Wordings
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.
5.1.15. Sterility and Infertility (Code-Excl17)

Expenses related to sterility and infertility. This includes:
a. Any type of contraception, sterilization
Internal
Policy Wordings
b. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT,
GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
5.1.16. Maternity Expenses (Code-Excl18)

a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred
during Hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the Policy
Period.
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
2.1.36 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 document to can return back your
review the terms and conditions of the policy. If he/she is not satisfied with any of the terms and conditions, policy, if you don’t like
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 return the policy to the insurer for cancellation, stating the reasons for
the same.
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 Simplified for you
insurer on medical examination of the proposer and stamp duty charges. You can cancel your
policy whenever you
6.1.2. Cancellation wish.
The policy holder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. The Note: We will NOT refund
insurer shall: any premium if we have
paid a claim.
b. Refund proportionate premium for unexpired policy period, if the term of the policy upto one year and there is
no claim(s) made during the policy period. We will refund part of
a. Refund premium for the unexpired policy period, in respect of policies with term more than 1 year and risk the premium depending
coverage for such policy years are not commenced on how many days your
Internal
Policy Wordings
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 or for, if there is no claim.
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 Simplified for you
acting on his/her behalf to obtain any benefit under this policy, all benefits under this policy and the premium paid
shall be forfeited. If we ever cancel your
policy, it will be for Fraud
Any amount already paid against claims made under this policy but which are found fraudulent later shall be repaid or Non disclosure only.
by all recipient(s)/policyholder(s), who has made that particular claim, who shall be jointly and severally liable for Insurance contract is a
such repayment to the insurer. legal contract too and it’s
based on trust.
For the purpose of this clause, the expression "fraud" means any of the following acts committed by the insured Fraud is an action by you
person or by his agent or the hospital/doctor/any other party acting on behalf of the insured person, with intent or anyone acting on your
to deceive the insurer or to induce the insurer to issue an insurance policy: a) the suggestion, as a fact of that behalf where you receive
which is not true and which the insured person does not believe to be true; b) the active concealment of a fact by benefits, financial or
the insured person having knowledge or belief of the fact; c) any other act fitted to deceive; and d) any such act or otherwise, for which you
omission as the law specially declares to be fraudulent are either not eligible at
all or not to the extent
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of Fraud, if the insured under the policy.
person / beneficiary can prove that the misstatement was true to the best of his knowledge and there was no
deliberate intention to suppress the fact or that such misstatement of or suppression of material fact are within Pay your renewal
the knowledge of the insurer. premium before end of
policy period to maintain
6.1.7. Withdrawal of Policy continuity of benefits. A
i. ln the likelihood of this product being withdrawn in future, the Company will intimate the insured person about grace period is also
the same 90 days prior to expiry of the policy. available to pay the
ii. lnsured Person will have the option to either renew (up to 90 days from renewal date) same product or to migrate premium after policy
to a similar health insurance product available with the Company at the time of renewal with all the accrued expiry.
continuity benefits such as cumulative bonus, waiver of waiting period as per IRDAI guidelines, provided the policy
has been maintained without a break.
Internal
Policy Wordings
Note: You are NOT

6.1.8. Redressal of Grievance: insured during the grace
ln case of any grievance the insured person may contact the company through: period.
Toll- Free: 1860-500-8888 Simplified for you
E-mail: Email us through our service platform https://rules.nivabupa.com/customer-service/ (Senior citizens We will cancel your
may write to us at: seniorcitizensupport@nivabupa.com) policy, will not pay any
claim, will not refund any
Fax : 011-41743397 premium paid and have
Courier: Customer Services Department right to take all possible
legal action against you
Niva Bupa Health Insurance Company Limited
including for recovery of
benefits paid earlier, if
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301
 You withheld any
information from us,
lnsured person may also approach the grievance cell at any of the company's branches with the details of grievance. whole or part that
If lnsured person is not satisfied with the redressal of grievance through one of the above methods, insured person would have invited any
may contact the grievance officer at: decision other than a
Grievance Redressal Officer ‘standard acceptance’
of your application for
Niva Bupa Health Insurance Company Limited
insurance.
Note: Non standard
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301 decisions are:
Contact No: 1860-500-8888 o Loading – We
Fax No.: 011-41743397 ask for additional
premium
Email our Grievance officer through our Grievance Redressal platform https://
o Exclusions –
transactions.nivabupa.com/pages/grievance-redressal.aspx We apply a additional
For updated details of grievance officer, kindly refer the link https://www.nivabupa.com/customer-care/health- waiting period for
services/grievance-redressal.aspx health conditions or
treatments
o Rejection – We
If the Insured person is not satisfied with the above, they can escalate to GRO@nivabupa.com. hate to do this. But
lf lnsured person is not satisfied with the redressal of grievance through above methods, the insured person may sometimes are
compelled to say no to a
also approach the office of lnsurance Ombudsman of the respective area/region for redressal of grievance as per
customer
lnsurance Ombudsman Rules 2017 ( at the addresses given in Annexure II).
IMPORTANT: We
Grievance may also be lodged at IRDAI integrated Grievance Management System – www.bimabharosa.irdai.gov.in understand you may
not know how
6.1.9. Claim settlement (Provision for Penal interest) important is the
i. The Company shall settle or reject a claim, as the case may be, within 15 days from the claim submission date. information on your
ii. ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from health and it’s
the date of receipt of claim intimation till the date of payment of claim at a rate of 2% above the bank rate. impact on your
policy. Hence it’s
(Explanation: "Bank rate" shall mean the rate fixed by the Reserve Bank of lndia (RBl) at the beginning of the financial very important that
year in which claim has fallen due) you disclose all
health information
6.1.10. Moratorium Period and we would
After completion of sixty continuous months of coverage (including portability and migration) in health insurance decide how
policy, no policy and claim shall be contestable by the insurer on the grounds of non-disclosure, misrepresentation, important (we call it
except on grounds of established fraud. The period of sixty continuous months is called as moratorium period. The ‘material’) it is.
moratorium will be applicable for the sums insured of the first policy. Wherever, the sum insured is enhanced,  Cause fraud of any
completion of sixty continuous months would applicable from the date of enhancement of sums insured only on the kind
enhanced limits.
Simplified for you
The policies would however be subject to all limits, sub limits, co-payments, deductibles as per the Policy contract. We will provide our
decision on claim within
Note: the accrued credits gained under the ported and migrated policies shall be counted for the purpose of 15 days from submission
calculating the Moratorium Period. of all necessary claim
documents. For any
Internal
Policy Wordings
6.1.11. Multiple Policies delay in payment of

A. Indemnity Based Policies: claim, we will pay
interest on the claim
a. In case of multiple policies taken by an Insured Person during a period from one or more insurers to amount at a rate 2%
indemnify treatment costs, the Insured Person shall have the right to require a settlement of his / her claim above bank rate.
in terms of any of his / her policies. In all such cases the insurer chosen by the Policyholder shall be .
considered as the Primary Insurer and will be obliged to settle the claim as long as the claim is within the
limits of and according to the terms of the chosen Policy. Simplified for you
b. If the amount to be claimed exceeds the available coverage of the said policy, then the primary insurer shall After 5 years, no health
seek the details of other available policies of the policyholder and shall coordinate with other insurers to insurance claim shall be
ensure settlement pf the balance amount as per the policy conditions, without causing any hassles to the contestable except for
policy holder. proven fraud and
permanent exclusions.
B. Benefit Based Policies:
a. On occurrence of the insured event, the policy holder can claim from all Insurers under all policies.
5.1.12. Migration
In case of migration of one policy to another with the same Insurer, the policyholder (including all members under
family cover and group insurance policies) can transfer the credits gained to the extent of the Sum Insured, No
Claim Bonus, Specific Waiting periods, waiting period for pre-existing diseases, Moratorium period etc. in the
previous policy to the migrated policy.
Simplified for you
The insurer may underwrite the proposal in case of migration, if the insured is not continuously covered for 36 In case you have multiple
months. policies, you can choose
the policy from which you
5.1.13. Portability want to claim first.
A Policyholder has the choice to port his/ her policies from one Insurer to another irrespective of individual or If claim amount exceeds
group policy subject to the Board approved underwriting policy of the insurers. the Sum Insured of first
The policyholder is entitled to transfer the credits gained to the extent of the Sum Insured, No Claim Bonus, policy you claim from;
specific waiting periods, waiting period for pre-existing disease, Moratorium period etc. from the Existing Insurer then you can claim the
to the Acquiring Insurer in the previous policy. balance amount from the
second policy.
5.1.14. 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 decision in the
context of underwriting the risk)
Simplified for you
5.1.15. Condition Precedent to Admission of Liability You can shift your policy
The terms and conditions of the policy must be fulfilled by the insured person for the Company to make any to any other health
payment for claim(s) arising under the policy. insurance product / plan
offered by us as per
5.1.16. Complete Discharge migration guidelines.
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 claim.
5.1.17. Premium Payment in Instalments

lf the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or
Monthly, as mentioned in the policy Schedule/Certificate of insurance, the following Conditions shall apply
(notwithstanding any terms contrary elsewhere in the policy) Simplified for you
You can also shift your
i. Grace Period of 30 days in all types of policies, and a period of 15 days in case of monthly instalments. policy to any other
ii. For policies where premium is paid in instalments only, the coverage will be given during grace period. insurer as per portability
iii. The insured person will get the accrued continuity benefit in respect of the "Waiting Periods", "Specific Waiting guidelines.
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.
Internal
Policy Wordings
6.2. Specific Terms and Clauses

7.2.1. 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.
7.2.2. Additional premium (Risk Loading)

a. 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.
b. We will never ask for more than 100% for any particular health condition and never more than 150% for any
individual.
c. Once applied, Risk loading continues even for all renewals. However, we offer discounts up to 30% under Live
Healthy for maintenance and improvement in health
7.2.3. Other Renewal Conditions:

a. Renewal Premium:
Renewal premium will alter based on Age (in case of claim). 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.
7.2.4. 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.
Please Note:
Internal
Policy Wordings
i. 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.
ii. 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
7.2.5. 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.
7.2.6. Territorial Jurisdiction

All claims shall be payable in India in Indian Rupees only.
7.2.7. 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.
7.2.8. Zonal pricing

For the purpose of calculating premium, the country has been divided into the following 2 zones:
a. Zone 1: Delhi NCR, Mumbai (including Navi Mumbai and Thane), Kolkata and Gujarat State. Delhi NCR
includes Delhi, Baghpat, Bulandshahr, Gautam Buddh Nagar, Ghaziabad, Hapur, Meerut, Muzaffarnagar,
Shamli, Charkhi Dadri, Faridabad, Gurugram, Jhajjar, Jind, Karnal, Mahendragarh, Nuh, Palwal, Panipat,
Rewari, Rohtak and Sonipat
b. Zone 2: Rest of India
Your premium depends upon your residential city. Please inform us immediately in case of change in your city.
7.2.9. Assignment
The Policy can be assigned subject to applicable laws.
Internal
Policy Wordings
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
Internal
Policy Wordings
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
Office Details Jurisdiction

AHMEDABAD
Shri Kuldip Singh

Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor, Gujarat, Dadra & Nagar Haveli, Daman and Diu
Tilak Marg, Relief Road,
AHMEDABAD – 380 001.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
Internal
Policy Wordings
BENGALURU
Mr Vipin Anand
Jeevan Soudha Building,PID No. 57-27-N-19 Karnataka
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL
Shri R. M. Singh
Insurance Ombudsman
Madhya Pradesh, Chhattisgarh
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market, Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESWAR
Shri Suresh Chandra Panda

Odisha
62, Forest park,
Bhubaneswar – 751 009.
Tel.: 0674 - 2596461 /2596455
Email: bimalokpal.bhubaneswar@cioins.co.in
CHANDIGARH
Mr Atul Jerath
Office of the Insurance Ombudsman, Punjab, Haryana (excluding Gurugram, Faridabad,
S.C.O. No. 101, 102 & 103, 2nd Floor, Sonepat and Bahadurgarh), Himachal Pradesh, Union
Batra Building, Sector 17 – D, Territories of Jammu & Kashmir,Ladakh & Chandigarh
Chandigarh – 160 017.
Tel.: 0172 - 2706196 / 2706468
Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI
Shri Segar Sampathkumar

Tamil Nadu, PuducherryTown and Karaikal (which are
Fatima Akhtar Court, 4th Floor, 453,
part of Puducherry)
Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Email: bimalokpal.chennai@cioins.co.in
Internal
Policy Wordings
DELHI
Shri Sudhir Krishna

Delhi & following Districts of Haryana - Gurugram,
2/2 A, Universal Insurance Building,
Faridabad, Sonepat & Bahadurgarh
Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in
GUWAHATI
Shri Somnath Ghosh

Assam, Meghalaya, Manipur, Mizoram, Arunachal
Jeevan Nivesh, 5th Floor,
Pradesh, Nagaland and Tripura
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD
Shri N. Sankaran
Andhra Pradesh, Telangana, Yanam and part of Union
6-2-46, 1st floor, "Moin Court",
Territory of Puducherry
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.
Tel.: 040 - 23312122
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR
Shri Rajiv Dutt Sharma

Jeevan Nidhi – II Bldg., Gr. Floor, Rajasthan
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM
Shri G. Radhakrishnan
Kerala, Lakshadweep, Mahe-a part of Union Territory
2nd Floor, Pulinat Bldg.,
of Puducherry
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Email: bimalokpal.ernakulam@cioins.co.in
Internal
Policy Wordings
KOLKATA
Shri P. K. Rath
Hindustan Bldg. Annexe, 4th Floor, West Bengal, Sikkim, Andaman & Nicobar Islands
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Email: bimalokpal.kolkata@cioins.co.in
Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba,

LUCKNOW
Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur,
Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi,
Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,
6th Floor, Jeevan Bhawan, Phase-II,
Gonda, Faizabad, Amethi, Kaushambi, Balrampur,
Nawal Kishore Road, Hazratganj,
Basti, Ambedkarnagar, Sultanpur, Maharajgang,
Lucknow - 226 001.
Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur,
Tel.: 0522 - 2231330 / 2231331
Deoria, Mau, Ghazipur, Chandauli, Ballia,
Email: bimalokpal.lucknow@cioins.co.in
Sidharathnagar
MUMBAI
Shri Bharatkumar S. Pandya

Goa, Mumbai Metropolitan Region (excluding Navi
3rd Floor, Jeevan Seva Annexe,
Mumbai & Thane)
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31
Email: bimalokpal.mumbai@cioins.co.in
NOIDA State of Uttarakhand and the following Districts of

Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor,
Shri Chandra Shekhar Prasad Budaun, Bulandshehar, Etah, Kannauj, Mainpuri,
Office of the Insurance Ombudsman, Mathura, Meerut, Moradabad, Muzaffarnagar,
Bhagwan Sahai Palace Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad,
4th Floor, Main Road, Naya Bans, Sector 15, Gautam Buddh nagar, Ghaziabad, Hardoi,
Distt: Gautam Buddh Nagar, U.P-201301. Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
Tel.: 0120-2514252 / 2514253 Sambhal, Amroha, Hathras, Kanshiramnagar,
Email: bimalokpal.noida@cioins.co.in Saharanpur
PATNA
Shri N. K. Singh
2nd Floor, Lalit Bhawan, Bihar, Jharkhand
Bailey Road,
Patna 800 001.
Tel.: 0612-2547068
Email: bimalokpal.patna@cioins.co.in
Internal
Policy Wordings
PUNE
Shri Vinay Sah

Maharashtra, Areas of Navi Mumbai and Thane
Jeevan Darshan Bldg., 3rd Floor,
(excluding Mumbai Metropolitan Region)
C.T.S. No.s. 195 to 198, N.C. Kelkar Road,
Narayan Peth, Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in
Council for Insurance Ombudsmen

3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054
Tel.: 022 -69038800/69038812| Email: inscoun@cioins.co.in
Internal
ENDORSEMENT DOCUMENT - Smart Health+
"Smart Health+" covers treatment taken within India only.
You are covered under Smart Health+ only if you have paid additional premium for this and it has been endorsed in to
your policy. Means it appears in your policy schedule.
Benefits applicable to you will depend on the chosen variant, mentioned in your policy schedule.
Unutilized Sum Insured will expire at the end of policy year.
1. Variants & Benefits description
A. Best consult
i. What is covered?
This plan covers 'Acute conditions' ONLY.
ii. What you get

You can avail UNLIMITED tele-consultation with general medical practitioner, specialists and super specialist
consultations through OUR PARTNER ONLY, whenever you need, 24 hours a day 7 days a week, 365 days a
year. 366 days if it's a leap year.
What is an acute condition?

Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return
the person to his or her state of health immediately before suffering the disease/ illness/ injury which leads to
full recovery
What it means?
These are the conditions that one suffers from every now and then and are unexpected like fever, cough, cold,
injury, diarrhea etc. In these conditions, once treated for a few days you get better completely and the
condition is 'cured'. No regular treatment, medicines, follow up, or monitoring is required for such conditions.
Example:
• Mr. X is suffering from diabetes and is on regular medication for diabetes. He falls ill and has urinary tract
infection. He can consult doctor through our partner to get treatment for the same.
• Mr. Y is a healthy individual. He has fever for which he can consult doctor through our partner.
iii. What is NOT covered?

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

a. You can avail UNLIMITED tele-consultation with general practitioner, specialists, and super specialist
consultations through OUR PARTNER ONLY, whenever you need, 24 hours a day 7 days a week, 365 days a
year. 366 days if it's a leap year :.
b. Investigations up to Sum Insured as per your policy schedule per year as prescribed by the general
practitioner, specialist or super specialist consulted through OUR PARTNER ONLY. We can help organize it
and we will pay. OR you can do it at centers of your choice and we still will pay. Of course, both instances,
up to limit only.
c. Medicines up to Sum Insured per your policy schedule year as prescribed by the general practitioner,
specialist or super specialist consulted through OUR PARTNER ONLY. We can help deliver it at your home
and we will pay. OR you can buy it from pharmacy of your choice and we still will pay. Of course, both
instances, up to limit only.
What is an acute condition?

Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to
return the person to his or her state of health immediately before suffering the disease/ illness/ injury which
leads to full recovery
What it means?
These are the conditions that one suffers from every now and then and are unexpected like fever, cough,
cold, injury, diarrhea etc. In these conditions, once treated for a few days you get better completely and the
condition is 'cured'. No regular treatment, medicines, follow up, or monitoring is required for such
conditions.
Example:
• Mr X is suffering from diabetes and is on regular medication for diabetes. He falls ill and has urinary tract
infection. He can consult doctor through our partner to get treatment for the same including medicine
and investigation prescribed by the doctor
• Mr. Y is a healthy individual. He has fever for which he can consult doctor through our partner to get
treatment for the same including medicine and investigation prescribed by the doctor
iii. What is NOT covered?

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

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

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

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

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

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

• Day 0 Coverage for inpatient hospitalization or day-care treatment for any complications arising out of
diabetes or hypertension from the date of this policy inception
• Up to 20% discount on renewal premium of base product and rider. The discount will be calculated as per the
grid in Annexure 1
• We will cover the cost of tests mentioned in Annexure 1. You can get them done through us, in our network, on
cashless basis. Or you can get them done at the center of your choice. We will still pay for the tests, on
reimbursement basis, up to Rs. 3,000 for all the tests in a policy year.
Rider Name:
Product Smart
Name: Health+
Smart | Rider
Health+, UIN:UIN:
xxxxxxxxxxxxxxxxx
Getting renewal premium discount is easy, here is how:
• You get discount for undergoing health check-up. Just undergo the complete set of tests mentioned under
Health Check-up in Annexure 1, and you can get up to 4% discount
• If you are getting the tests done on cashless basis, no need to do anything further. Just sit back, relax, and we
will take care of the rest
• If you are getting them done on reimbursement basis, you will need to submit the report to us and follow the
steps below:
¢ You get discount for results you get in these tests. Submit the test reports to us and get discounts as per
test report
¢ Take the tests up to 4 times a year and get the discount for every time you get the test done
¢ Just ensure that there is a gap of at least 60 days between 2 set of tests
¢ And remember, you must submit the report to us at least 75 days prior to the policy renewal date
E. Complete Care
Combination of either of Disease Management "Gold" or Disease Management "Platinum" plan with Best Consult
or Best Care Plan
Annexure 1
Health Check-up tests:
• BMI
• Lipid Profile
• HbA1C
The applicable discount would be aggregate of discount accrued for undergoing health check-up, and reported
value of the individual components of the health check-up (HbA1C Check-up, Lipid Profile, and BMI outcomes) as
per the below grid:
Check-up Discount
Health Check-up Done Discount/Quarter (%) Total Discount/Annum (%)
Yes 1 4
No 0 0
HbA1C
Reading Discount/Quarter (%) Total Discount/Annum (%)
<6.50 2.5 10
6.51 -7.00 2 8
7.01-8.00 1 4
>8.00 0 0
Lipid Profile
Total Cholesterol: HDL Cholesterol ratio
<4.00 1 4
4.01-5.00 0.5 2
>5.00 0 0
BMI
<18.5 0 0
18.5 - 24.9 0.5 2
>24.9 0 0
Disclaimer:
Niva Insurance
Bupa Health Insurance is a subject
Company matter
Limited; of solicitation.
Registered office:- C-98,Niva BupaLajpat
First Floor, Health Insurance
Nagar, Company
Part 1, New Limited (formerly known as Max Bupa Health
Delhi-110024
InsuranceInsurance
Disclaimer: Company is a Limited) (IRDAI
subject matter Registration
of solicitation. Number
Niva Bupa Health 145). 'Bupa'
Insurance and 'HEARTBEAT'
Company logo are
Limited (formerly known registered
as Max trademarks
Bupa Health of theirLimited)
Insurance Company respective
(IRDAI
owners and
Registration No. are
145).being used
‘Bupa’ and by Nivalogo
‘HEARTBEAT’ Bupa Health Insurance
are registered trademarks ofCompany Limited
their respective ownersunder
and arelicense.
being usedRegistered
by Niva Bupa office:- C-98, Company
Health Insurance First Floor, Lajpat
Limited under
Nagar,Customer
license. Part 1,Helpline:
New Delhi-110024, Customer
1860-500-8888. Website: Helpline: 1860-500-8888.
www.nivabupa.com. Website: www.nivabupa.com. CIN: U66000DL2008PLC182918.
CIN: U66000DL2008PLC182918.
Product Name: Smart Health, Product UIN: xxxxxxxxxxxxxxxxxxxx. Please read sales brochure carefully before concluding a sale.
Rider Name:
Product Smart
Name: Health+
Smart | Rider
Health+, UIN:UIN:
xxxxxxxxxxxxxxxxx
Customer ID: 2001590558
Member No. Name Age Valid From
11781142 Rakesh Kumar Agarwal 45 24/11/2021

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Date: 22/10/2024

Policy Number: 32057469202403

MR. RAKESH KUMAR AGARWAL

Subject : Niva Bupa Health Insurance Policy No. 32057469202403

Dear MR. RAKESH KUMAR AGARWAL,

Director - Operations & Customer Service

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

CLAIM SERVICING Turnaround Time*

Settlement of Claims - From the date of submission of claim 15 Days

GRIEVANCE HANDLING Turnaround Time*

Acknowledge a grievance – from the date of receipt of grievance Immediately

Resolve a grievance– from the date of receipt of grievance 14 Days

Policyholder Name: MR. RAKESH KUMAR AGARWAL Policy Number 32057469202403

MAHARKHURD, TEH. SHAHPURA, Base Sum Insured INR 10,00,000

JAIPUR RAJASTHAN, Variant Opted Titanium+

JAIPUR, Plan Opted Individual

RAJASTHAN - 303806 Policy Period 1 Year

Insurance Repository Name None

Mr. Rakesh Kumar Agarwal 10,00,000 1,49,200 0 11,49,200 0.00 0

Nominee Name Relationship with the Policyholder

Prabhu Dayal Modi Father

Intermediary Name Intermediary Code Intermediary Contact No.

Optional Benefit/Feature Details

Hospital Cash INR 2,000/day; for maximum up to 30 days

Personal Accident Not Opted

Smart Health+ (Disease Management) Not Opted

Smart Health+ (Acute Care) Best Consult

Pre Existing Disease Waiting Time Modification Not Opted

Co-payment Not Opted

Room Type Modification Not Opted

Annual Aggregate Deductible Not Opted

Product Benefit Table1

Expenses in Reaching Hospital • Road Ambulance: Up to Sum Insured

• ReAssure "Forever": First claim paid triggers ReAssure, forever. It is unlimited.

Insured Person Details

Permanent Exclusion (if any):

Location: New Delhi Director - Operations & Customer Service

Policyholder Name Mr. Rakesh Kumar Agarwal Policy Number 32057469202403

Policy Commencement Date # 24/11/2024 Policy Expiry Date 23/11/2025

Premium (Rs.) - Base Product 11,614.00

Premium (Rs.) - Hospital Cash 755.00

Premium (Rs.) - Safeguard+ 1,452.00

Premium (Rs.) - Smart Health+: Acute Care Add-on 1,070.00

Underwriting Loading (Rs.) 2,978.00

Net Premium / Taxable value (Rs.) 17,869.00

Integrated Goods and Service Tax (18.00 %) 0.00

Central Goods and Service Tax (9.00 %) 1,608.21

State/UT Goods and Service Tax (9.00 %) 1,608.21

Gross Premium (Rs.) 21,085.00

Details of persons Insured:

Mr. Rakesh Kumar Agarwal 45 Male Applicant

Location: New Delhi Director - Operations & Customer Service

The Sum Insured opted by you is mentioned in the

Product Name: ReAssure 2.0, Product UIN: NBHHLIP23169V012223

Product Name: ReAssure 2.0, Product UIN: NBHHLIP23169V012223

Product Name: ReAssure 2.0, Product UIN: NBHHLIP23169V012223

Product Name: ReAssure 2.0, Product UIN: NBHHLIP23169V012223

8 Financial Limits i. Sublimit

Product Name: ReAssure 2.0, Product UIN: NBHHLIP23169V012223

iii. Annual Aggregate Deductible- Optional 4.18