EbAmBgr H$s OrdZ Amamo` (Vm{bH$m 904)

LIC's Jeevan Arogya (WITHOUT PROFIT)

(`yAmBEZ: 512N266V02)/(UIN: 512N266V02)
UIN No. 512N266V02

(^maVr` OrdZ ~r_m {ZJ_ A{Y{Z`_,1956 mam gWm{nV) (Established by the Life Insurance Corporation Act, 1956)
^maVr` OrdZ ~r_m {ZJ_ H$mo ({Ogo `hm ~mX _| "{ZJ_' H$hm J`m h) `hm ZrMo gX{^V AZwgyMr _| Cpb{IV VmdH$ Ama _wI ~r{_V `pV go Vmd VWm KmofUmn Ama nhbo r{_`_ H$s mpflV hB h Ama CV Vmd
VWm KmofUm n na, Cg_| {Z{hV VWm Cpb{IV dV`m| g{hV, CV VmdH$ Ama {ZJ_ Ho$ ~rM Bg ~r_o Ho$ AmYma Ho$ $n _| gh_{V hmo J`r h& AV: {ZJ_ Bg nm{bgr mam H$ama H$aVm h {H$ AZwgyMr _| {ZYm[aV nadVu
r{_`_m| H$s {d{YdV mpflV hmoZo na Ama CgHo$ {V\$b d$n ~r_m am{e H$m ^wJVmZ {~Zm {H$gr `mO Ho$, {ZJ_ Ama Cg A{YH$V/_ZmoZrV H$m`mb` _| Ohm Bg nm{bgr Ho$ {bE godm CnbY H$amB OmVr h& Cg `pV `m CZ
`pV`m| H$mo {Oh| dh CV AZwgyMr H$s eVm] Ho$ AZwgma Xo` hmo, {ZJ_ H$mo Bg ~mV H$m gVmofOZH$ _mU VwV H$aZo na H$aoJm {H$ AZwgyMr Ho$ eVm] Ho$ AZwgma {hVbm^ Xo` hmo JE h. Ama CgH$m Xmdm H$aZo dmbm/dmbo CV
`pV CgHo$ hH$Xma h Ama Vmd n _| C[b{IV ~r{_V `pV H$s Am`w ghr h `{X nhbo go drH$V Z hmo &
Ama EVX>mam `h Kmo{fV {H$`m OmVm h {H$ `h ~r_m nm{bgr BgHo$ nR >^mJ na _w{V eV] Ama {deofm{YH$ma Ho$ AYrZ hmoJr Ama {ZZ{b{IV AZwgyMr Ama {ZJ_ mam nm{bgr na {H$`m J`m ha nR>mH$Z nm{bgr H$m AJ _mZm
THE LIFE INSURANCE CORPORATION OF INDIA (hereinafter called 'Corporation') having received a Proposal and Declaration and the first premium
from the Proposer and the Principal Insured named in the Schedule referred to herein below and the said Proposal and Declaration with the statements
contained and referred to therein having been agreed to by the Proposer and Corporation as basis of this assurance do by this Policy agree, in
consideration of and subject to due receipt of the subsequent premiums as set out in the Schedule, to pay the Benefits but without interest at the
authorized/ designated office of the Corporation where this policy is serviced to the person or persons to whom the same is payable in terms of the said
Schedule, on proof to the satisfaction of the Corporation of the Benefits having become payable as set out in the Schedule, of the title of the said person
or persons claiming payment and the correctness of the age of the Insured stated in the Proposal if not previously admitted.
And it is hereby declared that this Policy of Assurance shall be subject to the 'Conditions and Privileges' attached herewith and that the following
Schedule and every endorsement placed on the Policy by the Corporation shall be deemed part of this Policy.

AZwgyMr
nm{bgr g`m/Policy Number: Vmd g`m/Proposal Number :
nm{bgr ma^ hmoZo H$s {V{W/Date of Commencement of Policy: Vmd {V{W/Date of Proposal:
~r{_V `{$`m| H$s g`m/No. of members covered : flbmZ/Plan:
nr{_`_ H$s AXm`Jr H$m VarH$m/Mode of premium payment: r{_`_ H$s {H$V H$s {Z`V VmarI/Installment Premium due on:
_w` ~r{_V `{$ H$m Zm_, qbJ Ama nVm/Name, sex and address of Principal Assured: Hw$b r{_`_ H$s {H$V/Total Installment Premium:
A` ~r{_V `pV`m| Ho$ Zm_ d qbJ/ (_w` ~r{_V `opV go) g~Y
Name, sex and relationship (to PI) of other Insured

~r_m A{Y{Z`_, 1938 H$s Ymam 39 Ho$ AYrZ Zm{_Vr H$m Zm_, Am`w Ama g~Y
Name, age and relationship of Nominee under Section 39 of the Insurance Act, 1938

~r{_V `pV Ho$ `mao Ama ~r_m H$m {ddaU/Particulars of the Insured and details of the Insurance Cover
_wI ~r{_V `pV A` ~r{_V `pV A` ~r{_V `pV A` ~r{_V `pV A` ~r{_V `pV
`mao/Particulars Principal Insured Other Insured Other Insured Other Insured Other Insured
1 O_ H$s VmarI/Date of Birth
2 `m Am`w drH$V h/Whether age admitted
3 ma{^H$ X{ZH$ {hVbm^ (.)/Initial Daily Benefit (Rs.)
4 Omo{I_ Ama^ hmoZo H$s {V{W /Date of Cover Commencement
5 _yb `moOZm Ho$ AXa Omo{I_ g_m hmoZo H$s VmarI/Date of Cover Expiry under Basic Plan
6 dH$pnH$ amBS>a g_m hmoZo H$s VmarI/Date of Cover Expiry for Optional Rider(s)
7 XwKQ>Zm {hV bm^ Ho$ {bE ~r{_V am{e (.)/Accident Benefit Sum Assured (Rs.)
8 Amd{YH$ ~r_o Ho$ {bE ~r{_V am{e (.)/Term Assurance Sum Assured (Rs.)
9 nr{_`_ H$s Hw$b {H$V (.)/Instalment Premium (Rs.)
10 AndOZ Ama `{VH$_/Exclusions and Disorders
11 A{V_ nr{_`_ H$s AXm`Jr H$s {Z`V VmarI/Due Date of Payment of last premium
Bg nm{bgr Ho$ AYrZ gm_m` AndOZ Ho$ {ddaUm| Ho$ {bE nm{bgr H$s eV} XoI|& nr{_`_ H$s {H$Vm| H$mo nwZarjU H$aZo g~Yr {ddaUm| Ho$ {bE nm{bgr H$s eV} XoI|&
For details of general exclusions under the Policy refer Policy Conditions. For details about reviewability of installment premiums refer policy Conditions.

`o {hVcm^ {H$go Xo` h: _wI ~r{_V `pV `m ~r{_V OrdZ gmWr `m CgHo$/CgHo$ Zm{_V {~_m H$mZyZ (gWmoYZ) A{Y{Z`_ 1938 H$s Ymam 39 Ho$ AVJV `m VmdH$ `m CgHo$ Zm{_Vm| `m CgHo$ {ZnmXH$m| `m
emgH$m| `m A` H$mZyZr {V{Z{Y`m| H$mo {Ohm|Zo CZH$s gnXm `m Bg nm{bgr Ho$ AVJV Xo` YZam{e Ho$ {bE ^maV gK Ho$ {H$gr am` `m am` jo H$s {H$gr `m`mbm` go AnZo {V{Z{Y hmoZo H$m _mUn mflV {H$`m hmo &
TO WHOM BENEFITS ARE PAYABLE: The Principal Insured or Insured Spouse or his/her Nominees under Section 39 of the Insurance Act, 1938 or proving Executors or
Administrators or other Legal Representatives who should take out representation to his/her Estate or limited to the moneys payable under this Policy subject to any order
from any Court of any State or Union Territory of India.
Ad{Y {OgHo$ XmamZ nr{_`_ Xo` h: A{V_ nr{_`_ Ho$ ^wJVmZ H$s {ZYm[aV Xo` VmarI VH$ `m Bg nm{bgr H$s eVm} _| {d{Z{XQ>> ~r_o H$s g_m{flV go nhbo, Ogo {H$ Bg nm{bgr Ho$ {Z`_m| d eVm] _| CboI {H$`m J`m hmo&
Period during which premium payable: Till the stipulated Due Date of Payment of last premium or earlier termination of Insurance Cover as specified in the terms and
conditions of this Policy.
{deof nmdYmZ/Special Provisions:
(1) EbAmBgr H$m XwKQ>Zm {hVcm^ amBS>a (512B203V02) `{X XwKQ>Zm {hVbm^ amBS>a H$m {dH$n {X`m J`m hmo Ama nr{_`_m| H$s AXm`Jr H$s JB hmo, Vmo eV] Ama {deofm{YH$ma H$m IS> 17 XwKQ>Zm {hVbm^
H$s ~r{_V am{e Ho$ ~am~a aH$_ Ho$ g~Y _| bmJy hmoJm &
(1) LIC's Accident Benefit Rider (512B203V02): If Accident Benefit Rider is opted for and the premiums paid, clause 17 of "Conditions and Privileges" shall apply
for an amount equal to the Accident Benefit Sum Assured.
`{X XwKQ>Zm {hVbm^ ~r_o H$m {dH$n Zht {X`m J`m hmo Vmo eV] Ama {deofm{YH$ma H$m IS> 17 bmJy Zht hmoJm &
If Accident Benefit cover is not opted for, Clause 17 of "Conditions and Privileges" shall not apply.
(2) EbAmBgr H$m Z`m Amd{YH$ ~r_m amBS>a (512B210V01) : `{X {dH$n {X`m J`m hmo Ama nr{_`_ H$s AXm`Jr H$s JB hmo Vmo eV] Ama {deofm{YH$ma H$m IS> 18 Amd{YH$ ~r_o H$s ~r{_V am{e Ho$ ~am~a
aH$_ na bmJy hmoJr &
(2) LIC's New Term Assurance Rider (512B210V01): If this rider is opted and the premiums paid, clause 18 of "Conditions and Privileges" shall apply for an
amount equal to the Term Assurance Sum Assured.
`{X Bg amBS>a H$m {dH$n Zht {X`m J`m hmo Vmo eV] Ama {deofm{YH$ma H$m IS> 18 bmJy Zht hmoJm &
If this rider is not opted for, Clause 18 of "Conditions and Privileges" does not apply.
(3) AZwgyMr _| Cpb{IV _yb `moOZm Ho$ nr{_`_ H$s {H$V H$s nm{bgr Ama^ hmoZo H$s VmarI go VrZ df VH$ Ho$ {bE JmaQ>r Xr OmVr h& ^mdr dfm} Ho$ {bE _yb `moOZm H$s nr{_`_ H$s {H$V _| n[adVZ hmo gH$Vm
h Omo "eV] Ama {deofm{YH$ma' Ho$ IS> 10 _| {d{Z{XQ>> {ZJ_ Ho$ AZw^dm| na AmYm[aV hmoJm &
(3) Installment Premium for Basic Plan as stated in the Schedule are guaranteed for 3 years from the Date of Commencement of Policy. Installment Premium for
Basic Plan for future years will be subject to revision based on the Corporation's experience as specified in clause 10 of "Conditions and Privileges".

Cg emIm H$m`mb` _| {ZJ_ H$s Amoa go hVmj[aV {OgH$m nVm nm{bgr Ho$ nrNo> {X`m J`m h &
Signed on behalf of the Corporation at the Branch Office whose address is given at the back of the policy.

OmMH$Vm/Examined by:
{V{W/Date: H$Vo _wI/d[a>/emIm ~YH$
n g./Form No.: p. Chief/Senior/Branch Manager

EOoQ> H$m _mo~mBb Z~a/Qo>br\$moZ Z~a

EO|gr H$moS>/Agency Code EO|gr H$m Zm_/Agency Name Agent's Mobile Number/Landline Number

1
 Bg nm{bgr _| gX{^V eV] Ed gw{dYmE
1. n[a^mfmE
{ZZ{b{IV eXm| `m nXm| H$m dhr AW hmoJm Omo Bg nm{bgr _| {X`m J`m h Ama EH$dMZ Ho$ gX^ _| ~hdMZ Ama
nwpbJ Ho$ gX^ _| rqbJ ngJ Ho$ AZwgma _mZm OmEJm &
i) XwKQ>Zm go Vmn` h AMmZH$ A> VWm AZpN>H$ KQ>Zm Omo {H$gr ~m, {XImB XoZo dmbo VWm qhgH$
VarIo go H$s JB hmo &
ii) XwKQ>Zm Ho$ H$maU emar[aH$ MmoQ> go Vmn` h eara H$mo dmV{dH$ $n go nhMr hm{Z `m MmoQ> (bo{H$Z Bg_|
Eogr H$moB _mZ{gH$ ~r_mar, amoJ `m AdWVm em{_b Zht hmoJr) Omo nm{bgr H$s ~r_m Ad{Y Ho$ XmamZ
nhbo go hB XwKQ>Zm Ho$ H$maU hB hmo Ama {Og_| `WmpW{V {M{H$gH$ `m e`{M{H$gH$ mam CnMma Ho$
{b`o AnVmb _o ^Vu `m e` {M{H$gm Amd`H$ hmo &
iii) bmJy X{ZH$ {hVbm^ go Vmn` h nm{bgr df _| X{ZH$ {hVbm^ H$s aH$_ {OgH$m {hgm~ Bg nH$ma
bJm`m OmEJm
H$) Bg nm{bgr Ho$ AYrZ ~r{_V `{V Ho$ g~Y _| ~r_m ew$ hmoZo H$s VmarI go ~r_o Ho$$ nW_ df hmoZo
Ho$ H$maU nm{bgr df _|, AnVmb _| ^Vu hmoZo Ho$ H$maU bmJy X{ZH$ {hVbm^ Bg AZwgyMr _|
Cpb{IV nma{^H$ X{ZH$ {hVbm^ Ho$ ~am~a hm|Jo &
I) ~r_o Ho$ nhbo df Ho$ ~mX Ama ~r_o H$s nhbr dfJmR> H$mo `m CgHo$ ~mX nm{bgr H$s dfJmR> na ew$
hmoZo dmbo n`oH$ nm{bgr df VWm ~r{_V Ho$ H$da Ad{Y Ho$ XmamZ {nN>bo nm{bgr df Ho$ bmJy X{ZH$
{hVbm^ nma{^H$ X{ZH$ {hVbm^ Ho$ 5 n{VeV (nmM n{VeV) Ho$ ~am~a H$s aH$_ AH$ J{UVr`
VarHo$ go OmoS>H$a ~T>mB OmEJr & `{X nm{bgr "Xmdm a{hV {hVbm^'({OgH$s n[a^mfm IS>
14(1)_| Xr JB h) Ho$ AZwgma h Ama CgH$s nm h Vmo Bgo AmJo ~T>m`m OmEJm & Ama Bg nm{bgr
df Ho$ g~Y _| n[aUm_r aH$_ bmJy X{ZH$ {hVbm^ hmoJr &
Bg nH$ma nm{bgr df Ho$ ~mX n`oH$ nm{bgr df Ho$ {bE bmJy X{ZH$ {hVbm^ Ho$ Xmo ^mJ hm|Jo
{nN>bo nm{bgr df Ho$ bmJy X{ZH$ {hVbm^m| _| nma{^H$ X{ZH$ {hVbm^ H$s 5 n{VeV (nmM
n{VeV) Ho$ ~am~a H$s aH$_ AH$ J{UVr` VarHo$ go OmoS>r OmEJr& bmJy X{ZH$ {hVbm^ _o Eogr
d{ ~r_m Ad{Y Ho$ XmamZ n`oH$ ~r_m dfJmR> na bmJy hmoJr Ama V~ VH$ Omar ahoJr O~ VH$
`h nma{^H$ X{ZH$ {hVbm^ Ho$ 1.5 JwZm A{YH$V_ aH$_ VH$ Z nhM OmE& BgHo$ nMmV ^{d`
_| n`oH$ nm{bgr df _| `h aH$_ Bg CMV_ Va na ~Zr ahoJr &
"Xmdm Zht {hVbm^' Ho$ ~am~a aH$_ J{UVr` VarHo$ go Ama OmoS>r OmEJr, Ogm {H$ bmO 14 (I)
_| n[a^m{fV h, ~eV] {H$ `h nm{bgr H$moB H$m "Xmdm Zht {hVbm^' Ho$ {bE nm hmo Bg d{ H$s
H$moB A{Y{Z`_ gr_m Zht hmoJr {OgH$m AW `h h {H$ AJa `h nm{bgr "Xmdm Zht {hVbm^' H$s
nm h Vmo `h Cgo A{YH$V_ gr_m Ho$ {~Zm nyar ~r_m Ad{Y Ho$ XmamZ Xr OmE &
iv) g_w{MV nm{YH$mar go Vmn` h do gaH$mar Ama {d{Z`m_H$ {ZH$m` {Oh| am` `m H|$ gaH$ma mam g_`-
g_` na J{R>V {H$`m OmVm h Ama Omo AnVmbm| `m Eogo A` WmZm| Ohm na {M{H$gm CnMma {X`m OmVm
h, Ho$ nOrH$aU, Ch| AZw_{V XoZo Ama CZH$s {ZJamZr H$aZo Ho$ {bE EH$_m {O_oXma hm| &
v) d-ZdrH$aU H$s VmarI d-ZdrH$aU H$s VmarI _w` ~r{_V `pV Ho$ g~Y _| ~r_m ew$ hmoZo H$s
VmarI go ~r_o H$s Ad{Y Ho$ XmamZ n`oH$ Vrgar ~r_m dfJmR> na n`oH$ ~r{_V `pV Ho$ g~Y _| hmoJr &
n`oH$ dV ZdrH$aU H$s VmarI na Bg nm{bgr Ho$ AYrZ ~r_m V~ VH$ n`oH$ ~r{_V `pV Ho$ g~Y
_| ~T>m`m OmEJm O~ VH$ AJbr dV ZdrH$aU H$s VmarI Zht Am OmVr h & naVw `h V~ O~{H$ nr{_`_
H$s AXm`Jr H$s OmVr aho& BgHo$ Abmdm, `h ^r eV h {H$ Bg nm{bgr H$s eVm} Ama {Z~YZm| _| {d{Z{XQ>
~r_m nhbo g_mflV Z H$a {X`m J`m hmo &
vi) nyddVu eV H$m Vmn` h nm{bgr H$s eV `m Xem, {OgHo$ AVJV ~r_mH$Vm H$s nm{bgr Ho$ VhV Xo`Vm
geV h &
vii) O_OmV Xmof go Vmn` O_ go _mOyX Eogr Xem/XemE h Omo $n aMZm `m pW{V H$s pQ> go
Agm_m` h &
viii) ~r_o H$s Ad{Y go Vmn` h ~r_m ew$ hmoZo H$s VmarI Ama AZwgyMr _| {d{Z{XQ> n`oH$ `pV Ho$ g~Y _|
~r_o H$s g_mpflV H$s VXZw$nr VmarI Ho$ ~rM H$s Ad{Y go h ({Og_| `o XmoZm| VmarI| em{_b hm|Jr) ~eV}
{H$ Bg nm{bgr H$s eVm} Ama {Z~YZm| _| {d{Z{XQ> ~r_m nhbo hr g_mflV Zht H$a {X`m OmVm h &
ix) X{ZH$ {hVbm^ go Vmn` h n{V{XZ Xo` {hVbm^ H$s aH$_ &
x) ~r_m ew$ hmoZo H$s VmarI go Vmn` h AZwgyMr _| {d{Z{XQ> n`oH$ ~r{_V `pV Ho$ {bE Bg nm{bgr Ho$
AVJV ~r_m ew$ hmoZo H$s VmarI &
xi) ~o{gH$ flbmZ Ho$ AVJV ~r_m g_mflV hmoZo H$s VmarI go Vmn` h dh VmarI {Og_| Bg AZwgyMr _|
{d{Z{XQ>> n`oH$ ~r{_V `pV Ho$ g~Y _| nm{bgr Ho$ AVJV Amamo` ~r_m g_mflV hmo OmVm h &
xii) dH$pnH$ amBS>a Ho$ AVJV ~r_m g_mflV hmoZo H$s VmarI {Og_| Bg AZwgyMr _| {d{Z{XQ>> n`oH$ ~r{_V
`pV Ho$ g~Y _| dH$pnH$ amBS>a Ho$ AVJV ~r_m g_mflV hmo OmVm h &
xiii) nwZMbZ H$s VmarI IS> 13 _| d{UV H$s JB h VWm H$da Ho$ ~X hmo OmZo Ho$ ~mX, nwZMbZ hmoZo H$s
pW{V _| gJV h &
xiv) S>o Ho$`a {H$`m {hVbm^ go Vmn` bmO 2 (III) Ho$ AVJV Cpb{IV {hVbm^ go h, Omo {H$ nm{bgr
Ho$ {Z~YZ Ama eV] Ho$ AYrZ h&
xv) S>o Ho$`a Ho$ go Vmn` `Wm bmJy, WmZr` m{YH$aU mam nOrH$V {H$gr AnVmb _| Wm{nV H$moB
{M{H$gr` `dWm `m ~r_m{a`m| d/`m MmoQ>m| Ho$ S>o Ho$`a CnMma Ho$ {bE Wm{nV H$moB gWm, Omo {H$
{H$gr nOrH$V VWm AhVmmflV {M{H$gH$ H$s XoIaoI _| hmo VWm Bgo AYmo{b{IV `yZV_ _mnXS>m| H$m
AZwnmbZ Ad` H$aZm Mm{hE:-
- {Z`moOZ _| AhVmmflV Z{gJ Q>m\$ hmo
- ^mar Ho$ $n _| AhVmmflV {M{H$gH$ hmo
- nyUV: gwgpOV AnZm AmnaoeZ {WEQ>a hmo, Ohm g{OH$b {H$`mE H$s OmVr hm|
- amo{J`m| H$m X{ZH$ [aH$mS>g aIm OmVm hmo VWm ~r_m H$nZr Ho$ A{YH$V H$_Mmar Ho$ {ZarjU Ho$ {bE Bh|
CnbY H$am`m Om gH$Vm h &
xvi) XV CnMma go Vmn` h XV {M{H$gH$ mam {H$`m OmZo dmbm H$moB CnMma, {Og_| em{_b h, XV narjm,
{\$qbg (Ohm C{MV hmo), H$mCg, XmV {ZH$mbZm VWm gOar, {Og_| {H$gr H$ma H$s H$m_{Q>H$
gOar/BflbmQ>g em{_b Zht h &
xvii) OmZH$mar H$m H$Q>rH$aU- {H$gr JbV~`mZr, JbV OmZH$mar {XE OmZo `m {H$gr _hdnyU V` H$mo
{N>nmE OmZo H$s Xem _| nm{bgr ^J hmo OmEJr VWm AXm {H$E JE g^r r{_`g H$mo H$nZr mam OV H$a
{X`m OmEJm &
xviii) m`mo{JH$/Am_m{UH$ CnMma- Amf{Y `moJ CnMma g{hV Eogo CnMma Omo {H$ ^maV _| Wm{nV
{M{H$gm MbZm| na AmYm[aV Zht h, H$mo m`mo{JH$/Am_m{UH$ CnMma H$hm J`m h&
xix) [a`m`Vr Ad{Y go Vmn` r{_`_ H$s Xo` {V{W go VwaV ~mX H$s dh {Z{XoQ> Ad{Y h {OgHo$ XmamZ
nm{bgr Ho$ \$m`Xm| H$mo JdmE {~Zm, Ogo {H$ Vrjm Ad{Y VWm nyd `mnr ~r_m[a`m| H$m gajU nm{bgr H$m
ZdrZrH$aU H$am`m `m Cgo Omar aIm Om gH$Vm h& `h gajU Bg Ad{Y Ho$ {bE CnbY Zht h, {OgHo$
{bE r{_`_ Z {_bm hmo &
xx) AnVmb go Vmn` Eogo {H$gr gWmZ go h {Ogo ~r_m[a`m| Ama / `m MmoQ>m| Ho$ BbmO Ho$ {bE AnVmb _|
^Vu hmoH$a H$admZo VWm S>oHo$`a CnMma XoZo Ho$ {bE Wm{nV {H$`m J`m hmo VWm Omo {H$ pb{ZH$b
EQ>mpbg_oQ>g (a{OQ>oeZ ES> ao`wboeZ) EQ>, 2013 Ho$ AVJV CV EQ> H$s Ymam 56(1) Ho$
{eS>`yb Ho$ AVJV {d{ZYm[aV {dYmZm| Ho$ VhV WmZr` m{YH$aU Ho$ mam AnVmb Ho$ $n _| a{OQ>S>
{H$`m J`m hmo `m {ZZAZwgma g^r `yZV_ _mnXS>m| H$m nmbZ H$aVr hmo:
- Bg_| {Z`moOZ _| Mm~rgm| KQ>o AhVmmflV Z{gJ Q>m\$ hm|;
- 10,00,000 Ho$ H$_ Am~mXr dmbo eham| _| H$_ go H$_ 10 AVam}Jr ~oS>g Ama g^r A` WmZm| _|
H$_ go H$_ 15 AVam}Jr ~oS> dmbo AnVmb
- Mm~rgm| KQ>o BMmO Ho$ $n _| AhVmmflV _o{S>H$b pQ>gZa/g hm| &
- EH$ nyUV: gwgpOV AmnaoeZ {WEQ>a hmo {Og_| AnZr g{OH$b {H$`mE H$s OmVr hmo:
- amo{J`m| H$m X{ZH$ [aH$mS>g aIm OmVm hmo Omo {H$ B`moaog H$nZr Ho$ A{YH$V H$_Mmar Ho$ {bE CnbY hmo &
xxi) AnVmb _| ^Vu hmoZm go Vmn` {H$gr AnVmb _| bJmVma H$_ go H$_ 24 KQ>o Ho$ {bE BbmO hoVw ^Vu
hmoZm. [gdm` Eogo {d{ZYm[aV [H$`mAm|/CnMmam| Ho$ {bE, Ohm ^maV _| Amd`H$ {M{H$gm CnMma Ho$
{bE bJmVma 24 KQ>o go H$_ H$s Ad{Y n`mflV hmo &
xxii) AnVmb ZH$X {hVbm^ go Vmn` h ZrMo IS> 2(I) _| {d{Z{XQ> {hVbm^ ~eV] {H$ dh nm{bgr H$s
{Z~YZ Ama eV] Ho$ AVJV AmVm hmo &
xxiii) ~r_mar go Vmn` Eogr AdWVm `m amoJ `m emar[aH$ Xem go h, {Oggo nm{bgr Ad{Y Ho$ XmamZ
emar[aH$ H$m` H$mo gm_m` $n go H$aZo _| ~mYm nXm hmo VWm {M{H$gm CnMma H$s Amd`H$Vm hmo &
xxiv) MmoQ> bJZm go Vmn` nyUV: {H$gr ~m`, qhgH$ VWm {XImB XoZo dmbo Ed nQ> _m`_ go {OgH$s {H$gr
{M{H$gH$ mam OmM d Bgo _m{UV {H$`m Om gHo$, XKQ>Zm_H$ emar[aH$ $n go eara H$mo j{V nhMZo go
h, {Og_| amoJ `m ~r_mar em{_b Zht h &
xxv) ~r{_V `pV go Vmn` Eogo `pV go h Omo Bg nm{bgr Ho$ AVJV {hVbm^ Ho$ {bE ~r{_V hmo Ama Bg_|
_w` ~r{_V `pV, BgH$s ~r{_V OrdZ gmWr (~eV] {H$ Bgo _w` ~r{_V `pV mam em{_b {H$`m
J`m hmo), ~r{_V ~Mo (~eV] {H$ Bh| _w` ~r{_V `pV mam em{_b {H$`m J`m hmo) Ama ~r{_V _mVm-
{nVm (~eV] {H$ Bh| _w` ~r{_V `pV mam em{_b {H$`m J`m hmo) Ama {OZHo$ Zm_ Bg AZwgyMr _| `m
{d{Y_m` Eogo nR>mH$Z _| {d{Z{XQ> hm| {Ogo {ZJ_ mam Bg AZwgyMr _| em{_b {H$`m J`m hmo &
xxvi) ~r{_V ~Mo go Vmn` h Eogo Zm{_V `pV/`m| {Oh| Bg AZwgyMr _| {d{Z{XQ> {H$`m J`m hmo ({Og_|
_w` ~r{_V `pV Ho$ gmW BZH$m g~Y ~Vm`m J`m hmo), Omo _w` ~r{_V `pV VWm ~r{_V OrdZ
gmWr H$s Or{dV {d{Y_m` gVmZ hmo &
xxvii) ~r{_V OrdZgmWr go Vmn` h Bg AZwgyMr _| {d{Z{XQ> Zm{_V `pV ({OgH$m _w` ~r{_V `pV Ho$
gmW g~Y hmo) Ama Omo _w` ~r{_V `pV H$m Or{dV {d{Y_m` OrdZgmWr hmo &
xxviii) ~r{_V _mVm-{nVm go Vmn` h Bg AZwgyMr _| {d{Z{XQ> Eogm Zm{_V `pV `m Eogo Zm{_V `pV
({OZH$m _w` ~r{_V `pV Ho$ gmW g~Y hmo), Omo _w` ~r{_V `pV Ho$ Or{dV {d{Y_m` {nVm Ama
_mVm hmo `m Omo _w` ~r{_V `pV Ho$ {d{Y_m` ggwa Ama gmg hmo &
xxix) BQ>opgd Ho$`a `y{ZQ> go Vmn` AnVmb H$m EH$ {deof IS>, dmS> `m qdJ h Omo {H$ {ZYm[aV
{M{H$gH$/{M{H$gH$m| H$s bJmVma XoIaoI _| hmo VWm Eogo amo{J`m| H$s bJmVma _m{ZQ>[aJ Ama CnMma Ho$
{bE hmo, {OZH$s hmbV ZmOwH$ hmo `m bmB\$ gnmoQ> gw{dYmAm| Ho$ AVJV hmo VWm Ohm XoI^mb Ama
n`dojU H$m Va gmYmaU `m A` dmS>g H$s VwbZm _| H$m\$s D$Mm hmo &
xxx) ^Vu amoJr H$s XoI^mb go Vmn` Eogo CnMma go h {Og_o ~r{_V KQ>Zm Ho$ CnMma Ho$ {bE amoJr H$mo 24
KQ>o go A{YH$ g_` Ho$ {bE AnVmb _| ^Vu hmoZm nS>Vm h &
xxxi) ~S>r e`{M{H$gm {hVbm^ go Vmn` h ZrMo IS> 2 (II) Ho$ AVJV {d{Z{XQ>> {hVbm^ ~eV} {H$ do Bg
2
CONDITIONS AND PRIVILEGES WITHIN REFERRED TO
1. DEFINITIONS:
The following words or terms shall have the meaning ascribed to them wherever they
appear in this Policy, and references to the singular or to the masculine shall include
references to the plural or to the female wherever the context so permits;
i) Accident means a sudden, unforeseen and involuntary event caused by external,
visible and violent means.
ii) Accidental Bodily Injury means physical bodily harm or injury (but does not
include any mental sickness, disease or illness) which is caused by an Accident
which first occurs during the Cover Period of the policy and requires inpatient
treatment or surgery in a Hospital by a Physician or surgeon, as the case may be;
iii) Applicable Daily Benefit means the amount of Daily Benefit in a Policy Year
reckoned as follows:
a) In the Policy Year being the first year of cover starting from the Date of Cover
Commencement in respect of an Insured under this Policy, the Applicable
Daily Benefit due to Hospitalization shall be equal to the Initial Daily Benefit
mentioned in the Schedule.
b) After the first year of cover and for each Policy Year commencing at a Policy
anniversary on or after the first Policy anniversary and during the Cover
Period in respect of an Insured, the Applicable Daily Benefit of the previous
Policy Year shall be increased by arithmetic addition of an amount equal to
5% (five percent) of the Initial Daily Benefit. This shall be further enhanced if
the policy attracts and is eligible for "No Claim Benefit" (as defined in clause
14(I)). And the resulting amount shall be the Applicable Daily Benefit for that
Policy Year.
Thus, the Applicable Daily Benefit for each policy year, after the first policy
year, shall consist of 2 parts:
An arithmetic addition of an amount equal to 5% (five percent) of the Initial
Daily Benefit to the Applicable Daily Benefit of the previous Policy Year.
Such increase in the Applicable Daily Benefit shall be effected on each
Policy anniversary during the Cover Period and shall continue until it
attains a maximum amount of 1.5 times the Initial Daily Benefit
Thereafter, this amount in each Policy Year in future shall remain at that
maximum level attained.
Further arithmetic addition of an amount equal to "No Claim Benefit" as
defined in clause 14(I) provided the policy attracts and is eligible for it.
There shall be no maximum limit for such increase which means that if
this policy is eligible for "No Claim Benefit", the same shall be granted
throughout the Cover Period without any maximum limit.
iv) Appropriate Authority means those Governmental or regulatory bodies set up
by the State or Central Government from time to time that are solely responsible
for registering, permitting and monitoring hospitals and other similar places
where medical treatment is provided;
v) Automatic Renewal Date occurs in respect of each Insured on every third policy
anniversary during the Cover Period starting from the Date of Cover
Commencement for the Principal Insured. On every Automatic Renewal Date,
subject to continued payment of premiums, Cover under the Policy will be
extended for each Insured till the next Automatic Renewal Date unless the Cover
terminates earlier as specified in the terms and conditions of this Policy;
vi) Condition Precedent shall mean a policy term or condition upon which the
Insurer's liability under the policy is conditional upon.
vii) Congenital Anomaly refers to a condition(s) which is present since birth, and
which is abnormal with reference to form, structure or position.
viii) Cover Period means the period between the Date of Cover Commencement
and the corresponding Date of Cover Expiry (both dates inclusive) in respect of
each Insured as specified in the Schedule, unless the Insurance Cover
terminates earlier as specified in the terms and conditions of this Policy;
ix) Daily Benefit means the amount of benefit payable per day;
x) Date of Cover Commencement means the date of commencement of cover under
the policy for each Insured as specified in the Schedule;
xi) Date of Cover Expiry under the Basic Plan means the date on which the health
cover under the policy ceases for each Insured as specified in the Schedule;
xii) Date of Cover Expiry for optional rider(s) means the date on which the cover under
optional rider(s) under the policy ceases for each Insured as specified in the Schedule;
xiii) Date of Revival is described in clause 13 and is relevant in the event that the
Policy is revived after discontinuance of the Cover;
xiv) Day Care Procedure Benefit means the benefit as specified under clause 2 (III),
subject to terms and conditions of the policy
xv) Day care centre means any institution established for day care treatment
of illness and/or injuries or a medical setup within a hospital and which has been
registered with the local authorities, wherever applicable, and is under the
supervision of a registered and qualified medical practitioner AND must comply
with all minimum criteria as under:-
- has qualified nursing staff under its employment
- has qualified medical practitioner (s) in charge
- has a fully equipped operation theatre of its own where surgical procedures are
carried out
- maintains daily records of patients and will make these accessible to the
Insurance company's authorized personnel.
xvi) Dental treatment is treatment carried out by a dental practitioner including
examinations, fillings (where appropriate), crowns, extractions and surgery
excluding any form of cosmetic surgery/implants.
xvii) Disclosure to Information- The Policy shall be void and all premium paid hereon
shall be forfeited to the Company, in the event of misrepresentation, mis-
description or non-disclosure of any material fact.
xviii) Experimental/Unproven treatment- Treatment, including drug Experimental
therapy which is not based on established medical practice in India, is treatment
experimental or unproven.
xix) Grace period means the specified period of time immediately following the
premium due date during which a payment can be made to renew or continue a
policy in force without loss of continuity benefits such as waiting periods and
coverage of pre existing diseases. Coverage is not available for the period for
which no premium is received
xx) Hospital means any institution established for in-patient care and day care
treatment of illness and/or injuries and which has been registered as a hospital
with 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:
- has qualified nursing staff under its employment round the clock;
- has at least 10 in-patient beds in towns having a population of less than
10,00,000 and at least 15 in-patient beds in all other places:
- has qualified medical practitioner (s) in charge round the clock;
- has a fully equipped operation theatre of its own where surgical procedures are
carried out:
- maintains a daily records of patients and makes these accessible to the
insurance company's authorized personnel.
xxi) Hospitalization- Means admission in a Hospital for a minimum period of 24 In
patient Care consecutive hours except for specified procedures/ treatments,
where such admission could be for a period of less than 24consecutive hours
within India for medically necessary treatment
xxii) Hospital Cash Benefit means the benefit as specified under clause 2(I) below,
subject to the terms and conditions of this Policy;
xxiii) Illness means a sickness or a disease or pathological condition leading to the
impairment of normal physiological function which manifests itself during the
Policy Period and requires medical treatment.
xxiv) 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.
xxv) Insured means the person covered for the benefits under this Policy and shall
include the Principal Insured , the Insured Spouse (if included by the Principal
Insured), the Insured Children (if included by the Principal Insured) and Insured
Parents (if included by the Principal Insured) whose names are specified in the
Schedule or in a valid endorsement made by the Corporation to the Schedule ;
xxvi) Insured Child means the named person(s) specified as such in the Schedule
(under Relationship to Principal Insured), being a surviving legitimate child of the
Principal Insured and of the Insured Spouse;
xxvii) Insured Spouse means the named person specified as such in the Schedule
(under Relationship to Principal Insured), being the surviving legal spouse of the
Principal Insured
xxviii) Insured Parents means the named person/persons specified as such in the
Schedule (under Relationship to Principal Insured), being a surviving legitimate
father and mother of the Principal Insured or being a surviving legitimate father in
law and mother in law of the Principal Insured.
xxix) Intensive Care Unit means an identified section, ward or wing of a hospital which
is under the constant supervision o f a dedicated medical practitioner(s), and
which is specially equipped for the continuous monitoring and treatment o f
patients who are in a critical condition, or require life support facilities and where
the level of care and supervision is considerably more sophisticated and
intensive than in the ordinary and other wards;
xxx) Inpatient care means treatment for which the insured person has to stay in a
hospital for more than 24 hours for a covered event
xxxi) Major Surgical Benefit means the benefit as specified under clause 2(II) below,
 nm{bgr H$s {Z~YZ Ama eV] Ho$ AVJV AmVo hm|&
xxxii) {M{H$gm gbmh- {H$gr {M{H$gH$ go H$moB nam_e `m gbmh {Og_| H$moB opH$fleZ XoZm `m nwZ:
o{H$fleZ Omar H$aZm em{_b h &
xxxiii) {M{H$gm `` go Vmn` Eogo ``m| go h Omo {H$ {H$gr ~r{_V `pV Zo Amd`H$ $n go VWm dmVd _|
{H$gr ~r_mar `m XKQ>Zm Ho$ {bE {H$gr {M{H$gH$ H$s gbmh na {M{H$gm CnMma Ho$ {bE IM {H$E hm|,
~eV] AJa ~r{_V `pV ~r{_V Zht hmoVm Vmo BZgo A{YH$ Xo` Zht hmoVm VWm Bg {M{H$gm CnMma Ho$
{bE Bgr BbmHo$ Ho$ A` AnVmbm| `m S>mQ>am| Zo Bggo A{YH$ ngm dgyb Z {H$`m hmoVm &
xxxiv) {M{H$gr` $n go Amd`H$ CnMma H$mo Eogo {H$gr CnMma, OmM-narjU, Amf{Y boZo `m AnVmb _|
^Vu ahZo `m AnVmb _| Am{eH$ $n go ahZo Ho$ $n _| n[a^m{fV {H$`m J`m h, Omo {H$ ;
Bg ~r_mar `m MmoQ> Ho$ {M{H$gr` ~YZ Ho$ {bE Amd`H$ hmo, {Oggo {H$ ~r{_V `pV nr{S>V hmo;
gwa{jV, n`mflV Ama C{MV {M{H$gm XoI^mb XoZo _| jo, Ad{Y Ama VrdVm _| Amd`H$ Va go
A[YH$ Zht hmoZr Mm{hE;
{H$gr {M{H$gH$ mam oH$mB~ {H$`m J`m hmoZm Mm{hE
`mnH$ $n go AVamQ>r` {M{H$gm MbZ `m ^maV _| {M{H$gm g_wXm` mam drH$V mo\o$eZb
_mnXS>m| H$s nwpQ> H$aZr Mm{hE &
xxxv) {M{H$gH$ go Vmn` Bg `pV go h {OgHo$ nmg {H$gr am` Ho$ _o{S>H$b H$mCpgb `m _o{S>H$b H$mCpgb
Am\$ B{S>`m `m H$mCpgb \$ma B{S>`Z _o{S>{gZ `m hmo{_`monWr Ho$ {bE ^maV gaH$ma `m am` gaH$ma mam
Wm{nV gWm go dY a{OQ>oeZ hmo VWm CZHo$ `m` jom{YH$ma Ho$ AVJV {M{H$gm pQ>g H$aZo Ho$ {bE
`mo`Vm aIVm hmo; VWm bmBg|g Ho$ jo d `m` jom{YH$ma Ho$ AVJV H$m` ahm hmo & CnMmaH$Vm S>mQ>a `
~r{_V Zht hmoZm Om{hE AWdm ~r{_V `pV H$m {ZH$Q> g~Yr Zht hmoZm Mm{hE &
xxxvi) ZdOmV {eew go Vmn` Eogo {eewAm| go h {OZH$m O_ nm[bgr Ad{Y Ho$ XmamZ hAm hmo VWm C_ 1 {XZ
go boH$a 90 {XZm| Ho$ ~rM hmo, {Og_| XmoZm| {XZ em{_b h &
xxxvii) Xmdo H$s A{YgyMZm go Vmn` ~r_mH$Vm `m Q>rnrE H$mo {d{ZYm[aV g_` gr_m _| {XE JE nVo/Q>obr\$moZ
Z~a na Xmdo H$s gyMZm XoZo H$s {H$`m h &
xxxviii){M{H$gH$/e`{M{H$gH$ go Vmn` h `mo`VmnmflV Eobmon{WH$ {M{H$gH$ {OgHo$ nmg g_w{MV
bmBg|gXmVm nm{YH$mar mam Omar {H$`m J`m {d{Y_m` Ama AVZ bmBg|g hmo Ama Omo AnZo bmBg|g
Ho$ AVJV pQ>g H$aVm hmo &
xxxix) nm{bgr go Vmn` h dh nVmd, AZwgyMr, ~S>r e`{M{H$gm {hVbm^ Ho$ AZw~Y Ama S>o Ho$`a n{H$`m xxxix) Policy means the proposal, the Schedule, Major Surgical Benefit Annexure and
{hVbm^ Ho$ AZw~Y, nm{bgr XVmdoO Ama Eogm H$moB nR>mH$Z Omo BgHo$ gmW bJm hmo `m BgH$m ^mJ hmo &
xl) nm{bgr df go Vmn` h Xmo bJmVma nm{bgr dfJmR> Ho$ ~rM H$s EH$ df H$s Ad{Y Omo nm{bgr H$s dfJmR>
go ew$ hmoVr hmo Ama nm{bgr H$s AJbr dfJmR> go EH$ {XZ nhbo g_mflV hmoVr hmo Ama Omo nm{bgr Ho$
Omar ahZo Ho$ XmamZ nS>Vr hmo &
xli) nyd-`mnr ~r_mar/Xem-Eogr H$moB Xem, ~r_mar `m MmoQ> `m g~{YV Xem/E, {OgHo$ AmnH$mo Bg
nm{bgr Omar {H$E OmZo go nyd 48 _hrZm| go bjU `m gHo$V aho hm| VWm /`m {ZXmZ hAm hmo VWm/`m
{M{H$gm gbmh/CnMma {b`m J`m hmo &
xlii) _w` ~r{_V `{V go Vmn` h Bg AZwgyMr _| {d{Z{XQ>> Eogo Zm_ dmbm `{V& `{X _w` ~r{_V
`{V$ H$s _`w hmo OmVr h `m BgH$m ~r_m g_mflV hmo OmVm h Vmo Or{dV ~r{_V OrdZgmWr _w` ~r{_V
`pV$ ~Z OmEJr/Jm, ~eV} {H$ BgZo `h g{dXm ew$ H$aZo go nhbo Eogm {dH$n {X`m hmo Ama `h
nm{bgr Omar ahoJr &
xliii) ZdrH$aU go Vmn` BZ eVm] go h {Og na Amngr gh_{V go ~r_m H$s g{dXm H$m ZdrH$aU {H$`m Om
gH$Vm h & {Og_| g^r Vrjm Ad{Y`mo Ho$ `moOZ hoVw [a`m`Vr Ad{Y H$mo ZdrH$aU H$mo {ZaVa Omar
ahZm _mZm OmEJm &
xliv) AZwgyMr go Vmn` h Bg nm{bgr Ho$ gmW gbZ AZwgyMr Ama BgH$m ^mJ ~ZZo dmbr AZwgyMr & Bg_|
{ZJ_ mam Xr JB Eogr AZwgyMr Omo {d{Y_m` nR>mH$Z hmo, em{_b hmoJr &
xlv) ~r_mar go Vmn` h Eogr ~r_mar `m amoJ Omo nm{bgr Omar ahZo Ho$ XmamZ nhbr ~ma hB hmo Ama {OgHo$
g~Y _| {M{H$gH$ mam AnVmb _| AVaJ amoJr Ho$ $n _| CnMma {H$`m OmZm hmo `m e`{M{H$gm H$s
OmZr hmo &
xlvi) ~S>r e`{M{H$gm {hVbm^ H$s ~r{_V am{e n`oH$ ~r{_V `{V Ho$ g~Y _| {H$gr nm{bgr df _|
bmJy X{ZH$ {hVbm^ Ho$ 100 (EH$ gm) JwZm Ho$ ~am~a hmoJr &
xlvii) e` {M{H$gm `m e` {M{H$gm {H$`m go Vmn` {H$gr AnVmb `m S>o Ho$`a goQ>a _| {H$gr {M{H$gH$
mam {H$gr ~r_mar `m MmoQ> Ho$ CnMma, {dH${V Ama {dH$ma Ho$ gwYma, ~r_m[a`m| Ho$ {ZXmZ Ama CnMma,
VH$br\$ go amhV `m OrdZ _| d{ Ho$ {bE H$s OmZo dmbr _ZwAb Ama/`m Amnao{Q>d {H$`mE h &
xlviii) AmonrS>r (~m`amoJr) CnMma dh h {Og_| ~r{_V `pV {H$gr br{ZH$/AnVmb `m g~{YV gw{dYm
Ogo {H$ H$gQ>oeZ $_ _| {M{H$gH$ H$s gbmh na {ZXmZ Ama CnMma Ho$ {bE OmVm h& ~r{_V `pV
H$mo S>o Ho$`a `m AVam}Jr Ho$ $n _| ^Vu Zht {H$`m OmVm h &
xlix) A` e` {M{H$gm {hVbm^ go Vmn` nm{bgr Ho$ {Z~YZ Ama eV] Ho$ AYrZ IS> 2 (IV) Ho$ AVJV
{d{ZYm[aV {hVbm^ h &
Bg nm{bgr Ho$ `moOZ hoVw, H$moB {M{H$gr` eXmd{b`m {OZH$mo D$na n[a^m{fV Z [H$`m J`m hmo, do
S>moabS>g _o[S>H$b {S>eZar _| Cpb{IV g~{YV AW _| {bE OmEJo &
2. {hVbm^
(I) AnVmb ZH$X {hVbm^
`{X ~r_m ew$ hmoZo H$s VmarI Ho$ ~mX Ama ~r_m H$s Ad{Y Ho$ XmamZ XwKQ>Zm Ho$ H$maU emar[aH$ MmoQ>
bJVr h `m ~r_mar hmoVr h `m nhbr ~ma CgH$m nVm MbVm h Ama BgHo$ H$maU ~r_o H$s Ad{Y Ho$
AVJV bJmVma 24 KQo> H$s Ad{Y go A{YH$ Ad{Y VH$ ~r{_V `{V H$mo AnVmb _| ^Vu hmoZm nS>m
hmo Vmo BZ eVm} Ama {V~Ym| Ho$ AYrZ ahVo hE nVrjm Ad{Y Ama ~r_m H$m AndOZ, X{ZH$ {hVbm^
ZrMo {XE AZwgma {ZJ_ mam AXm {H$`m OmEJm, ^bo hr IM H$s JB dmV{dH$ bmJV Hw$N> ^r hmo &
(H$) AnVmb Ho$ gm_m` `m {deof dmS> (AWmV Ja-JhZ n[aM`m `y{ZQ> dmS>/H$_ao _|) _|
^Vu hmoZo na
nm{bgr df _| 24 KQo> `m BgHo$ {H$gr ^mJ (Cn`wV 24 KQo> nyao H$aZo Ho$ ~mX) & bJmVma
n`oH$ Ad{Y Ho$ g~Y _| bmJy X{ZH$ {hVbm^ AXm {H$`m OmEJm & naVw `h V~ O~{H$ Cn`wV
XwKQ>Zm _| AmB emar[aH$ MmoQ> `m ~r_mar Ho$ H$maU hr Mma KQo> go A{YH$ H$s bJVma Ad{Y `m
BgHo$ {H$gr ^mJ Ho$ {bE AnVmb _| ahZm nS>m hmo &
(I) AnVmb Ho$ JhZ n[aM`m `y{ZQ> _| ^Vu hmoZo na:
24 KQo> `m BgHo$ {H$gr ^mJ (Cn`wV 24 KQo> nyao H$aZo Ho$ ~mX)& bJmVma n`oH$ Ad{Y Ho$
g~Y _| nm{bgr df _| Cn`wV 2(i)(H$) Ho$ AZwgma {hgm~ bJm`m J`m bmJy XwJwZm X{ZH$
{hVbm^ AXm {H$`m OmEJm `h V~ O~{H$ Cn`wV XwKQ>Zm _| AmB emar[aH$ MmoQ> `m ~r_mar Ho$
H$maU hr Mma KQo> go A{YH$ H$s bJmVma Ad{Y `m BgHo$ {H$gr ^mJ Ho$ {bE AnVmb _| ahZm
nS>m hmo &
(J) Ja-AmBgr`y Ama AmBgr`y dmS>/H$_ao XmoZm| _| R>haZo na
AnVmb Ho$ bJmVma Mm~rg KQo> H$s EH$ Ad{Y Ho$ XmamZ (AWmV EH$ {XZ) (Cn`wV 24 KQo>
H$s Ad{Y nyar H$aZo Ho$ ~mX) `{X AnVmb _| JhZ n[aM`m `y{ZQ> Ama A` AVaJ/^Vu amoJr
dmS> (Ja-JhZ n[aM`m `y{ZQ>) _| ahZm nS>m hmo Vmo {ZJ_ Bg nH$ma AXm`Jr H$aoJm _mZmo {H$ dh
~r{_V `{V$ JhZ n[aM`m `y{ZQ> _| ^Vu hAm hmo ~eV] {H$ Bg AnVmb Ho$ JhZ n[aM`m H$j
`y{ZQ> _| dh ~r{_V `{V$ bJmVma H$_ go H$_ Mma KQo> ahm hmo &
gmV {XZ `m Bggo A{YH$ H$s bJmVma Ad{Y go A{YH$ Ad{Y VH$ n`oH$ ~ma AnVmb _| ahZo Ho$
g~Y _| AnVmb ZH$X {hVbm^ AnVmb _| ^Vu hmoZo Ho$ nhbo 24 KQ>m| (EH$ {XZ) Ho$ {bE ^r AXm
{H$E OmEJo, ^bo hr ~r{_V `pV gm_m` `m {deof dmS> _| ^Vu hAm hmo `m JhZ n[aM`m `y{ZQ> _| &
(II) ~S>r e`{M{H$gm {hVbm^
`{X Bg nm{bgr Ho$ AVJV {H$gr ~r{_V `{V H$mo XwKQ>Zm _| emar[aH$ MmoQ> bJZo `m Eogr ~r_mar Ho$
H$maU, {OgH$m nVm nhbr ~ma bJm hmo `m ~r_m ew$ hmoZo H$s VmarI Ho$ ~mX Ama ~r_o H$s Ad{Y Ho$
XmamZ hr nVm bJm hmo, AnVmb _| ~r_m Ad{Y Ho$ AXa {d{eQ>> e`{M{H$gm ({OgH$m CboI
~S>r e`{M{H$gm {hVbm^ Ho$ n[a{eQ> _| {X`m J`m h) H$admZr nSo> Vmo ~S>r e`{M{H$gm
{hVbm^ H$s ~r{_V aH$_ H$m EH$ {ZpMV n{VeV ({OgH$m CboI {d{eQ> e`{M{H$gm H$admE
OmZo na ~S>r e`{M{H$gm {hVbm^ Ho$ n[a{eQ _| {H$`m J`m h) H$s AXm`Jr {ZJ_ mam H$s OmEJr
^bo hr dmV{dH$ bmJV Hw$N> ^r hmo &
loUr 1 `m loUr 2 ({OgH$m CboI ~S>r e`{M{H$gm {hVbm^ Ho$ n[a{eQ _| {H$`m J`m h) Ho$
AVJV AmZo dmbr ~S>r e`{M{H$gm {hVbm^ H$s AXm`Jr H$s OmEJr Ama BgHo$ Abmdm E~wb|g mam
AmnmV pW{V _| AnVmb OmZo H$s bmJV E~wb|g `` Ho$ ~Xbo EH$_wV 1000/- nE H$s
A{V[aV$ AXm`Jr H$s OmEJr &
loUr 1 `m loUr 2 ({OgH$m CboI ~S>r e`{M{H$gm {hVbm^ Ho$ n[a{eQ _| {H$`m J`m h) Ho$
AVJV AmZo dmbr ~S>r e`{M{H$gm {hVbm^ H$s AXm`Jr H$s OmEJr& Bg nm{bgr Ho$ g~Y _| Hw$b
dm{fH$ nr{_`_ AWmV Hw$b EH$ df H$m nr{_`_, nr{_`_ H$s {Z`V VmarI go _m\$ {H$`m OmEJm& Bg
Ad{Y H$s JUZm e`{M{H$gm H$s VmarI go `m BgHo$ ~mX H$s VmarI go H$s OmEJr &
(III) X{ZH$ XoI^mb n{H$`m {hVbm^
`{X Bg nm{bgr Ho$ AVJV {H$gr ~r{_V `{V H$mo XwKQ>Zm _| emar[aH$ MmoQ> bJZo `m Eogr ~r_mar Ho$
H$maU, {OgH$m nVm nhbr ~ma bJm hmo `m ~r_m ew$ hmoZo H$s VmarI Ho$ ~mX Ama ~r_o H$s Ad{Y Ho$
XmamZ hr nVm bJm hmo, AnVmb _| ~r_m Ad{Y Ho$ AXa {d{eQ> e`{M{H$gm ({OgH$m CboI
~S>r e`{M{H$gm {hVbm^ Ho$ n[a{eQ _| {X`m J`m h) H$admZr nSo> Vmo eVm] d {V~Ym|, Vrjm
Ad{Y Ama Bg nm{bgr Ho$ AndOZm| Ho$ AYrZ ~S>r e`{M{H$gm {hVbm^ H$s bmJy X{ZH$ {hVbm^
Ho$ 5 JwZm Ho$ ~am~a aH$_ ({OgH$m CboI {d{eQ> X{ZH$ XoI^mb n{H$`m H$m bm^ CR>mE OmZo na
X{ZH$ XoI^mb n{H$`m {hVbm^ Ho$ n[a{eQ _| {H$`m J`m h) H$s AXm`Jr {ZJ_ mam H$s OmEJr ^bo
hr dmV{dH$ bmJV Hw$N> ^r hmo &
(IV) A` e`{M{H$gm {hVbm^
`{X Bg nm{bgr Ho$ AVJV {H$gr ~r{_V `pV$ ~r_m H$s Ad{Y Ho$ XmamZ H$moB Eogr e`{M{H$gm
H$admVm h Omo ~S>r e`{M{H$gm {hVbm^ `m X{ZH$ XoI^mb n{H$`m {hVbm^ H$s gyMr _| Z hmo Ama
`h ~S>r e`{M{H$gm/X{ZH$ XoI^mb ~r_m ew$ hmoZo H$s VmarI Ho$ ~mX XwKQ>Zm _| bJr emar[aH$
MmoQ> `m nhbr ~ma `mZ _| AmB ~r_mar `m nhbo go hr nVm ~r_mar Ho$ H$maU AnVmb _| 24 KQ>o go
A{YH$ Ad{Y Ho$ {bE ^Vu hmoH$a CnMma H$aVm h Vmo BZ eVm} Ed {V~Ym| Ho$ ahVo hE nVrjm Ad{Y
Ama Bg nm{bgr H$m AndOZ/bmJy X{ZH$ {hVbm^ Ho$ XwJwZo Ho$ ~am~a {ZJ_ mam AXm {H$`m OmEJm
3
subject to the terms and conditions of this Policy;
xxxii) Medical Advice- Any consultation or advice from a Medical Practitioner including
the issue of any prescription or repeat prescription.
xxxiii) 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
xxxiv) Medically necessary treatment is defined as any treatment, tests, medication,
or stay in hospital or part of a stay in hospital which;
is required for the medical management of the illness or injury suffered by the
insured;
must not exceed the level of care necessary to provide safe, adequate and
appropriate medical care in scope, duration, or intensity;
must have been prescribed by a medical practitioner,
must conform to the professional standards widely accepted in international
medical practice or by the medical community in India
xxxv) Medical Practitioner- A Medical practitioner is a person who holds a valid registration
from the medical council of any State or Medical Council of India or Council for
Indian Medicine or for Homeopathy set up by the Government of India or a State
Government and is thereby entitled to practice medicine within its jurisdiction; and is
acting within the scope and jurisdiction of licence. The treating Medical Practitioner
should not be the Insured himself or a close family member of the Insured(s).
xxxvi) Newborn Baby means those babies born during the Policy Period and is aged
between 1 day and 90 days, both days inclusive
xxxvii) Notification of Claim- Notification of claim is the process of notifying a claim to
the insurer or TPA by specifying the timelines as well as the address / telephone
number to which it should be notified.
xxxviii)Physician/Surgeon means a qualified allopathic medical practitioner holding a
valid and subsisting license, granted by the appropriate licensing authority, and
practicing within the scope of his license.
Day Care Procedure Benefit Annexure, the Policy document, and any
endorsements attaching to or forming part thereof;
xl) Policy Year means a period of one year between any two consecutive Policy
anniversaries, commencing on a Policy anniversary and ending one day prior to
the next succeeding Policy anniversary, during the continuance of policy;
xli) Pre-Existing Disease/Condition- Any condition, ailment or injury or related
condition(s) for which you had signs or symptoms, and / or were diagnosed, and /
or received medical advice / treatment within 48 months prior to the date of
commencement of this policy.
xlii) Principal Insured means the named person with such title as specified in the
Schedule. In case of death or expiry of cover of Principal Insured, the surviving
Insured Spouse shall become the Principal Insured provided the option is
exercised at the beginning of the contract and the policy will continue.
xliii) Renewal defines 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 o f all waiting periods
xliv) Schedule means the Schedule attached to and forming part of this Policy;
It would also include any valid endorsements made to the Schedule made by the
Corporation;
xlv) Sickness means a sickness or a disease which first manifests itself during the
continuance of policy and requires inpatient treatment or Surgery in a Hospital by
a Physician.
xlvi) Major Surgical Benefit Sum Assured is equal to 100 (one hundred) times the
Applicable Daily Benefit in any Policy Year for each Insured;
xlvii) 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 of suffering or prolongation of life,
performed in a hospital or day care centre by a medical practitioner.
xlviii) OPD(Out-Patient) treatment is one in which the Insured visits a clinic / hospital
or associated facility like a consultation room for diagnosis and treatment based
on the advice o f a Medical Practitioner. The Insured is not admitted as a day
care or in-patient.
xlix) Other Surgical Benefit means the benefit as specified under clause 2 (IV),
subject to terms and conditions of the policy.
For the purposes of this Policy, any medical terms not defined above shall have
their respective meaning as ascribed to it by the Dorlands' Medical Dictionary.
2. BENEFITS:
I) Hospital Cash Benefit:
In the event of Accidental Bodily Injury or Sickness first occurring or manifesting
itself after the Date of Cover Commencement and during the Cover Period and
causing an Insured's Hospitalization to exceed a continuous period of 24 hours
within the Cover Period, then, subject to the terms and conditions, waiting period
and exclusions of the Policy, the Daily Benefit is payable by the Corporation as
follows, regardless of the actual costs incurred:
a. In case of Hospitalization in the general or special ward (i.e. a non-
Intensive Care Unit ward/room) of a Hospital:
The Applicable Daily Benefit in a Policy Year, for each continuous period of
24 hours or any part thereof (after having completed the 24 hours as
above) provided any such part stay exceeds a continuous period of 4
hours of Hospitalization necessitated solely by reason of the said
Accidental Bodily Injury or Sickness, shall be payable.
b. In case of Hospitalization in the Intensive Care Unit of a Hospital:
Two times the Applicable Daily Benefit reckoned under clause 2(I)(a) above
for each continuous period of 24 hours or part thereof (after having
completed the 24 hours as above) provided any such part stay exceeds a
continuous period of 4 hours of Hospitalization in the Intensive Care Unit
of a Hospital during any period of Hospitalization necessitated solely by
reason of the said Accidental Bodily Injury or Sickness shall be payable.
c. Combined stay in Non-ICU and ICU ward/room:
During one period of 24 continuous hours (i.e. one day) of Hospitalisation
(after having completed the 24 hours as above), if the said Hospitalisation
included stay in an Intensive Care Unit as well as in any other in-patient
(non-Intensive Care Unit) ward of the Hospital, the Corporation shall pay
benefits as if the admission was to the Intensive Care Unit provided that
the period of Hospitalisation in the Intensive Care Unit was at least 4
continuous hours.
For every Hospitalization that extends for a continuous period of less than 7
(seven) days, no Hospital Cash Benefit would be paid for the first 24 hours
(one day) of hospitalization, regardless of whether the Insured was admitted
in a general or special ward or in an intensive care unit. However, in cases
where the hospitalization extends for a continuous period of 7 days or more,
the Hospital Cash Benefit would also be paid for the first 24 hours (day one)
of hospitalization.
II) Major Surgical Benefit:
In the event of an Insured under this Policy undergoing any specified Surgery (as
mentioned in the Major Surgical Benefit Annexure) within the Cover Period in a
Hospital due to Accidental Bodily Injury or Sickness first occurring or manifesting
itself after the Date of Cover Commencement and during the Cover Period then,
subject to the terms and conditions, waiting period and exclusions of this Policy, a
percentage (as mentioned in the Major Surgical Benefit Annexure against the
specified Surgery performed) of the Major Surgical Benefit Sum Assured shall be
payable by the Corporation, regardless of the actual costs incurred.
In the event that a Major Surgical Benefit falling under Category 1 or Category 2
(as mentioned in the Major Surgical Benefit Annexure) is payable and emergency
transportation costs by an ambulance have been incurred, an additional lump
sum of Rs. 1,000 will be payable in lieu of ambulance expenses.
In the event that a Major Surgical Benefit falling under Category 1 or Category 2
(as mentioned in the Major Surgical Benefit Annexure) is payable in respect of
any Insured, the total annualized premium i.e. total one year premium in respect
of this Policy from the installment premium due date coinciding with or next
following the date of the Surgery will be waived.
III) Day Care Procedure Benefit:
In the event of an Insured under this Policy undergoing any specified Day Care
Procedure (as mentioned in the Day Care Procedure Benefit Annexure) within the
Cover Period in a Hospital or Day Care Centre due to Accidental Bodily Injury or
Sickness first occurring or manifesting itself after the Date of Cover
Commencement and during the Cover Period then, subject to the terms and
conditions, waiting period and exclusions of this Policy, an amount equal to 5
(five) times the Applicable Daily Benefit, shall be payable by the Corporation,
regardless of the actual costs incurred.
IV) Other Surgical Benefit:
In the event of an Insured under this Policy undergoing within the Cover Period
any Surgery not listed under Major Surgical Benefit or Day Care Procedure Benefit,
in a Hospital due to Accidental Bodily Injury or Sickness first occurring or manifesting
itself after the Date of Cover Commencement and during the Cover Period and
causing an Insured's Hospitalization to exceed a continuous period of 24 hours
within the Cover Period, then, subject to the terms and conditions, waiting period
 ^bo hr Mm~rg KQo> `m BgHo$ {H$gr ^mJ H$s n`oH$ bJmVma Ad{Y na IM H$s JB dmV{dH$ bmJV Hw$N>
^r ahr hmo& bo{H$Z AnVmb _| R>haZo H$s Ad{Y H$m Eogm ^mJ bJmVma Mma KQo> go A{YH$ hmo&
3. bm^ H$s gr_mE Ama eV]
(I) AnVmb ZH$X {hVbm^ gr_mE Ama eV]
(i) AnVmb ZH$X {hVbm^ Ho$db Bgr pW{V _| Xo` hmoJm `{X ~r{_V `{V H$mo ^maV _|
AnVmb _| ^Vu {H$`m J`m hmo &
(ii) Eogo {XZm| H$s Hw$b g`m {OZHo$ {bE n`oH$ ~r{_V `{V Ho$ g~Y _| AXm`Jr H$s OmEJr, EH$
nm{bgr df _| {ZZ{b{IV gr_m VH$ gr{_V hmoJr
(H$) AnVmb _| ^Vu ahZo Ho$ A{YH$V_ 30 (Vrg) {XZ, {OZ_| go Bg ~r{_V `pV Ho$ g~Y _|
~r_m ew$ hmoZo H$s VmarI Ho$ ~mX Ho$ nhbo nm{bgr df _| JhZ n[aM`m `y{ZQ> _| A{YH$ go A{YH$
15 (nXh) {XZ hm|Jo &
(I)AnVmb _| ^Vu ahZo Ho$ A{YH$V_ 90 (Z~o) {XZ, {OZ_| go Cg ~r{_V `{V Ho$ g~Y _|
~r_m ew$ hmoZo H$s VmarI go AJbo nm{bgr df Ho$ Xygao Ama BgHo$ ~mX Ho$ dfm} _| JhZ n[aM`m
`y{ZQ> _| A{YH$ go A{YH$ 45 (nVmbrg) {XZ &
(iii) AnVmb _| ^Vu hmoZo Ho$ Hw$b {XZm| H$s g`m {OZHo$ g~Y _| AnVmb ZH$X {hVbm^ H$s AXm`Jr
H$s OmEJr, n`oH$ ~r{_V `{V Ho$ g~Y _| ~r_o H$s Ad{Y Ho$ XmamZ Xo` hmoJr Ama Bg nm{bgr _|
A{YH$V_ 720 (gmV gm ~rg) {XZ H$s gr_m hmoJr {OZ_| go A{YH$ go A{YH$ 360 (VrZ gm gmR>
{XZ) JhZ n[aM`m `y{ZQ> _| hm|Jo& ~r{_V `{V mam `h gr_m nmflV H$aZo na Bg ~r{_V `{V$ Ho$
g~Y _| AnVmb ZH$X {hVbm^ VH$mb ~X hmo OmEJo &
(iv) Bg nm{bgr Ho$ AVJV {H$gr ~r{_V `{V Ho$ g~Y _| Cn`wV IS> _| {d{Z{XQ> {hVbm^ H$s gr_m
Ho$db ~r{_V `{V$ na hr bmJy hmoJr& {H$gr ~r{_V `{V H$s AnVmb ZH$X {hVbm^ H$s Xmdm
Zht H$s JB aH$_ {H$gr A` ~r{_V `{V H$mo AV[aV Zht H$s OmEJr& Bg pW{V _| AnVmb ZH$X
{hVbm^ H$s AXm`Jr Zht H$s OmEJr &
(v) `{X Bg nm{bgr Ho$ AVJV ~r{_V `{V H$moB {d{eQ>> X{ZH$ XoI^mb n{H$`m AnZm ahm hmo
({OgH$m CboI X{ZH$ XoI^mb {hVbm^ n[a{eQ _| {H$`m J`m h) &
(II) ~S>r e`{M{H$gm {hVbm^ gr_mE Ed eV]
i `{X EH$ hr e`{M{H$gm Ho$ XmamZ ~r{_V `{V H$s EH$ go A{YH$ e`{M{H$gm H$s OmVr h
`m AbJ e`{M{H$gm H$s OmVr h Vmo {ZJ_ Ho$db H$s JB Bg e`{M{H$gm Ho$ g~Y _| hr
AXm`Jr H$aoJm {Og_| g~go ~S>r aH$_ Xo` hmo &
ii g~{YV {hVbm^ Ho$ {bE `Wm{d{Z{XQ> ~S>r e`{M{H$gm Ho$ {hVbm^ H$s AXm`Jr EH$_wV H$s
OmEJr Ama {ZJ_ H$s gVw{Q>> Ho$ {bE e`{M{H$gm H$m g~yV XoZm hmoJm &
iii Xmdm H$s JB g^r e`{M{H$gmAm| H$s n{H$`mAm| H$s `mo` {M{H$gH$ `m e`{M{H$gH$ mam
Amd`H$ Ama O$ar hmoZo Ho$ g~Y _| nw{Q> H$s OmZr Mm{hE {Oggo {ZJ_ H$mo gVwpQ> hmo gHo$ &
iv ~S>r e`{M{H$gm {hVbm^ H$s AXm`Jr Bg {M{H$gr` gm` Ho$ AmYma na {ZJ_ H$s gVw{Q>
Ho$ ~mX H$s OmEJr {H$ H$s JB {deof e` {M{H$gm Bg nm{bgr Ho$ AVJV AmVr h &
v ~S>r e`{M{H$gm {hVbm^ Ho$db V^r AXm {H$`m OmEJm `{X e`{M{H$gm ^maV _| H$s JB
hmo &
vi E~wb|g `` Ho$ ~Xbo aH$_ H$s AXm`Jr {H$gr nm{bgr df _| n`oH$ ~r{_V `{V Ho$ g~Y _|
Ho$db EH$ ~ma H$s OmEJr Ama BgHo$ {bE {ZJ_ H$s gVwpQ> Ho$ {bE g~yV nXmZ {H$`m OmEJm &
vii ~r_o H$s Ad{Y Ho$ XmamZ {H$gr ~r_m df _| ~S>r e`{M{H$gm {hVbm^ Ho$ AVJV n`oH$ ~r{_V
`{V Ho$ g~Y _| Hw$b Xo` aH$_ Bg nm{bgr df _| ~S>r e`{M{H$gm {hVbm^ H$s ~r{_V aH$_
Ho$ 100 n{VeV go A{YH$ Zht hmoJr &
viii ~r_m Ad{Y Ho$ XmamZ n`oH$ ~r{_V `{V Ho$ g~Y _o Xo` Hw$b aH$_ ~S>r e`{M{H$gm
{hVbm^ H$s ~r{_V aH$_ Ho$ 800 n{VeV H$s A{YH$V_ gr_m go A{YH$ Zht hmoJr& Bg ~r{_V
`{V Ho$ g~Y _| ~S>r e`{M{H$gm {hVbm^ VH$mb ~X H$a {X`m OmEJm &
ix Bg nm{bgr Ho$ AVJV ~r{_V `{V Ho$ g~Y _| Cn`wV IS> _| {d{Z{XQ>> {hVbm^ H$s gr_m
Ho$db Ama _m ~r{_V `{V$ na bmJy hmoJr& {H$gr ~r{_V `{V Ho$ Xmdm Zht H$s JB ~S>r
e`{M{H$gm Ho$ {hVbm^ H$s aH$_ {H$gr A` ~r{_V `{V H$mo AV[aV Zht H$s OmEJr &
x {H$gr ^r e`{M{H$gm Ho$ {bE ~S>r e`{M{H$gm {hVbm^ H$m Xmdm Zht {H$`m Om gH$Vm h
Ama nm{bgr H$s Ad{Y Ho$ XmamZ Bgr e`{M{H$gm Ho$ {bE EH$ go A{YH$ ~ma AXm`Jr Zht H$s
OmEJr &
(III) X{ZH$ XoI^mb n{H$`m {hVbm^ gr_m Ed eV]
i `{X EH$ hr e`{M{H$gm Ho$ XmamZ ~r{_V `{V H$s EH$ go A{YH$ ~ma Bgr BpggZ mam `m
AbJ-AbJ BpggZ H$aHo$, EH$ hr e`{M{H$gm g Ho$ XmamZ X{ZH$ XoI^mb n{H$`m H$s
OmVr h Vmo {ZJ_ Ho$db H$s JB EH$ X{ZH$ XoI^mb n{H$`m Ho$ g~Y _| hr AXm`Jr H$aoJm &
ii X{ZH$ XoI^mb n{H$`m Ho$ {hVbm^ H$s AXm`Jr EH$_wV H$s OmEJr Ama {ZJ_ H$s gVw{Q>> Ho$ {bE
e`{M{H$gm n{H$`m H$m g~yV XoZm hmoJm &
iii Xmdm H$s JB g^r e`{M{H$gmAm| H$s n{H$`mAm| H$s `mo` {M{H$gH$ `m e`{M{H$gH$ mam
Amd`H$ Ama O$ar hmoZo Ho$ g~Y _| nwpQ>> H$s OmZr Mm{hE {Oggo {ZJ_ H$mo gVwpQ> hmo gHo$ &
iv X{ZH$ XoI^mb n{H$`m {hVbm^ H$s AXm`Jr Bg {M{H$gr` gm` Ho$ AmYma na {ZJ_ H$s
gVw{Q>> Ho$ ~mX H$s OmEJr {H$ H$s JB {deof e`{M{H$gm Bg nm{bgr Ho$ AVJV AmVr h &
v X{ZH$ XoI^mb n{H$`m {hVbm^ Ho$db V^r AXm {H$`m OmEJm `{X e`{M{H$gm ^maV _| H$s JB hmo &
vi n`oH$ ~r{_V `{V$ Ho$ g~Y _| X{ZH$ XoI^mb n{H$`m {hVbm^ ~r_m Ad{Y Ho$ XmamZ {H$gr
~r_m df _| A{YH$V_ 3 (VrZ) e`{M{H$gm n{H$`m VH$ hr Xo` hmoJm &
vii ~r_o H$s Ad{Y Ho$ XmamZ n`oH$ ~r{_V `{V$ Ho$ g~Y _| X{ZH$ XoI^mb n{H$`m {hVbm^
OrdZ^a _| Ho$db A{YH$V_ 24 (Mm~rg) e`{M{H$gm n{H$`mAm| VH$ hr Xo` hmoJm& `{X
X{ZH$ XoI^mb n{H$`m {hVbm^ Ho$ {bE nm e`{M{H$gm n{H$`m H$s g`m {H$gr ~r{_V
`{V Ho$ OrdZH$mb H$s A{YH$V_ gr_m Ho$ ~am~a hmo Vmo Bg ~r{_V `{V$ Ho$ g~Y _| X{ZH$
XoI^mb n{H$`m {hVbm^ VH$mb ~X hmo OmEJm &
viii Bg nm{bgr Ho$ AVJV ~r{_V `{V$ Ho$ g~Y _| Cn`wV IS> _| {d{Z{XQ> {hVbm^ H$s gr_m
Ho$db Ama EH$ _m ~r{_V `{V$ na bmJy hmoJr& {H$gr ~r{_V `{V$ Ho$ Xmdm Zht H$s X{ZH$
XoI^mb n{H$`m {hVbm^ H$s aH$_ {H$gr A` ~r{_V `{V H$mo AV[aV Zht H$s OmEJr &
ix `{X X{ZH$ XoI^mb n[H$`m H$s OmVr h Vmo H$moB AnVmb ZH$X {hVbm^ AXm Zht {H$`m OmEJm &
(IV) A` e`{M{H$gm {hVbm^ gr_m Ed eV]
i `{X EH$ hr e`{M{H$gm Ho$ XmamZ ~r{_V `{V H$s EH$ go A{YH$ e`{M{H$gm EH$ hr
BpggZ `m AbJ-AbJ BpggZ go EH$ e`{M{H$gm g Ho$ XmamZ H$s OmVr h Vmo {ZJ_
Ho$db H$s JB EH$ e`{M{H$gm Ho$ g~Y _| hr AXm`Jr H$aoJm &
ii A` e`{M{H$gm {hVbm^ X{ZH$ {hVbm^ Ho$ $n _| AXm {H$E OmEJo Ama BZHo$ g~Y _| {ZJ_
H$s gVwpQ> Ho$ {bE e`{M{H$gm H$m g~yV XoZm hmoJm &
iii Xmdm H$s JB g^r e`{M{H$gmAm| H$s n{H$`m `mo` {M{H$gH$ `m e`{M{H$gH$ mam Amd`H$
Ama O$ar hmoZo Ho$ g~Y _| nw{Q> H$s OmZr Mm{hE {Oggo {ZJ_ H$m gVwpQ> hmo gHo$ &
iv A` e`{M{H$gm {hVbm^ H$s AXm`Jr Bg {M{H$gr` gm` Ho$ AmYma na {ZJ_ H$s gVw{Q>
Ho$ ~mX H$s OmEJr {H$ H$s JB {deof e` {H$`m Bg nm{bgr Ho$ AVJV AmVr h &
v A` e`{M{H$gm {hVbm^ H$mo Ho$db V^r AXm {H$`m OmEJm `{X e`{M{H$gm ^maV _| H$s
JB hmo &
vi A` e`{M{H$gm {hVbm^ Ho$ {bE AnVmb _| ^Vu hmoZo Ho$ {XZm| H$s Hw$b g`m Bg nm{bgr
Ho$ AVJV ~r{_V n`oH$ `{V$ Ho$ g~Y _| nm{bgr df Ho$ XmamZ Xo` aH$_ ~r{_V `{V Ho$
g~Y _| ~r_m ew$ hmoZo H$s VmarI go ~mX Ho$ ~r_m df _| 15 (nXh) {XZ go A{YH$ Zht hm|Jo Ama
Bg ~r{_V `{V$ Ho$ g~Y _| ~r_m ew$ hmoZo H$s VmarI go Xygao Ama ~mX Ho$ nm{bgr dfm} _| 45
(nVmbrg) {XZ go A{YH$ Zht hm|Jo &
vii Bg nm{bgr Ho$ AVJV ~r{_V n`oH$ `{V$ Ho$ g~Y _| ~r_m Ad{Y Ho$ XmamZ Xo` A`
e`{M{H$gm {hVbm^m| _| go AnVmb _| ^Vu hmoZo H$s$ Hw$b A{YH$V_ OrdZH$mb gr_m 360
(VrZ gm gmR>) {XZ hm|Jr & OrdZH$mb H$s A{YH$V_ gr_m nmflV H$a boZo na Bg ~r{_V `{V
Ho$ g~Y _| A` e`{M{H$gm {hVbm^ VH$mb g_mflV hmo OmEJo &
viii Bg nm{bgr Ho$ AVJV ~r{_V `pV Ho$ g~Y _| Cn`wV IS> _| {d{Z{XQ> {hVbm^ H$s gr_m
Ho$db Ama EH$ _m Bg ~r{_V `{V na bmJy hmoJr& {H$gr ~r{_V `{V Ho$ Xmdm Zht H$s X{ZH$
XoI^mb n{H$`m {hVbm^ H$s aH$_ {H$gr A` ~r{_V `{V H$mo AV[aV Zht H$s OmEJr &
4. bm^ Ho$ H$dg H$m ma^U Ama g_mpflV
n`oH$ ~r{_V `{V$ Ho$ g~Y _| AnVmb ZH$X {hVbm^, ~S>r e`{M{H$gm {hVbm^, X{ZH$ XoI^mb 4.
{hVbm^ Ama A` e`{M{H$gm {hVbm^ nm{bgr AZwgyMr _| C{b{IV AbJ-AbJ ~r_o Ho$ Ama^
hmoZo H$s VmarI go ew$ hmoJo&
n`oH$ ~r{_V `{V go g~{YV AnVmb ZH$X {hVbm^, ~S>r e`{M{H$gm {hVbm^, X{ZH$ XoI^mb n{H$`m
{hVbm^ Ama A` e`{M{H$gm {hVbm^ H$m ~r_m {ZZ{b{IV pW{V`m| _| VH$mb g_mflV hmo OmEJm:
i nm{bgr AZwgyMr _| C{b{IV ~r_m g_m{flV H$s VmarI na&
ii Cn`wV bmO 3 _| Cpb{IV OrdZH$mb Ho$ g^r A{YH$V_ {hVbm^m| H$s gr_m g_mflV hmoZo na&
iii _w` ~r{_V `{V H$s _`w hmoZo na `m ~r_o H$s g_m{flV H$s VmarI na Ama Bg pW{V _| `{X ~r{_V
OrdZgmWr H$mo _w` ~r{_V `{V Ho$ $n _| AmJo Omar Zht aIm OmVm h&
iv _w` ~r{_V `{V$ H$s _`w Ho$ ~mX `m _w` ~r{_V `{V$ Ho$ ~r_o H$s Ad{Y g_mflV hmoZo na _w`
~r{_V `{V$ Ho$ $n _| ~r{_V OrdZgmWr H$s nm{bgr Omar ahoJr&
v ~r{_V `{V H$s _`w hmoZo na&
4
and exclusions of this Policy, a Daily Benefit equal to 2 (two) times the Applicable Daily
Benefit, shall be payable by the Corporation, regardless of the actual costs incurred
for each continuous period of 24 hours or part thereof provided any such part stay
exceeds a continuous period of 4 hours of Hospitalization.
3. BENEFIT LIMITS AND CONDITIONS:
I) Hospital Cash Benefit Limits and Conditions:
i. The Hospital Cash Benefit shall be payable only if Hospitalisation has
occurred within India.
ii. The total number of days for which hospital cash benefit would be payable,
in respect of each Insured, in a Policy Year would be restricted to -
a. A maximum of 30 (thirty) days of Hospitalization out of which not more
than 15 (fifteen) days shall be in an Intensive Care Unit in the first Policy
Year following the Date of Cover Commencement in respect of that
Insured.
b. A maximum of 90 (ninety) days of Hospitalization out of which not more
than 45 (forty five) days shall be in an Intensive Care Unit in the second
and subsequent Policy Years following the Date of Cover Commencement
in respect of that Insured.
iii. The total number of days of Hospitalization for which Hospital Cash Benefit
is payable during the Cover Period, in respect of each and every Insured
covered under the policy, shall be limited to a maximum of 720 (seven
hundred and twenty) days out of which not more than 360 (three hundred
and sixty) days shall be in an Intensive Care Unit. Upon attainment of this
limit by an Insured, the Hospital Cash Benefit in respect of that Insured
shall cease immediately.
iv. The Benefit Limits specified in the above clauses in respect of an Insured
under this Policy, shall solely and exclusively apply to that Insured. Any
unclaimed Hospital Cash Benefit of any one Insured is not transferable to
any other Insured.
v. The Hospital Cash Benefit shall not be payable in the event of an Insured
under this Policy undergoing any specified Day Care Procedure (as
mentioned in the Day Care Procedure Benefit Annexure).
II) Major Surgical Benefit Limits and Conditions:
i. If more than one Surgery is performed on the Insured, through the same
incision or by making different incisions, during the same surgical session,
the Corporation shall only pay for that Surgery performed in respect of
which the largest amount shall become payable.
ii. The Major Surgical Benefit shall be paid as a lump sum as specified for
the benefit concerned and is subject to providing proof of Surgery to the
satisfaction of the Corporation.
iii. All Surgical Procedures claimed should be confirmed as essential and
required, by a qualified Physician or Surgeon, to the satisfaction of the
Corporation.
iv. The Major Surgical Benefit will be payable only after the Corporation is
satisfied on the basis of medical evidence that the specified Surgery
covered under the Policy has been performed.
v. The Major Surgical Benefit shall be payable only if the Surgery has been
performed within India.
vi. The amount in lieu of ambulance expenses shall be payable only once in
respect of each Insured in any Policy Year and is subject to providing
satisfactory evidence to the Corporation.
vii. The total amount payable in respect of each Insured under the Major
Surgical Benefit in any Policy Year during the Cover Period shall not exceed
100% of the Major Surgical Benefit Sum Assured in that Policy year.
viii. The total amount payable in respect of each Insured during the Cover
Period under the Major Surgical Benefit shall not exceed a maximum limit
of 800% of the Major Surgical Benefit Sum Assured. If the total amount
paid in respect of an Insured equals this lifetime maximum limit, the Major
Surgical Benefit in respect of that Insured will cease immediately.
ix. The Benefit Limits specified in the above clauses in respect of an Insured
under this Policy, shall solely and exclusively apply to that Insured. Any
unclaimed Major Surgical Benefit of any one Insured is not transferable to
any other Insured.
x. The Major Surgical benefit for any surgery cannot be claimed and shall not be
payable more than once for the same surgery during the term of the policy.
III) Day Care Procedure Benefit Limits and Conditions:
i. If more than one Day Care Procedure is performed on the Insured,
through the same incision or by making different incisions, during the
same surgical session, the Corporation shall only pay for one Day Care
Procedure performed.
ii. The Day Care Procedure Benefit shall be paid as a lump sum and is
subject to providing proof of Surgery to the satisfaction of the Corporation.
iii. All Surgical Procedures claimed should be confirmed as essential and
required, by a qualified Physician or Surgeon, to the satisfaction of the
Corporation.
iv. The Day Care Procedure Benefit will be payable only after the Corporation
is satisfied on the basis of medical evidence that the specified Surgical
Procedure covered under the policy has been performed.
v. The Day Care Procedure Benefit shall be payable only if the Surgical
Procedure has been performed within India.
vi. In respect of each Insured, the Day Care Procedure Benefit will be payable
only up to a maximum of 3 (three) Surgical Procedures in any Policy Year
during the Cover Period.
vii. In respect of each Insured during the Cover Period, the Day Care
Procedure Benefit will be payable only up to a lifetime maximum of 24
(twenty four) Surgical Procedures. If the number of Surgical Procedures
eligible for the Day Care Procedure Benefit in respect of an Insured
equals this lifetime maximum limit, the Day Care Procedure Benefit in
respect of that Insured will cease immediately.
viii. The Benefit Limits specified in the above clauses in respect of an Insured
under this Policy, shall solely and exclusively apply to that Insured. Any
unclaimed Day Care Procedure Benefit of any one Insured is not
transferable to any other Insured.
ix. If a Day Care Procedure Benefit is performed no Hospital Cash Benefit
shall be paid.
IV) Other Surgical Benefit Limits and Conditions:
i. If more than one Surgical Procedure is performed on the Insured, through
the same incision or by making different incisions, during the same surgical
session, the Corporation shall only pay for one Surgical Procedure.
ii. The Other Surgical Benefit shall be paid as a Daily Benefit and is subject
to providing proof of Surgery to the satisfaction of the Corporation.
iii. All Surgical Procedures claimed should be confirmed as essential and
required, by a qualified Physician or Surgeon, to the satisfaction of the
Corporation.
iv. The Other Surgical Benefit will be payable only after the Corporation is
satisfied on the basis of medical evidence that the specified Surgical
Procedure covered under the policy has been performed.
v. The Other Surgical Benefit shall be payable only if the Surgical Procedure
has been performed within India.
vi. The total number of days of Hospitalization for which the Other Surgical
Benefit is payable during a Policy Year in respect of each and every Insured
covered under the Policy shall not exceed 15 (fifteen) days in the first Policy
Year following the Date of Cover Commencement in respect of that Insured
and 45 (forty five) days for the second and subsequent Policy Years following
the Date of Cover Commencement in respect of that Insured.
vii. The total number of days of Hospitalization for which the Other Surgical
Benefit is payable during the Cover Period, in respect of each and every
Insured covered under the Policy shall not exceed a lifetime maximum
limit of 360 (three hundred and sixty) days. Upon attainment of this lifetime
maximum limit, the Other Surgical Benefit in respect of that Insured will
cease immediately.
viii. The Benefit Limits specified in the above clauses in respect of an Insured
under this Policy, shall solely and exclusively apply to that Insured. Any
unclaimed Other Surgical Benefit on any one Insured is not transferable to
any other Insured.
COMMENCEMENT AND TERMINATION OF BENEFIT COVERS:
The Hospital Cash Benefit, Major Surgical Benefit, Day Care Procedure Benefit
and Other Surgical Benefit cover in respect of each Insured shall commence on
the Date of Cover Commencement individually stated in the Schedule.
The Hospital Cash Benefit, Major Surgical Benefit, Day Care Procedure Benefit
and Other Surgical Benefit cover in respect of each Insured shall terminate at the
earliest of the following:
i. The Date of Cover Expiry mentioned in the Schedule;
ii. On attaining the lifetime maximum Benefit Limits as specified in clause 3 above;
iii. On death or date of cover expiry of the Principal Insured and if the Policy does
not continue with the Insured Spouse as the Principal Insured;
iv. On death or date of cover expiry of Insured Spouse after the policy continues
with the Insured Spouse as the Principal Insured after the Principal Insured
dies or reaches his / her date of cover expiry;
v. On death of the Insured;
 vi ~r{_V OrdZgmWr Ho$ _m_bo _| _w` ~r{_V `{V$ go VbmH$ boZo `m H$mZyZr $n go nWH$ hmoZo na&
vii nr{_`_ H$s AXm`Jr Z {H$E OmZo `m {H$gr A` H$maU go nm{bgr g_mflV hmoZo na&
5. nm{bgr H$s g_mpflV:
H$) AJa nm{bgr EH$b OrdZ H$mo Omar H$s JB h:
nm[bgr {ZZ{b{IV _| go g~go nhbo K{Q>V hmoZo dmbo H$maU go VH$mb g_mflV hmo OmEJr&
i nwZMmbZ Ad{Y Ho$ AXa nr{_`_ H$s AXm`Jr Z {H$E OmZo na, {OgH$m CboI nam 8 _| {H$`m J`m h
ii _`w na
iii nm{bgr AZwgyMr _| Cpb{IV ~r_m H$s g_mpflV H$s {V{W na
iv CnamoV Cpb{IV AZwgma g^r OrdZ H$mb A{YH$V_ {hVbm^ gr_mAm| H$s g_mpflV na
I) AJa nm{bgr EH$ go A{YH$ OrdZm| H$mo Omar H$s JB h:
nm[bgr {ZZ{b{IV _| go g~go nhbo K{Q>V hmoZo dmbo H$maU go VH$mb g_mflV hmo OmEJr:
i nwZMmbZ Ad{Y Ho$ AXa nr{_`_ H$s AXm`Jr Z {H$E OmZo na
ii _w` ~r{_V `pV Ho$ D$na CboI {H$E JE AZwgma OrdZH$mb A{YH$V_ {hVbm^ H$s gr_mAm| H$s g_mpflV na
iii _w` ~r{_V `pV H$s _`w `m ~r_m g_mflV hmoZo H$s VmarI H$mo Ama AJa ~r{_V OrdZgmWr
mam _w` ~r{_V `pV Ho$ $n _| nm{bgr H$mo Omar Zht aIm OmVm h&
iv _w` ~r{_V `pV H$s _`w hmoZo `m BgHo$ ~r_o H$s g_mpflV H$s VmarI Ho$ ~mX _w` ~r{_V `pV Ho$ $n _| ~r{_V
OrdZgmWr mam nm{bgr Omar aIZo Ho$ ~mX ~r{_V OrdZ gmWr H$s _`w `m ~r_m H$s g_m[flV H$s VmarI H$mo &
6. nVrjm Ad{Y
gm_m` nVrjm Ad{Y
`{X XwKQ>Zm Ho$ H$maU emar[aH$ MmoQ> bJVr h Vmo AnVmb _| ^Vu hmoZo `m e`{M{H$gm Ho$ _m_bo _| H$moB
gm_m` nVrjm Ad{Y Zht hmoJr& gm_m` nVrjm Ad{Y, dh Ad{Y hmoJr {Og_| AnVmb _| ^Vu hmoZo `m
e`{M{H$gm Ho$ _m_bo _| H$moB {hVbm^ Xo` Zht hm|Jo ~eV} {H$ AnVmb _| ^Vu hmoZo `m e`{M{H$gm H$s
KQ>Zm ~r_mar Ho$ H$maU hB hmo &
i gm_m` nVrjm Ad{Y n`oH$ ~r{_V `{$ Ho$ _m_bo _| ~r_m Ama^ hmoZo H$s VmarI go 90 (Z~o) {XZ hmoJr&
ii `{X ~r_m g_mflV hmoZo Ho$ ~mX nm{bgr nwZM{bV hmoVr h Vmo n`oH$ ~r{_V `{V$ Ho$ _m_bo _|
{ZZ{b{IV ~mV| bmJy hm|Jr
(H$) `{X {ZJ_ H$mo AXm Zht {H$E JE nhbo nr{_`_ H$s {Z`V VmarI go 90 (Z~o) {XZ Ho$ AXa
nwZMmbZ H$m AZwamoY nmflV hmoVm h Vmo n`oH$ ~r{_V `{V Ho$ _m_bo _| nwZMmbZ H$s VmarI go
gm_m` nVrjm Ad{Y 45 (nVmbrg) {XZ hmoJr &
(I) `{X {ZJ_ H$mo AXm Zht {H$E JE nhbo nr{_`_ H$s {Z`V VmarI go 90 (Z~o) {XZ Ho$ ~mX
nwZMmbZ H$m AZwamoY nmflV hmoVm h Vmo n`oH$ ~r{_V `{V Ho$ _m_bo _| nwZMmbZ H$s VmarI go
gm_m` nVrjm Ad{Y 90 (Z~o) {XZ hmoJr &
{deof nVrjm Ad{Y
Cn`wV Ho$ Abmdm, n`oH$ ~r{_V `{V Ho$ g~Y _| ZrMo {X`m J`m H$moB {hVbm^ CnbY Zht hmoJm Ama
AnVmb _| ^Vu hmoZo `m e`{M{H$gm H$aZo Ho$ H$maU Bg nm{bgr Ho$ AVJV {ZJ_ mam {H$gr Xmdo H$s
AXm`Jr Zht H$s OmEJr `m {deof nVrjm Ad{Y Ho$ XmamZ {ZZ{b{IV _| go {H$gr ^r `j `m A`j
H$maU go CnZ AmYma na `m CX>^d d$n Xmdo H$s AXm`Jr Zht H$s OmEJr
i ESo>ZmBS> `m Q>m|{gb H$s ~r_mar H$m CnMma
ii JwXm _mJ Ho$ \o$gwbm `m JwXm _mJ Ho$ {\$fa H$m CnMma
iii nmoQo>Q> J{W Ho$ ~T>Zo H$m CnMma
iv \$mB~mBS> `yQo>[a`Z nmobflg, {S>e\$eZb `yQo>[a`Z brqS>J Am{X Ogr _y g~Yr ~r_m[a`m| Ho$
CnMma Ho$ {bE&
v _mo{V`mq~X Ho$ CnMma Ho$ {bE&
vi {nVme` H$s nWar Ho$ CnMma Ho$ {bE&
vii pbn {S>H$ Ho$ CnMma Ho$ {bE&
viii ~dmgra Ho$ CnMma Ho$ {bE &
ix WmBamBS> Ho$ CnMma Ho$ {bE&
x h{Z`m Ho$ CnMma Ho$ {bE&
xi AS>H$mof Ho$ CnMma Ho$ {bE&
xii OmoS>m| H$s S>rOoZao{Q>d XemAm| Ho$ CnMma Ho$ {bE&
xiii gmBZg Ho$ {dH$mam| Ho$CnMma Ho$ {bE&
xiv {H$S>Zr `m noem~ Ho$ _mJ H$s nWar Ho$ CnMma Ho$ {bE&
xv ~[aH$moO Zgm| Ho$ CnMma Ho$ {bE&
xvi H$manb Q>Zb {gS>mo_ Ho$ CnMma Ho$ {bE&
xvii VZm| Ho$ CnMma Ho$ {bE, `Wm \$mB~moSo>Zmo_m, \$mB~mogmpQ>H$ ~r_mar Am{X
Cn`wV gyMr _| C{b{IV CnMmam| Ho$ g~Y _| {deof nVrjm Ad{Y Bg nH$ma hmoJr
i n`oH$ ~r{_V `{V$ Ho$ _m_bo _| ~r_m Ama^ hmoZo H$s VmarI go {deof nVrjm Ad{Y 2 (Xmo) df hmoJr&
ii `{X ~r_m ~X hmoZo Ho$ ~mX nm{bgr nwZ:Mm{bV hmoVr h Vmo n`oH$ ~r{_V `{$ Ho$ _m_bo _|
{ZZ{b{IV ~mV| bmJy hm|Jr
(H$) `{X {ZJ_ H$mo AXm Zht {H$E JE nhbo nr{_`_ H$s {Z`V VmarI go 90 (Z~o) {XZ go H$_ {XZ
Ho$ AXa nwZMmbZ H$m AZwamoY nm Zht hmoVm h Vmo n`oH$ ~r{_V `{$ Ho$ _m_bo _| ~r_m Ama^
hmoZo H$s VmarI go 2(Xmo) df hmoJr&
(I) `{X {ZJ_ H$mo AXm Zht {H$E JE nhbo nr{_`_ H$s {Z`V VmarI go 90 (Z~o) {XZ Ho$ ~mX
AZwamoY nm hmoVm h Vmo n`oH$ ~r{_V `{$ Ho$ _m_bo _| nwZMmbZ H$s VmarI go gm_m` nVrjm
Ad{Y 2 (Xmoo) df hmoJr&
7. AndOZ
n`oH$ ~r{_V `{V$ Ho$ g~Y _| ZrMo {X`m J`m H$moB {hVbm^ CnbY Zht hmoJm Ama AnVmb _| ^Vu hmoZo `m
e`{M{H$gm H$aZo Ho$ H$maU Bg nm{bgr Ho$ AVJV {ZJ_ mam {H$gr Xmdo hoVw H$moB AXm`Jr Zht H$s OmEJr Omo
{H$ {ZZ{b{IV _| go {H$gr `j `m A`j H$maU go, BgHo$ AmYma na `m \$bd$n CnZ hmo
i nhbo go {d_mZ H$moB pW{V ~eV} {H$ Cgo ~r_m Ama^ hmoZo H$s VmarI go nhbo `m nwZMmbZ H$s
VmarI go nhbo (`{X nm{bgr ~r_m ~X hmoZo Ho$ ~mX nm hmoVr h) {ZJ_ H$mo ~Vm Xr JB hmo `m {ZJ_
mam drH$ma H$s JB hmo&
ii H$moB CnMma `m e`{M{H$gm {M{H$gH$/gOZ mam `m CnMma Ho$ XmamZ `m e`{M{H$gm Ho$ XmamZ
Ho$db narjU Ho$ {bE H$s JB hmo&
iii H$moB Zo_r `m {ZYm[aV {M{H$gm OmM `m narjm&
iv {H$gr CnMma Ho$ g~Y _| Ho$db {ZXmZ, Eg-ao `m n`moJembm OmM na IM {H$`m J`m {M{H$gm ``&
v Eogr H$moB ~r_mar {Ogo H|$X gaH$ma `m am` gaH$ma Zo _hm_mar Ho$ $n _| dJuH$V {H$`m hmo&
vi {H$gr ^r nH$ma go IVZm H$aZo, H$m_o{Q>H$ `m gmX` g~Yr CnMma, qbJ n[adVZ H$aZo H$s
e`{M{H$gm, flbmpQ>H$ gOar (~eV} {H$ `h flbmpQ>H$ gOar {H$gr ~r_mar Ho$ H$maU `m XwKQ>Zm _|
eara _| bJr MmoQ> Ho$ H$maU Z H$s JB hmo Ama CgHo$ H$maU ~r{_V `{$ H$mo 6 _hrZo VH$ Bg KQ>Zm go
n^m{dV Z ahZm nS>m hmo `m `h CnMma Z H$amZm nS>m hmo)&
vii {H$gr AJ H$mo XmZ XoZo Ho$ {bE AnVmb _| ^Vu hmoZo `m e`{M{H$gm H$admZo&
viii O_ g~Yr {H$gr Xmof `m O_OmV H$_r H$mo Xya H$aZo Ho$ {bE {H$`m J`m CnMma&
ix {H$gr ^r nH$ma H$m XmVm| H$m CnMma `m CZH$s e`{M{H$gm ~eV} {H$ Eogm XwKQ>Zm _| eara H$mo MmoQ>
bJZo Ho$ H$maU Amd`H$ Z hmo&
x _yN>m AmZm, gm_m` Xw~bVm, V{H$m `m A` ~oH$S>mCZ, {dlm_, O_OmV ~r_mar, H$_r `m ~`rH$aU
`m ~mPnZ ({ZXmZ Ama CnMma), {H$gr Amamo` {Zdmg, {H$gr nm `m {dlm_ `m XrKH$m{bH$ XoI^mb
`m AnVmb _| ^Vu hmoZm Omo {ZdmaH$ `m j_Vm Ho$ Cnm` Ho$ $n _| {H$`m J`m hmo&
xi d` H$mo nhMmB JB MmoQ> `m pW{V (Am_h`m H$m n`mg), Ama/`m {H$gr S>J `m AH$mohb H$m Xwn`moJ&
xii H$moB `mZ gH${_V ~r_mar `m Eogr H$moB pW{V Omo n`j `m namoj $n go EMAmBdr dm`ag go AmB hmo
`m {H$gr qgS>mo_ `m ES>g go gX{^V {H$gr nH$ma H$s gm_m` pW{V&
xiii {H$gr Eogr gm_Jr H$mo hQ>mZm, R>rH$ H$aZm `m ~XbZm Omo ~r_m Ama^ hmoZo H$s VmarI `m nwZMmbZ H$s
VmarI go nhbo H$s JB nwamZr e`{M{H$gm Ho$ H$maU H$s JB hmo (~eV} {H$ nm{bgr ~r_m ~X hmoZo Ho$ ~mX
nm hB hmo)&
xiv J^mdWm H$m {ZXmZ `m Cggo CnZ CnMma `m CgHo$ H$maU {H$`m OmZo dmbm CnMma (^bo hr dh `yQo>[a`Z
hmo `m `yQo>[a`Z go A{V[a$), {eew H$m O_ {Og_| e`{M{H$gm go H$adm`m J`m ngd, J^mdWm Ho$ XmamZ
{M{H$gr` CnMma Ama/`m OMm H$m ngd-nyd Ama ngdmoma XoI^mb `m ZE {eew H$s XoI^mb&
xv {\${O`moWoaonr Ho$ n`moOZ go hr AnVmb _| ^Vu hmoZm `m {H$gr Eogr ~r_mar Ho$ H$maU AnVmb _| ^Vu
hmoZm {Og_| {M{H$gr` nmmo{JH$s Ho$ CZV hmoZo Ho$ H$maU AnVmb _| ^Vu hmoZm Amd`H$ Z hmo&
xvi `w, AmH$_U, {dXoer ew H$m H$m`, CnXd (^bo hr `w Kmo{eV hmo `m Zht), Jh `w, {dXmoh, H$m{V,
g{ZH$ {dXmoh `m {g{db Aem{V go gmm h{W`m boZo `m byQ> `m Cggo g~{YV Mmoar&
xvii ge ~bm| AWmV ZmgoZm `m WbgoZm H$s H$madmB ({Og_| em{V Ho$ g_` H$s S>`yQ>r ^r em{_b h) `m
dm`w goZm H$s H$madmB Ama e H$m n`moJ H$aZo g~Yr H$madmB _| ^mJ boZo `m Eogr H$madmB _| ^mJ
boZo {OgHo$ g~Y _| AmVH$dm{X`m| `m CnX{d`m| `m Eogo A` bmoJm| go Q>H$a boZo Ho$ {bE g{ZH$
nm{YH$m[a`m| mam AmXoe {X`m J`m hmo&
xviii H$moB Eogr Xdr KQ>Zm ({Og_| A` ~mVm| Ho$ gmW-gmW {h_nmV, ^yH$n, dmbm_wIr {d\$moQ> `m {H$gr
^r nH$ma H$m nmH${VH$ IVam em{_b h) &
xix IVaZmH$ {H$`mH$bmnm| `m Iobm| _| ^mJ boZm {Og_| A` ~mVm| Ho$ gmW-gmW XmS> bJmZm, JmoVm
bJmZm, hdmB Iob IobZm, D$Mr Hy$X bJmZm Ama ndVmamohU ^r em{_b h `m H$moB A` Amnam{YH$
`m Ja-H$mZyZr {H$`mH$bmn H$aZm&
xx `ypb`a {V{H$`m, ao{S>EeZ `m ao{S>`moEpQ>d gXyfU Ho$ H$maU `m BZgo CnZ `j $n go `m
A`j $n go hB H$moB hm{Z, j{V `m ``, Mmho `o H$go ^r hE hm|,
xxi CnMma H$s Ja-Ebmn{WH$ n{V`m| `m e` {M{H$gm g~Yr AnVmb _| ^Vu hmoZo go g~{YV ``,
xxii {H$gr Amnam{YH$ `m Ja-H$mZyZr {H$`m H$bmnm| _| ^mJ boZm,
xxiii C{MV {M{H$gm gbmh Ho$ nmbZ Ho$ {~Zm ~r{_V `{V go g~{YV XwKQ>Zm go CnZ CnMma&
8. Am`w H$m n_mU
AZwgyMr _| C{b{IV n`oH$ ~r{_V `{V Ho$ g~Y _| nr{_`_ H$s Hw$b {H$Vm| H$m {hgm~ nVmd _| Kmo{fV
~r{_V `{V$ H$s Am`w Ho$ AmYma na bJm`m OmVm h& `{X {H$gr ~r{_V `{V$ H$s Am`w Ho$ ~mao _| nVmd _|
5
vi. In respect of the Insured Spouse, on divorce or legal separation from the
Principal Insured;
vii. On termination of the Policy due to non-payment of premium or any other reason.
5. TERMINATION OF POLICY:
A) If Policy is issued on single life:
The Policy shall terminate at the earliest of the following:
i. Non-payment of premiums within the revival period described in Para 8;
ii. On death;
iii. On the Date of Cover Expiry mentioned in the Policy Schedule;
iv. On exhausting all the lifetime maximum Benefit Limits as specified above.
B) If policy is issued on more than one life:
The policy shall terminate at the earliest of the following:
i. Non-payment of premiums within the revival period;
ii. On PI exhausting all the lifetime maximum Benefit Limits as specified above.
iii. On death or Date of Cover Expiry, of the Principal Insured and if the Policy
does not continue with the Insured Spouse as the Principal Insured;
iv. On the death or Date of Cover Expiry, of Insured Spouse after the Policy
continues with the Insured Spouse as the Principal Insured after the PI dies
or reaches his/her Date of Cover Expiry.
6. WAITING PERIOD:
General waiting period:
There shall be no general waiting period in case Hospitalization or Surgery is due
to Accidental Bodily Injury. There shall be a general waiting period during which no
benefits shall be payable in the event of Hospitalization or Surgery, if the said
Hospitalization or Surgery occurred due to Sickness.
i. The general waiting period shall be 90 (ninety) days from the Date of Cover
Commencement in respect of each Insured.
ii. If the policy is revived after discontinuance of the Cover then the following
shall apply in respect of each Insured:
a. If the request for revival is received by the Corporation within 90 (ninety)
days from the due date of the first unpaid premium, then there shall be a
general waiting period of 45 (forty five) days from the Date of Revival in
respect of each Insured.
b. If the request for revival is received by the Corporation beyond 90 (ninety)
days from the due date of the first unpaid premium, then there shall be a
general waiting period of 90 (ninety) days from the Date of Revival in
respect of each Insured.
Specific waiting period:
Besides the above, in respect of each Insured, no benefits are available hereunder
and no payment will be made by the Corporation for any claim under this Policy on
account of Hospitalization or Surgery directly or indirectly caused by, based on,
arising out of or howsoever attributable to any of the following during the specific
waiting period:
i. Treatment for adenoid or tonsillar disorders
ii. Treatment for anal fistula or anal fissure
iii. Treatment for benign enlargement of prostate gland
iv. Treatment for benign uterine disorders like fibroids, uterine prolapse,
dysfunctional uterine bleeding etc.
v. Treatment for Cataract
vi. Treatment for Gall Stones
vii. Treatment for Slip Disc
viii. Treatment for Piles
ix. Treatment for Benign Thyroid Disorders
x. Treatment for Hernia
xi. Treatment for Hydrocele
xii. Treatment for Degenerative Joint Conditions
xiii. Treatment for Sinus Disorders
xiv. Treatment for Kidney or Urinary Tract Stones
xv. Treatment for Varicose Veins
xvi. Treatment for Carpal Tunnel Syndrome
xvii.Treatment for Benign Breast Disorders e.g. Fibroadenoma, Fibrocystic
Disease, etc.
The specific waiting period in respect of the treatments specified in the list above shall
be as follows:
i. The specific waiting period shall be 2 (two) years from the Date of Cover
Commencement in respect of each Insured.
ii. If the policy is revived after discontinuance of the Cover then the following
shall apply in respect of each Insured:
a. If the request for revival is received by the Corporation within 90 (ninety)
days from the due date of the first unpaid premium, then the specific
waiting period shall continue to be till 2 (two) years from the Date of Cover
Commencement in respect of each Insured.
b. If the request for revival is received by the Corporation beyond 90 (ninety)
days from the due date of the first unpaid premium, then there shall be a
specific waiting period of 2 (two) years from the Date of Revival in respect
of each Insured.
7. EXCLUSIONS:
No benefits are available hereunder and no payment will be made by the
Corporation for any claim under this policy on account of hospitalization or surgery
directly or indirectly caused by, based on, arising out of or howsoever attributable
to any of the following:
i. Any Pre-existing Condition unless disclosed to and accepted by the Corporation
prior to the Date of Cover Commencement or the Date of Revival (if the Policy
is revived after discontinuance of the Cover).
ii. Any treatment or Surgery not performed by a Physician/Surgeon or any
treatment or Surgery of a purely experimental nature.
iii. Any routine or prescribed medical check up or examination.
iv. Medical Expenses relating to any treatment primarily for diagnostic, X-ray or
laboratory examinations.
v. Any Sickness that has been classified as an Epidemic by the Central or State
Government.
vi. Circumcision, cosmetic or aesthetic treatments of any description, change of
gender surgery, plastic surgery (unless such plastic surgery is necessary for
the treatment of Illness or accidental Bodily Injury as a direct result of the
insured event and performed with in 6 months of the same).
vii. Hospitalisation expenses or Surgery for donation of an organ by donor.
viii. Treatment for correction of birth defects or congenital anomalies.
ix. Dental treatment or surgery of any kind unless necessitated by Accidental
Bodily Injury.
x. Convalescence, general debility, nervous or other breakdown, rest cure,
congenital diseases or defect or anomaly, sterilisation or infertility (diagnosis
and treatment), any sanatoriums, spa or rest cures or long term care or
hospitalization undertaken as a preventive or recuperative measure.
xi. Self afflicted injuries or conditions (attempted suicide), and/or the use or
misuse of any drugs or alcohol and complications arising from it.
xii. Any sexually transmitted diseases or any condition directly or indirectly caused
to or associated with Human Immuno Deficiency (HIV) Virus or any Syndrome
or condition of a similar kind commonly referred to as AIDS.
xiii. Removal or correction or replacement of any material/prosthesis/medical
devices that was implanted in a former surgery before Date of Cover
commencement or Date of Revival (if the Policy is revived after
discontinuance of the Cover).
xiv. Any diagnosis or treatment arising from or traceable to pregnancy (whether
uterine or extra uterine), childbirth including caesarean section, medical
termination of pregnancy and/or any treatment related to pre and post natal
care of the mother or the new born.
xv. Hospitalisation for the sole purpose of physiotherapy or any ailment for which
hospitalization is not warranted due to advancement in medical technology.
xvi. War, invasion, act of foreign enemy, hostilities (whether war be declared or
not), civil war, rebellion, revolution, insurrection military or usurped power of
civil commotion or loot or pillage in connection herewith.
xvii.Naval or military operations(including duties of peace time) of the armed
forces or air force and participation in operations requiring the use of arms or
which are ordered by military authorities for combating terrorists, rebels and
the like.
xviii. Any natural peril (including but not limited to avalanche, earthquake, volcanic
eruptions or any kind of natural hazard).
xix. Participation in any hazardous activity or sports including but not limited to
racing, scuba diving, aerial sports, bungee jumping and mountaineering or in
any criminal or illegal activities.
xx. To any loss, damage or expense due to or arising out of, directly or indirectly,
nuclear reaction, radiation or radioactive contamination regardless of how it
was caused.
xxi. Hospitalisation expenses related to non-allopathic methods of treatment or surgery.
xxii. Participation in any criminal or illegal activities.
xxiii.Treatment arising from the Insured's failure to act on proper medical advice.
8. Proof of Age :
The instalment premium in respect of each insured mentioned in the Schedule
has been calculated on the age of that Insured, as declared in the Proposal. If the
 JbV ~Vm`m J`m hmo `m ghr Zht ~Vm`m J`m hmo, Vmo BgHo$ {Ibm\$ {ZZ{b{IV _| go H$moB H$madmB H$s
OmEJr
`{X ~r{_V `{V H$s Am`w nm{bgr Ho$ XmamZ CgH$s Am`w go A{YH$ nmB OmVr h Vmo ~r_m A{Y{Z`_,
1938 Ho$ AYrZ AmZo dmbo A{YH$mam| g{hV {ZJ_ Ho$ A` A{YH$mam| Ama CnMmam| na n{VHy$b n^md S>mbo
{~Zm, Bg ~r{_V `{V$ H$s ndoe Ho$ g_` ghr C_ Ho$ AZwgma Eogo _m_bm| _| nr{_`_ _| ~Xbmd {H$`m
OmEJm Ama CgH$s am{e g~{YV ~r{_V `{V$ Ho$ g~Y _| ~r_m ew$ hmoZo H$s VmarI go AZwgyMr _|
C{b{IV A{V_ nr{_`_ H$s AXm`Jr H$s VmarI go H$s OmEJr & _w` ~r{_V `pV$ g~{YV ~r{_V
`{V H$s ghr C_ Ho$ g~Y _| nr{_`_ Ama _yb nr{_`_, Omo ~r{_V `{V mam Eogr AXm`Jr {H$E OmZo
H$s VmarI go ~r_m ew$ hmoZo H$s VmarI go AXm {H$`m J`m Wm, Ho$ ~rM Ho$ AVa H$mo Bg g_` {d_mZ `mO
H$s Xa g{hV dgyb {H$`m OmEJm Ama Bg VarHo$ go dgyb {H$`m OmEJm Omo nr{_`_ H$s AXm`Jr {db~ go
H$aZo Ho$ g~Y _| {ZJ_ mam dgyb {H$`m OmVm h&
`{X _w` ~r{_V `{V Cn`wV VarHo$ go `mO g{hV nr{_`_ Ho$ AVa H$s AXm`Jr Zht H$aVm h Ama
Bg_| {XImB JB Xa na nr{_`_ H$s AXm`Jr H$aVm ahVm h Vmo g~{YV ~r{_V `{V Ho$ g~Y _| ~r_m ew$
hmoZo H$s VmarI go Bg VmarI VH$ O~ nm{bgr EH$ Xmdm ~Z OmVr h, nr{_`_ Ho$ O_m AVa H$mo Bg g_`
{d_mZ Xa na `mO g{hV dgyb {H$`m OmEJm Ama ~r{_V `{V na CV nm{bgr Ho$ g~Y _| ~mH$s F$U
Ho$ $n _| Cgo g_Pm OmEJm Ama Cgo nm{bgr H$m Xmdm {H$E OmZo H$s pW{V _| nm{bgr H$s Xo` YZam{e go
H$mQ>m OmEJm&
`{X ~r{_V `{V$ H$s Am`w ghr nVmd _| Kmo{fV Am`w go H$_ nmB OmVr h Vmo Bg nm{bgr Ho$ AVJV Bg
~r{_V `{V$ H$m nr{_`_ Bg ~r{_V `{V$ H$s ghr C_ Ho$ AZwgma ~Xb {X`m OmEJm& ~r{_V `{V Ho$
g~Y _| Bg nH$ma H$m ~Xbmd ~r_m ew$ hmoZo H$s VmarI go {H$`m OmEJm Ama {ZJ_ AnZo {ddoH$ go _yb
nr{_`_ Ama gemo{YV nr{_`_ Ho$ ~rM Ho$ AVa H$s O_m YZam{e H$mo {~Zm `mO Ho$ bmQ>m XoJm&
`{X _w` ~r{_V H$s ndoe Ho$ g_` ghr C_ AZwgyMr _| C{b{IV ~r_m `moOZm Ho$ AVJV ~r_m `mo` Z hmo
Vmo `h nm{bgr g_mflV H$a Xr OmEJr Ama BgHo$ g~Y _| H$moB AXm`Jr Zht H$s OmEJr& bo{H$Z `{X A`
~r{_V {H$gr `{V$ H$s ghr Am`w ({Og_| _w` ~r{_V `{V$ em{_b Zht h) ndoe Ho$ g_` Eogr hmo {H$
dh `hm AZwgyMr _| C{b{IV ~r_o H$s loUr `m eVm} Ho$ AYrZ ~r_m `mo` Z hmo Vmo g~{YV ~r{_V `{V$
H$m ~r_m aX>X H$a {X`m OmEJm Ama eof ~r{_V `{V`m| Ho$ g~Y _| `h nm{bgr Omar aIr OmEJr&
9. nm{bgr Ho$ AYrZ {dH$n
(I) ZE A{V[aV gX`m| H$m ~r_m
`{X _w` ~r{_V `{V ~r_m Ad{Y Ho$ XmamZ {ddmh H$a boVm h/nwZ{ddmh H$a boVm h Vmo BgH$s
nZr Ama gmg ggwa H$mo {ddmh/nwZ{ddmh H$s VmarI go 6 _mh Ho$ AXa nm{bgr _| em{_b {H$`m Om
gH$Vm h& bo{H$Z nm{bgr H$s ewAmV BZH$m Zm_ em{_b H$aZo H$s VmarI go `m BgHo$ ~mX H$s VmarI
go hmoJr& ~T>m hAm nr{_`_ Eogr nm{bgr H$s dfJmR> go Xo` hmoJm &
`{X nm{bgr boZo Ho$ ~mX {H$gr ~Mo H$m O_ hmoVm h/{H$gr ~Mo H$mo H$mZyZr Vma go JmoX {b`m OmVm
h Vmo Bg nm{bgr Ho$ AVJV ~Mo H$mo Bg VmarI go `m Bg VmarI Ho$ ~mX ~r{_V {H$`m Om gH$Vm h
O~ ~Mm VrZ _mh H$s C_ nyar H$a bo& `{X H$mZyZr Vma na JmoX {bE JE ~Mo H$s Am`w VrZ _mh go
A{YH$ hmo Vmo dh ~Mm nm{bgr H$s dfJmR> go JmoX {bE OmZo H$s VmarI go `m BgHo$ ~mX ~r{_V {H$`m
Om gH$Vm h& ~T>m hAm nr{_`_ Eogr nm{bgr H$s dfJmR> go Xo` hmoJm &
Bg nH$ma H$m n[adVZ {ZJ_ mam Eogr KQ>Zm Ho$ n_mU Ho$ nm{flV H$s VmarI go {H$`m OmEJm Ama BgHo$
g~Y _| {ZJ_ H$s {ZYm[aV eVm] H$mo nyam H$aZm hmoJm& nhbo ~VmB JB nVrjm Ad{Y Ama AndOZ ZE
~r{_V `{V Ho$ g~Y _| bmJy hmoJm &
ZE `{V$ H$m Zm_ OmoS>Zo Ho$ g~Y _| Ho$db _w` ~r{_V `{V$ mam AZw_{V Xr OmEJr &
(II) {d_mZ gX`m| H$mo hQ>mZm
`{X _`w hmo OmVr h `m VbmH$ hmo OmVm h Vmo _w` ~r{_V `{V Ho$ {b{IV AZwamoY na Bg ~r{_V
`{V H$m Zm_ ~r_o go hQ>m {X`m OmEJm& Bg nH$ma hQ>mZo H$s ~mV ~r_o H$s {H$V H$s {Z`V VmarI go
`m Eogo AZwamoY H$s VmarI go `m BgHo$ ~mX go bmJy hmoJr& Eogo ~r{_V `{V Ho$ g~Y _| nr{_`_ H$s
{H$V H$s {Z`V VmarI Ho$ ~mX H$moB nr{_`_ Xo` Zht hmoJm &
{H$gr A` n[aW{V _| {d_mZ ~r{_V `{V$ H$mo hQ>mZo H$m H$m` nyUV {ZJ_ Ho$ {ddoH$ Ho$ AZwgma
Xr JB AZw_{V go {H$`m OmEJm &
(III) ~r{_V OrdZgmWr H$m _w` ~r{_V `{V ~ZZm
`{X _w` ~r{_V `{V H$s _`w hmo OmVr h `m CgH$m ~r_m g_mflV hmo OmVm h Vmo Or{dV ~r{_V
OrdZgmWr _w` ~r{_V `pV ~Z OmEJr/Jm, ~eV} {H$ g{dXm Ho$ ewAmV _| Bg nH$ma H$m {dH$n
{X`m J`m hmo Ama `h nm{bgr Omar ahoJr& Eogr pW{V _| ~r{_V OrdZgmWr H$m nr{_`_ nr{_`_ H$s
AJbr {H$V H$s {Z`V VmarI go ~Xb {X`m OmEJm Ama Z`m nr{_`_ _w` ~r{_V `pV$ na bmJy Xa
go hmoJm Ama Am`w Ho$ AZwgma gemo{YV nr{_`_ H$s Xa H$m {hgm~ bJmZo Ho$ {bE OrdZgmWr H$s ndoe H$s
C_ H$mo {hgm~ _| {b`m OmEJm& bo{H$Z ~r{_V OrdZgmWr H$m _yb ~r_m An[ad[VV ahoJm &
(IV) WmZmVaU H$m {dH$n
Bg flbmZ Ho$ AVJV ga{jV ~Mm| Ho$ nmg {d{ZYm[aV {ZH$mgr H$s Am`w H$s g_mpflV `m 18 df H$s C_
Ho$ ~mX nm{bgr Ho$ ZdrZrH$aU na Cn`wV ZE dm` ~r_m nm{bgr (~r_mboIZ Ho$ AYrZ) H$mo boZo
H$m {dH$n hmoJm&
(i) _mOyXm nm{bgr go ~Mo H$s ~r_m gajU H$s g_mpflV Ho$ 90 {XZm| Ho$ AXa ZB nm{bgr IarXr
OmZr Mm{hE&
(ii) ~r{_V gX` g_mflV nyd-dfm] Ho$ {bE Cn`wV nyd `mnr Xem Ho$ A{OV Ho${S>Q>g VWm g_`
AmYm[aV AndOZm| H$m nm hmoJm& hmbm{H$ ZB nm{bgr Ho$ AVJV ~H$m`m Vrjm Ad{Y`m VWm {H$ht
AndOZ H$s ~H$m`m Ad{Y bmJy hmoJr&
(iii) ZB nm{bgr hoVw r{_`_ Xam| g{hV A` {Z`_ d eV] bmJy hm|Jr&
(V) d[aV ZH$X gw{dYm
AJa H$moB ~r{_V OrdZ {H$gr gyMr~ ZoQ>dH$ AnVmb _| loUr 1 `m 2 ~S>r e` {M{H$gm {hVbm^
(n[a{eQ> _| CboI {H$E JE AZwgma) Ho$ AVJV AmZo dmbr H$moB nm e`{M{H$gm H$admVm h, Vmo
_wI ~r{_V `pV Ho$ nmg d[aV ZH$X gw{dYm mflV H$aZo H$m {dH$n hmoJm& Bg gw[dYm Ho$ AVJV
nm ~S>r e` {M{H$gm {hVbm^ am{e 50% {H$gr ~r{_V OrdZ Ho$ AnVmb _| ^Vu hmoZo Ho$ XmamZ
CnbY H$am`m OmEJm (e`{M{H$gm {Z`mo{OV `m XKQ>Zm Ho$ H$maU AmnmVH$mbrZ hmo gH$Vr h),
~Om` BgHo$ {H$ AnVmb go Nw>Q>Q>r {_bZo Ho$ ~mX {hVbm^ Ho$ {bE Xmdm {H$`m OmE& `h Ho$db _wI
~r{_V `pV H$mo loUr I d II Ho$ AVJV gyMr~ e`{M{H$gmAm| Ho$ {bE AnVmb _| ^Vu hmoZo na
~S>r e` {M{H$gm {hVbm^ H$m A{J_ ^wJVmZ hmoJr VWm flbmZ H$s nm{bgr eVm] Ho$ AVJV Xo` hmoJr&
hmbm{H$ `h {ZJ_ go drH${V Ho$ AYrZ hmoJr VWm ~S>r e` {M{H$gm {hVbm^ Ho$ AVJV g_m`moOZ
Ho$ g_` Bg A{J_ am{e H$mo g_m`mo{OV {H$`m OmEJm &
A{J_ ^wJVmZ H$s Bg gw{dYm H$mo {d{ZYm[aV \$m_}Q> _| _wI ~r{_V `pV Ho$ ~H$ AH$mCQ> H$m
{ddaU VwV H$aHo$ mflV {H$`m Om gH$Vm h& A{J_ H$s am{e H$mo _wI ~r{_V `pV Ho$ ~H$
AH$mCQ> _| grYo O_m H$am`m OmEJm&
10. nr{_`_
nr{_`_ H$s {H$V, VarH$m, {Z`V VmarI Ama A{V_ AXm`Jr H$s VmarI H$m CboI AZwgyMr _| {H$`m
J`m h& [a`m`Vr {XZm| H$mo `mZ _| aIVo hE nr{_`_ H$s {H$V {Z`V VmarI H$mo `m Cggo nhbo nmflV hmo
OmZr Mm{hE &
_w` ~r{_V `{V/~r{_V OrdZgmWr Ho$ g~Y _| Xo` nr{_`_ H$s Hw$b {H$V hmoJr {Og_| {ZZ{b{IV
~mV| em{_b hm|Jr
i _yb flbmZ Ho$ nr{_`_ H$s {H$V
ii EbAmBgr H$m XwKQ>Zm {hVbm^ amBS>a Ho$ nr{_`_ H$s {H$V
iii EbAmBgr H$m Z`m Amd{YH$ ~r_m amBS>a Ho$ nr{_`_ H$s {H$V
BZ_| go {OgHo$ g~Y _| ^r {dH$n {b`m J`m h&
A` ~r{_V `pV Ho$ {bE ""r{_`_ H$s {H$V'' _yb flbmZ _| r{_`_ H$s {H$V hmoJr
AZwgyMr _| Cpb{IV _yb `moOZm Ho$ nr{_`_ H$s {H$V Ho$ g~Y _| n`oH$ ~r{_V `{V$ H$s JmaQ>r hmoVr
h& `h JmaQ>r _w` ~r{_V `{V$ H$m ~r_m ew$ hmoZo H$s VmarI go 3 df H$s Ad{Y Ho$ {bE hmoVr h& _yb
`moOZm Ho$ g~Y _| nr{_`_ H$s {H$V nm{bgr _| g^r ~r{_V `{V`m| Ho$ g~Y _| dV ZdrH$aU H$s
VmarIm| H$mo ZdrH$V hmo OmVr h& ZdrH$aU H$mo bmJy _yb ~r_o Ho$ nr{_`_ H$s Xa AWmV dV ZdrH$aU H$s
VmarI go AJbo VrZ df H$s Ad{Y AWmV dV ZdrH$aU H$s AJbr VmarI VH$ JmaQ>rS> hmoJr &
`{X H$da Ho$ ma^U H$s VmarI Ho$ nMmV nm{bgr _| H$moB A{V[aV gX` em{_b {H$`m OmVm h Vmo Cg
gX` _| dgyb {H$`m J`m r{_`_ ^r AJbr dV: ZdrH$aU VmarI VH$ JmaQ>rH$V hmoJm Ama Bg{bE
nm{bgr _| CgHo$ em{_b hmoZo go 3 df H$s g_mpflV go nhbo Bg_| n[adVZ {H$`m Om gH$Vm h&
bo{H$Z AZwgyMr _| Cpb{IV XmoZm| {dH$n amBS>a Ho$ nr{_`_ H$s {H$V Bg nyar Ad{Y Ho$ XmamZ JmaQ>rS>
hmoVr h {OgHo$ {bE ~r_m {H$`m OmVm h&
^{d` _| {H$gr ^r dV: ZdrH$aU H$s VmarI H$mo ~r_m Ho$ Hw$b nr{_`_ Bg ~r{_V `{V$ Ho$ ndoe H$s
Am`w na {Z^a H$aoJr (AWmV nm{bgr Ho$ Ama^ hmoZo H$s {V{W H$mo C_/nm{bgr _| em{_b {H$E OmZo Ho$
g_` C_, Ogr ^r pW{V hmo) Ama V~ Bg CnmX Ho$ g~Y _| {ZJ_ Ho$ nr{_`_ H$s Xao bmJy hmoJr&
`{X ~r{_V OrdZgmWr _w` ~r{_V `{V$ ~Z OmVr/OmVm h (_w` ~r{_V `{V$ H$s _`w Ho$ H$maU `m
_w` ~r{_V `{V$ H$s ~r_m Ad{Y g_mflV hmoZo Ho$ H$maU) Vmo ~r{_V OrdZgmWr Ho$ g~Y _| nr{_`_ Bg
VmarI go `m nr{_`_ H$s VmarI Ho$ ~mX H$s VmarI go nr{_`_ H$s {H$V ~T>m Xr OmEJr, {Og VmarI H$mo
~r{_V OrdZgmWr H$m XOm _w` ~r{_V `{V Ho$ $n _| ~Xb OmVm h Ama Z`m r{_`_ _w` ~r{_V
`pV H$mo bmJy Q>o~wba r{_`_ Xam| na AmYm[aV hmoJm VWm gemo{YV r{_`_ H$s JUZm Ho$ {bE C_
OrdZgmWr Ho$ doe H$s C_ hmoJr&
11. [a`m`Vr {XZ
dm{fH$ `m N>_mhr H$s AXm`Jr Ho$ g~Y _| EH$ H$b|S>a _mh bo{H$Z H$_ go H$_ 30 (Vrg) {XZ H$s [a`m`V
6
age of any of the Insured has been misstated or incorrectly mentioned in the
proposal, then one of the following actions will be taken:
In case the age of any of the Insured is found higher than such age during the
term of the policy, without prejudice to the Corporation's other rights and
remedies, including those under the Insurance Act, 1938, the premium in such
case shall be altered corresponding to the correct age at entry of that Insured and
the same shall be payable from the Date of Cover commencement in respect of
the concerned Insured till the Due Date of Payment of last premium as mentioned
in the Schedule. The Principal Insured shall pay to the Corporation the
accumulated difference between the premium for the correct age of the
concerned Insured and the original premium, from the Date of Cover
commencement in respect of the concerned Insured up to the date of such
payment, with interest at the rate then prevailing and in such manner as is
charged by the Corporation for the late payment of premium.
In case the Principal Insured fails to pay the difference of premiums with interest
thereon as mentioned above and continues to pay the premium at the rates
shown herein, then the accumulated difference of premiums from the Date of
Cover commencement in respect of the concerned Insured up to the date on
which the policy becomes a claim, with interest at the rate then prevailing, shall
accrue and be treated as a debt due on the Principal Insured against the said
Policy and will be deducted from the Policy moneys payable on the Policy
becoming a claim.
If the correct age of any of the Insured is found to be lower than the age declared
in the proposal, the premium in respect of that Insured under this policy shall be
altered corresponding to the correct age of that Insured from the Date of Cover
commencement in respect of the concerned Insured and the Corporation may, at
its discretion, refund without interest, the accumulated difference between the
original premium and the revised premium.
If the Principal Insured's correct age at entry is such as would have made him/her
uninsurable under the Plan of Assurance specified in the Schedule, this policy
shall be terminated and nothing shall be paid. However, in case if any other
Insured's (other than Principal Insured) correct age at entry is such as would
have made him/ her uninsurable under the class or terms of assurance specified
in the said Schedule hereto, the coverage for the concerned Insured will cease
and the policy will continue for the remaining Insured lives.
9. OPTIONS UNDER THE POLICY:
I) Cover to new additional members:
If the Principal Insured gets married/ remarried during the Cover Period, the
spouse and parents-in-law can be included in the Policy within six months
from the date of marriage/remarriage, but the Cover shall start from the policy
anniversary coinciding with or next following the date of inclusion. Enhanced
premiums shall be due from such policy anniversary.
Any child born/legally adopted after taking the Policy can be covered from the
policy anniversary coinciding with or next following the date on which the
child completes the age of 3 months. If the age of the legally adopted child on
the date of adoption is more than 3 months, the child can be covered from
the policy anniversary coinciding with or next following the date of adoption.
Enhanced premiums shall be due from such policy anniversary.
Such changes will be carried out subject to receipt of the proof of the event by
the Corporation and will also be subject to fulfillment of underwriting
conditions of the Corporation. Waiting periods and Exclusions as described
earlier will apply for the new Insured.
Any addition of new lives shall be allowed by the Principal Insured only.
II) Removal of existing members:
In the event of death or divorce, an Insured may be removed from coverage
upon request by the Principal Insured in writing. This will be effective from the
installment premium due date coinciding with or next following the date of
such a request. No further premiums are due in respect of that Insured from
such installment premium due date.
In any other circumstances, removal of an existing Insured will be permitted
at the sole discretion of the Corporation.
III) Insured Spouse becomes Principal Insured:
In case of death or expiry of cover of Principal Insured, the surviving Insured
Spouse shall become the Principal Insured provided the option is exercised
at the beginning of the contract and the policy will continue. In such case, the
premium for the Insured Spouse will change from the coinciding or following
installment premium due date and the new premium would be based on
tabular premium rates applicable for Principal Insureds and the age for
calculation of revised premium rate will be the age at entry of the spouse.
However, the original cover of the insured spouse shall remain unaltered.
IV) Option to migrate:
Children covered under this plan shall have the option to take a suitable new
health insurance policy (subject to underwriting) at the end of the specified
exit age or at the renewal of the policy after completion of 18 years of age.
i) The new policy should be purchased within 90 days of the termination of
child's cover from the existing policy.
ii) The Insured member shall be eligible for suitable credits gained for pre-
existing conditions and time bound exclusions for all the previous years,
provided the policy is in-force. The outstanding Waiting periods and
outstanding period of any Exclusion will however apply under the new policy.
iii) These credits shall be available up to a maximum of the current SA level
under the existing policy.
iv) Other terms and conditions including premium rates will be as applicable
for the new policy.
V) Quick Cash Facility:
If any of the insured lives undergoes any eligible surgery falling under
Category 1 or Category 2 (as mentioned in the Major Surgical Benefit
Annexure) in any of the listed network hospitals, the PI will have an option to
avail Quick Cash facility. Under this facility, 50% of eligible MSB amount
would be made available even during the period of hospitalization of any of
the insured lives covered (the surgery may be either planned or emergency
due to accident) instead of waiting for making a claim for the benefit after
discharge. It will be only an advance payment to the PI in the event of
hospitalization for any MSB defined in the surgeries listed under categories I
& II and permissible under the policy conditions of the plan. This will be,
however, subject to approval from the Corporation, and the advance amount
will be adjusted from the final settlement of MSB claim amount.
This facility of advance payment could be availed by submitting the Bank
Account details of the PI in the prescribed format. The amount of advance
shall be credited in the PI's bank account directly.
10. PREMIUMS
The installment premium, mode, due dates and dates of last payment are
specified in the Schedule. Subject to the days of grace, the installment premiums
must be received on or before their due dates.
The premium payable in respect of Principal Insured/Insured Spouse will be
"instalment premium" which includes:
(i) Instalment premium for Basic Plan,
(ii) Instalment premium for LIC's Accident Benefit Rider,
(iii) Instalment premium for LIC's New Term Assurance Rider,
wherever these options have been exercised.
For other insured, the "instalment premium" shall be the instalment premium
under the basic plan.
The installment premium for Basic Plan specified in the Schedule is guaranteed
in respect of each Insured for a period of 3 (three) years from the Date of Cover
Commencement of the Principal Insured. The installment premiums for Basic
Plan are reviewable on the Automatic Renewal Dates in respect of all insured in
the Policy. The premium rates for the basic plan applicable on renewal, i.e. from
Automatic Renewal Date, shall be guaranteed for a further period of 3 years i.e.
till next Automatic Renewal Date.
If any additional member is included in the policy after the date of cover
commencement, the premium charged in respect of that member will also be
guaranteed till the next Automatic Renewal Date and hence may change even
before completion of 3 years from his/her joining the policy.
The installment premium for both the optional riders specified in the Schedule is
however guaranteed throughout the term for which cover is provided.
On any Automatic Renewal Date in the future, the total installment premium in respect
of each Insured will be based on the entry age of that Insured (i.e. age as on the date
of commencement of policy / age at the time of inclusion into the policy, as the case
may be) and the Corporation's premium rates then prevailing for this product.
If the Insured Spouse becomes the Principal Insured (either due to the death of
the Principal Insured or due to expiry of the Cover Period of the Principal
Insured), then the premium in respect of the Insured Spouse shall be enhanced
from the installment premium due date coinciding with or next following the date
on which the Insured Spouse changed status to become the Principal Insured
and the new premium would be based on tabular premium rates applicable for the
Principal Insured and the age for calculation of revised premium will be the age at
entry of the Spouse.
11. DAYS OF GRACE:
A grace period of one calendar month but not less than 30 (thirty) days shall be
 Ad{Y Xr OmEJr `{X [a`m`Vr {XZm| Ho$ AXa Xo` nr{_`_ H$s AXm`Jr Zht H$s OmVr h Vmo nm{bgr `nJV
hmo OmEJr& Bg pW{V _| IS> 12 (AWmV nr{_`_ ^aZm W{JV H$aZm) Ho$ nmdYmZ bmJy hmo OmEJo &
12. nr{_`_ ^aZm W{JV H$aZm
`{X nm{bgr Ho$ AVJV [a`m`Vr {XZm| _| nr{_`_ H$s AXm`Jr Zht H$s OmVr h Vmo nm{bgr `nJV hmo
OmEJr Ama BgHo$ nMmV H$moB {hVbm^ Xo` Zht hm|Jo& _w` ~r{_V `pV Ho$ nmg `h {dH$n hmoJm {H$ dh
nhbo AXm Z H$s JB nr{_`_ H$s {H$V H$s {Z`V VmarI go 2 (Xmo) df H$s Ad{Y Ho$ XmamZ {H$gr ^r g_`
nm{bgr H$mo nwZMm{bV H$a gH$Vm h ~eV} {H$ ZrMo IS> 13 H$s eVm} H$mo nyam {H$`m J`m hmo &
13. W{JV nm{bgr H$mo nwZMm{bV H$aZm/~hmb H$aZm:
_w` ~r{_V `pV AXm Z {H$E JE nhbo nr{_`_ H$s {Z`V VmarI go, {Ogo nwZMmbZ Ad{Y `m Ad{Y
H$m nwZMmbZ H$hm OmVm h, go 2 (Xmo) df H$s Ad{Y Ho$ XmamZ {H$gr ^r g_` nm{bgr H$mo nwZMm{bV H$a
gH$Vm h &
Bg nH$ma H$m nwZMmbZ `mO g{hV (N>_mhr MH$d{ Xa go) ~H$m`m r{_`_ H$s AXm`Jr H$aZo na {H$`m
OmEJm Ama Bg nH$ma H$m nwZMmbZ nhbo nVm{dV eVm} go {^Z hmo gH$Vm h& nhbo Cpb{IV nVrjm
Ad{Y Ama AndOZ nwZMmbZ na bmJy hmoJm& _w` ~r{_V `pV$ H$mo AnZo `` na {ZJ_ mam Ano{jV
n`oH$ ~r{_V `pV$ Ho$ g~Y _| ANo> dm` H$m gVmofOZH$ n_mU XoZm hmoJm& nwZMmbZ H$s VmarI
dh VmarI hmoJr O~ nwZMmbZ/~hmbr H$s g^r AnojmE nyar H$s JB hm| {ZJ_ Ho$ nmg hmbm{H$ "" _S>b
mam _Oya H$s JB AS>aamB[Q>J nm{bgr'' Ho$ AZwgma _yb eVm] na drH$ma H$aZo, gemo{YV eVm] na
drH$ma H$aZo `m nwZMmbZ go AdrH$ma H$aZo H$m A{YH$ma gwa{jV h &
{Og Ad{Y _| `h nm{bgr W{JV AdWm _| Wr, Bg Ad{Y go Ad{Y H$mo nwZMm{bV H$aZo H$s `nJV
Ad{Y Ho$ XmamZ K{Q>V {H$gr KQ>Zm Ho$ g~Y _| {H$gr {hVbm^ H$s AXm`Jr Zht H$s OmEJr &
AmJo `{X dV ZdrH$aU VmarI nwZMbZ Ad{Y Ho$ ~rM _o nS>Vr h Ama nwZMbZ dV ZdrH$aU VmarI
Ho$ ~mX {H$`m OmVm h Vmo r{_`_ dV ZdrH$aU VmarI go nhbo Ama ~mX _| AbJ hmo gH$Vm h &
nhbr AXm Z H$s JB r{_`_ H$s Xo` {V{W go 2 dfm] H$s g_mpflV Ho$ ~mX nwZMmbZ/~hmbr nwZMmbZ
Ad{Y Ho$ ~mX Zht H$s OmEJr &
14. A` {hVbm^
I) Xmdm a{hV {hVbm^ Cg pW{V _| Xmdm a{hV {hVbm^ H$s AXm`Jr H$s OmVr h O~ nm{bgr ew$
hmoZo H$s VmarI Ama AJbr d-ZdrH$aU H$s VmarI Ho$ ~rM AWdm Xmo dV ZdrH$aU H$s VmarIm| Ho$
~rM {H$gr ~r{_V `pV$ Ho$ g~Y _| H$moB Xmdm Zht {H$`m J`m hmo& Xmdm a{hV {hVbm^ H$s aH$_
n`oH$ ~r{_V `[V Ho$ g~Y _| Ama{^H$ X{ZH$ {hVbm^ Ho$ 5 (nmM) n{VeV Ho$ ~am~a hmoJr Ama
Bg aH$_ _| {nN>br dV ZdrH$aU VmarI Ho$ ~mX AJbo nm{bgr df Ho$ {bE n`oH$ ~r{_V `pV$ Ho$
g~Y _| bmJy X{ZH$ {hVbm^ H$mo OmoS>H$a aH$_ {ZH$mbr OmEJr &
II) nr{_`_ _m\$s {hVbm^ `{X loUr 1 `m loUr 2 ({OgH$m CboI ~S>r e`{M{H$gm {hVbm^ Ho$
n[a{eQ> _| {H$`m J`m h) Ho$ AVJV AmZo dmbr ~S>r e`{M{H$gm {hVbm^ {H$gr ~r{_V `pV$ Ho$
g~Y Xo` hmoVm h Vmo Hw$b dm{fH$ nr{_`_ AWmV EH$ df _| AXm {H$E OmZo dmbo Hw$b nr{_`_ Ho$ g~Y
_| e`{M{H$gm H$s VmarI go `m BgHo$ ~mX H$s VmarI go Xo` nr{_`_ H$s {H$V H$mo _m\$ {H$`m OmEJm
III) nm{b{g`m| H$m A`nU Bg nm{bgr Ho$ AVJV A`nU H$s AZw_{V Zht Xr OmEJr &
IV) F$U Bg nm{bgr Ho$ AVJV H$moB F$U Zht {X`m OmEJm &
V) _yb `moOZm Ho$ AVJV _`w {hVbm^ {H$gr ^r ~r{_V `pV$ H$s _`w Ho$ g~Y _| V~ VH$ H$moB _`w
{hVbm^ Xo` Zht hmoJm, O~ VH$ {H$ ZrMo IS> 17 Ama 18 _| Cpb{IV amBS>a {hVbm^ H$m {dH$n
Zht {X`m J`m hmo &
_w` ~r{_V `pV H$s _`w na
(H$) Or{dV ~r{_V OrdZgmWr _w` ~r{_V `pV$ ~Z OmEJr/Jm, ~eV} {H$ g{dXm Ho$ ew$ _| Eogm
{dH$n {X`m J`m hmo Ama nm{bgr Omar ahoJr& ~r{_V OrdZgmWr Ho$ _m_bo _| nr{_`_ IS> 9(iii)
_| Xr JB nr{_`_ H$s {H$V H$s {Z`V VmarI go `m BgHo$ ~mX go ~T> OmEJo &
(I)`{X ~r{_V OrdZgmWr H$s _`w _w` ~r{_V `pV$ go nhbo hmo OmVr h Vmo A` ~r{_V `pV$
Ho$ nmg `h {dH$n hmoJm {H$ dh ZB nm{bgr b| Ama {d_mZ nm{bgr g_m hmo OmEoJr & BZ A`
~r{_V `pV`m| Ho$ g~Y _|:
i) ZB nm{bgr {H$gr AS>aamBqQ>J Ho$ {~Zm Omar H$s OmEJr, `{X _mOyXm nm{bgr Ho$ g_mflV hmoZo
Ho$ 90 {XZ Ho$ AXa ZB nm{bgr br OmVr h. hmbm{H$, ZB nm{bgr Ho$ AVJV ~r_m gajU H$s
am{e _mOyXm nm{bgr go A{YH$ Zht hmoJr &
ii) ZB nm{bgr Ho$ g~Y _| ndoe H$s A{YH$V_ C_ H$s eV bmJy Zht hmoJr &
iii) bo{H$Z ZB nm{bgr Ho$ AVJV eof nVrjm Ad{Y Ama AndOZ H$s eof Ad{Y bmJy hmoJr &
iv) nr{_`_ H$s Xa g{hV A` {Z`_ d eV} ZB nm{bgr na ^r bmJy hm|Jr &
_w` ~r{_V `pV$ go {^Z ~r{_V `pV H$s _`w hmoZo na ~r{_V `pV H$m Zm_ hQ>mZo Ho$ ~mX Omar
ahoJr Ama {Z`V VmarI go `m ~r{_V `{V$ H$s _`w H$s gyMZm H$s VmarI go AJbr VmarI go nr{_`_
H$s {H$V _| n[adVZ {H$`m OmEJm &
VI) n[andVm {hVbm^ nm{bgr H$s n[andVm/~r_m Ad{Y H$s g_mpflV na H$moB {hVbm^ Xo` Zht
hmoJm/~r_m Ad{Y H$s g_mpflV na nm{bgr g_mflV hmo OmEJr &
15. Hw$N> pW{V`m| _| OVr
~og flbmZ Ho$ _m_bo_|:
`{X nr{_`_m| H$m {d{YdV ^wJVmZ Z {H$`m OmE `m `{X Bg_| {Z{hV AWdm Bg na nR>m{H$V {H$gr eV H$m
CbKZ {H$`m OmE `m `{X `h nm`m OmE {H$ nVmd, {ZOr dV`, KmofUm-n VWm g~{YV nboIm| _|
H$moB {_`m `m JbV ~`mZ {X`m J`m h `m `{X H$moB _hdnyU OmZH$mar {N>nmB JB hmo, Vmo Ama Eogo ha
_m_bo _|, `h nm{bgr ey` hmo OmEJr Ama BgHo$ AmYma na {_bZo dmbm H$moB ^r {hVbm^ g_mflV VWm I_
hmo OmEJm Ama BgHo$ {Z{_m Xr JB gmar YZam{e {ZJ_ H$s hmo OmEJr, {gdm` Bg amhV Ho$ Omo Bg_| {Z{hV
nmdYmZm| Ho$ AZwgma CnbY H$amB OmE `m Omo {ZJ_ mam H$mZyZr Vma na Xr OmE &
dH$pnH$ amBS>g Ho$ _m_bo _| (EbAmBgr `y Q>_ E`moaog amBS>a Ama EbAmBgr H$m EpgS>oQ> ~o{Z{\$Q>
amBS>a), AJa MwZm J`m hmo:
`hm {Z{hV `m nR>m{H$V {H$gr eV Ho$ {VHy$b hmoZo na `m AJa `h nm`m OmVm h {H$ Vmd, `pVJV H$WZ, KmofUm
VWm g~{YV XVmdoOm| _| {X`m J`m H$moB H$WZ Ag` `m JbV h `m {H$gr _hdnyU OmZH$mar H$mo {N>nm`m J`m h Vmo
Eogo `oH$ _m_bo _| amBS>g A_m` hmoo OmEJo VWm CZHo$ H$maU {H$ht bm^ Ho$ g^r Xmdo g_`-g_` na `Wm
gemo{YV ~r_m A{Y{Z`_, 1938 H$s Ymam 45 Ho$ mdYmZm| Ho$ AYrZ hm|Jo.
16. g_ZwXoeZ Ama Zm_H$Z
Bg nm{bgr Ho$ AVJV H$moB g_ZwXoeZ Zht H$aZo {X`m OmEJm &
g_`-g_` na `Wm gemo{YV ~r_m A{Y{Z`_ H$s Ymam 39 Ho$ AZwgma OrdZ ~r_m nm{bgr Ho$ YmaH$ mam
Zm_m{H$V Ano{jV h. Ymam 39 Ho$ _mOyXm mdYmZ Bg nm{bgr XVmdoO Ho$ n[a{eQ>-1 _| {XE JE h.
Zm_mH$Z `m Zm_mH$Z H$mo ~XbZo H$s gyMZm nm{bgr H$mo godm XmZ H$aZo dmbo {ZJ_ Ho$ H$m`mb` _| nOrH$aU
hoVw Xr OmZr Mm{hE. Zm_mH$Z H$m nOrH$aU H$aVo g_` {ZJ_ CgH$s dYVm `m H$mZyZr ^md na H$moB
{O_oXmar drH$ma Zht H$aVm h `m H$moB am` Zht `V H$aVm h.
17. EbAmBgr H$m XwKQ>Zm {hVbm^ amBS>a
XKQ>Zm {hVbm^ A{V[aV r{_`_ Ho$ ^wJVmZ na CnbY h, ~eV] EbAmBgr H$m Z`m Amd{YH$ ~r_m
amBS>a H$mo MwZm J`m hmo& `h {hVbm^ _w` ~r{_V `pV VWm ~r{_V OrdZgmWr Ho$ Abmdm {H$gr A`
~r{_V Ho$ OrdZ na nm{bgr Ho$ AVJV CnbY Zht hmoJm&
D$na H$ho JE Ho$ AYrZ, AJa EbAmBgr H$m XKQ>Zm {hVbm^ amBS>a MwZm J`m hmo, Vmo {H$gr ^r g_`
XKQ>Zm H$s {V{W H$mo amBS>a gajU nyar ~r_m am[e Ho$ {bE ^mdr hmoJm, `h {hVbm^ Ho$db V^r CnbY
hmoJm, AJa EbAmBgr H$m Z`m Amd{YH$ ~r_m amBS>a CnbY hmo&
Bg {hVbm^ Ho$ {bE A{V[aV r{_`_ H$m ^wJVmZ Bg nm{bgr dfJmR> go Zht H$aZm hoJm, O~ `h
{hVbm^ g_mflV hmo OmVm h& bo{H$Z _yb flbmZ Ho$ AVJV nm{bgr H$s Ad{Y H$s g_mpflV VH$, Omo ^r bmJy
hmo, r{_`_ H$m ^wJVmZ Omar ahoJm&
^maVr` OrdZ ~r_m {ZJ_ Ho$ gmW Cgr OrdZ na, {Og na AJm{H$V bm^ bmJy hmoVo h, d`pVH$
nm{b{g`m| Ama gmW hr g_yh nm{b{g`m| Ho$ AVJV br JB g^r nm{b{g`m|, {OZ_| nhbo go hr XwKQ>Zm
{hVbm^ dmbr nm{b{g`m em{_b h, Ho$ AVJV ~r_m H$s A{YH$V_ g_o{H$V gr_m {H$gr ^r Xem _|
XwKQ>Zm bm^ ~r_mH$V am{e Ho$ . 100 bmI go A{YH$ Zht hmoJr. AJa Bg_| EH$ go A{YH$ nm{b{g`m h
Ama AJa Hw$b XwKQ>Zm {hVbm^ . 100 bmI go A{YH$ hmoVm h, Vmo Omar nm{b{g`m| H$s {V{W Ho$ H$_ _|
W_ . 100 bmI XwKQ>Zm bm^ ~r_mH$V am{e Ho$ {bE {hVbm^ bmJy hm|Jo.
AJa Bg nm{bgr Ho$ nyU ~r_m am{e hoVw ^mdr ahZo Ho$ XmamZ {H$gr g_` ~r{_V `pV {H$gr XKQ>Zm H$m
{eH$ma hmoVm h Ama Eogr MmoQ> bJZo Ho$ 180 {XZm| Ho$ AXa, EH$_m,`j Ed A` g^r go dV H$maU
go _`w hmo OmVr h VWm Bgo {ZJ_ Ho$ {bE gVmofOZH$ $n go _m{UV [H$`m OmVm h, Vmo {ZJ_ Bg
nm{bgr Ho$ AVJV XKQ>Zm {hVbm^ ~r_m am{e Ho$ g_mZ A{V[aV am{e H$m ^wJVmZ H$aoJm &
{ZJ_ Cn`w$ A{V[a$ am{e H$s AXm`Jr Cg pW{V _| Zht H$aoJm, `{X ~r{_V `{$ H$s _`w -
i) d` H$mo MmoQ> nhMmZo Ho$ BamXo go, Am_h`m H$aZo go, nmJbnZ `m AZ{VH$Vm Ho$ H$maU hB hmo `m Bg
pW{V _| hB hmo, O~ ~r{_V `pV Zerbo no`, AmfY `m ZmaH$mo{Q>g go n^m{dV hmo, `m
ii) Cg g_` hB XwKQ>Zm go hB hmo, O~ ~r{_V `pV$ ^mS>m AXm H$aZo, Am{eH$ AXm`Jr H$aZo `m {H$gr
E`aH$mQ> _| {ZewH$ `mr go {^Z {H$gr h{g`V go CS>mZ `m hdmB `mm H$a ahm hmo, Omo Eogo `m{`m|
H$mo bo OmZo Ho$ {bE gJV {d{Z`_m| Ho$ AYrZ nm{YH$V hmo Ama Wm{nV {d_mZnmZm| Ho$ ~rM `mm H$a ahm
hmo Ama ~r{_V `pV$ H$s {H$gr ^r g_` Bg E`aH$mQ> _| S>`yQ>r Z hmo `m Bggo H$moB g~Y Z hmo; AWdm
iii) XJm|, {dmoh, `w (Mmho `w Kmo{fV {H$`m J`m hmo `m Zht), AmH$_U, {eH$ma IobZo, ndVmamohU,
pQ>nb MoqgJ `m {H$gr nH$ma H$s XmS> Ho$ H$maU hB hmo `m
7
allowed for payment of yearly or half-yearly premiums. If the due premiums are not
paid within the days of grace the policy will lapse. The provisions of clause 12 (i.e.
Discontinuance of Premiums) shall be applicable in that case.
12. DISCONTINUANCE OF PREMIUMS:
If premiums have not been paid within the days of grace under the Policy, the Policy
will lapse and no benefits will be payable thereafter. The Principal Insured shall
have an option to revive the policy at anytime within a period of 2 (two) years from
the due date of first unpaid premium subject to conditions in clause 13 below.
13. REVIVALS/REINSTATEMENT OF DISCONTINUED POLICIES:
The Policy can be revived by the Principal Insured anytime during a period of 2
(two) years from the due date of first unpaid premium called the "period of revival"
or "revival period".
The revival will be subject to payment of outstanding premiums with interest
(compounding half-yearly) at such rate as may be prevailing at the time of payment,
Waiting periods and Exclusions as described earlier will apply on revival. The
Principal Insured may need to provide satisfactory evidence of good health in
respect of each Insured as required by the Corporation, at his own expense. The
Date of Revival will be when all requirements for revival/reinstatement are met...
The Corporation however, reserves the right to accept at original terms, accept with
modified terms or decline the revival of a discontinued policy as per the "Board
approved underwriting policy".
No benefit will be paid for an event that occurred during the lapse period till the
Date of Revival when the Policy was in a discontinued state.
Further, if the Automatic Renewal Date falls between the revival period and revival
is done after the Automatic Renewal Date, the premium before and after the
Automatic Renewal Date may be different.
No revival /reinstatement will be allowed after the expiry of 2 years from the due
date of first unpaid premium.
14. OTHER BENEFITS:
I) No Claim Benefit: A "No Claim Benefit" is payable in the event that during the
period between Date of Commencement of Policy and next Automatic Renewal
Date or between two Automatic Renewal Dates there have been no claims in
respect of any Insured. The amount of the no claim benefit would be equal to
5% (five per cent) of the Initial Daily Benefit in respect of each Insured and the
resulting amount shall be added to arrive at the Applicable Daily Benefit in
respect of each Insured for the Policy Year next following the most recent
Automatic Renewal Date.
II) Premium Waiver Benefit: In the event that a Major Surgical Benefit falling
under Category 1 or Category 2 (as mentioned in the Major Surgical Benefit
Annexure) is payable in respect of any Insured, the total annualized premium
i.e. total one year premium in respect of this Policy for the Policy Year from the
instalment premium due date coinciding with or next following the date of the
Surgery will be waived.
III) Surrender: No surrender shall be allowed under the Policy.
IV) Loan: No loan shall be allowed under this Policy.
V) Death Benefit under the basic plan: No death benefits will be payable on the
death of any Insured unless any of the Rider Benefits mentioned in Clause 17
and 18 below has been opted for.
On death of the Principal Insured;
a) The surviving Insured Spouse will become the Principal Insured provided
the option was execised at the beginning of the contract and the Policy will
continue. The premium in respect of the Insured Spouse shall be enhanced
from the date coinciding with or next following the instalment premium due
date as specified in Clause 9 (III).
b) If the Insured Spouse had predeceased the Principal Insured, then the
other Insured will have the option to take a new Policy and the existing
Policy will terminate. In respect of these other Insured:
i. The New Policy will be issued with out any Underwriting, if the new policy
is bought with in 90 days of the termination of the existing policy.
However, the cover available under new policy shall not exceed the
amount of cover under the existing policy.
ii. The maximum entry age condition will not apply for the new Policy.
iii. The outstanding waiting periods and outstanding period of any Exclusion
will, however, apply under the new Policy.
iv. Other terms and conditions including premium rates will be as applicable
for the new Policy.
In the event of death of an Insured person other than the Principal Insured, the
Policy will continue after removal of the Insured and change in premium will
apply from the instalment premium due date coinciding with or next following
the date of intimation of death of the Insured.
VI) Maturity Benefit: No benefits are payable at maturity of the Policy/at the end
of the Cover Period and the Policy shall stand terminated.
15. FORFEITURE IN CERTAIN EVENTS:
In case of Base Plan:
In case the premiums shall not be duly paid or in case any condition herein
contained or endorsed hereon shall be contravened or in case it is found that any
untrue or incorrect statement is contained in the proposal, personal statement,
declaration and connected documents or in case any material information is
withheld, then and in every such case this Policy shall be void and all claims to any
benefit in virtue hereof shall cease and determine and all moneys that have been
paid in consequence hereof shall belong to the Corporation, excepting always
insofar as relief is provided in terms of the Privileges herein contained or as may be
lawfully granted by the Corporation.
In case of Optional Riders (LIC's New Term Assurance Rider and LIC's
Accident Benefit Rider), if opted for:
In case any condition herein contained or endorsed hereon shall be contravened or
in case it is found that any untrue or incorrect statement is contained in the
proposal, personal statement, declaration and connected documents or any
material information is withheld, then and in every such case the riders shall be
void and all claims to any benefit in virtue hereof shall be subject to the provisions
of Section 45 of the Insurance Act, 1938, as amended from time to time.
16. ASSIGNMENTS AND NOMINATIONS:
No assignment will be allowed under this Policy.
Nomination by the holder of a policy of life assurance is required as per section 39
of the Insurance Act, 1938, as amended from time to time. The current provisions of
Section 39 are contained in Annexure-I of this policy document.
The notice of nomination or change of nomination should be submitted for
registration to the office of the Corporation, where the policy is serviced. In
registering nomination the Corporation does not accept any responsibility or
express any opinion as to its validity or legal effect.
17. LIC's ACCIDENT BENEFIT RIDER:
Accident Benefit is available on payment of additional premium provided LIC's New
Term Assurance Rider has been opted for. The benefit will not be available under
the Policy on the life of any Insured other than Principal Insured and Insured
Spouse.
Subject to stated above, If the LIC's Accident Benefit Rider is opted for, at any time
when the Rider cover is in force for the full Sum Assured as on date of accident,
this benefit shall be available only till the cover under LIC's New Term Assurance
Rider is available.
The additional premium for this benefit will not be required to be paid from the
policy anniversary at which this benefit ceases. However, the premium under the
basic plan assured shall continue to be paid years till the end of policy term,
wherever applicable.
The maximum aggregate limit of assurance under all policies including policies with
in-built Accident Benefit taken with Life Insurance Corporation of India under
individual as well as group policies on the same life to which following benefits
apply shall not in any event exceed Rs.100 lakhs. If there be more policies than one
and if the total Accident Benefit exceeds Rs. 100 lakhs, the benefits shall apply to
the first Rs. 100 lakhs Sum Assured in order of date of policies issued.
If the Insured is involved in an accident at any time when this Policy is in force for
the full Sum Assured and such injury shall within 180 days of its occurrence solely,
directly and independently of all other causes result in death of the Insured and the
same is proved to the satisfaction of the Corporation, the Corporation agrees to pay
an additional sum equal to the Accident Benefit Sum Assured under this policy.
However, the policy shall have to be in force at the time of accident irrespective of
whether or not it is in force at the time of death.
The Corporation will not be liable to pay the additional sum referred above, if or the
death of the Insured shall:
(i) be caused by intentional self injury, attempted suicide, insanity or immorality or
whilst the Insured is under the influence or consumption of intoxicating liquor,
drug or narcotic; or
(ii) take place as a result of accident while the Insured is engaged in aviation or
aeronautics in any capacity other than that of a fare paying, part-paying or non-
paying passenger in any air-craft which is authorized by the relevant
regulations to carry such passengers and flying between established
aerodromes. The Insured flying as a passenger in such capacity should have
at that time no duties on board the aircraft or require descent therefrom; or
 iv) ~r{_V `pV mam Amnam{YH$ BamXo go H$moB H$mZyZ VmoS>Zo Ho$ H$maU hB hmo, `m
v) (H$)`{X _`w ~r{_V `pV$ Ho$ ge goZm `m `w Ho$ g_` Wb goZm H$s godm (^bo hr `w Kmo{fV hmo
`m Zht) Ho$ H$maU hB hmo& `h AndOZ V~ bmJy Zht h AJa ~r{_V `pV XKQ>Zm H$m {eH$ma hAm
hmo, O~ dh S>`yQ>r _| Zht Wm `m h_mao Xoe H$s mH${VH$ {dnXmAm| Ho$ g_` {H$gr amhV H$m` _|
em{_b Wm &
(I){H$gr Wb goZm, Zm goZm `m nw{bg gJR>Z _| nw{bg H$s S>`yQ>r Ho$ H$maU hB hmo `m AndOZ Bg
pW{V _| bmJy Zht hmoJm `{X nw{bg S>`yQ>r _| H$m_ H$aVo g_` XwKQ>Zm hmoZo na XwKQ>Zm {hVbm^ Ho$
~r_o H$m {dH$n {X`m J`m hmo &
vi) `{X ~r{_V `pV H$s XKQ>Zm H$s {V{W go 180 {XZm| Ho$ ~mX hB hmo &
18. EbAmBgr H$m Z`m Amd{YH$ ~r_m amBS>a
`{X _w` ~r{_V `pV$ Ama/`m ~r{_V OrdZgmWr mam Eogo {H$gr ^r g_` Bg amBS>a H$m {dH$n
{X`m OmVm h O~ amBS>a H$m ~r_m bmJy hmo Vmo Amd{YH$ ~r_m YZam{e Ho$ ~am~a H$s A{V[aV aH$_ ~r{_V
`pV$ H$s _`w na Xo` hmoJr& Bg amBS>a _| A{YH$V_ ~r_m {ZJ_ H$s br JB g^r nm{b{g`m| Ho$ AVJV
25 bmI nE VH$ hmoJm& `{X ~mX _| `h nVm MbVm h {H$ Hw$b Amd{YH$ ~r_m YZam{e ~r{_V am{e go
A{YH$ h Vmo A{YH$V_ 25 bmI nE H$s gr_m go A{YH$ H$s AXm`Jr Zht H$s OmEJr &
`h {hVbm^ Ho$db B>g nm{bgr dfJmR> VH$ CnbY h O~ {H$ ~r{_V `pV H$s Am`w ZOXrH$s O_{XZ
na Am`w 60 df VH$ nhMZo `m nm{bgr Ho$ Ama^ hmoZo H$s {V{W go Ama^ hmoH$a 35 df H$s Ad{Y Ho$ nyao
hmoZo (Ogm {H$ AZwgyMr _| {X`m J`m h), Omo ^r nhbo hmo, VH$ CnbY h& Bg {hVbm^ Ho$ g_mflV hmoZo H$s
nm{bgr dfJmR> go H$moB r{_`_ H$mQ>m Zht OmEJm &
19. Xmdo H$s AXm`Jr
i) Bg nm{bgr Ho$ AYrZ {ZJ_ H$s Xo`Vm H$s `h nyd eV h {H$ Xmdo _| Xm{Ib H$s JB XwKQ>Zm Ho$ H$maU
emar[aH$ MmoQ> `m ~r_mar H$s pW{V _| _w` ~r{_V `pV$ (`m ~r{_V OrdZgmWr Ho$db Bg pW{V _|
O~ _w` ~r{_V `pV$ H$s nhbo _`w hmo OmE `m BgH$m ~r_m g_mflV hmo OmE)
(H$) VH$mb `m AnVmb go Nw>>r hmoZo Ho$ 30 {XZ Ho$ AXa {ZJ_ mam {ZYm[aV \$m_ _| Ama {ZJ_ mam
{ZYm[aV g_WH$ XVmdoOm| g{hV {b{IV $n _| {ZJ_ H$mo gy{MV H$aoJm; Ama
(I) AnZo OrdZ Ama g^r A` ~r{_V `pV`m| Ho$ g~Y _| emar[aH$ MmoQ> `m ~r_mar Ho$ n[aUm_V
Xmdo H$mo H$_ go H$_ H$aZo Ho$ {bE Eogo n`oH$ C{MV H$X_ CR>mEJm Ama/`m Cnm` H$aoJm; Ama
(J) {ZJ_ H$mo Eogr gyMZm VH$mb CnbY H$amEJm `m CnbY H$amZo H$s `dWm H$aoJm Ama Eogr g^r
gyMZm VWm XVmdoO Bg g~Y _| {ZJ_ H$s Xo`Vm Ho$ AnZo Xmdo Ama/`m {ZJ_ H$s Xo`Vm Ho$ g~Y
_| Eogo XVmdoO nVwV H$aoJm {OZ_| `h AZwamoY {H$`m J`m hmo Ama d` H$mo {ZJ_ mam Amd`H$
g_Po OmZo na g_`-g_` na {ZJ_ Ho$ {M{H$gm gbmhH$ma Ho$ gm_Zo OmM Ho$ {bE nVwV H$aoJm &
ii) {hVbm^ EH$_wV AXm {H$E OmEJo Ama BZH$s AXm`Jr {ZJ_ Ho$ g_mYmZ Ho$ {bE bmJy AnVmb _| ^Vu
hmoZo `m e`{M{H$gm {H$E OmZo H$m n_mU nVwV H$aZo na H$s OmEJr Ama Bg eV na H$s OmEJr {H$
Bg nm{bgr H$s eVm} Ho$ AVJV AnVmb _| ^Vu hmoZm `m e`{M{H$gm H$amZm AmVm h &
iii) {ZJ_ Bg nm{bgr Ho$ AVJV Ho$db _w` ~r{_V `pV$ H$mo AXm`Jr H$aoJm `m _w` ~r{_V `pV$
H$s _`w hmoZo na BgHo$ ~r{_V OrdZgmWr, `{X H$moB hmo, H$mo AXm`Jr H$aoJm& `{X ~r{_V `pV`m| _|
go {H$gr H$s _`w hmo OmVr h Vmo _w` ~r{_V `pV$ (`m _w` ~r{_V `pV$ H$s _`w hmoZo AWdm
~r_m g_mflV hmoZo na ~r{_V OrdZgmWr) AnVmb _| ^Vu hmoZo `m e`{M{H$gm H$amE OmZo Ho$
g~Y _| {hVbm^ H$m Xmdm H$a gH$Vr/Vm h& `h {hVbm^ Cn`wV$ _VH$ ~r{_V `pV$ H$s _`w go
nhbo {H$E JE AnVmb _| ^Vu `m e`{M{H$gm Ho$ H$maU AXm {H$`m OmEJm Ama Eogr _`w Ho$ 30
{XZ Ho$ AXa-AXa {H$`m OmEJm Ama `h ^r eV h {H$ _`w AnVmb _| ^Vu ahZo Ho$ XmamZ hB hmo
`m Cn`wV IS> 19(i)(H$) _| {ZYm[aV g_`-gr_m Ho$ AXa hB hmo &
iv) {ZJ_ mam D$na ~VmE JE AZwgma ~r{_V OrdZgmWr `m Zm{_Vr H$mo gXme`Vm go AXm`Jr H$aZo na
Eogm g_Pm OmEJm {H$ Eogo Xmdo Ho$ g~Y _| Bg nm{bgr Ho$ AVJV {ZJ_ H$s Xo`Vm H$m nyam Ama A{V_
^wJVmZ H$a {X`m J`m h &
v) amoJr H$m CnMma H$aZo dmbo {M{H$gH$/ e`{M{H$gH$ mam `m Bg AnVmb mam, {Og_| amoJr {M{H$gm
CnMma Ho$ {bE ^Vu hAm Wm, Omar {H$`m J`m n_mU-n {ZJ_ mam Xmdo na {dMma H$aZo Ho$ {bE Amd`H$
h Vm{H$ AnVmb _| ^Vu hmoZo VWm AnVmb go Nw>>r hmoZo H$s ghr VmarI Ama g_` H$s nwpQ> hmo gHo$ &
vi) AnVmb ZH$X {hVbm^ Ho$ _m_bo _| `{X JhZ n[aM`m `y{ZQ> _| CnMma H$m Xmdm {H$`m J`m hmo Vmo Bgo
Eogo CnMma Ho$ g~Y _| {O_oXma {M{H$gH$ mam n_m{UV {H$`m OmEJm {H$ JhZ n[aM`m `y{ZQ> _|
CnMma H$amZm {H$Z H$maUm| go Amd`H$ Wm Ama Bg ~mV Ho$ g~Y _| {H$ JhZ n[aM`m `y{ZQ> _| dmVd
_| CnMma {H$`m J`m h Ama JhZ n[aM`m `y{ZQ> go ^Vu hmoZo Ama Nw>>r hmoZo H$s dmV{dH$ VmarI Ama
g_` Ho$ g~Y _| n_mU-n boZm hmoJm {OgH$s nwpQ> {ZJ_ mam {Z`wV {M{H$gH$ go ^r H$amZr hmoJr &
vii) {ZJ_ EH$ `m EH$ go A{YH$ bmBg|gYmar Q>rnrE (WS> nm{Q> emgH$)$ H$s godmE ^r bo gH$Vm h Vm{H$
nemgZ Ho$ {d{^Z nhbwAm| H$s nwpQ> H$s Om gHo$ {Og_| A` ~mVm| Ho$ gmW-gmW Xmdo H$m nemgZ ^r
em{_b h& ~r{_V `{V$ Bg ~mV Ho$ {bE ^r AnZr gh_{V XoVm h {H$ dh Eogo nm{YH$V Q>rnrE (WS>
nm{Q> emgH$) H$mo g^r Amd`H$ Ama ghr gyMZm XoJm Ama nm{bgr Ho$ gwMm nemgZ Ho$ {bE Q>rnrE
(WS> nm{Q> emgH$) mam V` H$s JB n{H$`m Ama {XE JE AZwXoem| H$m nmbZ H$aoJm &
viii) Xmdo na H$madmB H$aVo g_` {ZJ_ H$mo `h A{YH$ma hmoJm {H$ dh `Wm Ano{jV {M{H$gr`,
ao{S>`mobm{OH$b, {hQ>mobm{OH$b Ama n`moJembm gm` _Jm gH$Vm h Ama _w` ~r{_V `pV$ Bg
~mV H$mo drH$ma H$aVm h {H$ dh BgHo$ OrdZ Ho$ g~Y _| Ama A` ~r{_V `pV`m| Ho$ g~Y _|
AnZo IM} na `Wm Ano{jV Eogo gm` {ZJ_ H$mo CnbY H$amZo H$s {O_oXmar boJm& ~r{_V `pV$
Bg ~mV Ho$ {bE ^r gh_V hmoJm {H$ dh d` H$mo Ama A` ~r{_V `pV`m| H$mo {H$gr Eogr
{M{H$gr` OmM Ho$ {bE, ({Og_| emar[aH$ OmM ^r em{_b h) {ZJ_ mam, {ZJ_ Ho$ nm{YH$V
H$m{_H$/S>mQ>a mam _mJ {H$E OmZo na AnZo IM} na noe H$aoJm Ama Eogr OmM Ho$ g~Y _| AZwXoem|
H$m nmbZ H$aoJm Ama gh`moJ H$aoJm& `{X _w` ~r{_V `pV$ mam Eogo gm` nVwV Zht {H$E OmVo
h `m d` H$mo AWdm A` ~r{_V `pV H$mo Eogr {M{H$gr` OmM Ho$ {bE noe Zht {H$`m OmVm h Vmo
{H$gr Xmdo na {dMma Zht {H$`m OmEJm &
ix) hmbm{H$ {ZJ_ `h gw{ZpMV H$aZo H$m nyam n`mg H$aoJm {H$ {ZJ_ mam `m Q>rnrE (A` njH$ma
nemgH$) mam Ano{jV Eogr OmM {ZJ_ mam nm{YH$V ZXm{ZH$ H|$m| Ama/`m {M{H$gH$ mam H$s OmE
Ama `h OmM gwa{jV VWm `mdgm{`H$ VarHo$ go H$s OmE& bo{H$Z _w` ~r{_V `pV$ Bg g~Y _|
{ZJ_ H$mo {O_oXma Zht R>hamEJm Ama {ZJ_ Eogr OmM Ja-`mdgm{`H$ VarHo$ go H$aZo Ama AZmno{jV
VarHo$ go H$aZo Ho$ {bE {O_oXma Zht hmoJm &
x) ~r{_V `pV Bg ~mV Ho$ {bE ^r gh_V hmoJm `m hm|Jo {H$ {ZJ_ `m BgHo$ H$m{_H$ `m BgH$m nm{YH$V
EO|Q> {H$gr {M{H$gH$, {M{H$gm n[aMa, AnVmb, {M{H$gm gWm, \$m_}gr `m {H$gr A` gJR>Z
{Og_| A` bmoJm| Ho$ gmW-gmW ~r{_V `pV$ H$m {Z`moVm ^r em{_b h, go `Wm Ano{jV ~r{_V
`pV Ho$ OrdZ Ho$ dm` Ho$ g~Y _| gyMZm nmflV H$a gH$Vm h& ~r{_V `pV$ EVXmam Eogo
`pV$, gWm `m gJR>Z H$mo nm{YH$V H$aVm h {H$ do {ZJ_ mam _mJr JB gyMZm CnbY H$amE &
xi) Xmdo Ho$ {bE Ano{jV XVmdoO {d{^Z nH$ma Ho$ Xmdm| Ho$ {bE Amd`H$ g_Po OmZo dmbo XVmdoO Bg nH$ma h
_yb `moOZm Ho$ AVJV Xmdm
(H$) nm{bgr Ho$ IS> 19(i)(H$) {d{Z{XQ> A{YgyMZm
(I) XmdmH$Vm mam (`{X XmdmH$Vm H$s _`w hmo JB hmo Vmo BgHo$ Zm{_Vr mam) ^am J`m Xmdm \$m_
(J) {ZZ{b{IV XVmdoOm| H$s _yb/gm`m{H$V n{V \$moQ>moH$mnr {H$E JE XVmdoOm| H$m gm`mH$Z
Bgr pW{V _| drH$ma {H$`m OmEJm `{X Cgo _yb XVmdoOm| H$m g`mnZ H$aZo Ho$ ~mX CnMma
H$aZo dmbo {M{H$gH$/AnVmb `m nm{YH$V Q>rnrE (A` njH$ma nemgH$) `m {ZJ_ Ho$
nm{YH$V H$m{_H$ mam {H$`m J`m hmo &
1. AnVmb go Nw>>r hmoZo H$m H$mS> {Og_| nmflV CnMma H$m {ddaU, {ZXmZ, H$s JB OmM Ama
AnVmb _| ^Vu hmoZo Ama AnVmb go Nw>>r hmoZo H$s ghr VmarI Ama g_` {X`m J`m hmo &
2. `{X e`{M{H$gm H$s JB hmo Vmo e`{M{H$gH$ Ho$ mam AmnaoeZ g~Yr ZmoQ> H$s n{V `m
gma (~eV] {H$ XmdmH$Vm Zo e`{M{H$gm H$admB hmo) &
3. `{X CnMma Ho$ XmamZ amoJr H$s _`w hmo JB hmo Vmo _`w g~Yr gmame (S>oW g_ar)&
4. Cn`w$ 19(vi) Ho$ AVJV {M{H$gH$ mam Omar {H$`m J`m n_mU-n &
5. AnVmb _| ^Vu ahZo Ama/`m e`{M{H$gm ({Og_| AmnmV pW{V _| E~wb|g H$s godm boZo)
Ho$ XmamZ {H$E JE `` Ho$ g~yV Ho$ $n _| IM} H$m {~b &
(K) `{X Am`w H$m CboI nhbo Zht {H$`m J`m hmo Vmo, Am`w H$m n_mU &
(S>) Eogm A` XVmdoO Omo Xmdo Ho$ _y`mH$Z Ho$ XmamZ _mJm OmE &
Amd{YH$ amBS>a {hVbm^ Xmdm _yb nm{bgr ~mS>, {ZYm[aV Xmdm nn Omo {d{YdV ^am J`m
hmo, _yb _`w n_mU-n, hH$Xmar H$m g~yV, A{V_ ~r_mar H$s VmarI go nhbo `m BgHo$ ~mX
{bE JE {M{H$gm CnMma H$m g~yV, {OgHo$ XmamZ _`w hB h& Am`w H$m n_mU, `{X nhbo Am`w
H$m CboI Zht {H$`m J`m hmo &
XwKQ>Zm Ho$ H$maU _`w na Xmdm Cn`wV Amd{YH$ amBS>a {hVbm^ Xmdo erfH$ Ho$ AVJV
Cpb{IV XVmdoOm| Ho$ Abmdm, XwKQ>Zm H$m g~yV, nMZm_m, E\$AmBAma/nw{bg H$s OmM
[anmoQ>, CnMma H$aZo dmbo {M{H$gH$ H$s [anmoQ>/ AnVmb H$s [anmoQ>, AnVmb go Nw>>r H$m
gmame, nmoQ> _mQ>_(ed-narjm) H$s [anmoQ>, Omo ^r bmJy hmo &
xii) H$nQ>: `{X H$moB ^r ~r{_V `pV$ `m XmdmH$Vm Eogm H$moB Xmdm H$aVm h `m Xmdo H$s noeJr boVm h {OgHo$ g~Y
_| Cgo OmZH$mar h {H$ dh PyR>m h `m H$nQ>nyU h, ^bo hr `h aH$_ Ho$ g~Y _| hmo `m A`Wm, Vmo `h nm{bgr
VH$mb a hmo OmEJr Ama BgHo$ mam AXm {H$E JE nr{_`_ OV H$a {bE OmEJo Ama Bg nm{bgr Ho$ AVJV
g^r ~r{_V `pV`m| Ho$ g^r Xmdo Ama AXm`{J`m OV hmo OmEJr& Eogr {H$gr dm` g~Yr ~mV `m
~r_mar/pW{V/AdWVm/e`{M{H$gm H$mo Z ~VmZm Omo `h nm{bgr boZo go nhbo hB hmo `m Bg nm{bgr
H$s `nJV Ad{Y Ho$ XmamZ hB hmo, ^bo hr `h Bg ~r_mar/amoJ e`{M{H$gm H$s AdWm go g~{YV hmo `m
Zht {OgHo$ g~Y _| ~r{_V `pV$ H$mo AnVmb _| ^Vu {H$`m J`m/CgH$m CnMma {H$`m J`m, Vmo dh ^r H$nQ>
_mZm OmEJm Ama BgHo$ g~Y _| ^r `h _mZm OmEJm {H$ ~r{_V `pV$ Zo _hdnyU gyMZm {N>nmB h &
20. gm_m` eV}
I) ~r{_V `pV$ Ho$ H$m` Ama Xm{`d Ama ~r{_V `pV mam C{MV AZwnmbZ
i) _w` ~r{_V `pV {H$gr A` ~r{_V `pV H$s _`w `m H$mZyZr nWH$H$aU H$s gyMZm
8
(iii) be caused by injuries resulting from taking any part in riots, civil commotion,
rebellion, war (whether war be declared or not), invasion, hunting,
mountaineering, steeple chasing, racing of any kind, paragliding or
parachuting, taking part in adventurous sports; or
(iv) result from the Insured committing any breach of law with criminal intent; or
(v) (a) arise from employment of the Insured in the armed forces or military
service of any country at war (whether war be declared or not). This
exclusion is not applicable if the Insured was involved in an accident when he
is not on duty or was involved in any rescue operations while combating
natural calamities in our country.
(b) arise from being engaged in police duty in any military, naval or police
organization. This exclusion is not applicable where the option to cover Accident
Benefit arising on accident while engaged in police duty, has been chosen; or
(vi) occur after 180 days from the date of accident of the Insured.
18. LIC's New TERM ASSURANCE RIDER:
If this Rider is opted for by the Principal Insured and/or Insured Spouse, at any
time when the Rider cover is inforce, an additional amount equal to the Term
Assurance Sum Assured will be payable on the death of the Insured. The
maximum cover for this Rider will be Rs.25 lakh under all policies of the Insured
with the Corporation taken together. In case it is subsequently revealed that the
total Term Assurance Sum Assured exceeds the maximum limit of Rs.25 lakh, the
excess shall not be payable.
This benefit shall be available only till the policy anniversary on which the age
nearer birthday of the Insured is 60 years or for a term of 35 years starting from
the date of cover commencement (as given in the schedule), whichever is earlier.
No premium for this benefit shall be deducted from the Policy anniversary at which
the benefit ceases.
19. CLAIM PAYMENTS:
i. It is a condition precedent to the Corporation's liability under this Policy that in
the event of any Accidental Bodily Injury or Sickness that may give rise to a
claim, the Principal Insured (or the Insured Spouse, only in case of prior death
or cover expiry of the Principal Insured):
a. shall immediately and in any event within 30 days from the date of
discharge provide the Corporation with written notification of a claim in the
forms prescribed by the Corporation and along with the supporting
evidences as prescribed by the Corporation and
b. shall take every other reasonable step and / or measure to minimize the
consequences of the Bodily Injury or Sickness in respect of their own lives
and all other Insureds, and
c. shall expeditiously provide the Corporation with or arrange for the
Corporation to be provided with any and all information and
documentation in respect of the claim and/or the Corporation's liability
hereunder that may be requested, and submit himself for examination by
the Corporation's medical advisors as often as may be considered
necessary by the Corporation.
ii. The benefits shall be paid as a lump sum and will be subject to providing
proof of occurrence of Hospitalization or Surgery as applicable to satisfaction
of the Corporation and subject to Hospitalization or Surgery being covered
under the terms of this Policy.
iii. The Corporation shall only make payment under this Policy to the Principal
Insured or in the event of death of the Principal Insured, to the Insured
Spouse, if existing. In case of death of any of the Insured, the Principal
Insured (or the Insured spouse, in case of death or cover expiry of the
Principal Insured) can claim the benefits in respect of the Hospitalization or
Surgery that occurred prior to the death of the said deceased Insured, within
30 days of such death and provided that the death occurred during
Hospitalization or within the time limit stipulated in clause 19(i)(a) above.
iv. Any payment made in good faith to the Insured Spouse or the nominee by the
Corporation as aforesaid shall operate as a complete and final discharge of
the Corporation's liability to make payment under this Policy for such claim.
v. A written certification from the Physician/Surgeon who attended on the patient
and from the hospital where the patient was warded for medical treatment, as
to the treatment in the Hospital having actually occurred during hospitalization
as to the exact date and time of admission to and discharge from the Hospital
is necessary for the Corporation to consider a claim.
vi. In case of a Hospital Cash Benefit, claim treatment in an Intensive Care Unit
needs to be certified by the Physician responsible for such treatment, to the
effect that the treatment in the Intensive Care Unit as having been necessary
with reasons for the same and the treatment in the Intensive Care Unit having
actually occurred and the exact date and time of admission to and discharge
from in the Intensive Care Unit along with a confirmation from a physician
appointed by the Corporation.
vii. The Corporation may use the services of one or more licensed Third Party
Administrator (TPA) to manage various aspects of administration including but
not limited to claims administration. The Insured agrees to provide all
necessary and accurate information to such authorized TPA and follow the
processes and instructions as stipulated by such TPA for smooth
administration of the policy.
viii. In processing of a claim, the Corporation reserves the right to call for any
clinical, radiological, histological and laboratory evidence as may be required
and the Principal Insured agrees to take on the responsibility of providing
such evidence as required by the Corporation on his life and that of the other
Insureds at his own expense. The Insured also agrees to submit himself and
other Insureds and undergo at his own expense, any medical investigation
(including physical examination) as may be required by the Corporation, by
personnel/Doctors authorized by the Corporation and to comply and co-
operate with such instructions of such investigation. No claim shall be
considered in case of failure of the Principal Insured to provide such evidence
or submit himself or any of the other Insureds to such medical investigations.
ix. While the Corporation shall do its best to ensure that such investigation called
for by the Corporation or by the TPAs at the Diagnostic Centres and/or by the
Doctors authorized by the Corporation shall be carried out in a safe and
professional manner, the Principal Insured shall not hold the Corporation and
the Corporation shall not be responsible for any unprofessional conduct and
unexpected effects of such investigation.
x. The Insured/s also agree to the Corporation or its personnel or its authorized
agents in seeking any personal information affecting the health of the Assured
life as may be required by the Corporation from any Doctor, Medical
attendant, Hospital, medical institution, pharmacy or any organisation
including but not limited to the employer of the Insured. The Insured hereby
authorize any such person, institution or organisation to provide the
Corporation with the information requested.
xi. Documents Required for Claim: The documents required for consideration
of various types of claims are mentioned below :
Claim under the Basic Plan:
a. Notification as specified in Clause 19(i)(a) of the Policy.
b. Claim form completed by the claimant (by nominee in case of death of claimant).
c. Original/attested copy of the following documents. The attestation of the
photocopied documents will be accepted if done by the treating Doctor/Hospital
or by the TPA or by authorized personnel of the Corporation after verification of
the originals:
1. Discharge card with details of treatment received, diagnosis and
investigation done as well as the correct date and time of admission and
discharge from hospital.
2. Copy or Summary of surgeon's operation notes where surgical intervention
done (in case the claimant has undergone a surgery).
3. A death summary in case of death of the patient while under treatment.
4. Certificate from Physician as under clause 19(vi) above.
5. Bills of expenses as proof of expenses during hospitalisation and/or
Surgery (including emergency ambulance).
d. Proof of age, if the age is not admitted earlier.
e. Any other document that may be called for in the course of claim evaluation.
Term Rider Benefit Claim: Original Policy Bond, prescribed Claim Forms,
duly completed, Original Death Certificate, Proof of title, Proof of medical
treatment taken prior to and after the date of last illness in which death
takes place, Age Proof, if the age is not admitted earlier.
Claim on Death due to Accident: Besides the documents mentioned
above under the caption 'Term Rider Benefit Claim', Proof of accident,
Panchnama/ FIR, Police Investigation Report, Attending Physician's
report/ Hospital Report, Discharge Summary, Post Mortem Report,
whichever is applicable.
xii. Fraud: If any of the Insured or the claimant shall make or advance any claim
knowing the same to be false or fraudulent as regards amount or otherwise, this
Policy shall immediately become void, the premiums paid forfeited and all claims
or payments in respect of all the Insured under this Policy shall be forfeited. Non-
disclosure of any health event or ailment/condition/sickness/Surgery which
occurred prior to the taking of this Policy, or during the lapsed period of this Policy,
whether such condition is relevant or not to the ailment/ disease/ Surgery for
which the Insured is admitted/treated, shall also constitute Fraud or material non-
disclosure by the Insured.
20. GENERAL CONDITIONS:
 VH$mb {ZJ_ H$mo XoJm &
ii) ~r{_V OrdZgmWr, ~r{_V _mVm-{nVm `m ~r{_V ~Mo (`m `{X ~r{_V ~o Ad`H$ hm| Vmo
Zm{_Vr) _w` ~r{_V `pV$ H$s _`w H$s gyMZm {ZJ_ H$mo VH$mb XoJm &
iii) _w` ~r{_V `pV$ Ano{jV VarHo$ go {ZJ_ go AnZo H$mZyZr OrdZgmWr Ho$ ~mao _| AZwamoY
H$aoJm {H$ Cgo ^r ~r{_V H$a {X`m OmE, bo{H$Z Bg nH$ma H$m AZwamoY ~r{_V OrdZgmWr go
{ddmh H$aZo Ho$ 6 (N>h) _mh Ho$ AXa {H$`m OmEJm& ~r{_V OrdZgmWr H$m ~r_m Bg VmarI go
_mZm OmEJm {Og VmarI H$mo _w` ~r{_V `pV$ H$mo {ZJ_ mam gy{MV {H$`m OmE ~eV} {H$
BgZo g^r Amd`H$ gm` nVwV {H$E hm| Ama {ZJ_ BZgo gVwQ> hmo &
iv) _w` ~r{_V `pV$ {ZJ_ mam Ano{jV VarHo$ go {ZJ_ go AZwamoY H$aoJm {H$ dh _w` ~r{_V
`pV$ Ho$ dY ~Mo H$mo Bg_| em{_b H$ao, `m|{H$ nm{bgr H$s dfJmR> go nhbo H$^r ^r ~Mo Zo
VrZ _mh H$s Am`w hmb hr _| nyar H$s hmo& H$mZyZr Vma na JmoX {bE JE ~Mo Ho$ _m_bo _| JmoX boVo
g_` VrZ _mh go A{YH$ C_ Ho$ ~Mo Ho$ g~Y _| _w` ~r{_V `pV$ {ZJ_ mam Ano{jV
VarHo$ go {ZJ_ go AZwamoY H$a gH$Vm h {H$ dh nm{bgr H$s dfJmR> go nhbo {H$gr ^r g_` Bg
~Mo H$m ~r_m H$a Xo Ama ~Mo H$mo JmoX boZo H$s VmarI go dh AZwamoY H$a gH$Vm h& Eogo ~r{_V
~Mo H$m ~r_m {ZJ_ mam gy{MV {H$E OmZo H$s VmarI go bmJy hmoJm ~eV] {H$ g^r Amd`H$
gm` nVwV {H$E JE hm| Ama {ZJ_ BZgo gVwQ> hmo &
II) jor` gr_mE
{hVbm^ Bgr pW{V _| Xo` hm|Jo `{X ~r{_V `pV$ ^maV _| AnVmb _| ^Vu hAm hmo Ama/`m Eogr
e`{M{H$gm ^maV _| H$s JB hmo Ama AXm`Jr Ho$ g~Y _| {ZJ_ H$s Xo`Vm `h hmoJr {H$ dh ^maV _|
hr AXm`Jr H$aoJm Ama Ho$db ^maVr` n`o _| AXm`Jr H$aoJm &
21. H$a
H$moB H$a Xo` hmoZo na do g_`-g_` na bmJy H$a g~Yr H$mZyZm| Ho$ AZwgma VWm H$a H$s Xa go bmJy hm|Jo&
H$a H$s am{e _mOyXm Xa go nm{bgrYmaH$ Ho$ mam Xo` r{_`_ Ed A{V[aV r{_`_ na bmJy hmoJr &
22. dYm{ZH$ n^ma
Bg nm{bgr Ho$ AVJV Xo` nr{_`_ Ama {hVbm^ g{hV eVm} Ama {V~Ym| _| n[adVZ VH$mbrZ bmJy 22.
{dYmZ Ama {d{Z`_m| Ho$ AZwgma hm|Jo &
23. Hy$qbJ-Am\$ nr[a`S>
`{X nm{bgrYmaH$ nm{bgr H$s eVm} Ama {V~Ym| go gVwQ> Z hmo Vmo dh nm{bgr nmflV hmoZo H$s VmarI go 23.
15 {XZ Ho$ AXa {ZJ_ H$mo `h nm{bgr bmQ>m gH$Vm h& {ZJ_ Bg nm{bgr H$mo a H$a XoJm Ama AXm {H$E
JE nr{_`_m| H$mo dmng H$a XoJm, naVw Bg_| go {ZZ{b{IV H$Q>m{V`m H$s OmEJr (1) nm{bgr go g~{YV
Q>n S>`yQ>r, (2) _yb `moOZm Ama amBS>a, `{X {dH$n {X`m J`m hmo, Ho$ AYrZ Omo{I_ H$m nr{_`_,
(3) ~r{_V `pV$ H$s {M{H$gm OmM H$admZo na {ZJ_ mam {H$`m J`m H$moB `` &
~r_m A{Y{Z`_, 1938 H$s Ymam 45
~r_m A{Y{Z`_ 1938 Ho$ AZwN>oX 45 Ho$ mdYmZ Ho$db am`S>a {hVbm^ (Eb Am` gr Z`m Amd{YH$
~r_m am`S>a Ama Eb Am` gr XwKQ>Zm {hV bm^ am`S>a) {Og_o bmB\$ H$da KQ>H$ em_rb h, Ho$ {bE hr
bmJy hm|Jo&
`Wmgemo{YV ~r_m A{Y{Z`_ 1938 Ho$ AZwN>oX 45 Ho$ mdYmZ bmJy hm|Jo& _mOyXm mdYmZ _| nm{bgr
S>m`w_|Q> Ho$ n[a{e> II _o {XE JE h&
{eH$m`V {ZamH$aU aMZm:
JmhH$m| H$s {eH$m`Vm| H$m {ZamH$aU H$aZo hoVw {ZJ_ Zo emIm/{d^mJ/jor`/H|$r` H$m`mb` Ho$ Va na
{eH$m`V {ZamH$aU A{YH$mar H$s {Z`wpV H$s h& JmhH$m| H$s {eH$m`Vm| H$m OX {ZamH$aU gw{ZpMV H$aZo
hoVw {ZJ_ Zo AnZo JmhH$ nmoQ>b (do~gmBQ>) http://www.licindia.in, Ho$ _m`_ go JmhH$ gMmbZ
`mo` EH$mp_H$ {eH$m`V `dWmnZ Um{b VwV H$s h, Ohm na nOrH$V nm{bgr YmaH$ AnZm
AgVmof/{eH$m`V `j XO H$a gH$Vo h, VWm CgH$s pW{V H$m AdbmoH$Z H$a gH$Vo h& {eH$m`Vm|
Ho$ {ZamH$aU Ho$ hoVw JmhH$ co_crmgrv@licindia.com Bg B-_ob AmBS>r na gnH$ H$a gH$Vo h&
`{X JmhH$ {_bo Odm~ go gVw> Zhr h `m h_go 15 {XZm| Ho$ ^rVa Odm~ Zht nmVm h, Vmo dh JmhH$
AmBAmaS>rEAmB Ho$ {eH$m`V H$j go {H$gr ^r {ZZ{b{IV _mJ go gnH$ H$a gH$Vo h&
Q>mob \$s g`m 155255/18004254732 (`m{Z AmBAmaS>rEAmB {eH$m`V H$j H|$) na H$mb
H$a|&
complaints@irda.gov.in na B-_ob ^oO H$a
http://www.igms.irda.gov.in na {eH$m`V XO H$a|&
JmhH$ _m_bm {d^mJ, ^maVr` ~r_m {Z`U VVm {dH$mg m{YH$aU, 9dr _{Ob, `wZmBQ>oS>
B{S>`m Q>mdg, ~era~mJ, hXam~mX - 500029, AmY Xoe Ho$ nVo na {eH$m`V nmam/Hw$[a`a
mam ^oO H$a&
040-66789768 na AnZr {eH$m`V \$g na ^oO X|&
_`w Xmdm n[a`mJ Ho$ {ZU` go AgVw> XmdoXmam| Ho$ nmg AnZo _m_bm| H$m nwZ:arjU H$aZo Ho$ {bE jor`
H$m`mb` Xmdm {ddmX {ZamH$aU g{_Vr `m H|$r` H$m`mb` Xmdm {ddmX {ZamH$aU g{_Vr Ho$ nmg ^oOZo
H$m {dH$n CnbY h& CM `m`mb`/{Obm `m`mb` Ho$ godm {Zdm `m`m{Ye `oH$ Xmdm {ddmX
{ZamH$aU g{_Vr Ho$ gX` ah|Jo& Xmdm| Ho$ gX^ _| {eH$m`Vm| Ho$ {ZamH$aU hoVw XmdoXma ~r_m bmH$nmb go
^r gnH$ H$a gH$Vo h, Omo JmhH$m| H$mo H$_ I{Mbm VWm ObX _`W {ZU` XoZo H$m n~Y H$aVo h&
I) Duties and Obligations and Due Observance of the Insured:
i. The Principal Insured shall immediately inform the Corporation of the death
or legal separation of any other Insured.
ii. The Insured Spouse, Insured Parent or Insured Child (or the Appointee, in
case of the Insured Child/ren being minor/s) shall immediately inform the
Corporation of the death of the Principal Insured.
iii. The Principal Insured may apply to the Corporation in the manner required by
it to include his or her legal spouse as an Insured Spouse at any time but
within 6 (six) months of the marriage to the Insured Spouse. The cover in
respect of the Insured Spouse shall commence from the date as
communicated by the Corporation to the Principal Insured, subject to the
fulfillment of all evidence necessary and to the satisfaction of the Corporation.
iv. The Principal Insured may apply to the Corporation in the manner required
by it to include a legitimate child of the Principal Insured as an Insured
Child at any time before the Policy anniversary that occurs immediately
after the child attains 3 months of age. In case of a legally adopted child
older than 3 months at the time of adoption, the Primary Insured may
apply to the Corporation in the manner required by it to include the child
as an Insured Child at any time before the Policy anniversary that occurs
immediately after or coinciding the date of adoption of the child. The
cover in respect of the Insured Child shall commence from the date as
communicated by the Corporation, subject to the fulfillment of all evidence
necessary and to the satisfaction of the Corporation.
II) Territorial Limits :
The Benefits shall be payable if such Hospitalization and/or such Surgery has
occurred only in India, and the Corporation's liability to make any payment
shall be limited to payments within India and in Indian Rupees only.
21. TAX:
Taxes, if any, shall be as per the Tax laws and the rate of tax shall be as applicable
from time to time. The amount of tax as per the prevailing rates shall be payable
by the policyholder on premiums including extra premiums, if any.
LEGISLATIVE CHANGES:
The Terms and Conditions including the premiums and benefits payable under this
policy are subject to variation in accordance with the relevant Legislation &
Regulations.
COOLING-OFF PERIOD:
If the policyholder is not satisfied with the "Terms and Conditions" of the policy,
he/she may return the policy to the Corporation within 15 days from the date of
receipt of the policy. The Corporation will cancel the policy and return the premium
paid subject to the following deductions: 1) Stamp duty on the policy 2)
Proportionate Risk Premium for the period on cover 3) Any expense borne by the
Corporation on medical examination and special reports, if any of the Insured
persons.
SECTION 45 OF INSURANCE ACT, 1938
The Section 45 of the Insurance Act, 1938 is applicable only to the rider(s)
benefits (LIC's New Term Assurance Rider & LIC's Accident Benefit Rider) having
life cover component.
The provisions of Section 45 of the Insurance Act, 1938 shall be applicable as
amended from time to time. The current provisions are contained in Annexure-II of
this policy document.
Grievance Redressal Mechanism:
The Corporation has Grievance Redressal Officers at Branch/ Divisional/ Zonal/
Central Office to redress grievances of customers. For ensuring quick redressal of
customer grievances the Corporation has introduced Customer friendly Integrated
Complaint Management System through our Customer Portal (website) which is
http://www.licindia.in, where a registered policy holder can directly register
complaint/ grievance and track its status. Customers can also contact at e-mail id
co_crmgrv@licindia.com for redressal of any grievances.
In case the customer is not satisfied with the response or do not receive a
response from us within 15 days, then the customer may approach the Grievance
Cell of the IRDAI through any of the following modes:
Calling Toll Free Number 155255 / 18004254732 (i.e. IRDAI Grievance
Call Centre)
Sending an email to complaints@irda.gov.in
Register the complaint online at http://www.igms.irda.gov.in
Address for sending the complaint through courier / letter:
Consumer Affairs Department, Insurance Regulatory and Development
Authority of India, 9th Floor, United India Towers, Basheerbagh,
Hyderabad - 500 029, Andhra Pradesh.
Sending the complaint by Fax to 040-66789768
Claimants not satisfied with the decision of death claim repudiation have the
option of referring their cases for review to Zonal Office Claims Dispute Redressal
Committee or Central Office Claims Dispute Redressal Committee. A retired High
Court/ District Court Judge is member of each of the Claims Dispute Redressal
Committees. For redressal of Claims related grievances, claimants can also
approach Insurance Ombudsman who provides for low cost and speedy
arbitration to customers.

X{ZH$ XoI^mb n{H$`m {hVbm^ AZw~Y Day Care Procedure Benefit Annexure
H$_ g. X{ZH$ XoI^mb e`{M{H$gm S.No. DAY CARE SURGERIES
H$mZ Ho$ ~rM _| _mBH$mog{OH$b AmoeZ Microsurgical Operations on the Middle ear
1. Q>onoS>moQ>mo_r 1 Stapedotomy
2. Qo>nr{S>Q>mo_r 2 Stapedectomy
3. Qo>nrSo>Q>mo_r _| gwYma 3 Revision of Stapedectomy
4. Am{S>Q>ar Am{gH$g H$m A` AmoeZ 4 Other operations on the Auditory Ossicles
5. {_[aJmoflbmQ>r (Q>mBn I {Q>nZmoflbmQ>r) 5 Myringoplasty (Type-I Tympanoplasty)
6. {Q>nZmoflbmQ>r (B`aS>_ na\$moaoeZ H$mo ~X H$aZm/Am{S>Q>moar Am{gH$g H$m nwZ{Z_mU H$aZm) 6 Tympanoplasty (Closure of Eardrum Perforation / reconstruction of the Auditory Ossicles)
7. Jmo_oQ> S>mbZo g{hV {_[aJmoQ>mo_r 7 Myringotomy with Grommet Insertion
8. _Q>mo`S> {\$gwbm ~X H$aZm 8 Closure of Mastoid Fistula
9. {Q>nZmoflbmQ>r _| gwYma 9 Revision of a Tympanoplasty
10. H$mZ Ho$ ~rM _| Ama AXa A` _mBH$mog{OH$b AmoeZ H$aZm 10 Other microsurgical operations on the Middle Ear
H$mZ Ho$ ~rM Ama AXa A` AmoeZ Other Operations on the Middle and Internal Ear
11. {_[aJmoQ>mo_r 11 Myringotomy
12. ~mhar H$mZ go ~oqZJ Q>`y_a hQ>mZm 12 Benign Tumour removal from the external ear
13. _Q>mo`S> n{H$`m Ama H$mZ Ho$ ~rM H$m AmoeZ 13 Incision of the mastiod process and Middle ear
14 gmYmaU _Q>m`S>oQ>mo_r 14 Simple Mastoidectomy
15. ~rM Ho$ H$mZ H$m nwZ {Z_mU H$aZm 15 Reconstruction of the middle ear
16. _` H$mZ Ama AmV[aH$ H$mZ H$m A` AmoeZ 16 Other excisions of the middle and inner ear
17. AmV[aH$ H$mZ H$m \o$ZoQo>eZ 17 Fenestration of the inner ear
18. AmV[aH$ H$mZ Ho$ \o$ZoQo>eZ _| gwYma 18 Revision of fenestration of the inner ear
19 noQ>g Eo{ngoQ>mo_r 19 Petrous Apicectomy
20. AmV[aH$ H$mZ H$m A` _mBH$mog{OH$b AmoeZ 20 Other microsurgical operations on the inner ear
Operations on the nose and nasal sinuses
ZmH$ Ama ZmH$ Ho$ gmBZg H$m AmoeZ
21 Excision and destruction of diseased tissue of the nose
21. ZmH$ Ho$ amoJJV D$VH$m| H$mo hQ>mZm Ama ZQ> H$aZm 22 Operation on Nasal Turbinates
22. ZmH$ Ho$ Q>{~ZoQ> H$m AmoeZ H$aZm 23 Septoplasty (medically necessitated)
23. goflQ>moflbmQ>r ({M{H$gr` $n go Amd`H$) 24 Functional Endoscopic Sinus Surgery
24. \$eZb ES>moH$mo{nH$ gmBZg H$s e`{M{H$gm 25 Endoscopic placement /removal of stents
25. ES>moH$mo{nH$ bJmZm/Q|>Q>g H$mo hQ>mZm Operations on the Eyes
AmIm| H$m AmoeZ 26 Dacrocystorhinostomy
26. S>mBH$mo{gQ>moZmoQ>mo_r 27 Other Operations for tear gland/ duct lesions
27. {Q>`a bS>/S>Q> bgZ Ho$ A` AmoeZ 28 Tarsorraphy
28. Q>magmoao\$s 29 Excision of the diseased tissue of the eyelid
29. AmI H$s nwV{b`m| Ho$ amoJJV D$VH$m| H$mo hQ>mZm 30 Operations of canthus and epicanthus when done for adhesions due to chronic infections
30. XrKH$m{bH$ gH$_U Ho$ H$maU ESo>gZ {H$E OmZo na H$Wg Ama BnrH$Wg H$m AmnofZ 31 Corrective surgery of entropion
31. EQ>mo{n`Z H$mo R>rH$ H$aZo Ho$ {bE e`{M{H$gm 32 Corrective surgery for blepharoptosis
32. co\$mamonQ>mo{gg H$mo R>rH$ H$aZo Ho$ {bE e`{M{H$gm 33 Excision of lacrimal sac and passage
33. bH$s_b gH$ Ama ngoO H$mo hQ>mZm 34 Removal of a deep or embedded foreign body from cornea
34. H$m{Z`m go ~mhar MrO H$mo JhamB go `m Wm`r Vma na hQ>mZm

9
 35. BQ>mo{n`Z H$mo R>rH$ H$aZo Ho$ {bE e`{M{H$gm 35 Corrective surgery of ectropion
36. JmpQ>J g{hV `m {~Zm J{mQ>J Ho$ flQo>[a{O`_ H$m AmoeZ 36 Operations for Pterygium with or without grafting
37. H$m{Z`m Ho$ A` AmoeZ 37 Other operations on the cornea
38. AmI Ho$ bg go ~mhar MrO H$mo hQ>mZm 38 Removal of a foreign body from the lens of the eye
39. AmI Ho$ nmoQ>r[a`a M~a go ~mhar MrOm| H$mo hQ>mZm 39 Removal of a foreign body from posterior chamber of the eye
40. Am{~Q> Ama AmB~mb go ~mhar MrOm| H$mo hQ>mZm 40 Removal of a foreign body from orbit and eyeball
41. _mo{V`mq~X H$s e`{M{H$gm (BQ>am Am`wba bg g{hV `m {~Zm bg Ho$ BgrgrB `m 41 Cataract Surgery ( ECCE or Phacoemulsification with or without intraocular
\$mH$mo_b{g{\$Ho$eZ) lens implant)
42. cyH$mo_m H$m AmoeZ 42 Operation for glaucoma
43. H$OpQ>db bn g{hV H$m{Z`m bogaoeZ `m Kmd H$m CnMma 43 Repair of corneal laceration or wound with conjunctival flap
dMm Ama g~`wQo>{Z`g D$VH$m| H$m AmoeZ Operations on the skin and subcutaneous tissues
44. nmBcmoZmBS>b gmBZg H$s e`{M{H$gm 44 Surgery for pilonidal sinus
45. e`{M{H$gm Kmd Q>m`boQ> (Kmd So>~arSo>_|Q>) Ama EZoWr{g`m go dMm Ama g~`wQo>{Z`g 45 Surgical wound toilet (Wound debridement) and removal of diseased tissue of
D$VH$m| Ho$ amoJJV D$VH$m| H$mo hQ>mZm the skin and subcutaneous tissues under anaesthesia
46. EZoWr{g`m go dMm Ama g~`wQo>{Z`g D$VH$m| Ho$ amoJJV D$VH$m| H$mo WmZr` $n go hQ>mZm `m ZQ> H$aZm 46 Local excision or destruction of diseased tissue of skin and subcutaneous
tissues under anaesthesia
47. nmBcmoZmBS>b {gQ> H$s e`{M{H$gm 47 Surgery for pilonidal cyst
48. Ohm CnMma {H$`m J`m hmo, dhm nwZ dMm bJmZm 48 Free skin transplantation, recipient site
49. dMm flbm>r H$mo R>rH$ H$aZm 49 Revision of skin plasty
50. dMm H$ga H$s H$s_mo e`{M{H$gm 50 Chemosurgery for skin cancer
{Ohdm H$m AmoeZ H$aZm Operations on the tongue
51. {Ohdm Ho$ amoJJV D$VH$m| H$mo R>rH$ H$aZm, hQ>mZm Ama ZQ> H$aZm 51 Incision, excision and destruction of diseased tissue of the tongue.
52. Am{fH$ bygoQ>mo_r 52 Partial glossectomy
53. {Ohdm H$m nwZ{Z_mU H$aZm 53 Reconstruction of the tongue
54. {Ohdm Ho$ A` AmoeZ 54 Other operations on the tongue
55. bma JWr Ama bma S>Q> H$mo R>rH$ H$aZm `m CgH$s bqgJ H$aZm 55 Incision and lancing of salivary glands and Salivary ducts
56. bma JWr Ama bma S>Q> Ho$ amoJJV D$VH$m| H$mo hQ>mZm 56 Excision of a diseased tissue of salivary glands and Salivary ducts
57. bma S>Q> g{hV `m CgHo$ {~Zm bma JWr H$mo R>rH$ H$aZm 57 Resection of a salivary gland with or without salivary duct
58. bma JWr Ama bma S>Q> H$m nwZ{Z_mU H$aZm 58 Reconstruction of a salivary gland and salivary duct
59. Iwbr {gAmbmo{bWmoQ>mo_r 59 Open Sialolithotomy
_wh Ama Mohao Ho$ A` AmoeZ Other operations on the mouth and face
60. _wh, O~So> `m Mohao Ho$ Amgnmg ~mh` {Q>`wAmo H$mo R>rH$ H$aZm `m So>ZoO H$aZm 60 External incision and drainage in the region of the mouth, jaw and face
61. amoJJV hmS> Ama gmQ> Vmbw H$mo hQ>mZm 62.Amoamo\o$[a{Zg go amoJJV T>mMo H$mo hQ>mH$a 61 Excision of the diseased hard and soft palate
~m`flgr H$aZm Ama/`m Cgo hQ>mZm 62 Excision biopsy and/or destruction of diseased structures from the oropharynx.
63. flbQ>moflbmQ>r 63 Palatoplasty
64. _wh Ho$ A` AmoeZ 64 Other operations in the mouth
Q>m{gc Ama ESo>Zm`S> H$m AmoeZ Operations on the tonsils and adenoids
65. \$arZOrb A~gog Ho$ Q>m{gbm| H$mo hQ>mZm Ama So>ZoO H$aZm 65 Transoral incision and drainage of a pharyngeal abscess
66. ESo>Zm`So>Q>mo_r Ho$ {~Zm Q>m{gb hQ>mZm 66 Tonsillectomy without adenoidectomy
67. ESo>Zm`So>Q>mo_r g{hV Q>m{gb hQ>mZm 67 Tonsillectomy with adenoidectomy
68. qbJwAb Q>m{gb H$mo hQ>mZm `m ZQ> H$aZm 68 Excision and destruction of a lingual tonsil
69. Q>m{gb Ho$ A~gogog/q$gr H$m So>ZoO 69 Drainage of tonsillar abscess/quinsy
A{^KmV e`{Mpgm Ama AmWm}no{S>g Trauma surgery and orthopaedics
70. gopflQ>H$ Ama AgopflQ>H$ pW{V _| ApW H$mo R>rH$ H$aZm Ama So>ZoO H$aZm 70 Incision and Drainage of the bone for septic and aseptic conditions
71. \o$Ma H$mo ~X H$aZm 71 Closed reduction of fracture
72. g~-bgoeZ H$mo ~X H$aZm 72 Closed reduction of sub-luxation
73. AmQo>`moqgWo{gg g{hV Eo{n{\${O`mob{gg 73 Epiphyseolysis with osteosynthesis
74 Suture and other Operations on tendons and tendon sheath
74. Q|>S>m|g Ama Q|>S>Z erW H$m gmoMa Ama A` AmoeZ
75 Reduction of dislocation under GA
75. Or E Ho$ AVJV {S>bmoHo$eZ H$mo H$_ H$aZm 76 Arthoscopic knee aspiration
76. AmWm}H$mo{nH$ Zr EpnaoeZ Operations on the breast
N>mVr H$m AmoeZ 77 Incision and Drainage of breast abscess
77. N>mVr Ho$ A~gog H$mo R>rH$ H$aZm Ama So>ZoO H$aZm 78 Operations on the nipple except congenitally inverted nipples
78. H$m|Oo{Z`br BZd{Q>S> {Zflnb Ho$ {gdm` {Zflnb H$m AmoeZ H$aZm Operations on the digestive tract
nmMZ Q>Q> H$m AmoeZ 79 Incision and excision of tissue in the perianal region
79. no[a`Zb jo Ho$ D$VH$m| H$mo R>rH$ H$aZm Ama hQ>mZm 80 Surgical treatment of anal fistulas
80. EZb {\$gwbm H$s e`{M{H$gm H$aZm 81 Surgical treatment of Haemorrhoids.
81. ho_moam`S> H$s e`{M{H$gm H$aZm 82 Division of the anal sphincter (sphincterotomy)
82. EZb p\$ZQ>a (p\$ZQo>Q>mo_r) H$mo I{S>V H$aZm 83 Other operations of the anus
83. EZg H$m A` AmoeZ 84 Ultrasound guided aspiration of deep seated rectal abscess
84. S>rn erQo>S> aoQ>b A~gogog H$m AQ>mgmCS> Ho$ AmYma na EpnaoeZ 85 Sclerotherapy
85. pH$boamoWoaonr 86 Dilation of digestive tract strictures
86. nmMH$ Q>Q> pQ>Mmoag H$m S>m`boeZ 87 Endoscopic gastrotomy
87. BS>moH$monr JQ>moQ>mo_r 88 Endoscopic decompression of colon
88. H$mobmoZ H$m BS>moH$monr {S>H$noeZ 89 Endoscopic Polypectomy
89. BS>moH$mo{nH$ nm{bnoQ>mo_r Operations on the female reproductive organs
_{hbmAm| Ho$ nOZZ AJm| H$m AmoeZ 90 Incision of the ovary
90. Amodar BgreZ 91 Other operations on the Fallopian tubes
91. \$bmo{nZ Q>`y~ Ho$ A` AmoeZ 92 Dilatation of the cervical canal
92. gadmBH$b H$Zmb H$m S>mBboQo>eZ 93 Conisation of the uterine cervix
93. `yQo>[aZ g{dg H$m H$mo{ZgoeZ 94 Incision of the Uterus (Hysterotomy) not done as a part of MTP
94. `yQ>g (hoQo>amoQ>mo_r) H$mo R>rH$ H$aZm Omo E_Q>rnr Ho$ ^mJ Ho$ $n _| Z {H$`m J`m hmo 95 Therapeutic / diagnoistic dilatation and curettage ( not done as part of MTP)
95. Woamfl`mo{Q>H$/S>m`mopQ>H$ S>mB{bQo>eZ ES> `yaoQ>rO (Omo E_Q>rnr Ho$ ^mJ Ho$ $n _| Z {H$`m J`m hmo) 96 Culdotomy
96. H$S>moQ>mo_r 97 Hymenectomy
97. hm`_oZQ>mo_r 98 Local excision and destruction of diseased tissue of the vagina and the pouch
of Douglas
98. doOmBZm Ama S>Jbg Ho$ nmD$M Ho$ amoJJV D$VH$m| H$mo WmZr` $n go hQ>mZm Ama Z> H$aZm 99 Incision and drainage of the Vulva
99. dmdm H$m CnMma Ama So>ZoO 100 Operations on the Bartholin's glands(cyst)
100. ~{W`mo{bZ H$s J{W`m| ({gQ>) H$m AmoeZ 101 Hysteroscope guided biopsy of uterus
101. hoQo>amoH$mon go `yQ>g H$s ~m`flgr 102 Suprapubic cytostomy
102. gwnmfl`y{~H$ {gQ>moQ>mo_r Operations on the prostate and seminal vesicles
nmoQo>Q> Ama go{_Zb do{gH$g H$m AmoeZ 103 Drainage of Prostatic abscess
103. nmoQo>{Q>H$ A~gogg H$m So>ZoO 104 Transurethral excision and destruction of prostate tissue
104. nmoQo>Q> D$VH$m| H$mo Q>mgwaoWab go hQ>mZm Ama Z> H$aZm 105 Percutaneous excision and destruction of prostate tissue
105. nmoQo>Q> D$VH$m| H$mo na`wQo>Zg go hQ>mZm Ama Z> H$aZm 106 Excision of seminal vesicle
106. go{_Zb do{gH$b H$mo hQ>mZm 107 Incision and excision of periprostatic tissue
107. no[anmoQo>{Q>H$ D$VH$m| H$mo R>rH$ H$aZm Ama hQ>mZm Operations on the Scrotum and tunica vaginalis testis
H$moQ>_ Ama Q>`y{ZH$m doOmBZ{bg Qo>pQ>g H$m AmoeZ 108 Incision and Drainage of the Scrotum and tunica vaginalis testis
108. H$moQ>_ Ama Q>`y{ZH$m doOmBZ{bg Qo>pQ>g H$mo R>rH$ H$aZm Ama So>ZoO H$aZm 109 Operations on testicular hydrocele
109. Qo>pQ>Hw$ba hmBS>mo{gb H$m AmoeZ 110 Excision or Eversion of Hydrocele
110. hmBS>mo{gb H$mo hQ>mZm `m {_Q>mZm Operations on the testis
Qo>pQ>g H$m AmoeZ 111 Incision and drainage of the testis
111. Qo>pQ>g H$mo R>rH$ H$aZm Ama So>ZoO H$aZm 112 Excision or destruction of testicular lesion
112. Qo>pQ>Hw$ba bo{g`Z H$mo hQ>mZm `m ZQ> H$aZm 113 Unilateral orchidectomy
113. `y{ZcoQ>ab Am{MSo>Q>mo_r 114 Other operations on the testis
114. Qo>pQ>g Ho$ A` AmoeZ Operations on the spermatic cord, Epididymis and ductus deferens
n_}{Q>H$ H$mS>, Eo{n{S>S>mB{_g Ama S>Q>g So>\o$aZ H$m AmoeZ 115 Surgical treatment of a varicocele and hydrocele of a spermatic cord
115. n_}{Q>H$ H$mS> Ho$ do[aH$mo gob Ama hmBS>mo{gb H$s e`{M{H$gm 116 Excision of epididymal cyst
116. Eo{n{S>S>mB_b {gQ> H$mo hQ>mZm 117 Epididymectomy
117. Eo{n{S>S>mB_oQ>mo_r 118 Other operations on the spermatic cord, epididymis and ductus deferens
(other than vasectomy)
118. n_}{Q>H$ H$mS>, Eo{n{S>S>mB{_g Ama S>Q>g So>\o$aZ (doH$mQ>mo_r go {^Z) Ho$ A` AmoeZ
Operations on the Penis
119. no{Zg H$m AmnoeZ 119 Circumcision and other Operations on the foreskin (if medically necessitated)
120. AmJo H$s dMm H$m gH$_{gOZ Ama A` AmoeZ (`{X {M{H$gr` $n go Amd`H$ hmo) 120 Local excision and destruction of diseased tissue of the penis
121. no{Zg Ho$ amoJJV D$VH$m| H$mo WmZr` $n go hQ>mZm Ama ZQ> H$aZm 121 Other operations on the penis
122. no{Zg Ho$ A` AmoeZ Operations on the Urinary system
`y[aZar {gQ>_ H$m AmoeZ 122 Cystoscopic removal of stones
122. nWar H$mo {gQ>moH$mo{nH$ VarHo$ go hQ>mZm 123 Lithotripsy
123. {bWmoQo>flgr Other Operations
A` AmoeZ 124 Coronary angiography
124. H$moamoZar E{O`moJm\$s 125 Bronchoscopic treatment of bleeding lesion
125. brqS>JboOZ H$m ~m|H$moH$mo{nH$ CnMma 126 Bronchoscopic treatment of fistula/stenting
126. \o$gwbm/Q|>qQ>J H$m ~m|H$moH$mo{nH$ CnMma 127 Bronchoalveolar lavage and biopsy
127. ~m|H$mobdoba bdoO ES> ~m`moflgr 128 Pericardiocentesis
128. no[aH$m{S>`mog|Qo>{gg 129 Insertion of filter in Inferior Vena cava
129. BZ\$s[a`a doZmH$mdm _| {\$Q>a bJmZm 130 Insertion of gel foam in artery or vein
130. AmQ>aar `m doZ _| Ooc \$mo_ bJmZm 131 Carotid angioplasty
131. Ho$amoQ>mBS> E{O`moflbmQ>r 132 Renal angioplasty
132. aoZc E{O`moflbmQ>r 133 Tumor embolisation
133. Q>`w_a B~mo{bgofZ 134 Endoscopic drainage of pseudo pancreatic cyst
134. `wS>monoZ{H$E{Q>H$ {gQ> H$m BS>moH$mo{nH$ So>ZoO 135 Varicose vain stripping or ligation
135. do[aH$moO doZ pQ>qnJ `m {bJofZ 136 Excision of dupuytren's contracture
136. Sw>nwQo>Z H$mQo>Mwa H$mo hQ>mZm 137 Carpal tunnel Decompression
137. H$mnb Q>Zb {S>H$noeZ 138 PCNS (Percutaneous neprostomy)
138. nrgrEZEg (naHw$Qo>{Z`g ZonmoQ>mo_r) 139 PCNL(Percutaneous nephro lithotomy)
139. nrgrEZEb (naHw$Qo>{Z`g Zonmo{bWmoQ>mo_r) 140 Nail bed deformity/resection and reconstruction
140. Zob ~oS> H$s {dH${V/[ageZ Ama nwZ{Z_mU

10
 ~S>r e`{M{H$gm {hVbm^ AZw~Y Major Surgical Benefit Annexure
H$_ g. ~S>r e`{M{H$gmAm| H$s gyMr~mS>r % e`{M{H$gm loUr Sl. No. LIST OF MAJOR SURGERIES % of Category
{hVbm^ Major
Surgical
YZam{f Benefit Sum
H$m n{VeV Assured
I flhXdm{hH$m V (H$m{S>`modmHw$ca {gQ>_) I CARDIOVASCULAR SYSTEM
1 _hm Y_Zr (EAmoaQ>m) H$s ~S>r e`{M{H$gm 100 n{VeV loUr 1 1 Major Surgery of Aorta 100% Category 1
2 AmonZ MoQ> e`{M{H$gm Ho$ O[aE grE~rOr (Xmo `m Xmo go A{YH$ 100 n{VeV loUr 1 2 CABG (two or more coronary arteries must be 100% Category 1
H$moamoZar AmQ>arO H$m ~m`nmg hmoZm Mm{hE) loUr 1 bypassed) via open chest surgery
3 `m{H$ nmoWo{gg H$m Cn`moJ H$aVo hE hX` Ho$ dmd H$mo ~XbZm 100 n{VeV 3 Heart Valve Replacement using mechanical 100% Category 1
4 hmQ>/hmQ>-bJ ~Zm 100 n{VeV loUr 1 prosthesis
5 nmo{_gb EAmoamo{Q>H$ EZo`y[aH$_ H$mo nwZ n`mamo{nV H$aZo Ho$ {bE 100 n{VeV loUr 1 4 Heart/Heart-Lung Transplant 100% Category 1
H$moamoZar AmQ>ar go EAmoao{Q>H$ $n H$m n`mamonU 5 Aortic root transplantation with coronary artery 100% Category 1
6. no[aH$m{S>`moQ>mo_r/no[aH$mS}>Q>mo_r 60 n{VeV loUr 2 reimplantation for proximal aortic aneurysm
7 hmQ> _| Wm`r nog_oH$a H$mo Ama^ _| n`mamo{nV H$aZm 60 n{VeV loUr 2 6 Pericardiotomy / Pericardectomy 60% Category 2
8 {_Q>ac dmd H$m CnMma 60 n{VeV loUr 2 7 Initial implantation of permanent pacemaker 60% Category 2
9 EAmoa{Q>H$ dmd H$m CnMma 60 n{VeV loUr 2 in the heart
10. {Q>H$pnS> dmd H$m CnMma 60 n{VeV loUr 2 8 Mitral valve repair 60% Category 2
9 Aortic valve repair 60% Category 2
11. n_moZdar dmd H$m CnMma 60 n{VeV loUr 2 10 Tricuspid valve repair 60% Category 2
12. Q|>Q> n`mamonU g{hV H$moamoZar E{O`moflbmQ>r (Bg_| Xmo `m Xmo go 40 n{VeV loUr 3 11 Pulmonary valve repair 60% Category 2
A{YH$ H$moamoZar AmQ>arO Q|>Q> hmoZo Mm{hE) 12 Coronary Angioplasty with stent implantation 40% Category 3
13 A{^kmV Ama Ja-A{^kmV bo{gAmZ Ho$ {bE JmpQ>J g{hV `m {~Zm 40 n{VeV loUr 3 (two or more coronary arteries must be stented)
JqQ>J Ho$ ~S>r doZ H$m CnMma 13 Major vein repair with or without grafting for 40% Category 3
II aVO Ama bgdm{hH$m V traumatic & nontraumatic lesions
14. ApW_mm (_oamo) H$m n`mamonU (nmH$Vm Ho$ $n _|) 100 n{VeV loUr 1 II HAEMIC AND LYMPHATIC SYSTEM
15. qb\$moE{S>_m H$mo hQ>mZo Ama JqQ>J H$aZo Ho$ {cE ~S>r e`{M{H$gm 60 n{VeV loUr 2 14 Bone marrow transplant (as recipient) 100% Category 1
16 noboZoQ>mo_r 60 n{VeV loUr 2 15 Major excision and grafting of Lymphoedema 60% Category 2
III V{H$m V 16 Splenectomy 60% Category 2
17 goao~b `m nmBZb Am{Q>[a`mo H$m CnMma drZg _mb\$moa_ofZ 100 n{VeV loUr 1 III NERVOUS SYSTEM
`m E{Z`mo[a_ 17 Repair of Cerebral or Spinal Arterio- Venous 100% Category 1
18 _o{bJZQ> goao~c Q>`y_a Ho$ {cE Ho${Z`moQ>mo_r 100 n{VeV loUr 1 Malformations or aneurysms
19 nmBZrb JWr H$mo hQ>mZm 100 n{VeV loUr 1 18 Craniotomy for malignant Cerebral tumours 100% Category 1
20 {nQ>`wQ>ar JWr H$mo hQ>mZm 100 n{VeV loUr 1 19 Excision of pineal gland 100% Category 1
21 Ja-_o{bJZQ> nog Am`wnmBJ bo{gAmZ Ho$ {bE Ho${Z`moQ>mo_r 60 n{VeV loUr 2 20 Excision of the pituitary gland 100% Category 1
22 ~oZ Ho$ ga~oamH$Zm`S> nog H$m AmoeZ 60 n{VeV loUr 2 21 Craniotomy for non malignant space occupying lesions 60% Category 2
23 Ho${Z`b V{H$m H$m BQ>amHo${Z`b n`mamonU 60 n{VeV loUr 2 22 Operations on Surbaracahnoid space of brain 60% Category 2
24 ~oZ Ho$ _o{ZZ{Og Ho$ A` AmoeZ 60 n{VeV loUr 2 23 Intracranial transection of Cranial nerve 60% Category 2
25 Ho${Z`b V{H$m/ZadoQ>mo_r H$m _mBH$mo~mHw$ba {S>H$noeZ 60 n{VeV loUr 2 24 Other operations on the meninges of the Brain 60% Category 2
25 Microvascular decompression of cranial 60% Category 2
26 EgS>`yab g~S>`yab `m BQ>amgo~b nog Ho$ So>ZoO Ho$ 40 n{VeV loUr 3 nerves/nervectomy
{bE Ho${Z`moQ>mo_r 26 Craniotomy for drainage of extradural, 40% Category 3
27 BZQo>n_|Q> qgS>mo_ Ho$ {cE {S>H$noeZ e`{M{H$gm 40 n{VeV loUr 3 subdural or intracerebral space
28 `y{ZcoQ>ab `m ~mBboQ>ab qgnWoH$Q>mo_r 40 n{VeV loUr 3 27 Decompression surgery for Entrapment Syndrome 40% Category 3
29 no[a\$ab Zd JmQ> 40 n{VeV loUr 3 28 Unilateral or Bilateral sympathectomy 40% Category 3
30 \o${g`b V{H$m noam{b{gg Ho$ {cE \$s\o${gH$m JmQ> 40 n{VeV loUr 3 29 Peripheral nerve Graft 40% Category 3
31 S>rn grQ>oS> no[a\$ab Zd Q>`y_a H$mo hQ>mZm 40 n{VeV loUr 3 30 Free Fascia Graft for Facial Nerve Paralysis 40% Category 3
32 S>{OQ>b Zd H$m ~h _mBH$moe`{M{H$gm CnMma 40 n{VeV loUr 3 31 Excision of deep seated peripheral nerve tumour 40% Category 3
33. EQ>mS>`yab, g~S>`yab `m BQ>amgoaoab nog H$m ~ahmoc So>ZoO 20 n{VeV loUr 4 32 Multiple Miscrosurgical Repair of digital nerve 40% Category 3
IV flQ>dgZ V 33 Bur-hole Drainage of Extradural, subdural or 20% Category 4
34 \o$\$So> H$m n`mamonU 100 n{VeV loUr 1 intracerebral space
35 `y{ZboQ>ab Zo_moZoQ>mo_r 60 n{VeV loUr 2 IV RESPIRATORY SYSTEM
36 S>m`m\o$_o{Q>H$/{h`mQ>g h{Z`m H$m CnMma 60 n{VeV loUr 2 34 Lung Transplantation 100% Category 1
37 WmoamH$moQ>moflbmQ>r 60 n{VeV loUr 2 35 Unilateral Pneumonectomy 60% Category 2
38 \o$\$So> H$s AmonZ bmo~oQ>mo_r 60 n{VeV loUr 2 36 Diaphragmatic/Hiatus Hernia Repair 60% Category 2
39 ewAmVr _o{S>EpQ>Zb bo{gAmZ H$mo hQ>mZm 60 n{VeV loUr 2 37 Thoracotoplasty 60% Category 2
40 ~m|H$g H$m Am{eH$ Eg{Q>anoeZ 60 n{VeV loUr 2 38 Open Lobectomy of Lung 60% Category 2
41 Am{eH$ \o$[aJOoQ>mo_r 60 n{VeV loUr 2 39 Excision of benign mediastinal lesions 60% Category 2
42 nyU \o$[aJOoQ>mo_r 60 n{VeV loUr 2 40 Partial Extirpation of Bronchus 60% Category 2
43 nyU b[aJOoQ>mo_r 60 n{VeV loUr 2 41 Partial Pharyngectomy 60% Category 2
42 Total Pharyngectomy 60% Category 2
44 S>m`m\o$_o{Q>H$ Q>`y_a H$mo hQ>mZm 60 n{VeV loUr 2 43 Total Laryngectomy 60% Category 2
45 flbyaoQ>mo_r `m flbo`yab {S>H$mo{Q>Ho$eZ 40 n{VeV loUr 3 44 Excision of Diaphragmatic tumours 60% Category 2
46 {d{^Z bo{gAmZ Ho$ {bE Q>mMrb H$m nwZ{Z_mU 60 n{VeV loUr 3 45 Pleurectomy or Pleural decortication 40% Category 3
V S>m`OopQ>d V 46 Tracheal reconstruction for various lesion 40% Category 3
47 Bgmo\o$Jg Ama Q>mo_H$ H$mo hQ>mZm 100 n{VeV loUr 1 V DIGESTIVE SYSTEM
48 H$mobmo-EZb EZoQ>mo_mo{gg g{hV aoQ>_ H$mo nwZ I{S>V H$aHo$ ES>mo{_Zb 100 n{VeV loUr 1 47 Excision of esophagus and stomach 100% Category 1
no[a{Zb nwb 48 Abdominal-Perineal Pull Through Resection of rectum with 100% Category 1
49 Bgmo\o$Jg H$mo nyar Vah hQ>mZm 60 n{VeV loUr 2 Colo-Anal Anastomosis
50 Q>mo_H$ H$mo nyar Vah AbJ H$aZm 60 n{VeV loUr 2 49 Total excision of oesophagus 60% Category 2
51 nmMZ Q>H$ Ho$ {H$gr ^r ^mJ H$mo nwZ I{S>V H$aZm Ama EZoQ>mo_mo{gg 40 n{VeV loUr 3 50 Total excision of stomach 60% Category 2
52 nopflQ>H$ Aga Ho$ CnMma Ho$ {bE Iwbr e`{M{H$gm 40 n{VeV loUr 3 51 Resection and Anastomosis of any part of digestive tract 40% Category 3
53 Q>mo_H$ _| Am{Q>{\${e`b AmonqZJ 20 n{VeV loUr 4 52 Open Surgery for treatment of Peptic Ulcer 40% Category 3
VI AVmdr (BS>moH$mBZ) V 53 Artificial opening into stomach 20% Category 4
54 ESo>Zc JWr H$mo nyar Vah hQ>mZm 60 n{VeV loUr 2 VI ENDOCRINE SYSTEM
55 Wm`amBS> JWr H$mo nyar Vah hQ>mZm 60 n{VeV loUr 2 54 Complete excision of Adrenal glands 60% Category 2
56 noamWm`amBS> JWr H$mo nyar Vah hQ>mZm 60 n{VeV loUr 2 55 Complete excision of Thyroid gland 60% Category 2
57 ESo>Zb JWr H$mo Am{eH$ $n go hQ>mZm 40 n{VeV loUr 3 56 Complete excision of Parathyroid gland 60% Category 2
58 Wm`amBS> JWr H$mo Am{eH$ $n go hQ>mZm 40 n{VeV loUr 3 57 Partial excision of Adrenal glands 40% Category 3
59 noamWm`amBS> JWr H$mo Am{eH$ $n go hQ>mZm 40 n{VeV loUr 3 58 Partial excision of Thyroid gland 40% Category 3
59 Partial excision of Parathyroid gland 40% Category 3
VII H$mZ, ZmH$ Ama Jbm VII ENT
60 nwZ{Z_mU H$aHo$ nyao H$mZ H$mo AbJ hQ>mZm 60 n{VeV loUr 2 60 Total ear amputation with reconstruction 60% Category 2
61 {dVm[aV _mgQ>m`So>Q>mo_r g{hV Q>mg-_mgQ>m`S> Ho$ 60 n{VeV loUr 2 61 Transmastoid removal cholesteatoma with extended 60% Category 2
H$moboQo>Q>mo_m H$mo hQ>mZm Mastoidectomy
62 A{^KmV bo{gAmZ Ho$ H$maU nyar ZmH$ H$mo nwZ {Z{_V H$aZm 60 n{VeV loUr 2 62 Total Nasal Reconstruction due to Traumatic lesions 60% Category 2
63 {d{^Z bo{gAmZ Ho$ {bE bo{~ZWmoQ>mo_r 40 n{VeV loUr 3 63 Labyrinthotmy for various lesions 40% Category 3
VIII _wI g~Yr VIII ORAL
64 _qbJO|Q> Amoamo-\o$aoJOrb Q>`y_a H$mo `mnH$ $n go hQ>mZm Ama ~So> $n _| 60 n{VeV loUr 2 64 Wide excision and Major reconstruction of malignant 60% Category 2
nwZ {Z{_V H$aZm Oro-pharyngeal tumours
65 nyU bmogoQ>mo_r 40 n{VeV loUr 3 65 Total Glossectomy 40% Category 3
66 _wI bo`wH$moflbm{H$`m Ho$ {bE Cgo `mnH$ $n go dhm go hQ>mZm 20 n{VeV loUr 4 66 Wide local Excision for oral leukoplakia 20% Category 4
IX AmI IX EYE
67 Am{~Q> Q>`y_a EOoZQo>aoeZ/bn H$s nwZaMZm 40 n{VeV loUr 3 67 Orbit Tumour Exenteration /Flap reconstruction 40% Category 3
68 A{^KmV go AmI H$s MmoQ> Ho$ H$maU H$m{Z`b `m ao{Q>Zb CnMma 20 n{VeV loUr 4 68 Corneal or Retinal Repair for Traumatic eye injuries 20% Category 4
69 AmI H$s noZoQo>qQ>J MmoQ> `m aflMS> bmo~ H$m CnMma 20 n{VeV loUr 4 69 Penetrating injuries of the eye or repair of ruptured globe 20% Category 4
X `H$V, {nVme` Ama Ame` (n{H$`mO) X LIVER, GALL BLADDER & PANCREAS
70 `H$V H$m n`mamonU 100 n{VeV loUr 1 70 Liver Transplantation 100% Category 1
71 `H$V H$m AmV[aH$ {dIS>Z 60 n{VeV loUr 2 71 Partial Resection of Liver 60% Category 2
72 Am{eH$ n{H$EQo>Q>mo_r 60 n{VeV loUr 2 72 Partial Pancreatectomy 60% Category 2
73 {d{^Z {nVme` bo{gAmZ Ho$ {cE H$mobo{ggQo>Q>mo_r/H$moboSo>Q>mo_r 40 n{VeV loUr 3 73 Cholecystectomy/Choledochotomy for various Gall 40% Category 3
bladder lesions
XI noer H$H$mbr (_Hw$bmoHo$boQ>b) V (Ho$db XwKQ>Zm H$s pW{V Ho$ H$maU)
XI MUSCULOSKELETAL SYSTEM (due to accident only)
74 D$nar AJ H$mo nwZ n`mamo{nV H$aZm 60 n{VeV loUr 2
75 {ZMco AJ H$mo nwZn`moamo{nV H$aZm 60 n{VeV loUr 2 74 Replantation of upper limb 60% Category 2
76 gr_|Q> H$m Cn`moJ H$aHo$ {hn OmBQ> Ho$ nmoo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 75 Replantation of lower limb 60% Category 2
76 Total prosthetic replacement of hip joint using cement 40% Category 3
77. gr_|Q> H$m Cn`moJ Z H$aHo$ {hn OmBQ> Ho$ nmoo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 77 Total prosthetic replacement of hip joint not using cement 40% Category 3
78. {hn OmBQ> Ho$ A` moWmo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 78 Other total prosthetic replacement of hip joint 40% Category 3
79 gr_|Q> H$m Cn`moJ H$aHo$ Zr OmBQ> Ho$ nmoWo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 79 Total prosthetic replacement of knee joint using cement 40% Category 3
80 gr_|Q> H$m Cn`moJ Z H$aHo$ Zr OmBQ> Ho$ nmoo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 80 Total prosthetic replacement of knee joint not using cement 40% Category 3
81 Zr OmBQ> Ho$ A` nmoWo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 81 Other total prosthetic replacement of knee joint 40% Category 3
82 gr_|Q> H$m Cn`moJ H$aHo$ A` OmBQ> Ho$ nmoWo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 82 Total prosthetic replacement of other joint using cement 40% Category 3
83 gr_|Q> H$m Cn`moJ Z H$aHo$ A` OmBQ> Ho$ nmoWo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 83 Total prosthetic replacement of other joint not using cement 40% Category 3
84 A` OmBQ> Ho$ A` nmoWo{Q>H$ H$mo nyar Vah ~XbZm 40 n{VeV loUr 3 84 Other total prosthetic replacement of other joint 40% Category 3
85 gr_|Q> H$m Cn`moJ H$aHo$ \o$_a Ho$ fre Ho$ nmoWo{Q>H$ H$mo ~XbZm 40 n{VeV loUr 3 85 Prosthetic replacement of head of femur using cement 40% Category 3
86 gr_|Q> H$m Cn`moJ Z H$aHo$ \o$_a Ho$ fre Ho$ nmoWo{Q>H$ H$mo ~XbZm 40 n{VeV loUr 3 86 Prosthetic replacement of head of femur not using cement 40% Category 3
87. \o$_a Ho$ fre Ho$ A` nmoWo{Q>H$ H$mo ~XbZm 40 n{VeV loUr 3 87 Other prosthetic replacement of head of femur 40% Category 3
88. gr_|Q> H$m Cn`moJ H$aHo$ h`w_oag Ho$ fre Ho$ nmoWo{Q>H$ H$mo ~XbZm 40 n{VeV loUr 3 88 Prosthetic replacement of head of humerus using cement 40% Category 3
89 gr_|Q> H$m Cn`moJ Z H$aHo$ h`w_oag Ho$ fre Ho$ nmoWo{Q>H$ H$mo ~XbZm 40 n{VeV loUr 3 89 Prosthetic replacement of head of humerus not using 40% Category 3
90 h`w_oag Ho$ fre Ho$ A` nmoWo{Q>H$ H$mo ~XbZm 40 n{VeV loUr 3 cement
91 gr_|Q> H$m Cn`moJ H$aHo$ nmoWo{Q>H$/A` ApW H$mo ~XbZm 40 n{VeV loUr 3 90 Other prosthetic replacement of head of humerus 40% Category 3
91 Prosthetic replacement of any other bone using cement 40% Category 3
92 gr_|Q> H$m Cn`moJ Z H$aHo$ nmoWo{Q>H$/A` ApW H$mo ~XbZm 40 n{VeV loUr 3 92 Prosthetic replacement of any other bone not using cement 40% Category 3
93 A` ApWV Ho$ A` nmoWo{Q>H$ H$mo ~XbZm 40 n{VeV loUr 3 93 Other prosthetic replacement of any other bone 40% Category 3
94 OmBQ> H$m nmoWo{Q>H$ BQ>anmo{OfZ nwZ{Z_mU 40 n{VeV loUr 3 94 Prosthetic interposition reconstruction of joint 40% Category 3
95 OmBQ> H$m A` BQ>anmo{OfZ nwZ{Z_mU 40 n{VeV loUr 3 95 Other interposition reconstruction of joint 40% Category 3
96 OmBQ> H$mo hQ>mZo na nwZ{Z_mU 40 n{VeV loUr 3 96 Excision reconstruction of joint 40% Category 3
97 OmBQ> H$m A` nwZ{Z_mU 40 n{VeV loUr 3 97 Other reconstruction of joint 40% Category 3
98 AJ Ho$ {bE nmoWo{gg H$m n`mamonU 40 n{VeV loUr 3 98 Implantation of prosthesis for limb 40% Category 3
99 ~mOy hQ>mZm 40 n{VeV loUr 3 99 Amputation of arm 40% Category 3
100 Q>mJ hQ>mZm 40 n{VeV loUr 3 100 Amputation of leg 40% Category 3
101 nmBZ Ho$ \o$Ma H$mo OmoS>Zm 40 n{VeV loUr 3 101 Fixation of fracture of spine 40% Category 3
102 \o$Ma hE {OJmo_m H$mo CR>mZm, EgflbmoaofZ H$aZm Ama OmoS>Zm 40 n{VeV loUr 3 102 Elevation, Exploration and Fixation of fractured Zygoma 40% Category 3
103 hmW H$mo hQ>mZm 20 n{VeV loUr 4 103 Amputation of hand 20% Category 4
104 na H$mo hQ>mZm 20 n{VeV loUr 4 104 Amputation of foot 20% Category 4
105 Zr Ho$ OmBQ> H$s H${dQ>r H$m Woamfl`w{Q>H$ BS>moH$mo{nH$ AmnofZ 20 n{VeV loUr 4 105 Therapeutic endoscopic operations on cavity of knee joint 20% Category 4
106 A{^KmV _| hQ>mE OmZo Ho$ ~mX CJbr H$m n`mamonU 20 n{VeV loUr 4 106 Replantation of finger following traumic amputation 20% Category 4
107 AmpQ>`mo_mBbo{Q>g Ho$ {cE e`{M{H$gm So>ZoO Ama `waoQo>O 20 n{VeV loUr 4 107 Surgical Drainage and Curettage for osteomyelitis 20% Category 4

11
 XII Amamo-_pObmo \${g`b e`{M{H$gm XII ORO-MAXILLOFACIAL SURGERY
108 A{^KmV `m ObZo Ho$ H$maU Amamo-_pObmo \${g`b e`{M{H$gm H$aHo$ 108 Major reconstructive oro-maxillafacial surgery due to
nwZ Cgo ~So> $n _| ~ZmZm bo{H$Z Omo H$m_o{Q>H$ Ho$ n`moOZ Ho$ {bE Z hmo 60 n{VeV loUr 2 trauma or burns and not for cosmetic purpose 60% Category 2
109 _{S>~wba Ama _pObar bo{gAmZ Ho$ {bE ~moZ JmpQ>J g{hV AmpQ>`moQ>mo_r 109 Osteotomy including segmental resection with bone
{Og_| go_|Q>b nwZIS>Z ^r fm{_b h 60 n{VeV loUr 2 grafting for Mandibular and maxillary lesions 60% Category 2
XIII ({H$S>Zr)/_y _mJ/nOZZ V XIII KIDNEY/URINARY TRACT/REPRODUCTIVE SYSTEM
110. aoZc n`mamonU (nmH$Vm) 100 n{VeV loUr 1 110 Renal transplant (recipient) 100% Category 1
111. _oqcJZ|Q> H$s pW{V Ho$ {bE {hQo>aoQ>mo_r 60 n{VeV loUr 2 111 Hysterectomy for malignant conditions 60% Category 2
112 ao{S>H$b noQo>Q>modo{gHw$boQ>mo_r 60 n{VfVloUr 2 60 n{VeV loUr 2 112 Radical prostatovesiculectomy 60% Category 2
113 A{^KmV _| hQ>mE OmZo Ho$ ~mX no{Zg H$mo _mBH$modo{gHw$ba go nwZ OmoS>Zm 60 n{VeV loUr 2 113 Microvascular reattachment of penis following traumatic
114 {M{H$gm gbmh Ho$ H$maU (Z {H$ n`mamonU XmZ H$aZo Ho$ H$maU) nyar Zo\o$Q>mo_r 40 n{VeV loUr 3 amputation 60% Category 2
115 {H$S>Zr H$mo Am{eH$ $n go hQ>mZm 40 n{VeV loUr 3 114 Total nephrectomy due to medical advic
116 {H$S>Zr Ho$ bo{gAmZ H$m Iwcm Eg{Q>anoeZ 40 n{VeV loUr 3 (not as a transplant donor) 40% Category 3
115 Partial excision of kidney 40% Category 3
117 `yaoQ>a H$mo hQ>mZm 40 n{VeV loUr 3 116 Open extirpation of lesion of kidney 40% Category 3
118 bS>a H$mo nyar Vah hQ>mZm 40 n{VeV loUr 3 117 Excision of ureter 40% Category 3
119 {H$S>Zr _| cJr MmoQ> H$m CnMma 40 n{VeV loUr 3 118 Total excision of bladder 40% Category 3
120 nopdH$ `yao{Q>H$ OeZ _| H$mdQ> Ho$ H$maU no{bflbmQ>r/`yaoQo>amoH${b{gH$moQ>mo_r 40 n{VeV loUr 3 119 Kidney injury repair 40% Category 3
121 no{Zg H$mo hQ>mZm 40 n{VeV loUr 3 120 Pyloplasty/Ureterocalcycostomy for pelvic ureteric
122 do{OZm H$mo hQ>mZm 40 n{VeV loUr 3 junction obstruction 40% Category 3
123 `yQ>g Ho$ ESo>Zogm H$mo `y{ZboQ>ab `m ~m`boQ>ab VarHo$ go hQ>mZm 40 n{VeV loUr 3 121 Amputation of penis 40% Category 3
124 boS>a H$mo Am{eH$ $n go hQ>mZm 20 n{VeV loUr 4 122 Excision of vagina 40% Category 3
125 `yaoQ>a H$m Woamfl`y{Q>H$ `yaoQ>oamoH$m{nH$ AmoeZ 20 n{VeV loUr 4 123 Unilateral or Bilateral excision of adnexa of uterus 40% Category 3
124 Partial excision of bladder 20% Category 4
126 `y[aZar {dnWZ 20 n{VeV loUr 4 125 Therapeutic ureteroscopic operations on ureter 20% Category 4
127 `yaoQ>a H$m n`mamonU 20 n{VeV loUr 4 126 Urinary diversion 20% Category 4
128 Qo>Qo>g H$m `y{ZboQ>ab `m ~m`boQ>ab nWH$aU 20 n{VeV loUr 4 127 Replantation of ureter 20% Category 4
129 H$moQ>_ Ama Q>`y{ZH$m doOmBZb Qo>Qo>g H$m A` AmoeZ 20 n{VeV loUr 4 128 Unilateral or Bilateral excision of testes 20% Category 4
130 Qo>Q>g H$m nwZ{Z_mU 20 n{VeV loUr 4 129 Other operations on Scrotum and tunica vaginalis testis 20% Category 4
131 nmoQo>Q> Ho$ D$VH$m| H$mo Iwbr e`{M{H$gm mam hQ>mZm Ama Ch| ZQ> H$aZm 20 n{VeV loUr 4 130 Reconstruction of the testis 20% Category 4
132 dmdm Ho$ bo{gAmZ H$m Eg{Q>anofZ 20 n{VeV loUr 4 131 Open surgical excision and destruction of prostate tissue 20% Category 4
133 dmdm H$mo hQ>mZm 20 n{VeV loUr 4 132 Extirpation of lesion of vulva 20% Category 4
133 Excision of vulva 20% Category 4
XIV gmBZg H$m AmoeZ
XIV Operations on the sinuses
134 AmJo Ho$ gmBZg H$m AmoeZ 40 n{VeV loUr 3
135 g~bo{~`b H$m Cn`moJ H$aVo hE _pgbar EQ>_ H$m AmoeZ 20 n{VeV loUr 4 134 Operations on frontal sinus 40% Category 3
135 Operations on maxillary antrum using sublabial approach 20% Category 4
XV A` XV Others
136 ao{S>H$b _oQo>Q>mo_r 60 n{VeV loUr 2
136 Radical Mastectomy 60% Category 2
137 Q>`y_a Ho$ _oqbJZQ> Za_ D$VH$m| H$mo hQ>mZm Ama CZH$m nwZ{Z_mU H$aZm 40 n{VeV loUr 3 137 Malignant soft tissue tumour excision and reconstruction 40% Category 3
138 ~hV A{YH$ Ob OmZo Ho$ H$maU dMm Ama g~`wQo>{Z`g H$mo hQ>mZm 138 Excision and Major Flap Repair of skin and Subcutaneous
Ama CgH$m ~S>m bn CnMma H$aZm 40 n{VeV loUr 3 tissue due to Major Burns 40% Category 3
139 gmYmaU _Qo>Q>mo_r 20 n{VeV loUr 4 139 Simple Mastectomy 20% Category 4
140 nmoQ>b hmBnaQ|>fZ Ho$ {bE Q>rAmBnrEg n{H$`m 20 n{VeV loUr 4 140 TIPS procedure for portal Hypertension 20% Category 4
n[a{e> I Annexure-I
Nomination - As Section 39 of the Insurance Act 1938, as amended by the Insurance Laws
Zm_mH$Z- ~r_m H$mZyZ (gemoYZ) A{Y{Z`_, 2015 mam `Wmgemo{YV ~r_m A{Y{Z`_, 1938 H$s Ymam 39 Ho$ (Amendment) Act, 2015
AZwgma (1) The holder of a policy of life insurance on his own life may, when effecting the policy or at any
1. OrdZ ~r_m H$s nm{bgr H$m YmaH$ AnZo OrdZ na, nm{bgr boVo g_` `m ^wJVmZ hoVw nm{bgr Ho$ n[and hmoZo go nhbo time before the policy matures for payment, nominate the person or persons to whom the money
{H$gr ^r g_`, {H$gr `pV `m `pV`m| H$mo Zm{_V H$a gH$Vm h, {Ogo/{Oh| CgH$s _`w H$s pW{V _| nm{bgr mam secured by the policy shall be paid in the event of his death:
ga[jV am{e H$m ^wJVmZ {H$`m OmEJm& Provided that, where any nominee is a minor, it shall be lawful for the policy holder to appoint any
person in the manner laid down by the insurer, to receive the money secured by policy in the
eV `h h {H$, AJa Zm{_V `pV Zm~m{bJ hmo, Vmo nm{bgrYmaH$ Ho$ {bE `h H$mZyZZ C{MV hmoJm {H$ ~r_mH$Vm mam event of his death during the minority of the nominee.
{ZYm[aV VarHo$ go {H$gr `pV H$mo {Z`wV H$ao Omo {H$ Zm{_V `pV Ho$ Zm~m{bJ ahZo Ho$ XmamZ nm{bgrYmaH$ H$s _`w (2) Any such nomination in order to be effectual shall, unless it is incorporated in the text of the
hmoZo na nm{bgr mam ga{jV am{e H$mo mflV H$a gHo$& policy itself, be made by an endorsement on the policy communicated to the insurer and
registered by him in the records relating to the policy and any such nomination may at any time
2. Eogo {H$gr Zm_mH$Z H$mo ^mdr hmoZo Ho$ {bE, AJa dh nm{bgr H$s eX `moOZm _| {ZJ{_V Zht h, Vmo Cgo ~r{_V H$aZo before the policy matures for payment be cancelled or changed by an endorsement or a further
Ho$ {bE gy{MV nm{bgr na n>mH$Z VWm nm{bgr go g~{YV [aH$mS>g _| CgHo$ mam nOrH$aU Ho$ O[aE {ZJ{_V {H$`m endorsement or a will, as the case may be, but unless notice in writing of any such cancellation
OmEJm, VWm Eogo H$moB Zm_mH$Z nm{bgr Ho$ n[and hmoZo go nhbo {H$gr ^r g_` ^wJVmZ go nyd {H$gr n>mH$Z `m or change has been delivered to the insurer, the insurer shall not be liable for any payment under
dgr`V, Ogr ^r pW{V hmo, mam a {H$E `m ~Xbo Om gH$Vo h, bo{H$Z AJa Bg H$ma {ZaVrH$aU `m n[adVZ Ho$ {bE the policy made bona fide by him to a nominee mentioned in the text of the policy or registered in
~r_mH$Vm H$mo {b{IV _| gyMZm Z Xr JB hmo Vmo ~r_mH$Vm nm{bgr Ho$ AVJV CgHo$ mam dmV{dH$ ~ZmE JE nm{bgr H$s records of the insurer.
eX `moOZm _| C{b{IV `m ~r_mH$Vm Ho$ [aH$mS>g _| nOrH$V Zm_m{H$V H$mo {H$gr ^wJVmZ Ho$ {bE Xm`r Zht hmoJm& (3) The insurer shall furnish to the policy holder a written acknowledgement of having registered
a nomination or a cancellation or change thereof, and may charge such fee as may be specified
3. ~r_mH$Vm mam nm{bgrYmaH$ H$mo Zm_mH$Z Ho$ nOrH$V H$amE OmZo `m CgHo$ {ZaVrH$aU `m ~Xbo OmZo Ho$ ~mao _| by regulations for registering such cancellation or change.
{b{IV nmdVr XoJm VWm {d{Z`_m| mam {d{ZYm[aV Eogo {ZaVrH$aU `m n[adVZ H$mo nOrH$V H$aZo Ho$ {bE ewH$ ^r bo (4) A transfer or assignment of a policy made in accordance with section 38 shall automatically
gH$Vm h& cancel a nomination:
Provided that the assignment of a policy to the insurer who bears the risk on the policy at the
4. Ymam 38 Ho$ AZwH$_ _| nm{bgr _| {H$gr AVaU `m g_ZwXoeZ go Zm_mH$Z dV: a hmo OmEJm: time of the assignment, in consideration of a loan granted by that insurer on the security of the
eV `h h {H$ ~r_mH$Vm H$mo nm{bgr H$m g_ZwXoeZ, Omo {H$ g_ZwXoeZ Ho$ g_` nm{bgr na Omo{I_ H$m dhZ H$aVm hmo, policy within its surrender value, or its reassignment on repayment of the loan shall not cancel a
Cg ~r_mH$Vm mam nm{bgr H$s O_mZV na, CgHo$ A`nU _y` `m nwZ: g_ZwXoeZ Ho$ AVJV hmo, F$U d$n H$s nomination, but shall affect the rights of the nominee only to the extent of the insurer's interest in
^anmB H$aZo na Zm_mH$Z a Zht hmoJm, bo{H$Z Zm{_V Ho$ A{YH$ma Ho$db Cg hX VH$ ^m{dV hm|Jo, {OVZm {H$ nm{bgr the policy:
_| ~r_mH$Vm H$m {hV hmo: Provided further that the transfer or assignment of a policy, whether wholly or in part, in
consideration of a loan advanced by the transferee or assignee to the policyholder, shall not
AmJo eV `h h {H$ nm{bgrYmaH$ H$mo AV[a{V `m g_ZwXo{eV mam A{J_ $n go {XE JE F$U Ho$ {V\$b d$n nm{bgr cancel the nomination but shall affect the rights of the nominee only to the extent of the interest
H$m AVaU `m g_ZwXoeZ, Mmho `h nyUV: hmo `m AeV:, Zm_mH$Z a Zht hmoJm, bo{H$Z Zm_m{H$V `pV Ho$ A{YH$mam| H$mo of the transferee or assignee, as the case may be, in the policy:
Cgr hX VH$ ^m{dV H$aoJm, Omo {H$ nm{bgr _| AV[aVr `m g_ZwXo{eV H$m {hV hmoJm: Provided also that the nomination, which has been automatically cancelled consequent upon the
transfer or assignment, the same nomination shall stand automatically revived when the policy is
eV `h ^r h {H$ Zm_mH$Z Omo {H$ AVaU `m g_ZwXoeZ na CgHo$ n[aUm_d$n AnZo Amn a hAm hmo, dh Zm_mH$Z reassigned by the assignee or retransferred by the transferee in favour of the policyholder on
g_ZwXo{eV mam nwZ: g_ZwXoeZ `m AV[aVr mam F$U Ho$ ^wJVmZ na {gdm` ~r_mH$Vm H$mo nm{bgr H$s O_mZV na, nwZ: repayment of loan other than on a security of policy to the insurer.
AVaU go dV: nwZ: Mm{bV hmo OmEJm& (5) Where the policy matures for payment during the lifetime of the person whose life is insured
5. Ohm nm{bgr H$s ^wJVmZ hoVw n[andVm Cg `pV Ho$ OrdZH$mb _| hmoVr h {OgHo$ OrdZ H$mo ~r{_V {H$`m J`m h `m or where the nominee or, if there are more nominees than one, all the nominees die before the
policy matures for payment, the amount secured by the policy shall be payable to the
AJa Zm{_V `pV `m EH$ go A{YH$ Zm{_Vm| _| go g^r nm{bgr Ho$ ^wJVmZ hoVw n[and hmoZo go nhbo _a OmVo h, dhm policyholder or his heirs or legal representatives or the holder of a succession certificate, as the
nm{bgr Ho$ AVJV gwa{jV am{e H$m ^wJVmZ nm{bgrYmaH$ `m CgHo$ Cmam{YH$m[a`m| `m H$mZyZr {V{Z{Y`m| `m case may be.
Cmam{YH$ma _mUn Ho$ YmaH$ H$mo, Ogr ^r pW{V hmo, {H$`m OmEJm& (6) Where the nominee or if there are more nominees than one, a nominee or nominees survive
6. Ohm EH$ `m A{YH$ Zm{_V hm| VWm EH$ `m EH$ go A{YH$ Zm{_V, Cg `pV Ho$ ~mX Or{dV ahVo h, {OgHo$ OrdZ H$mo the person whose life is insured, the amount secured by the policy shall be payable to such
survivor or survivors.
~r{_V {H$`m J`m h, Vmo nm{bgr mam gwa{jV H$s JB am{e H$m ^wJVmZ Eogo CmaOrdr `m CmaOr{d`m| H$mo {H$`m OmEJm& (7) Subject to the other provisions of this section, where the holder of a policy of insurance on his
7. Bg Ymam Ho$ A` mdYmZm| Ho$ AYrZ, Ohm ~r_m nm{bgr Ho$ YmaH$ Zo AnZo OrdZ na AnZo _mVm/{nVm `m AnZo own life nominates his parents, or his spouse, or his children, or his spouse and children, or any
OrdZgmWr `m AnZo ~Mm| `m AnZo OrdZ gmWr Ama ~Mm| `m CZ_| go {H$gr H$mo Zm{_V {H$`m hmo, Eogo Zm{_V Cn-Ymam of them, the nominee or nominees shall be beneficially entitled to the amount payable by the
(6) Ho$ AVJV ~r_mH$Vm mam Xo` am{e Ho$ {bE bm^mWu hm|Jo, O~ VH$ {H$ `h gm{~V Zht hmoVm {H$ nm{bgr H$m YmaH$, insurer to him or them under sub-section (6) unless it is proved that the holder of the policy,
nm{bgr _| CgHo$ Q>mBQ>b H$s H${V Ho$ AZwgma Zm_m{H$V H$mo Eogm bm^mWu Q>mB{Q>b XmZ Zht H$a gH$Vm h& having regard to the nature of his title to the policy, could not have conferred any such beneficial
title on the nominee.
8. CnamoV H$ho JE Ho$ AYrZ, Ohm Zm{_V `m AJa EH$ go A{YH$ Zm{_V hm|, {OZ na Cn-Ymam (7) bmJy hmoVr h, (8) Subject as aforesaid, where the nominee, or if there are more nominees than one, a nominee
nm{bgr mam gwa{jV am{e Ho$ ^wJVmZ go nhbo, bo{H$Z Cg `pV {OgHo$ OrdZ Ho$ ~r{_V {H$`m J`m h, Ho$ ~mX _a OmVm or nominees, to whom sub-section (7) applies, die after the person whose life is insured but
h Vmo nm{bgr mam gwa{jV am{e `m _aZodmbo Zm{_V `m Zm{_Vm| Ogr ^r pW{V hmo Ho$ {hgo H$m {V{Z{Yd H$aZo dmbr before the amount secured by the policy is paid, the amount secured by the policy, or so much of
nm{bgr mam gwa{jV am{e H$m ^wJVmZ Zm{_V `m Zm{_Vm| Ho$ Cmam{YH$m[a`m| `m H$mZyZr {V{Z{Y`m| `m Cmam{YH$ma the amount secured by the policy as represents the share of the nominee or nominees so dying
(as the case may be), shall be payable to the heirs or legal representatives of the nominee or
_mUn Ho$ YmaH$, Ogr ^r pW{V hmo, H$mo {H$`m OmEJm VWm do Eogr am{e H$mo nmZo Ho$ {bE A{YH$V bm^mWu hm|Jo& nominees or the holder of a succession certificate, as the case may be, and they shall be
9. Cn-YmamAm| (7) Ama (8) _| Hw$N> ^r OrdZ ~r_m H$s {H$gr nm{bgr H$s Am_X{Z`m| go {H$gr CYmaXmVm Ho$ A{YH$ma beneficially entitled to such amount.
H$mo Z> `m g_mflV Zht H$aoJm& (9) Nothing in sub-sections (7) and (8) shall operate to destroy or impede the right of any creditor
to be paid out of the proceeds of any policy of life insurance.
10. Cn-YmamAm| (7) Ama (8) Ho$ mdYmZ ~r_m H$mZyZ (gemoYZ) A{Y{Z`_ 2015 Ho$ Ama^ hmoZo Ho$ ~mX ^wJVmZ Ho$ (10) The provisions of sub-sections (7) and (8) shall apply to all policies of life insurance maturing
{bE n[and hmoZo dmbr OrdZ ~r_m H$s g^r nm{b{g`m| na bmJy hm|Jo& for payment after the commencement of the Insurance Laws (Amendment) Act, 2015.
11. Ohm nm{bgrYmaH$ H$s _`w nm{bgr Ho$ n[and hmoZo Ho$ ~mX hB hmo, bo{H$Z nm{bgr H$s Am` Ama {hVbm^ H$m (11) Where a policyholder dies after the maturity of the policy but the proceeds and benefit of his
^wJVmZ Cgo CgH$s _`w Ho$ H$maU Z hE hm|, Vmo CgHo$ mam Zm{_V CgH$s nm{bgr Ho$ AVJV Am_XZr Ama {hVbm^ H$mo policy has not been made to him because of his death, in such a case, his nominee shall be
nmZo H$m nm hmoJm& entitled to the proceeds and benefit of his policy.
(12) The provisions of this section shall not apply to any policy of life insurance to which section 6
12. Bg Ymam Ho$ mdYmZ OrdZ ~r_m H$s Eogr {H$gr nm{bgr na bmJy Zht hm|Jo, {Og na Ymam 6, {ddm{hV r gn{m of the Married Women's Property Act, 1874, applies or has at any time applied;
A{Y{Z`_ 1874 bmJy hmoVm hmo `m H$^r bmJy {H$`m J`m hmo& Provided that where a nomination made whether before or after the commencement of the
eV `h h {H$, Ohm ~r_m H$mZyZ (gemoYZ) A{Y{Z`_, 2015 Ho$ Ama^ hmoZo go nhbo ~r{_V `pV Ho$ nZr `m CgH$s Insurance Laws (Amendment) Act, 2015, in favour of the wife of the person who has insured his
life or of his wife and children or any of them is expressed, whether or not on the face of the
nZr VWm ~Mm| `m CZ_| go {H$gr Ho$ nj _| A{^`V $n go Zm_mH$Z {H$`m J`m hmo, Mmho dh nm{bgr na A{H$V hmo `m policy, as being made under this section, the said section 6 shall be deemed not to apply or not
Zht, Ogm {H$ Bg Ymam Ho$ AVJV {H$`m J`m h, H${WV Ymam 6 nm{bgr na bmJy Zht _mZr OmEJr `m bmJy Zht hmoJr& to have applied to the policy.
n[a{e> II Annexure -II
~r_m H$mZyZ (gemoYZ) A{Y{Z`_, 2015 mam `Wmgemo{YV ~r_m A{Y{Z`_, 1938 H$r Ymam 45 Ho$ AZwgma Section 45 as per the Insurance Act 1938, as amended by the Insurance Laws (Amendment)
Act, 2015
1. OrdZ ~r_m H$s {H$gr nm{bgr H$mo, nm{bgr H$s {V{W go AWmV nm{bgr Ho$ Omar hmoZo H$s {V{W `m Omo{I_ Ho$ Ama^ (1) No policy of life insurance shall be called in question on any ground whatsoever after the
hmoZo H$s {V{W go `m nm{bgr Ho$ nwZMbZ H$s {V{W go `m nm{bgr na amBS>a H$s {V{W go VrZ dfm] H$s g_mpflV na, Omo ^r expiry of three years from the date of the policy, i.e. from the date of issuance of the policy or the
~mX _| hmo, {H$gr ^r AmYma na Z Ho$ {bE ~wbm`m Zht Om gH$Vm h& date of commencement of risk or the date of revival of the policy or the date of the rider to the
policy, whichever is later.
2. OrdZ ~r_m H$s {H$gr nm{bgr H$mo, nm{bgr Ho$ Omar hmoZo H$s {V{W `m Omo{I_ Ama^ hmoZo H$s {V{W `m nm{bgr Ho$ (2) A policy of life insurance may be called in question at any time within three years from the
nwZMbZ H$s {V{W go `m nm{bgr Ho$ amBS>a H$s {V{W go VrZ dfm] Ho$ AXa {H$gr ^r g_`, Omo ^r ~mX _| hmo, YmoIoYS>r Ho$ date of issuance of the policy or the date of commencement of risk or the date of revival of the
AmYma na Z Ho$ {bE ~wbm`m Om gH$Vm h& policy or the date of the rider to the policy, whichever is later on the ground of fraud:
eV `h h {H$ ~r_mH$Vm mam ~r_mYmaH$ H$mo `m ~r_mYmaH$ Ho$ H$mZyZr {V{Z{Y `m Zm{_Vm| `m g_ZwXo{eVm| H$mo {b{IV _| Provided that the insurer shall have to communicate in writing to the insured or the legal
CZ AmYmam| VWm V`m| Ho$ ~mao _| gy{MV H$aZm hmoJm, {OZHo$ AmYma na `h \$gbm {b`m J`m h& representatives or nominees or assignees of the insured the grounds and materials on which
such decision is based.
n>rH$aU 1: Bg Cn-Ymam Ho$ `moOZ hoVw, YmoIoYS>r H$m AW h ~r_mYmaH$ `m CgHo$ EOoQ> mam ~r_mH$Vm H$mo YmoIm Explanation I- For the purposes of this sub-section, the expression "fraud" means any of the
XoZo `m ~r_mH$Vm H$mo OrdZ ~r_m nm{bgr Omar H$aZo Ho$ {bE ^m{dV H$aZo Ho$ BamXo go {H$`m J`m {ZZ{b{IV _| go H$moB following acts committed by the insured or by his agent, with the intent to deceive the insurer or
H$m`: to induce the insurer to issue a life insurance policy:-
(a) the suggestion, as a fact of that which is not true and which the insured does not believe to
A. gwPmd, Omo {H$ V` $n _| ghr Zht h VWm {OgHo$ gM hmoZo na ~r_mYmaH$ H$mo {ddmg Zht h; be true;
~. ~r_mYmaH$ mam {H$gr V` H$mo {N>nmZm, Omo CgH$s OmZH$mar _| Wm `m CgH$s dmV{dH$Vm na Cgo {ddmg Wm; (b) the active concealment of a fact by the insured having knowledge or belief of the fact;
g. YmoIoYS>r Ho$ BamXo go CR>m`m J`m H$moB A` H$X_; VWm (c) any other act fitted to deceive; and
(d) any such act or omission as the law specially declares to be fraudulent.
X. H$moB A` Eogm H$X_ `m ^yb-MyH$ {Ogo H$mZyZ {deof $n go YmoImYS>r _mZVm hmo& Explanation II- Mere silence as to facts likely to affect the assessment of the risk by the insurer is
n>rH$aU 2: ~r_mH$Vm mam Omo{I_ Ho$ AmH$bZ H$mo ^m{dV H$aZo dmbo V`m| Ho$ ~mao _| {g\$ Mwn ahZm YmoImYS>r Zht not fraud, unless the circumstances of the case are such that regard being had to them, it is the
h, O~ VH$ {H$ _m_bo H$s n[apW{V`m| Ho$ AZwgma, ~r_mYmaH$ `m CgHo$ EOoQ> H$m `h H$V` h& ~mobZo go Mwn ahZm `m duty of the insured or his agent, keeping silence to speak, or unless his silence is, in itself,
A`Wm CgH$s Im_moer AnZo Amn _| ~mobZo Ho$ ~am~a hmo& equivalent to speak.

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 3. CnYmam (2) _| Hw$N> ^r {Z{hV hmoZo Ho$ ~mdOyX, H$moB ^r ~r_mH$Vm {H$gr OrdZ ~r_m nm{bgr H$mo YmoIoYS>r Ho$ AmYma (3) Not with standing anything contained in subsection (2), no insurer shall repudiate a life
na AdrH$V Zht H$a gH$Vm h, AJa ~r_mYmaH$/bm^mWu `h _m{UV H$a gHo$ {H$ CgHo$ mam H$s JB JbV~`mZr insurance policy on the ground of fraud if the insured can prove that the misstatement of or
CgH$s A{YH$V_ OmZH$mar Ho$ AZwgma ghr Wr Ama CgZo OmZ~yPH$a V`m| H$mo {N>nmZo H$s H$mo{ee Zht H$s `m H${WV suppression of a material fact was true to the best of his knowledge and belief or that there was
no deliberate intention to suppress the fact or that such misstatement of or suppression of a
JbV~`mZr `m _hdnyU V` H$mo {N>nm`m OmZm ~r_mH$Vm H$s OmZH$mar _| Wm& material fact are within the knowledge of the insurer:
YmoIoYS>r Ho$ _m_bo _| Bgo JbV gm{~V H$aZo H$m Xm{`d bm^m{W`m| na h AJa nm{bgrYmaH$ Or{dV Zht h& Provided that in case of fraud, the onus of disproving lies upon the beneficiaries, in case the
n>rH$aU - H$moB `pV Omo ~r_m H$s g{dXm H$m AmJh Ama CgH$s gmXo~mOr H$aVm h Cgo g{dXm Ho$ `moOZ Ho$ {bE policyholder is not alive.
~r_mH$Vm H$m EOoQ> _mZm OmEJm& Explanation - A person who solicits and negotiates a contract of insurance shall be deemed for
the purpose of the formation of the contract, to be the agent of the insurer.
4. OrdZ ~r_m H$s {H$gr nm{bgr H$mo nm{bgr Ho$ Omar H$aZo H$s {V{W go `m Omo{I_ Ho$ Ama^ hmoZo H$s {V{W go `m nm{bgr (4) A policy of life insurance may be called in question at any time within three years from the
Ho$ nwZMbZ H$s {V{W go `m nm{bgr Ho$ amBS>a H$s {V{W go VrZ dfm] Ho$ AXa, Omo ^r ~mX _| hmo, {H$gr ^r g_`, Bg date of issuance of the policy or the date of commencement of risk or the date of revival of the
AmYma na Z Ho$ {bE ~wbm`m Om gH$Vm h {H$ ~r{_V `pV Ho$ OrdZH$mb go g~{YV {H$gr V` H$mo Vmd n _| `m policy or the date of the rider to the policy, whichever is later, on the ground that any statement of
{H$gr A` H$mJOmV _|, {OgHo$ AmYma na nm{bgr Omar H$s JB Wr `m nwZMm{bV H$s JB Wr `m amBS>a Omar {H$`m J`m or suppression of a fact material to the expectancy of the life of the insured was incorrectly made
Wm, {N>nm`m J`m Wm `m JbV {XIm`m J`m Wm& in the proposal or other document on the basis of which the policy was issued or revived or rider
issued:
eV `h h {H$ ~r_mH$Vm mam ~r_mYmaH$ H$mo `m ~r_mYmaH$ Ho$ H$mZyZr {V{Z{Y `m Zm_m{H$V `pV`m| `m g_ZwXo{eVm| H$mo Provided that the insurer shall have to communicate in writing to the insured or the legal
{b{IV _| CZ AmYmam| VWm V`m| Ho$ ~mao _| gy{MV H$aZm hmoJm, {OZHo$ AmYma na OrdZ ~r_m H$mo nm{bgr H$mo AdrH$V representatives or nominees or assignees of the insured the grounds and materials on which
H$aZo H$m `h \$gbm {b`m J`m h& such decision to repudiate the policy of life insurance is based:
AmJo eV `h h {H$ _hdnyU V` H$s JbV~`mZr `m {N>nmE OmZo Ho$ AmYma na nm{bgr H$mo AdrH$V {H$E OmZo VWm Provided further that in case of repudiation of the policy on the ground of misstatement or
suppression of a material fact, and not on the ground of fraud the premiums collected on the
YmoIoYS>r H$s pW{V Z hmoZo na, AdrH${V H$s {V{W VH$ nm{bgr na O_m {H$E JE g^r r{_`_m| H$m ^wJVmZ ~r_mYmaH$ policy till the date of repudiation shall be paid to the insured or the legal representatives or
`m ~r_mYmaH$ Ho$ H$mZyZr {V{Z{Y `m Zm{_Vm| `m g_ZwXo{eVm| H$mo Eogr AdrH${V H$s {V{W go Z~o {XZm| Ho$ AXa H$a {X`m nominees or assignees of the insured within a period of ninety days from the date of such
OmEJm& repudiation.
n>rH$aU - Bg Cn-Ymam Ho$ `moOZ hoVw, {H$gr V` H$s JbV~`mZr `m {N>nmE OmZo H$mo V~ VH$ _hdnyU Zht _mZm Explanation - For the purposes of this sub-section, the misstatement of or suppression of fact
shall not be considered material unless it has a direct bearing on the risk undertaken by the
OmEJm, O~ VH$ {H$ CgH$m ~r_mH$Vm mam drH$ma {H$E JE Omo{I_ na H$moB `j ^md Z hmo, `h _m{UV H$aZo H$m insurer, the onus is on the insurer to show that had the insurer been aware of the said fact no life
Xm{`d ~r_mH$Vm H$m hmoJm {H$ AJa ~r_mH$Vm H$mo Wm{nV V` H$s OmZH$mar hmoVr Vmo dh ~r_mYmaH$ H$mo `h OrdZ ~r_m insurance policy would have been issued to the insured.
nm{bgr Omar Zht H$aVm& (5) Nothing in this section shall prevent the insurer from calling for proof of age at any time if he
5. Bg Ymam _| {Z{hV Hw$N> ^r ~r_mH$Vm H$mo {H$gr ^r g_` C_ H$m _mU _mJZo go Zht amoH$Vr h, AJa dh BgHo$ {bE is entitled to do so, and no policy shall be deemed to be called in question merely because the
A{YH$V h VWm {H$gr nm{bgr H$mo {g\$ Bg{bE Z Ho$ {bE ~wbm`m Zht Om gH$Vm h `mo{H$ Vmd _| JbV CboI terms of the policy are adjusted on subsequent proof that the age of the life insured was
incorrectly stated in the proposal.
H$s JB ~r{_V `pV H$s C_ H$mo g~yV Ho$ AmYma na ~mX _| g_m`mo{OV {H$`m J`m Wm&

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 {Q>flnUr `{X AmnH$mo H$moB {eH$m`V hmo Vmo Amn {eH$m`V {ZamH$aU A{YH$mar/cmoH$nmc _| gnH$ H$a gH$Vo h {OgH$m nVm ZrMo {X`m Om ahm h:
NOTE: In case you have any complaint/grievance, you may approach Grievance Redressal Officer/Ombudsman whose address is as under:

emIm H$m`mc` H$m nVm {eH$m`V {ZdmaU A{YH$mar H$m nVm cmoH$nmc H$m nVm
Address of Branch Address of Grievance Redressal Officer Address of Ombudsman

{Q>flnUr `{X BZ eVm} Ama {Z~YZm| Ama {deof nmdYmZm|/eVm} Ho$ g~Y _| H$moB {ddmX nXm hmoVm h Vmo AJoOr nmR> {d{Y_m` hmoJm&
Note: In case of dispute in respect of interpretation of these terms and conditions and special provisions/conditions the English version shall stand valid.

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