IRDAI Guidelines on Standard Travel Insurance Policy

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Insurance Regulatory and Development Authority

Exposure draft
Ref. No:–
Date:28-12-2020

Guidelines on Standard Travel Insurance Policy

In order to make available a standard travel insurance product with common coverage and policy wordings across the industry, an exposure draft on “Guidelines on Standard travel insurance policy” along with Standard terms & conditions (Annexure -1), Customer Information Sheet (Annexure- 2) and Use and File format (Annexure-3) is issued and attached herewith.

All the stakeholders are requested to forward their comments/suggestions on the exposure draft by 6th January, 2021 in the attached format.

Stakeholders are also requested to suggest a suitable name for the product. The person whose suggested name is selected will be issued a certificate of appreciation by Chairman, IRDAI.

The comments along with the suggested name may be mailed to munshi@irdai.gov.in.

SURESH MATHUR
Executive Director (Health)

FORMAT FOR SUGGESTIONS ON

Exposure Draft on

Guidelines on Standard Travel Insurance Policy

Change suggested by
Date
Note		♦ It is suggested that ONE Page may be used for one change. ♦ This will enable us to group all the suggestions and take a decision on the changes suggested
Sl. No.	Page No	Guidelines /Annexure	Guidelines and Sub-Clause No./Para Number	Comments / Change suggested	Rationale

EXPOSURE DRAFT ON STANDARD TRAVEL INSURANCE PRODUCT

A. Preamble:

1. Indian travel market is one of the biggest in the world. As per reports, around 36% of Indian households undertake trips for one purpose or other both within and outside the country. While it is essential that every travel undertaken shall be a safe journey, there is a need to make every trip a secured journey by providing suitable safety net. Though, there are a number of travel insurance products available in India, the penetration of travel insurance is yet to take off. Further, each product has unique features and the insuring public may find it difficult to choose an appropriate product. In order to deepen the penetration of travel insurance, which shall provide safety net to every individual who is undertaking travel, it is considered essential to have a standard travel product. This standard product shall have common benefits and policy wordings across the industry.

2. Towards this, the following Guidelines on Standard Travel Insurance Product are issued.

3. The standard product shall have the basic mandatory covers as specified in these Guidelines which shall be uniform across the market. The product may be both as an individual product and as a group product.

4. The optional covers which are specified are allowed to be offered along with the standard product.

5. The insurer may determine the price keeping in view the covers proposed to be offered subject to complying with the norms specified in the IRDAI (Health Insurance) Regulations, 2016 (HIR, 2016) and Guidelines notified there under.

6. The policy tenure of the standard product shall be the duration of the journey of policyholder as a fare paying passenger and during their stay at overseas, in case of overseas travel policy, as specified in the policy schedule.

7. The standard Product shall comply with all the provisions of IRDAI (Health Insurance) Regulations, 2016, all other applicable Regulations, Consolidated Guidelines on Product filing in Health Insurance Business (Ref: IRDAI/HLT/REG/CIR/194/07/2020 dated 22nd July, 2020), Master Circular on Standardization of Health Insurance Products (Ref: IRDAI/HLT/REG/CIR/193/07/2020 dated 22nd July, 2020) and other applicable Guidelines as amended from time to time.

8. Every General and Stand-alone Health Insurer, who has been issued a Certificate of Registration to transact General and/or Health Insurance Business, shall endeavour to offer this product.

B. Construct of Standard Travel Insurance (Individual/Group) is as follows

(I) Plans & Coverages under Domestic Travel Insurance

S N	Proposed Plans	Sum Insured	Claim Type	Plan-A	Plan-B	Plan- C	Plan-D	Plan- E
				Travel by any mode of public transport (Within City)	Travel by any mode of public transport (Outside City)	Train Journey	Air-travel	Domestic Tours involving Road, Water, Train and Air travel
				Coverage only within India
	Tenure (Minimum & maxi-mum)			A single journey of 20 minutes onwards, upto 12 hours	A single trip from 12 hours onwards upto 7 days.	Single trip- Point to Point (PP) Boar-ding to Destina-tion& Return	Single trip- Point to Point (PP) Boar-ding to Destina-tion & Return	Use of several modes of travel. From more than 24 hours up to 1 year.
	Mandatory Benefits	Rs.
1	Accidental Hospita-lization Expenses	Rs. 2 Lakh	Inde-mnity	Yes	Yes	Yes	Yes	Yes
2	Accidental Death	Rs. 10 lakh per person	Benefit Based	Yes	Yes	Yes	Yes	Yes
3	Permanent Total Disability (PTD)	Rs. 10 lakh per person	Benefit Based	Yes	Yes	Yes	Yes	Yes
4	Permanent Partial Disability (PPD)	Rs. 5 lakh per person	Benefit Based	Yes	Yes	Yes	Yes	Yes
5	Repat-riation Of Mortal Remains	Rs. 50,000	Inde-mnity	Yes	Yes	Yes	Yes	Yes
6	Ambulance Charges	Rs. 2000	Inde-mnity	Yes	Yes	Yes	Yes	Yes
	Optional Benefits	Rs.
7	Hospital Cash (for a maximum of 7 days with 2 days deductible)	Rs. 1000 per day	Benefit Based	Yes	Yes	Yes	Yes	Yes
8	Compa-ssionate Visit	Rs. 10,000	Inde-mnity	No	No	Yes	Yes	Yes
9	Compa-ssionate Visit Stay (Maximum of 7 days)	Rs. 2000 per day	Inde-mnity	No	No	Yes	Yes	Yes
10	Missed Flight /Missed Train	Rs. 10,000	Inde-mnity	No	No	Yes	Yes	Yes
11	Loss Of Checked-in Baggage (applicable only for air travel)	Rs. 10,000	Benefit Based	No	No	No	Yes	Yes
12	Trip Delay (applicable only for air travel) (beyond 3 hour)	Rs. 1,000	Benefit Based	No	No	No	Yes	Yes
13	Carrier Cance-llation (applicable only for air travel)	Rs. 10,000	Benefit Based	No	No	No	Yes	Yes
14	Trip cancellation due to pandemic/ epidemic & natural calamities	Rs. 100000	Inde-mnity	No	No	No	No	Yes
15	Automatic trip extension	available		No	No	No	No	Yes

B (II) Overseas Travel Insurance

Section	Coverages provided	Sum Insured US$ or equivalent (proposed)	Type of payment	Long-term Trip (Students)	Short-term trip (Tours/ Leisure)(Covers travel through Road, Water, Train and Air)	Multi-trip during policy period (Business)	Coverage only for Travel (Onward & Return)
				Plan-F	Plan – G	Plan- H	Plan- I
	Coverage only OUTSIDE India			Incidence during journey and stay	Home to Home Coverage (Journey + Stay)	Home to Home Coverage (Journey + Stay)	During the period of journey only
	Tenure (Minimum & maximum)			6 months to 36 months	1 day to 180 days	1 year – Annual Policy	Period of Travel only
	Mandatory Benefits
16	Hospita-lisation (accident+ illness)	1,00,000	Indemnity	Yes	Yes	Yes	Yes
17	Hospital Cash (for a maximum of 7 days;2 days deductible)	25	Benefit Based	Yes	Yes	Yes	Yes
18	Life Threatening Condition Due To PED	10,000		Yes	Yes	Yes	Yes
19	Accidental Death / PA	10,000	Benefit Based	Yes	Yes	Yes	Yes
20	Permanent Total Disability (PTD)	10,000	Benefit Based	Yes	Yes	Yes	Yes
21	Permanent Partial Disability (PPD)	5,000	Benefit Based	Yes	Yes	Yes	Yes
22	Repatriation of Mortal Remains	10,000	Indemnity	Yes	Yes	Yes	Yes
23	Ambulance Charges	500	Indemnity	Yes	Yes	Yes	Yes
	Optional Benefits
24	Automatic trip extension	available		No	Yes	Yes	No
25	Bounced Airline Booking	250	Indemnity	Yes	Yes	Yes	Yes
26	Bounced Hotel booking	250	Indemnity	No	Yes	Yes	No
27	Compa-ssionate Visit (2 ways)	5,000	Indemnity	Yes	Yes	Yes	No
28	Contin-uation of treatment at country of residence (India)	available		No	Yes	Yes	Yes
29	Delay of check-in baggage (after 12 hrs)	100	Benefit Based	Yes	Yes	Yes	Yes
30	Emergency Assistance Services	available		Yes	Yes	Yes	No
31	Emergency Medical Evacuation		Indemnity	Yes	Yes	Yes	No
32	Flight Delay (beyond 3 hour)	500	Indemnity	No	Yes	Yes	Yes
33	Loss of Checked-in Baggage	500	Indemnity	Yes	Yes	Yes	Yes
34	Loss of passport	200	Indemnity	Yes	Yes	Yes	Yes
35	Missed departure/ connecting flight	500	Indemnity	Yes	Yes	Yes	Yes
36	Personal Liability	50,000	Indemnity	Yes	Yes	Yes	No
37	Sponsor Protection	10,000	Indemnity	Yes	No	No	No
38	Trip cancellation due to pandemic/ epidemic and natural calamities	10,000	Indemnity	No	Yes	Yes	No

C. Other Norms applicable:

S.N	Particulars	Norms Applicable
1.	Plan Variants	There are 5 variants under domestic travel and 4 variants under overseas travel. Other than plan variants specified no other plant variant is allowed to be offered under standard travel product.
2.	Distributions Channels	Standard product may be distributed across all distribution channels including Point of Sale persons and Common Public Service Centres. Distribution of standard product shall be governed by the regulations of concerned distribution channels.
3.	Category of Cover	Coverages are based on indemnity and benefit basis as specified herein. The product will be offered on an individual, family floater and on group basis.
4.	Minimum and Maximum Sum Insured	The benefit wise sum insured are provided under Table B (I) and B (II).
5.	Policy Period	The policy provides coverage only during the period of journey under domestic insurance. Both stay and travel are covered under overseas travel insurance under Plan variants – F, G, H. Only period of travel is covered under Plan I.
6.	Premium payment	There shall be no instalment premium. Premium shall be paid in advance (except in case of Plan F- multi-year student’s policy where the same may be annual).
7.	Entry age	There shall be no restrictions on age of entry. However, the proposer shall be at minimum of age 18 years.
8.	Family Floater	Standard product shall be offered on family floater basis also.
9.	Definition of family	Family consists of the proposer and any one or more of the family members as mentioned below: (i) Legally wedded spouse. (ii) Parents and Parents-in-law. (iii) Dependent Children (i.e. natural or legally adopted) between day 1of birth to 25 years if attending as a full time student of a recognized institution who are unmarried, who permanently reside with the Insured person at the country of residence.
10.	Benefit Structure	The benefit pay out should be explicitly disclosed in the format of application (Form – IRDAI-UNF-STIP) along with other relevant documents
11.	Co-payment& deductibles	There shall be no co-payment & deductibles under the product for claims payment.
12.	Specific Waiting Period	There shall be no initial waiting period.
13.	Underwriting	Underwriting is subject to board approved underwriting policy
14	Renewal /Extension of policy	The product shall be subject to renewal at the request of policyholder should there be extension of travel duration. The maximum period of extension of policy shall be less than or equal to the original policy. Request for extension for policy to be submitted before completion of term of the existing policy..
15	Free Look Period	There shall be no free look period for the standard travel insurance except for Plan- G Student Travel Insurance.
16	Pricing	Domestic Travel Insurance – The premium under this product shall be pan-India basis and no geographic location / zone based pricing is allowed. Pricing in respect of Overseas Travel Insurance is permitted based on the country of travel and stay.(E.g. Asia (except Japan & Korea), Europe, USA & Canada, Asia (Japan & Korea), other countries).
17	Basis of payout	The Sum Insured & payment of claims shall be on individual basis/floater basis as per plan variant.
18	Eligibility	There will no restrictions on entry and exit ages. However, for the individuals upto age of 18 years, the proposer should be more than 18 years of age.
19	Sublimit for room/doctors fee	1. Room Rent, Boarding, Nursing Expenses all inclusive as provided by the Hospital / Nursing Home up to 2% of the sum insured subject to maximum of Rs.5000/- per day. 2. Intensive Care Unit (ICU) charges/ Intensive Cardiac Care Unit (ICCU) charges all inclusive as provided by the Hospital / Nursing Home up to 5% of the sum insured subject to maximum of Rs.10,000/-, per day. These limits are applicable to hospitalization section of domestic travel plan.
20	Portability	It is not applicable under both domestic and overseas travel plans.

D: Proposed construct of Terms and Conditions for Standard Product:

9. The Policy Terms and Conditions of the Standard Product shall be in the format specified in Annexure – 1. Insurer may suitably modify the definitions and other clauses of the policy contract prospectively based on the Regulations or Guidelines that may be issued by the Authority from time to time.

E: Other Norms:

10. The nomenclature of the product shall be Standard Travel Insurance Policy, succeeded by name of insurance company, (Standard Travel Insurance Policy, <name of insurer>). No other name is allowed in any of the documents.

11. The Proposal Form used for the product shall be subject to the norms specified under the Guidelines on Product Filing in Health Insurance.

12. Insurers shall mandatorily issue Customer Information Sheet (CIS) as per the format specified in these guidelines.

13. The Standard product shall be launched without prior approval of the Authority subject to complying with the following conditions.

a. The product shall be approved by the Product Management Committee.

b. Insurers shall obtain UIN for the standard product by filing the relevant particulars in Form – IRDAI-UNF-STIP (as specified in these Guidelines) along with a certificate from Chief Compliance Officer that the product filed is in compliance with the norms specified under these guidelines.

c. On review of the application, the Authority may call for such further information as may be required and may issue suitable directions which shall be retrospectively effected in respect of all contracts issued under this product.

14. All General and Health Insurers shall endeavour to offer this product from 01^st April, 2021onwards.

15. This has the approval of the competent authority.

General Manager (Health)

Annexure-1

Standard Travel Insurance,[Company Name]

1. PREAMBLE

This Policy is a contract of insurance issued by [name of the Company] (hereinafter called the ‘Company’) to the proposer mentioned in the schedule (hereinafter called the ‘Insured’) to cover the person(s) named in the schedule (hereinafter called the ‘Insured Persons’). The policy is based on the statements and declaration provided in the proposal Form by the proposer and is subject to receipt of the requisite premium.

2. OPERATIVE CLAUSE

Any amount payable under the policy shall be subject to the terms of coverage, exclusions, conditions and definitions contained herein. Maximum liability of the Company under all such Claims during each Policy Year shall be the Sum Insured specified in the Schedule.

3. DEFINITIONS

The terms defined below and at other junctures in the Policy have the meanings ascribed to them wherever they appear in this Policy and, where, the context so requires, references to the singular include references to the plural; references to the male includes the female and references to any statutory enactment includes subsequent changes to the same.

3.1 Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.

3.2 Age means age of the Insured person on last birthday as on date of commencement of the Policy.

3.3 Air Travel shall mean travel by an airline/aircraft for the purpose of flying therein as a passenger. Air travel means being in or on, or boarding an aircraft for the purpose of flying therein or alighting there from following a flight bound outside India.

3.4 Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured person in accordance with the Policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved.

3.5 Checked in baggage means the baggage handed over by the Insured Person and accepted by an International Airlines / carrier outside India for transportation in the same mode of conveyance as the Insured Person travels and for which the carrier has issued a baggage receipt.

3.6 Condition Precedent means a Policy term or condition upon which the Company’s liability under the Policy is conditional upon.

3.7 Common Carrier means any public road conveyance which is operating under a valid license from the relevant authority for the transportation of passengers for hire or reward.

3.8 Dependent Family consists of the proposer and any one or more of the family members as mentioned below:

i. legally wedded spouse.

ii. Parents and Parents-in-law.

iii. Dependent Children (i.e. natural or legally adopted) between `1 day to 25 years if attending as a full time student of a recognized institution who are unmarried, who permanently reside with the Insured person at the country of residence.

3.9 Disclosure to information norm: The policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, mis-description or non-disclosure of any material fact.

3.10 Emergency Care: Emergency care means management for an illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious long term impairment of the insured person’s health.

3.11 Emergency Dental Treatment means the services or supplies provided by a Licensed dentist, Hospital or other provider that are medically and immediately necessary to treat dental problems resulting from injury. However, this definition shall not include any treatment taken for a pre-existing condition.

3.12 Emergency Medical Treatment means the services or supplies provided by a Physician, Hospital or Licensed provider that are Medically Necessary to treat any illness or other covered condition that is acute (onset is sudden and unexpected), considered life threatening, and one which, if left untreated, could deteriorate resulting in serious and irreparable harm.

3.13 Emergency Medical Evacuation means the medical condition of the Insured Person warrants Immediate transportation of the insured person from the place he/she is sick/sustains accidental injuries to the nearest hospital for appropriate treatment and/or after the treatment the medical condition of the Insured person warrants transportation to the Country where the Trip commenced for the purpose of further medical treatment or recovery.

3.14 Hospital means any institution established for in-patient care and day care treatment of disease/ injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under Schedule of Section 56(1) of the said Act, OR complies with all minimum criteria as under:

i. has qualified nursing staff under its employment round the clock;

ii. has at least ten inpatient beds, in those towns having a population of less than ten lakhs and fifteen inpatient beds in all other places;

iii. has qualified medical practitioner (s) in charge round the clock;

iv. has a fully equipped operation theatre of its own where surgical procedures are carried out

v. maintains daily records of patients and shall make these accessible to the Company’s authorized personnel.

3.15 (a) Hospitalisation means admission in a hospital for a minimum period of 24 consecutive ‘in-patient care’ hour except for specified procedures / treatments, where such admission could be for a period of less than 24 consecutive hours.

(Note: Clause 3.16 (a) is applicable to domestic travel insurance policies)

(b) Hospitalisation means admission in a hospital for a minimum period of twenty four (24) consecutive ‘In-patient care’ hours.

i. Acute Condition means a disease, illness or injury that is likely to response quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/ illness/ injury which leads to full recovery.

ii. Chronic Condition means a disease, illness, or injury that has one or more of the following characteristics

a) it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and / or tests

b) it needs ongoing or long-term control or relief of symptoms

c) it requires rehabilitation for the patient or for the patient to be special trained to cope with it

d) it continues indefinitely

e) it recurs or is likely to recur

(Definition of Clause 3.16 (b) is applicable for overseas travel insurance policies)

3.16 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.

3.17 In-Patient Care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

3.18 Insured Person means person(s) named in the schedule of the Policy.

3.19 Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.

3.20 ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses on a per day basis which shall include the expenses for ICU bed, general medical support services provided to any ICU patient including monitoring devices, critical care nursing and intensivist charges.

3.21 Immediate Relative mean sister(s), brother(s), sister(s)-in-law, brother(s)-in-law, parents-in-law, Step Parents.

3.22 Medical Advice means any consultation or advice from a Medical Practitioner including the issue of any prescription or follow up prescription.

3.23 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.

3.24 Medical Practitioner means a person who holds a valid registration from the Medical Council of any state or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of the licence.

3.25 Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which

i. is required for the medical management of illness or injury suffered by the insured;

ii. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity;

iii. must have been prescribed by a medical practitioner;

iv. must conform to the professional standards widely accepted in international medical practice or by the medical community in India.

3.26 Network Provider means hospitals enlisted by insurer, TPA or jointly by an insurer and TPA to provide medical services to an insured by a cashless facility.

3.27 Non- Network Provider means any hospital that is not part of the network.

3.28 Notification of Claim means the process of intimating a claim to the Insurer or TPA through any of the recognized modes of communication.

3.29 Pre-Existing Disease (PED): Pre-existing disease means any condition, ailment, injury or disease

a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or

b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy or its reinstatement.

c) A condition for which any symptoms and or signs if presented and have resulted within three months of the issuance of the policy in a diagnostic illness or medical condition.

3.30 Policy means these Policy wordings, the Policy Schedule and any applicable endorsements or extensions attaching to or forming part thereof. The Policy contains details of the extent of cover available to the Insured person, what is excluded from the cover and the terms & conditions on which the Policy is issued to The Insured person

3.31 Policy period means the duration of journey in the public carrier as a fare paying passenger as mentioned in the policy schedule

3.32 PERIOD OF INSURANCE This insurance is valid from the First Day of Insurance or date and time of departure from India,whichever is later, subject to General Condition and expires on the last day of the number of days specified in the policyschedule or on return to India whichever is earlier. When injury/illness accident covered under this policy is contracted during policy period and treatment for the same commences during the period and continues beyond the expiry date of this policy, only emergency expenses would be paid up to 45 days from the date of expiry of the policy provided the insured person is medically incapable of travel. The insurer must be notified immediately as soon as it is known that insured person is unfit to return to India. If any new illness/injury/accident is contracted beyond the expiry date of the policy, treatment for the same would not be covered. Extension of the period of insurance is automatic for the period not exceeding days, and without extra charge if necessitated by delay of public transport services beyond the control of the Insured person.

3.33 Policy Schedule means the Policy Schedule attached to and forming part of Policy

3.34 Qualified Nurse means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India.

3.35 Room Rent means the amount charged by a hospital towards Room and Boarding expenses and shall include the associated medical expenses.

3.36 Sub-limit means a cost sharing requirement under a travel insurance policy in which an insurer would not be liable to pay any amount in excess of the pre-defined limit

3.37 Sum Insured means the pre-defined limit specified in the Policy Schedule. Sum Insured represents the maximum liability for any and all claims made under the Policy, in respect of that Insured Person (on Individual basis) or all Insured Persons (on Floater basis) during the Policy Year.

3.38 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 and prolongation of life, performed in a hospital or day care centre by a medical practitioner.

3.39 Third Party Administrator (TPA) means a Company registered with the Authority, and engaged by an insurer, for a fee or by whatever name called and as may be mentioned in the health services agreement, for providing health services.

4. Coverage under Domestic & Overseas Travel Insurance

We will pay the insured person the benefits as detailed below, for events described, if it occurs during the insured journey only. Each Benefit is subject to its own Sum Insured as mentioned in the policy schedule.

Coverage	Domestic Travel Insurance	Overseas Travel Insurance
Base Covers	Section 1 to 6	Section 16 to 23
Optional Covers	Section 7 to 15	Section 24 to 38

Domestic Travel (Sections 1 to 15)

Base Cover: (Sections 1 to 6)

The cover listed below is in-built Policy benefit and shall be available to all Insured Persons in accordance with the procedures set out in this Policy.

Section 1. Accidental Hospitalization Expenses: The Company will indemnify the Insured person up to the sum insured as mentioned in the Certificate of Insurance/Policy Schedule in respect of Hospitalisation Expenses reasonably and necessarily incurred as an in-patient, for treatment of injuries sustained following an accident to the Common Carrier during the period of travel.

The medical expenses shall include and be limited to the following services:

I. Room, Boarding expenses

II. Intensive Care Unit bed charges

Associated medical expenses as specified below:

i. Doctor’s fees

ii. Nursing Expenses

iii. Surgical Fees, Operation Theatre Charges, Anesthetist, Anesthesia, Blood, Oxygen and their administration, Physical Therapy

iv. Prescribed Drugs and medicines consumed on the premises

v. Investigation Services such as Laboratory, X-Ray, Diagnostic tests

vi. Dressing, Ordinary splints and plaster casts

vii. Cost of Prosthetic and other devices that are used intra operatively during a Surgical Procedure, if recommended by the attending Medical Practitioner

If the Insured Person is admitted in a room where the Room Rent incurred or the Room Category is different than the one specified in the Policy Certificate, then the Insured shall bear the rateable proportion of the total associated Medical Expenses (including surcharge or taxes thereon) in the proportion of the difference between the room rent actually incurred and the room rent limit or the Room Rent of the entitled room category to the room rent actually incurred.

Specific Exclusions to this Section

In addition to the General exclusions under this policy, we will not make any payment for any claim in respect of any Insured Person directly or indirectly for, caused by, arising from or in any way attributable to:

a) Any travel which is for the purpose of obtaining medical treatment.

b) A Pre-existing Condition/Disease

c) If the Insured Person is travelling against the advice of a Doctor or is receiving or on a waiting list for specified medical treatment.

d) Any treatment of cancer, orthopedic, degenerative or oncology diseases, unless immediate medical treatment was required in order to maintain life or relieve acute pain or distress.

e) Any treatment relating to the removal of physical flaws or anomalies or any form of cosmetic treatment or surgery.

f) Any costs or periods of residence incurred in connection with rest cure or recuperation at spas or health resorts, sanatorium, convalescence homes or any similar institution.

g) Any costs in any way related to psychiatric or mental disorders.

h) Any costs relating to the Insured Person’s pregnancy, childbirth or the consequences of either provided that:

i. This exclusion shall not apply if the Insured Person’s pregnancy had not advanced beyond the 30th week, in which case We will reimburse the reasonable cost of the medically necessary emergency treatment required because of acute complications during the course of her pregnancy to directly avert danger to her life or that of the unborn child.

ii. This exclusion does not include admissions for ectopic pregnancy

iii. We will not make any payment towards the cost of abortion, childbirth except condition (i) above or any postnatal illness or disease or their consequences.

i) Rehabilitation or physiotherapy or the costs of artificial limbs or any other external appliance and/or device used for diagnosis or treatment; any external diseases, defects or anomalies

j) The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.

k) Treatment of Obesity and any weight control program.

l) Any non allopathic treatment.

m) Charges related to a Hospital stay not expressly mentioned as being covered, such as charges for admission, discharge, administration, registration, documentation and filing.

n) Treatment rendered by a Doctor which is outside his discipline;

o) Doctor’s fees charged by the Medical Practitioner sharing the same residence as an Insured Person or who is an immediate relative of an Insured Person’s family.

p) The provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.

q) Non-prescription drugs or treatments.

r) Venereal disease, sexually transmitted disease or illness; “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human immunodeficiency virus) like conditions related to or arising out of HIV/AIDS such as ARC (AIDS related complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.

s) Intentional self injury

t) Injury directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, warlike operations (whether war be declared or not).

u) Injury directly or indirectly caused by or contributed to by nuclear weapons/materials

v) Charges incurred on diagnostics that are not consistent with the treatment for which the insured is admitted in the hospital / nursing home. Admission primarily for diagnostic purpose with no positive existence of injury and no further treatment is indicated.

w) Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Physician of the hospital where the insured underwent treatment

x) Hospital registration charges, record charges telephone charges and such other charges.

Section 2. Accidental Death: If the Common Carrier in which the insured person is travelling meets with an accident resulting in death of insured person within 365 days from the date of Accident, then the Company will pay as compensation to the legal heirs / nominee, the amount stated as sum insured in the policy schedule/ Certificate of Insurance.

Section 3. Permanent Total Disablement :If following an Accident to the common carrier which caused permanent total impairment of the Insured’s physical capabilities, then the Company will pay the benefits as provided in “Benefits Schedule (Table – T1)” depending upon the degree of disablement provided that:

a) The disablement occurs within 365 days from the date of the Accident.

b) The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement.

Benefits Schedule (Table – T1)
Benefits	% of SI
1. Permanent Total Disablement Payable only when the insured person, following accidental injuries is unable to engage in each and every occupation or employment for compensation or profit for which he is reasonably qualified by education, training or experience for the rest of his life. If at the time of loss the insured person is unemployed, Permanent Total Disability shall mean the total and permanent inability to perform all of the usual and customary duties and activities of a person of like age and sex even with the use of special equipment routinely available to help and having taken any appropriate prescribed medication	100%
2. Total and irrevocable loss of (i) Sight of both eyes (ii) Physical separation of two entire hands (iii) Physical separation of two entire foot (iv) One entire hand and one entire foot (v) Sight of one eye and loss of one hand (vi) Sight of one eye and loss of one entire foot (vii) Use of two hands (viii) Use of two foot (ix) Use of one hand and one foot (x) Sight of one eye and use of one hand (xi) Sight of one eye and use of one foot (xii) Sight of one eye (xiii) Physical separation of one entire hand (xiv) Physical separation of one entire foot (xv) Use of one hand without physical separation (xvi) Use of one foot without physical separation	100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 50% 50% 50%

Section 4. Permanent Partial Disablement: If following an Accident to the common carrier which caused permanent partial impairment of the Insured’s physical capabilities, then the Company will pay the benefits as provided in “Benefits Schedule (Table – T2)” depending upon the degree of disablement provided that:

Benefits Schedule (Table-T2) (Permanent Partial Disablement)
Benefits		% of SI
1	Loss of toes all Loss of Great toe (Both Phalanges) Loss of Great toe (One Phalanx) Other than Great, if more than One toe lost, for each toe	20 5 2 1
2	Loss of hearing both ears Loss of hearing one ear	75 30
3	Loss of four fingers and thumbs of One hand	40
4	Loss of four fingers Loss of thumb both phalanges (Both Phalanges) Loss of thumb both phalanges (One phalanx)	35 25 10
5	Loss of index finger three phalanges Loss of index finger two phalanges Loss of index finger One phalanx	10 8 4
6	Loss of middle finger three phalanges Loss of middle finger Two phalanges Loss of middle finger One phalanx	6 4 2
7	Loss of ring finger Three Phalanges Loss of ring finger Two Phalanges Loss of ring finger One Phalanx	5 4 2
8	Loss of little finger Three phalanges Loss of little finger Two phalanges Loss of little finger One phalanx	4 3 2
9	Loss of metacarpals Additional (Third, fourth or fifth )	3 2
10	Any other Permanent partial disablement : Percentage as assessed by the Medical Board or by the government doctor.

Special Condition for Benefits PTD and PPD are provided below:

a) The disablement occurs within 365days from the date of the Accident.

b) The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement.

c) If the Accident affects any physical or mental function of the Insured Person, which was already impaired prior to the accident, a deduction as certified by an independent medical practitioner will be made in respect of this prior disablement.

d) If the accident impairs a number of physical or mental functions, the degree of disablement given in the Table of Benefits will be added together, but liability in any case shall not exceed 100% of the Sum Insured.

e) Any injuries/conditions which are Pre-existing are not covered.

f) Any claim which arises out of Accidents whilst the insured is engaged in any criminal or illegal act.

g) Any claim for Death or Permanent Disablement of the Insured Person (a) from intentional self-injury / suicide or attempted suicide or (b) caused by the insured person whilst the he/she is under the influence of intoxicating liquor or drugs or (c) from self-endangerment unless in self-defence or to save human life

h) Provoked murder or assault or any attempt thereat

i) In the event of Permanent Disablement, the Insured Person will be under obligation:

i. To have himself/herself examined by independent doctors (doctors not associated with the insurer). The costs for such examination will be paid by the insurer as an reimbursement to the insured.

ii. To authorize doctors providing treatments or giving expert opinion and any other authority to supply the Company any information that may be required.

Section 5. Repatriation Of Mortal Remains: Following an admissible claim under Death due to Accident (PA), the Company shall pay for repatriation of mortal remains of the insured person from the place of death to the Insured’s place of residence up to the limits mentioned in the Certificate of Insurance/policy schedule, provided, the death of the insured person occurred in a location that is not the place of residence of the insured person and the place of death is at least 100 kilometres from his place of residence.

Section 6. Ambulance Charges and Emergency Medical Evacuation: Subject to an admissible claim under Hospitalisation due to Accident, the Company shall pay up to the limits mentioned in the Certificate of Insurance/Policy Schedule towards

a) Ambulance charges to go to nearest hospital for emergency treatments or

b) The cost of emergency medical evacuation if the treatment facility is not available in the nearest hospital. Recommendation by the treating doctor for evacuating the insured to another hospital with required equipment from where the insured is primarily admitted is required to be submitted for an admissible claim under this Section

Optional Covers (Sections 7 to 15)

The cover listed below are Optional Policy benefit and shall be available to Insured Persons in accordance with the terms set out in the Policy, if the listed cover is opted by the insured person.

Section 7. Hospital Cash: If during the period of insurance, the insured person sustains accidental injuries, due to an accident to the Common Carrier, resulting in hospitalization as an in-patient, the Company shall pay cash benefit mentioned in the policy schedule for each completed 24 hours upto a maximum of 7 days, provided there is an admissible claim under the policy. Benefits under this Section are payable as benefit based irrespective of the costs incurred.

Section 8. Compassionate Visit

In event of the Insured being Hospitalized consequent upon any Injury sustained and/ or Illness contracted at any place being part of the Trip covered hereunder during the policy period and such Hospitalisation shall in the opinion of the Medical Practitioner attending on the Insured extend beyond a period of 5 days, the Insurer shall reimburse the cost of the economy class air ticket/common carrier incurred by any one person of the Family or immediate relative rendering such special assistance from and to the place of origin of such person or the place of residence of the person upto the actuals or Sum Insured as mentioned in the Policy Schedule whichever is less.

Provided that

i. The Hospitalisation has been advised by the Medical Practitioner attending on the Insured and such Hospitalisation is admitted under Section 1 – Medical Expenses Cover of this Policy; and

ii. The need of such assistance is essential in the opinion of the Medical Practitioner attending on the Insured and recommended by him/ her accordingly.

The Company’s liability under this Benefit, however, shall in respect of any one event or all events of Hospitalisation during the Policy Period shall not exceed the Sum Insured as specified in the Policy Schedule.

Terms and Conditions:

a) The Insured shall as far as possible seek for such special assistance from any one of his/ her relatives, either at the place of Hospitalisation or any other nearest place.

b) It is a condition precedent to the Company’s liability hereunder that the need for such a special assistance and consequent visit of any one of the Family or relative from a particular place is also approved by the Overseas Administrator before any one of the Family or near relative undertakes the Trip.

c) The Insured Person is Hospitalized at a distance of at least 100 kilometres from his place of residence;

d) We shall not accept more than one claim under this Cover Benefit in respect of the Insured Person following from the same Accident.

c. We will reimburse only those expenses that are Reasonable and Customary Charges;

Section 9. Compassionate Visit Stay (maximum of 7 days)

We will pay the daily amount specified in the Certificate of Insurance/policy schedule towards accommodation expenses for a family member/ an Immediate Relative of the Insured Person to stay at the place of Hospitalization of the Insured Person during the Coverage Period.

This Cover Benefit will be payable provided that:

a. We have accepted a claim under Hospitalisation due to Accident

b. The Insured Person is Hospitalized at a distance of at least 100 kilometres from his place of residence;

b. This Cover Benefit shall not be payable in respect of the Insured Person for more than the maximum number of days specified in the Certificate of Insurance/policy schedule for the Coverage Period;

d. We will reimburse only those expenses that are Reasonable and Customary Charges;

c. We shall not be liable to pay any amount under this Cover Benefit after the Insured Person’s discharge from Hospital;

e. We shall not accept more than one claim under this Cover Benefit in respect of the Insured Person following from the same Accident.

Section10. Missed Flight (applicable to air travel only):

We will reimburse the cost of the booking up to the limit specified in the Certificate of Insurance/Policy Schedule on the Common Carrier due to the Insured Person’s failure to reach the original departure point of the booked journey caused by the delayed arrival of a public transport or any other Common Carrier that the Insured Person was travelling in as a passenger, or due to any Accident during the Coverage Period.

This Benefit will be payable provided that:

a. The Insured Person provides Us with a written proof from the Common Carrier of the missed departure;

b. We shall not accept more than one claim under this benefit during the Coverage Period.

c. We shall not be liable to reimburse any expenses for any loss which will be paid or refunded by any applicable Common Carrier.

Conditions and Exclusions applicable for Sections10 (applicable to air travel only):

a) Destination specified while booking a trip in the public transport or common carrier should be the departure Airport for an admissible claim under these covers. If the destination is changed to places other than airport during the trip, claim under these optional covers is not admissible.

b) The trip to the Airport of departure should commence adequately in advance to reach the Airport as per the timeline rules of the Airline Authority or 90 minutes before the schedule departure time of the Aircraft, whichever is higher.

c) The Company shall not be liable to reimburse any expenses in respect of delay caused due to, arising out of or in consequence of any acts or omissions of the Insured Person.

Section 11. Loss of Checked-in Baggage (applicable to air travel only)

If the Insured Person’s checked-in accompanying baggage is permanently lost by the carrier (land, sea or air) to whom it was entrusted, then the Insurer will pay a fixed amount as specified in the policy schedule/certificate of insurance. The compensation shall be relating to the loss of baggage as a whole, and shall be on actuals on declaration of such loss by the Insured, provided that the overall liability under this Benefit shall be limited to the sum specified in the Policy Schedule hereunder. Should the lost Checked In Baggage be traced and delivered to the Insured, the Insured shall return to the Company the entire amount paid hereunder.

Specific Conditions:

1. The amount payable in respect of any one article, pair or set is limited to the amount stated in the Schedule.

2. In the event of loss of property whilst in the custody of a carrier, a Property Irregularity Report (PIR) must be obtained from thecarrier immediately upon discovering the loss, which must be submitted to “Assistance Service Provider”/the insurer in the event of a claim.

3. The baggage should be totally lost .No partial loss or damage shall become payable. However, total loss or damage of an individual unit (s) of baggage shall not beconstrued as falling within this exclusion.

4. The insurers reserve the right to replace or pay the intrinsic value of any lost article.

5. In the event of total loss of more than one checked-in baggage, the maximum amount payable per baggage will be 50% and per article contained in the bag will be 10% of the Limit of Indemnity.

6. Our payment will be reduced by any sum for which the Carrier is liable to make payment

7. In the event of loss of a pair/set, Insurer can repair or replace any part, to restore the pair or set to its value before the loss; or pay the difference between the cash value of the property before and after the loss.

8. The Insurer liability under this cover will be limited to the travel destinations specified in the main travel ticket from India and return trip back to India during trip abroad. All halts and via destinations included in this main travel ticket will also be considered for payment under this cover.

9. The liability of the Insurer to make payment shall not arise until liability is admitted by the airline.

Exclusions

The Insurer shall not be liable for any claim under this Cover that is caused by or is attributable to or arises out of or is howsoever connected to any of the following:

a) any electronic, electrical, visual or audio visual equipment, item or aid;

b) any loss due to complete/partial damage for the Checked-in-Baggage

c) any partial loss of the items in the Checked-in-Baggage;

d) Damage to the baggage

e) any item in the Checked-in-Baggage, which is valued above $ 100 without appropriate proof of ownership;

f) any loss arising from any delay, detention or confiscation by customs officials, police or other public authorities;

g) any kind of precious metals or articles made from any precious metals, cash, currency (Indian or foreign), precious stones or models or coins or curios, sculptures, manuscripts, stamps, collections of stamps, rare books, medals, moulds, designs or any other collectibles, deeds, ATM cards, credit cards, charge cards, bonds, bills of exchange, bank notes, treasury or promissory notes, cheques, money, securities, or any other negotiable instrument.Eyeglasses, sunglasses, contact lenses, hearing aids, artificial teeth and limbs; Tickets, keys, money, securities, bullion, stamps, documents (travel or otherwise),Jewellery, watches, gems, furs, cameras and camera equipment, camcorders, sporting equipment, computers (other than lap tops), radios and anyelectronic item. Such items should at all times be carried by the Insured Person and not packed as part of checked in baggage

Section 12. Trip Delay (applicable only for air travel) (beyond 3 hour)

We will pay the Insured person up to the amounts specified in the policy schedule/certificate of insurancein respect of reasonable additional accommodationand travelling and any other reasonableexpenses incurred as a result of the Insured’s flight being delayed by more than three hours from the scheduled time until travel becomespossible, due to a strike, industrial action, mechanical breakdown and inclement weather. Incurred expenses must be accompanied bysupporting receipts.

The insured will be reimbursed for –

1. Additional transportation costs to join the trip (by the lowest expensive class).

2. Reasonable accommodations and meals up to Rs. 1000 per day.

Provided always that

1. The delay is beyond three hours of scheduled departure.

2. The insured shall submit to the Company all relevant bills and receipts to substantiate the expenses incurred.

3. The Insured Person provides Us with a written proof from the Common Carrier of the length of the delay unless this proof is available to Us directly from a reliable source in the public domain;

4. We shall not accept more than one claim under this Benefit during the Travel Period.

5. The Common Carrier must certify the delay of the regularly scheduled airline flight.

6. The indemnity provided hereunder is in excess of what is provided by the Common Carrier or any other party free of charge.

Exclusion applicable:

In addition to the general exclusions, this section shall not cover any delay due to an covered hazard which was made public orknown to the Insured Person/s prior to the purchase of this policy or prior to departure of flight or prior to booking of flight ticket. for any departure which is delayed as a result of the Insured or anyother person who has arranged to travel with failing to check in correctly as required by the Common Carrier.

Section 13. Carrier Cancellation (applicable only for air travel)

We will pay the Sum Insured if the Insured Person’s booked and confirmed journey is cancelled within 48 hours prior to the scheduled departure by the Common Carrier.

The Benefit will be payable provided that:

a. The Insured Person provides Us with a written proof from the Common Carrier of the cancellation of the journey unless this proof is available to Us directly from a reliable source in the public domain.

b. Any cancellation of the journey by the Insured Person is not payable under the policy.

Section 14. Trip cancellation due to pandemic/epidemic & natural calamities

The Company will reimburse the unused and non-refundable portion of the pre-paid lodging cost and/or the ticket cancellation charges (up to the maximum amount specified in the schedule) if the Trip is cancelled and the Insured Person is unable to undertake the Trip due to:

i. death or serious injury or sudden sickness requiring minimum 3 days of hospitalization within 5 days before the date of departure specified in the policy schedule of (a) of the Insured Person or (b) Traveling Companion or (c) immediate Family member of the Insured Person.

ii. Covered occurrence provided they take place at and in the vicinity of any port involved

in the Insured’s Trip which shall mean the following:

1. Earthquake.

2. Lighting, Storm, Tempest, Typoon, Huricane, Inudation, Subsidence

3. Landslide and rockslide

4. Avalanche

5. Floods resulting from unseasonal rains, storm or cyclone.

6. Terrorism.

7. Tsunami

8. Volcano Eruption.

Amount payable under this section will be only in excess of any amount paid or payable if any by the Hotel/Airlines. The booking should have been made in advance prior to the cancellation.

Exclusions applicable to this benefit:

a. Negligence or fault of the travel agent.

b. Suspension of services by the Common Carrier whether pursuant to any order from any authority.

c. General exclusions applicable as specified in the policy

Claims provisions applicable to Trip Cancellation benefit

In event of any of the contingencies covered hereunder occurring either at the place of origin in the Country of Residence of the Insured or at any intermediary place any time after the commencement of the Trip and before termination of the same, resulting in the interruption of the scheduled travel being part of the Trip necessitating cancellation of the Trip, immediate notice thereof shall be given by the Insured to the Assistance Service Provider of Company.

Section 15:Automatic trip extension

The period of insurance is automatically extended upto a period of 7 days when there is a delay in Common Carrier, due to a Covered Occurrence and when no alternative travel arrangement is available. Travel Policy Extension beyond seven days can be granted on all travel plans up to the age of 80 years subject to following,

1. No claims being incurred under the original Policy.

2. Declaration from the Insured that the person is in good health and there are no claims reported/occurred during original Policy period.

3. Request should be received by the Company at least 7 days prior to expiry of the earlier Policy period in order to ensure that there is no break in insurance between the original Policy period and requested extension period.

4. Grace period of 7 days with exclusions for the break period will be acceptable and allowed. However all such proposals need to be referred to and approved by the Company as per the Underwriting Policy.

Overseas Travel Insurance (Sections 16 to 38)

The cover listed below is in-built Policy benefit and shall be available to all Insured Persons in accordance with the procedures set out in this Policy.

Mandatory (Sections 16 to 23)

Section 16. Emergency Inpatient Hospitalization (Illness + Accident)

This policy is not a general health insurance policy. Coverage under the medical expense section of this insurance is intended for use by the Insured person in the event of a sudden and unexpected sickness or accident arising when the insured person is outside the Republic of India.

The Company will indemnify the Insured Person (s) up to the Sum Insured specified in the Policy Schedule for reasonable and customary medical expenses incurred by the Insured Person (s) towards hospitalization on account of illness or accidental injury occurring during the trip. The medical expenses shall include and be limited to the following services: