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 [email protected]

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 01st 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:

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 17. Hospital Cash (for a maximum of 7 days;2 days deductible)

If the Insurer admits a claim under the Section 14- Emergency Inpatient Hospitalization (Illness + Accident), the Insurer will pay the fixed Sum stated in the Schedule/certificate of insurance for each continuous and completed period of 24 hours of Hospitalisation that requires the Insured Person to be Hospitalised Overseas. This benefit will not be payable for the first 48 hours of hospitalisation and the maximum period for payment is 7 days.

Section 18. Life Threatening Condition Due To PED

It is hereby declared and agreed that notwithstanding anything to the contrary contained in the Policy, the scope of cover under the Policy is extended to cover Medical Expenses incurred by the Insured for the treatment rendered in a Life Threatening Medical Condition due to pre-existing disease while overseas during the policy period, for any sudden, unexpected, unforeseen development attributable to any Pre-Existing Condition(s), subject to the following:

The treatment for these emergency measures would be paid till the Insured becomes Medically Stable or is relieved from acute pain. All further medical cost to maintain Medically Stable state or to prevent the onset of acute pain would have to be borne by the Insured.

The Liability of the Company under this extension will be equal to the actual Medical Expenses incurred by the Insured for such treatment or the Sum Insured as specified against this extension in the Policy Schedule, whichever is lesser.

Section 19. Accidental Death/ PA

The company will pay as compensation to the legal heirs / nominee the amount stated as sum insured in the policy schedule/ Certificate of Insurance if the Insured Person suffers Accidental Bodily Injury while Overseas, during the Policy Period and this is the sole and direct cause of his Death within the period of 365 days, then.

In the event of Accidental death of a minor below 18 years of age, the maximum liability of the Insurer will be limited to 50% of the sum insured under this Section.

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 loss resulting directly or indirectly from any external Congenital Anomalies;

b) Accidental Bodily Injury due to mental or psychiatric disorders, disturbances of consciousness, strokes, fits affecting the entire body, and pathological disturbances caused by mental reactions;

c) Any loss caused directly or indirectly, wholly or partly by medical or surgical treatment except as may be necessary solely as a result of Injury.

d) Intentional self injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)

e) Accident while under the influence of alcohol or drugs.

f) Participation in an actual or attempted felony, riot, crime, misdemeanor or civil commotion.

g) Any Accident of which a contributing cause was the Insured’s actual or attempted commission of, or wilful participation in, an illegal act or any violation or attempted violation of the law or the Insured’s resistance to arrest.

h) Whilst engaging in aviation or ballooning or whilst mounting into, dismounting from or travelling in any balloon or aircraft other than as passenger (fare paying or otherwise) in any duly licensed standard type of aircraft.

i) Participating in motor racing or trial run as a driver, co-driver or passenger.

j) Pregnancy and childbirth, miscarriage, abortion or complications arising out of any of these.

k) War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition of or damage or under the order of any government or public authority.

l) Nuclear energy, radiation.

m) Any existing disablement prior to the inception of the Policy.

n) Losses arising from Accidents on motorized vehicles unless at the time of the Accident the driver is duly qualified in possession of a current full international driving license and the driver is wearing a safety crash helmet in case of two wheeled motorized vehicle.

Section 20. Permanent Total  Disability (PTD)

The Company agrees to pay to the Insured the Compensation stated in the specific Table of Benefits below, if during the Trip an Insured sustains Bodily Injury which directly and independently of all other causes results in disablement within 365 days from the Date of accident.

Specific Condition

1) The insurance shall terminate for an Insured under this Section upon payment of a benefit equal to the Total Sum Insured.

2) The total amount payable in respect of more than one disablement due to the same Accident is arrived at by adding together the various percentages shown in the Table of Benefits, but shall not exceed the Total Sum Insured.

3) If an Insured dies as the result of the Bodily Injury any amount claimed and paid to an Insured under the Permanent Disablement Section will be deducted from any payment under the Accidental Death and/or Permanent Partial Disablement Section.

The company shall pay the benefit equal to 100% of Sum Insured, specified in the policy schedule, if an insured Person suffers Permanent Total Disablement of the nature specified below, solely and directly due to an Accident which occurs during the Policy Period, provided that the Permanent Total Disablement occurs within 12 months from the date of the Accident:

a) Total and irrecoverable loss of both eyes or

b) Physical separation or loss of use of both hands or feet or

c) Physical separation or loss of one hand and one foot or

d) loss of sight of one eye and Physical separation or loss of use of hand or foot

e) If such Injury shall as a direct consequence thereof, permanently, and totally, disables the Insured Person from engaging in any employment or occupation of any description whatsoever.

Section 21. Permanent Partial Disability (PPD)

The Company agrees to pay to the Insured the Compensation stated in the specific Table of Benefits below, if during the Trip an Insured sustains Bodily Injury which directly and independently of all other causes results in Permanent Partial Disablement within 365 days from the date of accident.

Specific Condition

1) The insurance shall terminate for an Insured under this Section upon payment of a benefit equal to the Total Sum Insured.

2) The total amount payable in respect of more than one disablement due to the same Accident is arrived at by adding together the various percentages shown in the Table of Benefits, but shall not exceed the Total Sum Insured.

3) If an Insured dies as the result of the Bodily Injury any amount claimed and paid to an Insured under the Permanent Partial Disablement Section will be deducted from any payment under the Accidental Death and/or Permanent Total Disablement Section.

Table of benefits Applicable under Death, Permanent Total disablement & Permanent Partial disablement:- Type of Disablement

Compensation in % of Total Sum Insured available under specific benefit

Total Loss or dismemberment of two limbs 100
Permanent Total Loss of Sight of Both Eyes 100
Permanent Total Loss of Sight of One Eye and one limb 100
Permanent Total Loss of Hearing of Both ears 100
Quadriplegia 100
Death 100
Loss of each arm at the shoulder joint 70
Loss of each leg above center of the femur 70
Loss of each arm to a point above elbow joint 65
Loss of each leg up to a point below the femur 65
Loss of each arm below elbow joint 60
Loss of each hand at the wrist 55
Loss of each leg to a point below the knee 50
Permanent Total Loss of one eye/one limb 50
Loss of each eye 50
Paraplegia/Hemiplegia 50
Loss of each leg up to the center of tibia 45
Loss of each foot at the ankle. 40
Loss of Hearing in each ear 30
Permanent Total Loss of foot at ankle/arm at wrist 25
Loss of each thumb 20
Loss of each index finger 10
Loss of Sense of smell 10
Permanent Total Loss of any of the fingers or toes 5
Loss of each other finger 5
Loss of each big toe 5
Loss of Sense of taste 5
Loss of each other toe 2

Section 22. Repatriation Of Mortal Remains

If the Insured Person dies outside the Republic of India due to Accidental Bodily Injury during overseas travel, the expenses for preparing the air transportation of the remains for repatriation to the Republic of India or up to an equivalent amount for a local burial or cremation in the country where the death occurred. All expenses must be approved by ‘Assistance Service Provider’ before the remains are prepared for transportation to the Republic of India or for local burial or cremation.

Section 23. Ambulance Charges (per trip)

The Company will indemnify the Insured up to the Sum Insured specified in the Policy Schedule for Ambulance charges incurred by the Insured Person (s) towards transportation to the nearest Hospital on account of illness or accidental injury, subject to valid claim admissible under Section 14: Hospitalization.

Optional Covers:

The following are the list of Optional benefits available to Insured Persons in accordance with the terms & conditions set out in the Policy, if the listed cover is opted by the insured.

Section 24: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 isavailable.

Covered occurrence shall mean the following:

i. Pamdemic & epidemic as declared by WHO

ii. Earthquake.

iii. Lighting, Storm, Tempest, Typhoon, Hurricane, Inundation, Subsidence

iv. Landslide and rockslide

v. Avalanche

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

vii. Terrorism.

viii. Tsunami

ix. Volcano Eruption.

x. Cancellation or rescheduling of flights done at the instance of the Common Carrier that causes delay.

Specific terms & conditions applicable to this benefit:

1) Automatic extension of the Period of insurance is granted upto a period of 7 days, from the Policy Expiry Date,

2) if the extension is due to delay of a Common Carrier, due to a Covered Occurrence and when no alternative travel arrangement is available.

3) the perils mentioned above shall take place at and around the location of the trip.

Section 25: Bounced Airline Booking

We shall indemnify the Insured Person for the actual additional expenses / cost incurred by the Insured Person for alternative flight arrangements in the event of the confirmed flight booking for any part of the Trip within the Period of Insurance not getting confirmed at the sole instance of the Common Carrier, provided that:

(i) Our liability shall be in relation to the travel covered by such confirmed booking and shall be in relation to the same class of travel as the case may be covered by the original confirmed bookings.

(ii) It is a Condition Precedent to Our admission of liability under this Optional Benefit that the Insured Person shall take all steps to fix the primary responsibility for the bouncing of bookings with the Common Carrier and try to recover from them the consequential loss incurred by the Insured Person by way of additional expenses for alternative travel arrangement. Details of the steps taken by the Insured Person shall be furnished to Us.

(iii) Any recovery towards additional expenses incurred for alternative travel effected from the Common Carrier, if any, shall be remitted to the company to the extent of the amount of claim admitted and paid by Us to the Insured Person.

Exclusions applicable Bounce Booking:

Any Claim in respect of any Insured Person for, arising out of or directly or indirectly due to any of the following shall not be admissible under this cover unless expressly stated to the contrary elsewhere in the Policy terms and conditions:

(i) If the Insured shall fail to adhere to the rules of the Common Carrier in connection with reconfirmation of the booking before the date of travel as the case may be;

(ii) In connection with any waitlisted travel booking irrespective of whether such bookings have been promised to be confirmed later;

(iv) Where the alternative arrangements for either the travel is provided by the Common Carrier within 6 hours from the time of departure of the travel covered by the bounced booking.

Section 26: Bounced Hotel Booking

We shall indemnify the Insured Person for the actual additional expenses incurred by the Insured Person for alternative accommodation in the event of the confirmed accommodation booking at the place of stay in any part of the Trip not getting confirmed solely at the instance of the accommodation provider, provided that:

(i) Our liability shall be in relation to accommodation in the same place of stay and same category of accommodation (lower of original booking amount or limit as specified in Certificate of Insurance / Policy Schedule) as the case may be covered by the original confirmed bookings.

(ii) It is a Condition Precedent to Our admission of liability under this Optional Benefit that the Insured Person shall take all steps to fix the primary responsibility for the bouncing of bookings both with the accommodation provider and try to recover from them the consequential loss incurred by the Insured Person by way of additional expenses for alternative accommodation arrangement. Details of the steps taken by the Insured Person shall be furnished to Us.

(iii) Any recovery towards additional expenses incurred for alternative accommodation arrangement effected from accommodation provider, if any, shall be remitted to the company to the extent of the amount of claim admitted and paid by the company to the Insured Person.

Exclusions applicable Bounce Booking:

Any Claim in respect of any Insured Person for, arising out of or directly or indirectly due to any of the following shall not be admissible under this cover unless expressly stated to the contrary elsewhere in the Policy terms and conditions:

(i) If the Insured shall fail to adhere to the rules of the accommodation provider in connection with reconfirmation of the booking before the date of travel or date of accommodation as the case may be;

(ii) In connection with any accommodation booking irrespective of whether such bookings have been promised to be confirmed later;

(iii) If the confirmed accommodation is a personal arrangement or is free of charge;

(iv) Where the alternative arrangements for accommodation is provided by the accommodation provider within 6 hours from the time of commencement of stay covered by the earlier confirmed accommodation booking.

Section 27: Compassionate Visit (2 ways)

We will reimburse the cost of the economy class flight ticket incurred by the immediate family member of the Insured Person to travel to the place of Hospitalization of the Insured Person during the Coverage Period upto the limit specified in the Certificate of Insurance/Policy Schedule.

This Cover Benefit will be payable provided that:

a. We have accepted a claim under the Section 14

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

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

e. when the insured person is hospitalized on account of an illness/accident for a period exceeding 5 days and as opined and recommended by the attending Medical Practitioner requires special assistance from an immediate family member.

f. This benefit shall be payable only once during the policy period.

Section 28: Continuation of treatment at country of residence

If We have accepted a claim under Section-14 Hospitalisation due to Illness/Accident and the Insured has been evacuated to India in an Emergency for further medical treatment, then We will also indemnify the Reasonable and Customary Charges incurred as Medical Expenses on the continuation of the Insured’s Medically Necessary Treatment in India provided that We shall not be liable to indemnify any Medical Expenses incurred after the completion of 90 days from the Accident or first manifestation of the sickness or disease in respect of which the Insured is receiving Medically Necessary Treatment.

This cover is applicable subject to balance sum insured being available under HospitalisationSection-14.The sub limits specified under Section14 would also be applied for the medical treatment in India. In case of “Continuation of Medical Treatment In India , the rate of exchange as published by the Reserve Bank of India (RBI) as on the date of Hospitalisation in India , shall be used for conversion of foreign currency amounts into Indian rupees for payment of any claim under this Benefit.

Section 29: Delay of check-in baggage (after 12 hrs)

If the arrival of the Insured Person’s checked-in accompanying baggage for a journey Overseas is delayed by the carrier to whom it was entrusted for more than 12 hours from the scheduled arrival time, then the Insurer will pay the amount towards the costs of the Insured Person’s purchase of replacement of essential items comprising Toiletries, Medication and Clothing, but any amount paid or payable shall be set against any amount payable under Total Loss of Checked Baggage (Section-35). .

Terms and conditions:

a) The Insurer’s Liability under this cover will be limited to the travel destinations specified in the main travel ticket from India.

b) The Insurer’s payment to the Insured Person will be reduced by any sum for which the airline is liable to make payment.

c) The insurer is not liable to make the payment for the delayed arrival of baggage, if it occurs in the place of residence of the insured.

Section 30: Emergency Assistance Services

This policy has been supported by “emergency assistance provider” who may be contacted by the insured person in case he/she falls ill or involved in an accident. It will help you as you’re not familiar with the area, and you don’t speak the language.

The details of contact number of the emergency assistance provider shall be given in the policy document and the website of the company. An assistance provider will have worldwide, multilingual representatives available 24 hours a day, 7 days a week, 365 days a year to assist you with a variety of situations you may encounter when you’re travelling.

The below services would be provided by the company through its Service provider, with prior intimation and acceptance by the Company and can be availed anytime during the Policy period and there are no restrictions on the number of times the facility can be utilized.

i. Medical Consultation, Evaluation and Referral– In case of any emergency situation, the Service Provider will evaluate, troubleshoot and make immediate recommendations including referrals to qualified doctors and/or hospitals. The Company will only arrange for the medical consultant, the consultant fee will be borne by the Policyholder as OPD expenses are not covered under the policy.

ii. Medical Monitoring and Case Management- A team of doctors, nurses, and other medically trained personnel would be in regular communication with the attending physician and hospital, monitors appropriate levels of care and relay necessary and legally permissible information to the members of the Family / Employer.

iii. Emergency Medical Evacuation or Repatriation- If the Insured / Insured Person/s becomes ill or injured in an area where appropriate care is not available, the Company via Service Provider will intervene and use available transportation equipment by means of air, road or rail transportation and personnel necessary to evacuate the Individual safely to the nearest facility for medical care or repatriate to the home town.

iv. Assistance in Repatriation of Mortal Remains- The Company via Service Provider will assist in making all necessary arrangement for the return of mortal remains of the Insured person to the home town in case of a death during the Insured journey.

v. Telephone Medical Assistance: The Company will provide access to 24X7 alarm centre where the Insured Person can get basic medical assistance in case of medical emergency.

vi. Delayed / Lost / Damaged Baggage Assistance: The Company via Service Provider will assist the Insured Person for delayed/ lost/ damaged baggage while traveling by contacting the local authorities and agencies involved and providing directions for recovery. The assistance will be provided for coordinating with common carriers to locate and recover the lost or stolen baggage, using available tracking systems and establishing, on the eligible person’s behalf and as appropriate liaison with transportation carriers, airports, ports, hotels, and others.

vii. Lost / Expired Travel Documents / Tickets: To assist the Insured Person by arranging for emergency tickets, replacements of tickets and arrangement of hotel accommodation when traveling outside the home town or usual Town of residence.

viii. Trip Rescheduling: To assist the Insured Person in rescheduling the trip by cancelling and making travel and accommodation reservations as per the new schedule.

ix. Compassionate Visit: When an Insured Peron/s is/are hospitalized, the Company via Service Provider will assist by making travel reservation for a family member to travel to visit the Insured Person/s.

x. Assistance with Emergency Family Member Accommodation: The Company will assist the Insured Person’s family member by making accommodation booking to / in the place where the Insured Person is hospitalized.

xi. The shall also assist in Transfer of funds, if your cash is lost or stolen and Legal and bail referrals.

xii. Assistance in contacting the appropriate authorities to replace lost or stolen passport and travel documents.

xiii. Assistance with locating lost or delayed baggage.

xiv. Emergency travel arrangements home.

Section 31: Emergency Medical Evacuation:

Subject to an admissible claim under Hospitalisation due to Accident, the Company shall pay up to the limits mentioned in the Policy Schedule towards 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.We will be liable to indemnify only those Reasonable and Customary Charges incurred on transportation of the Insuredand medical services and medical supplies that are required to be rendered to the Insured during the transportation.Our Service Provider authorizes in writing in advance and arranges the conveyance for transporting the Insured.

Section 32: Flight Delay (beyond 3 hours)

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

The insured will be reimbursed for –

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

2. Reasonable accommodations and meals up to $ 100 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:

In addition to the general exclusions, this section shall not cover any delay due to an insured 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.

Section 33: Total Loss of Checked-in Baggage

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/certificate of insurance. 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 be construed 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;

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

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

j) Damage to the baggage

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

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

m) 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 any electronic item. Such items should at all times be carried by the Insured Person and not packed as part of checked in baggage

Section 34: Loss of passport

If the Insured Person loses his passport overseas during the policy period, the company will indemnify the costnecessarily and reasonably incurred by theInsured Person in connection with obtaining emergency travel documents or duplicate/fresh passport either overseas or within 30 days upon return to India.

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 claim not reported within 24 hours of the incident giving rise to the claim;

b) any loss not reported to the police having jurisdiction at the place of loss within 24 hours of the incident and a written report is obtained from the police.

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

c) Loss or theft of passport left unattended by you unless located in a locked hotel room or apartment.

Section 35: Missed departure/connecting flight

The company 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.

1) Public transport services fail or

2) The vehicle in which you are travelling is involved in an accident, on the way to catch the return flight/train journey.

The missed departure has to be certified by the concerned Schedule airlines. Any benefit payable for ticket loss will be in excess of any amount paid or payable by The Common Carrier, if any. For a claim to be admissible under this section it is a condition precedent to liability that the claim is admissible under Flight Delay (Section-33)

Missed Connecting Flight:

If the Insured Person misses a travel connection overseas arising out of and consequent upon the delayed arrival of his inward flight caused by reasons beyond the control of the Insured, which causes him to miss a connecting flight, any time during the Trip within the Period of Insurance, We will pay the cost of direct route economy class airfare actually incurred by the Insured Person to continue the journey to the scheduled Place of Destination, provided that, no claim shall be payable hereunder in case such delay is foreseen by the Insured or that the Insured could have reasonably become aware of such delay in advanceby the way of sources such as travel advisories issued by competent / Government authority(s) etc.

Terms and Conditions

(i) Our liability to make payment under this Optional Benefit shall be in excess of the total amount refunded or returned to the Insured Person by the flight service provider.

(ii) A Claim has already been made under Trip Delay (Section-33).

(iii) In the event of the forfeited amount by the Common Carrier for the Missed Flight being refunded / returned to the Insured, subsequent to any payment under this benefit, the insured shall return the amount so refunded in full.

Exclusions applicable to Optional Benefit – Missed Connection

The Insurer shall not be liable for any claim in respect of any Insured Person directly or indirectly for, caused by, arising from or in any way attributable to:

a) If the time gap between the scheduled arrival of the previous flight and the scheduled departure of the next flight (Missed Flight) shall be less than 3 hours.

b) A strike or industrial action of which the Insured Person should reasonably have been aware before the Risk Period.

c) The Insured Person’s failure to arrive for the Flight’s departure in sufficient time to complete all departure formalities in accordance with the Carrier’s published time schedule.

d) Any deviation from the originally scheduled route done at the instance of the Insured for reasons whatsoever.

e) Any occasion when the carrier has offered a reasonable alternative transport or connection or the Insured Person’s ticket for the connecting flight could have been used for an alternative connection.

f) Any advance intimation given to the Insured Person of a possible delay of the Common Carrier that might lead to missing of the connecting flight;

g) Any circumstances other than those directly attributable to the delay of the earlier Common Carrier.

c) Documents to be submitted in support of the Claim:

It is a Condition Precedent to Our liability under this Optional Benefit that the following necessary information and documentation shall be submitted to Us or the emergency service provider immediately and in any event within 30 days of the event giving rise to the Claim under this Optional Benefit:

(i) Confirmation from the Common Carrier of the delay as to the expected time of arrival and the actual time of arrival at Place of Destination;

(ii) Copy of unused ticket for the missed flight;

(iii) Certificate from the Common Carrier of the missed flight that the fare for the part of the journey covered by the missed flight is forfeited in full or in part together with the amount of forfeiture;

(iv) Original used ticket obtained afresh towards the alternative flight for the part of the journey covered by the missed flight indicating the amount paid as fare.

Section 36: Personal Liability

We will indemnify the Insured against any legal liability incurred by the Insured in the Insured’s private capacity to pay damages for third party civil claims for Accidental Injury or Accidental Property Damage occurring during the covered trip, subject to the following terms and conditions:

a) No Deductible shall be applicable in respect of the legal liability incurred by the Insured in the Insured’s private capacity to pay damages for third party Accidental Injury.

b) Our liability to indemnify the Insured under this Section shall be to the extent finally determined by a foreign court of law or otherwise as consented to in advance by Us.

c) In the event that legal action is taken against the Insured within India, it is a condition precedent to Our liability here under that the Insured shall:

d) Give immediate written notice to Us to the address specified in the Schedule, and

e) Not incur any defence costs or expenses, admit liability for or settle or attempt to settle, make any admission or offer any payment or otherwise assume any contractual obligation with respect to any claim or claimant without Our prior written consent. We shall be entitled (but in no case obligated) at any time to take over and conduct in the Insured’s name the defence and/or settlement of any action or claim and shall be entitled at all times to receive the Insured’s cooperation and assistance and to appoint lawyers on the Insured’s behalf. Any and all costs and expenses incurred by Us or the lawyers appointed by Us shall be a first charge on the Sum Insured here under.

f) We shall not settle any claim without the Insured’s express consent, but if the Insured refuses an available settlement recommended by Us then Our liability shall thereafter be restricted to the amount by which the claim could have been settled.

Exclusions Applicable: We shall not be liable to make any payment under this Section in connection with or in respect of:

a) The Insured’s liability to any employee (whether under a contract of or for services);

b) Liability arising out of the rental or holding for rental of any part of any premises by the Insured,

c) Liability arising out of the rendering of or failure to render professional services,

d) Liability arising out of a premises, water craft or aircraft that is owned by, rented to or rented by the Insured,

e) Liability arising out of the ownership, maintenance, use, loading or unloading of motor vehicles, all other motorized land conveyances, water craft or aircraft,

f) Liability arising out of sexual molestation, corporal punishment, or physical or mental abuse,

g) Liability arising out of the use, sale, manufacture, delivery, transfer or possession by any person of a controlled substance or contraband as defined by the appropriate authority or the Federal Food and Drug Agency or equivalent or similar organization,

h) Liability under any contract or agreement,

i) Property Damage to property owned by the Insured,

j) Property Damage to property rented to, occupied or used by or in the care of the Insured,

k) Injury to any person eligible to receive any benefits voluntarily provided or required to be provided by the Insured under any worker’s compensation law, non-occupational disability law or occupational diseases law, or any other similar law,

l) No claims shall be paid arising from liability to any uninsured members of the Insured Person’s family, travelling companion, friend or colleague say parents, children, spouse, brothers, sisters, uncles, aunts, grandparents or parents-in-law, or any Travelling Companion or a Travelling Companion’s parents, children, spouse, brothers, sisters,uncles, aunts, grandparents or parents-in-law.

m) No claims will be paid that is less than the deductible stated in the Schedule. The deductible shall apply to each insured event and shall be borne by the Insured Person. However, the deductible shall only apply to claims in respect of Third Party Property Damage.

n) No claims shall be paid for any liability arising directly or indirectly from or due to:

a. animals belonging to the Insured Person or in their care, custody or control :

b. any willful, malicious or unlawful act;

c. pursuit of a trade, business or profession, employment or occupation:

d. ownership, possession or use of vehicles, aircraft, watercraft, parachuting, hand gliding, hot air ballooning or use of firearms;

e. legal costs of any proceedings that result from any criminal or illegal act;

f. insanity, the use of any alcohol, drugs, (except as medically prescribed) or drug addiction;

g. Any form of ownership or occupation of land or building (other than occupation only of any temporary residence.)

Section 37: Sponsor Protection

In the event of injury to the Insured Person’s Sponsor as stated in the Enrolment Form resulting in Death or Permanent Disablement as defined in the Policy, the Company shall reimburse the insured person the Tuition Fee incurred for the remaining period of this education upto the maximum limit stated in the policy schedule.The term sponsor as used in the Policy shall mean any individual responsible for paying the Tuition fees of the student of his full-time study in a registered educational institution outside of his home country. The term Educational Institution shall mean any registered and accredited educational institution which is duly licensed to provide educational services by trained or qualified teacher and where the Insured Person is registered as a full-time student.

Terms & Conditions:

(i) Our cumulative liability under this Optional Benefit shall be limited to the actual unpaid fees for the remaining period of the course or the Period of Insurance, whichever is earlier.

(ii) We shall be liable to pay for such fees only after the demand for such fees is raised by the educational institute.

(iii) We shall pay the outstanding fees semester wise or as per the periodicity based on which demand for such fees is raised by the educational institute.

(iv) We shall be liable to pay such fees under this Optional Benefit only if the Insured Person continues to be enrolled and attend that course at the educational institute as per the rules of such institute.

(v) If the Insured Person discontinues his studies for any reason, We shall have the right to recover such fees paid by it from the Insured Person.

Section 38: TRIP CANCELLATION

The Company shall indemnify the insured up to the amount specified in the policy schedule if the insured shall sustain pecuniary loss in respect of any irrecoverable deposits and payments for unused travel and accommodation for which the Insured contracted prior to the commencement of the Insured trip as a result of the Insured’s necessary and unavoidable inability (and not merely disinclination) to commence travel as arranged arising from –

a. Accidental bodily injuries or death of insured or a family member of the insured. Family member means the insured person, spouse, children, parents, siblings and parents in law.

b. Compulsory quarantine, jury or other legal service, witness call or redundancy of the insured.

c. Police authorities of the Country of Residence requesting the Insured’s presence at his/her home following actual burglary.

Subject to Insured notify the insurer about the cancellation or interruption within 24 hours unless the condition prevents it, then as soon as reasonably possible, failing which the right to compensation will lapse.

In addition to the general exclusions, the following exclusions also would apply to this Section. The Insurance Company shall not cover the loss arising directly or indirectly.

a. From failure to notify the Travel Agent, or Tour Operator through whom the trip was booked within a reasonable time of the need to cancel or curtail the travel arrangements.

b. From the financial circumstances of the insured.

c. The insured (i). making changes to personal plans. (ii). Having a business or contractual obligation. (iii). Being unable to obtain necessary travel documents. (iv). Being detained or having property confiscated by any Customs.

d. As a result of any unlawful act of an Insured or criminal proceedings involving any of the aforementioned other than the attendance under subpoena as a witness (other than in an expert, occupational, professional or other similar capacity) in a Court of Law.

e. From failure in provision of any service (including error, omission or default) forming part of the booked trip, or from delay or amendment of the booked itinerary.

f. From prohibitive regulations by the Government of any Country except from any such regulation which the insured was unaware existed (and could not reasonably be expected to be aware of) at the time of booking the Insured trip.

g. On account of a Criminal Assault, where the insured, any family member of the insured, has been a Principal or accessory in the Assault committed.

5. COMMON EXCLUSIONS APPLICABLE TO ALL SECTIONS (Including Optional Benefits)

This policy does not cover:

1. Where the Insured Person:

a. is travelling against the advice of a Physician: or

b. is receiving or on a waiting list for specified medical treatment declared in the Physician’s report or certificate; or

c. is travelling for the purpose of obtaining treatment; or

d. Has received a terminal prognosis for a medical condition.

e. If the insured is aware of any circumstances that could reasonably be expected to give rise to a claim.

f. Direct participation in riot or civil commotion.

2. Liability arising out of suicide, attempted suicide or wilful self inflicted injury or illness, mental disorder, anxiety, stress or depression, venereal disease, alcoholism, drunkenness or the use/abuse of drugs.

3. Liability arising out of insured person taking part in Naval, Military or Airforce operations.

4. Liability arising out of War, invasion, acts of foreign enemy, hostilities (Whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or destruction of or damage to property by or under the order of any government or local authority.

5. Liability arising out of the loss or destruction or damage to any property whatsoever or any loss or expenses whatsoever resulting or arising there from or any consequential loss directly or indirectly caused by or contributed to by or arising from

a. ionising radiation or contamination by radioactivity from any nuclear waste from the combustion of nuclear fuel; or

b. radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.

6. Liability arising out of from the Insured person engaging in Air Travel unless he or she flies as a passenger on an aircraft properly licensed to carry passengers. For the purpose of this exclusion, Air Travel means being in or on, or boarding an aircraft for the purpose of flying therein or alighting there from following a flight.

7. Any claim relating to events occurring before the commencement of the Period of Insurance or after the completion of the Period of Insurance, except sections relating to Trip Delay and Missed Departure.

8. Claims increased by the Insured Person’s own act or omission.

9. Liability arising out of due to participation of the Insured person in winter sports, mountaineering (where ropes or guides are customarily used), riding or driving in races or rallies, caving or potholing, hunting or equestrian, skew diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles). Further no claim will be paid in case Insured Person participates in professional sports or any other hazardous sports. The claim is neither payable if it arises from participation in potentially dangerous sports for which the Insured Person is either untrained or physically unfit or using improper equipment.

10. Liability arising out of accidents on two wheeled motorised vehicles unless at the time of the accident the driver is dully qualified, is in possession of a current full International driving license and the insured person is wearing a safety crash helmet, or losses arising from accidents on two wheeled motorised vehicles over 50 cc.

11. Liability arising out of losses arising directly or indirectly from manual work or hazardous occupation, or if engaging in any criminal or illegal act. MANUAL WORK is physical work done by people most especially in contrast to that done by machines. HAZARDOUS OCCUPATION would include occupation that are risky, perilous, dangerous and uncertain and would include interalia occupations related to Aviation, Mountain climbing, surfing, race car driving, scuba diving, parachuting and such similar activities.

12. Any loss covered directly or indirectly from any injury, illness, death expenses or other liability attributable HIV (Human Immunodeficiency virus) and/or any HIV related illness including AIDS (Acquired Immune Deficiency Syndrome) or AIDS related Complex however caused and/or mutant derivatives, variations or treatment thereof however caused.

13. Pre-existing whether physical or mental defect or infirmity

14. Deliberate exposure to exceptional danger (except in an attempt to save human life).

15. Liability arising out of the transmission of a communicable disease by insured.

16. Liability arising out of sexual molestation, corporal punishment, or physical or mental abuse.

17. Suits or legal actions arising from the insured’s family member against the insured.

18. Loss, damage or destruction arising from confiscation or detention by customs or other official authorities

19. Liability arising out of any loss or damage due to insured being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Physician and taken as prescribed.

20. No claim will be paid in respect of expenses for treatment, which could reasonably be delayed until the Insured Person’s return to Republic of India. The question of what can or what cannot be reasonably delayed will be decided jointly by the treating physician and the Medical Advisors.

21. No claim in respect of cosmetic surgery will be paid, unless such cosmetic surgery is rendered necessary as a result of a covered accident.

22. No claims will be paid in respect of routine physical examination or any other examination where there is no objective indication of impairment of normal health.

23. The insurance will not cover pregnancy of the Insured Person including resulting childbirth, miscarriage, abortion or complication of any of these except ectopic Pregnancy which would be life threatening if left untreated.

24. Any hospital admission or routine examination for investigative/ diagnostic purpose.

25. Non-allopathic medicine.

26. Any costs incurred on spectacles, contact lenses, hearing aids, corrective and cosmetic dental surgeries.

27. In respect of your travel to any country other than declared in proposal form which is in the sanctioned list of travel issued by Government of India

28. Any treatment related to alcoholism or drug dependency.

29. Participation in an actual or attempted felony, riot, crime, misdemeanour, or civil commotion.

30. Act of Terrorism by the Insured or which is abetted by the Insured in any manner.

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

32. Injury or Illness directly or indirectly caused by or contributed to by nuclear weapons/materials.

6. GENERAL CONDITIONS (APPLICABLE TO ALL SECTIONS – BASE AND OPTIONAL COVERS UNLESS STATED OTHERWISE)

1. The premium payable under this policy shall be payable in advance. No receipt of premium shall be valid except acknowledged on the official form of the company signed by a duly authorized official of the company. The due payment of premium and the observance of fulfilment of the terms, provision, conditions and endorsements of this policy by the Insured Person/s, in so far as they relate to anything to be done or complied with by the Insured Person/s, shall be a condition precedent to any liability of the Company to make any payment under this policy. No waiver of any terms, provisions, conditions, and endorsements of this policy shall be valid unless made in writing and signed by an authorized official of the Company.

2. Duty of Disclosure: The Policy shall be null and void and no benefit shall be payable in the event of untrue or incorrect statements, misrepresentation, mis-description or on non-disclosure in any material particular in the proposal form or at the time of claim, personal statement, declaration and connected documents, or any material information having been withheld, or a claim being fraudulent or any fraudulent means or devices being used by the Insured Person or any one acting on his behalf to obtain any benefit under this Policy.

3. Written notice of insured events which may give rise to a claim should be given to the insurer immediately but in no case exceeding 30 days from date of occurrence. All certificates, information and evidence required by the Company shall be furnished at the expense of the Insured or his legal representatives.

If the Insured does not comply with the provisions of this Clause or other obligations cast upon the Insured under this Policy, in terms of the other clauses referred to herein or in terms of the other clauses in any of the Policy documents, all benefits under the Policy shall be forfeited.

7. CLAIM PROCEDURE

7.1 Procedure for Cashless claims:

(i) Treatment may be taken in a network provider and is subject to pre authorization by the Company or its authorized TPA or Emergency Service Provider (ESP) in case of overseas travel insurance.

(ii) Cashless request form available with the network provider and TPA shall be completed and sent to the Company/TPA/ Emergency Service Provider (ESP) in case of overseas travel insurance

(iii) The Company/ TPA/Emergency Service Provider (ESP) upon getting cashless request form and related medical information from the insured person/ network provider will issue pre-authorization letter to the hospital after verification.

(iv) At the time of discharge, the insured person has to verify and sign the discharge papers, pay for non-medical and inadmissible expenses.

(v) The Company / TPA/ ESP reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant details.

(vi)In case of denial of cashless access, the insured person may obtain the treatment as per treating doctor’s advice and submit the claim documents to the Company / TPA for reimbursement.

7.2 Procedure for reimbursement of claims:

For reimbursement of claims the insured person may submit the necessary documents to the insurer/ TPA/ ESP (as applicable) within the prescribed time limit as specified hereunder.

7.3 Notification of Claim

Notice with full particulars shall be sent to the Insurer/TPA/ESP (as applicable) within 24 hours from the date of emergency hospitalization.

7.4 Documents to be submitted:

The claim is to be supported with the following documents and submitted within the prescribed time limit.

Benefits Claims Documents Required
1. Accidental Hospitalization Expenses
  • Original Discharge Summary (wherever applicable)
  • Original Medical Reports
  • Original Invoices/Bills
  • Original Payment Receipts
2. Hospital Cash
  • Discharge Summary
3. Accidental Death
  • Death Certificate
  • Post-mortem Certificate, if conducted
  • FIR (wherever required)
  • Police Investigation report
  • Viscera Sample Report
  • Forensic Laboratory report
  • Legal Heir Certificate
  • Succession Certificate
4. Permanent Total Disability (PTD)
  • Certificate from Government doctor not below the rank of Civil Surgeon, confirming the disability and its %.
5. Permanent Partial Disability (PPD)
  • Certificate from Government doctor not below the rank of Civil Surgeon, confirming the disability and its %.
6. Repatriation Of Mortal Remains
  • Flight itinerary and Boarding pass and/or ticket details as applicable
  • Copy of death certificate with date, time, place and cause of death.
  • Post mortem report, if conducted.
  • Documentary evidence towards expenses incurred on disposal of mortal remains.
  • In case of transportation of mortal remains, receipt towards expenses incurred in preparation and packing of mortal remains of the deceased along with the transportation of the same to the city of residence.
7. Ambulance Charges
  • FIR (wherever required)
  • Proof of hospitalization
  • Proof of utilization of Ambulance services
  • Duly filled and signed Claim Form.
  • Original Policy copy.
  • Original Bill with Original Payment Receipt.
  • Treating Doctor’s consultation prescription indicating Emergency Hospitalization
8. Compassionate Visit
  • Report from the treating doctor advising the requirement of support from immediate family member
  • Copy of the ticket
9. Compassionate Visit Stay (Maximum of 7 days)
  • Report from the treating doctor advising the requirement of support from immediate family member
  • Copy of the receipt for accommodation
10. Missed Flight (applicable only for air travel)
  • Original bill towards additional travel tickets
11. Loss Of Checked-in Baggage (applicable only for air travel)
  • Copy of letter lodging complaint with police authorities duly acknowledged
  • Proof of Compensation received from the carrier
  • Details of individual items lost, approximate cost and purchase date, Copies of baggage tags.
  • Copies of correspondence with airline authorities / others about loss of checked baggage, along with details of compensation received from airlines / other authorities (if any),
  • Property Irregularity Report (obtained from airline),
  • Copy of the passport / visa with entry & exit stamp, and/or boarding pass.
  • Adequate proof of ownership in excess of the Indian rupee equivalent of US $ 100 for loss/delay of checked-in baggage will need to be submitted.
  • Further, the Insured has to provide a undertaking in writing stating that in the event if the baggage is traced and returned to him / her, he / she will be refunding the entire claim amount settled under this policy.
  • Flight itinerary.
  • Original Bills/Receipts for the items lost.
12. Trip Delay (applicable only for air travel) (beyond 3 hour)
  • Copy of ticket & boarding pass,
  • Certificate from the Common Carrier confirming the delay and detailing the circumstances of delay. (Mandatory)
  • Copies of correspondence with airline authorities certifying the delay, along with details of compensation received from airlines / other authorities (if any).
  • Invoices related to List of essential purchases made, such as meals, refreshments or other related expenses directly resulting from the flight delay.
  • Copies of Boarding Pass, Ticket.
  • Please Note: Claim payment can be made only against the receipts for expenses directly resulting from flight delay.
13. Carrier Cancellation (applicable only for air travel)
  • Certificate from the Common Carrier confirming the cancellation and detailing the circumstances of cancellation (Mandatory)
  • Copies of correspondence with airline authorities certifying the cancellation, along with details of compensation received from airlines / other authorities (if any)
14. Hospitalisation (accident+illness)
  • Original Discharge Summary (wherever applicable)
  • Original Medical Reports
  • Original Invoices/Bills
  • Original Payment Receipts
15. Hospital Cash
  • Discharge Summary
16. Life Threatening Condition Due To PED
  • Original Discharge Summary (wherever applicable)
  • Original Medical Report
17. Accidental Death / PA
  • Medical reports giving the details of the Accident, nature of the Injury, the extent of disability (if applicable) and the details of treatment provided.
  • Death certificate (if applicable).
  • Post-mortem report/certificate (wherever applicable).
  • Police report (wherever applicable).
  • Copy of discharge summary (if available).
18. Permanent Total Disability (PTD)
  • Certificate from Government doctor not below the rank of Civil Surgeon, confirming the disability and its %.
19. Permanent Partial Disability (PPD)
  • Certificate from Government doctor not below the rank of Civil Surgeon, confirming the disability and its %.
20. Repatriation of Mortal Remains
  • In case of transportation of the body of the deceased to the Country of Residence/City of Residence, the receipt for expenses incurred towards preparation and packing of the mortal remains of the deceased and also for the transportation of the mortal remains of the deceased.
  • Copy of Embalming certificate
  • Flight itinerary and Boarding pass and/or ticket details as applicable
  • Copy of death certificate with date, time, place and cause of death.
  • Post mortem report, if conducted.
  • Documentary evidence towards expenses incurred on disposal of mortal remains.
21. Ambulance Charges
  • FIR (wherever required)
  • Proof of hospitalization
  • Proof of utilization of Ambulance services
  • Duly filled and signed Claim Form.
  • Original Policy copy.
  • Original Bill with Original Payment Receipt.
  • Treating Doctor’s consultation prescription indicating Emergency Hospitalization
22. Automatic trip extension
  • Certificate from common carrier on cancellation of flight.
  • Newspaper articles
23.
24. Bounced Airline Booking
  • A declaration from the Insured Person that he / she has strictly complied with the rules laid down by the Common Carrier or accommodation provider as the case may be relating to the reconfirmation of the booking prior to the date of departure of the flight or occupation of the accommodation.
  • A confirmation from the Common Carrier of the bounced booking having occurred solely at their instance and responsibility.
  • The Insured shall lodge his / her claim on the Common Carrier in writing
  • Statement of Claim for the expenses incurred;
  • Original receipt for payment of charges to the other Common Carrier.
  • Duly filled and signed claim form
  • Policy copy
  • Cancelled cheque
  • Proof against hotel/common carrier booking Details
  • Letter from Hotel/common carrier mentioning reason for non-accommodation and compensation received if any
  • Bills/invoices and receipt raised against the accommodation or transportation
25. Bounced Hotel booking
  • Confirmation from the accommodation provider of the bounced booking solely at their instance and responsibility.
  • Insured shall lodge his/ her claim on the accommodation provider as the case may be for the additional charges that he/ she might have incurred for which he/ she has lodged a claim on this Company and in case of any recovery from the concerned agencies, shall return such recovery to the Company to extent of amount paid hereunder.
26. Compassionate Visit (2 ways)
  • Certificate from the Medical Practitioner recommending the presence in the form of special assistance to be rendered by a member of the Family or near relative during the entire period of Hospitalisation.
  • Certificate to also specify the minimum period of Hospitalisation.
  • Discharge Summary of the Hospital furnishing details – date of admission, date of discharge and the presence of the member of the Family or near relative on all days of Hospitalisation.
  • Copy of ticket used for the travel to and fro by the member of the family or near relative
  • Original ticket with invoice used for the travel by the Immediate Family Member.
  • Copy of passport of Immediate Family Member with entry and exit stamp.
27. Continuation of treatment at country of residence
  • Certificate from the treating doctors that the treatment can be delayed and continued at the place of residence of the insured person.
  • Police report confirming the accident
  • Medical report confirming the injury
28. Delay of check-in baggage (after 12 hrs)
  • Property irregularity report issued by the appropriate authority stating the scheduled time of delivery and actual time of delivery of the Checked-In Baggage;
  • Voucher of the Common Carrier for the delay in delivery of the Checked-In Baggage;
  • Copies of correspondence exchanged, if any, with the Common Carrier in connection with the delay in delivery of the Checked-In Baggage;
  • A valid ticket / proof of travel to the location the Insured Person is travelling as a bona fide passenger.
  • Copies of travel tickets/boarding pass/baggage tags
  • Details of Compensation received from Airlines If Any.
  • Flight itinerary
  • Policy copy
  • Original Bills/Receipts of medication, toiletries or clothing purchased
29. Emergency Assistance Services
  • The insured shall contact the emergency service provider through email or telephone as per the contact details provided in the policy document or in the website of the insurer.
30.
31.
32. Emergency Medical Evacuation
  • Original pathological or diagnostic reports and medical prescriptions issued by the treating Medical Practitioner or Hospital, discharge summary, day care summary, case papers and prescriptions issued by the treating Medical Practitioner or Hospital;
33. Flight Delay (beyond 3 hour)
  • Certificate from the common carrier confirming the delay with actual time and scheduled time of departure.
34.
35. Loss of Checked-in Baggage
  • Property irregularity report issued by the appropriate authority;
  • Voucher of the Common Carrier for the compensation paid for the non-delivery/short delivery of the Checked-In Baggage;
  • Copies of correspondence exchanged, if any, with the Common Carrier in connection with the non-delivery / short delivery of the Checked-In Baggage.
  • Statement of claim furnishing the details of items contained in the Checked-In Baggage and the values thereof (excluding Valuables).
  • Values of the items shall represent their market value after allowing for age and usage.
  • In case of items of individual value equal to or more than US$ 100 contained within the Checked-In Baggage, proof of ownership in the form of purchase bill.
  • A valid ticket / proof of travel to the location the Insured Person is travelling as a bona fide passenger.
36. Loss of passport
  • Please attach Copy of new passport,
  • Copy of previous passport (if available),
  • Original bills / invoices of expenses incurred for obtaining a new/duplicate passport, Copy of FIR / police report.
  • Copy of the police report (wherever applicable)
37. Missed departure/ connecting flight Missed Departure:

  • Original Travel ticket and boarding pass
  • Missed departure certified by the concerned Schedule airlines/ Scheduled Railways / Scheduled Road Transport
  • Proof of complaint to local police in case vehicle in which You are travelling is involved in an accident
  • Proof of Public transport services failure

Missed Connection:

  • Copies of Travel ticket and boarding pass of flight Scheduled from the first port of arrival
  • Copies of Travel ticket and boarding pass of New flight Scheduled from the first port of arrival
  • Confirmation from the Common Carrier of the delayed flight
  • Reasons for delay
  • Unused ticket for the ongoing flight (Missed Flight) with an endorsement of the Common Carrier of cancellation of the same
  • Original used ticket obtained afresh towards the alternative flight.
  • Certificate from the Common Carrier of the Missed Flight that the fare for the part of the Trip covered by the Missed Flight is forfeited in full or in part together with the amount of forfeiture.
  • Original used ticket obtained afresh towards the alternative Common Carrier for the part of the journey covered by the missed Common Carrier indicating the amount paid as fare, and in which such Insured Person has travelled.
  • Confirmation of the delay from the Common Carrier which is used for transit to the Place of Origin of the booked journey as to the scheduled ETA and the actual time of arrival at Place of Origin.
38. Personal Liability
  • Original Travel ticket and boarding pass
  • Self-Declaration and statement of event in writing
  • Legal notice/summons or any other documents relevant to incident
  • Copy of Judgment of the Court
  • Statement of claim furnishing particulars of the event leading to the liability, such as the court order;
  • Photocopy of the police report (wherever reported).
  • Witness statements if available
  • Any other documents relevant to the incident including summons, legal notice, copy of court award, notice from third party claiming the amount.
39. Sponsor Protection
  • Medical reports specifying the details of the Accident and the nature of Injury.
  • Death certificate of the sponsor in case deceased
  • Post-mortem certificate / report (wherever applicable).
  • Police report (wherever applicable).
  • Copy of the original fee schedule.
  • Certificate from educational institute establishing the continuity of studies.
  • Last semester passing certificate.
  • Documentary proof of last fee paid by the Sponsor.
  • Letter from school / college authority informing about the balance tuition fees, if any, for the course.

Documents to be submitted

  • Medical records /Consultation Papers/Investigation Reports of hospitalisation of sponsor
  • Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India.
  • Copy of the original fee schedule
40. Trip Cancellation
  • Letter from insured mentioning the reason of trip cancellation with related proof
  • Confirmation of cancellation of the Trip from the Common Carrier detailing the circumstances of cancellation
  • Copies of Travel ticket and boarding pass of flight or travel ticket in case of rail or any other common carrier boarded by Insured.
  • Medical reports and doctor’s certificate in case of medical reasons for Trip cancellation/Curtailment
  • Copy of death certificate in case of death of the immediate family member.
  • Proof of travel and accommodation expenses made in advance for the trip
  • Copies of receipts of travel and accommodation and proof of refund received for travel and accommodation expenses.
  • Certificate from service providers about deductions of travel and accommodation charges.

[Note: Insurer may specify the documents required in original and waive off any of above required as per their claim procedure]

Note:

1. The company shall only accept bills/invoices/medical treatment related documents only in the Insured Person’s name for whom the claim is submitted

2. In the event of a claim lodged under the Policy and the original documents having been submitted to any other insurer, the Company shall accept the copy of the documents and claim settlement advice, duly certified by the other insurer subject to satisfaction of the Company

3. Any delay in notification or submission may be condoned on merit where delay is proved to be for reasons beyond the control of the Insured Person

4. If the Hospital does not accept the guarantee of payment/authorization letter from the Service Provider, then it is hereby agreed that we cannot be held liable for any loss arising from such circumstances. The cost will then have to be borne by the Insured and will then be reimbursed by Us, as per Policy terms and conditions upon submission of required documentsspecified under the Policy or requested by Us.

5. Reimbursement of all claims (except claims under Emergency Financial Assistance) will be made by the Service Provider in Indian Rupees on the Insured’s return back to India, at the exchange rate specified by the Reserve Bank of India, as applicable on the date the amount is billed. In case of “Continuation of Medical Treatment In India, the rate of exchange as published by the Reserve Bank of India (RBI) as on the date of Hospitalisation in India , shall be used for conversion of foreign currency amounts into Indian rupees for payment of any claim under this Benefit. Claims under Financial Emergency Assistance shall be settled/ arranged directly with the Insured, whilst abroad, by the Service Provider. The Insured shall immediately and in any event not later than 30 days after his return to India, notify the Service Provider and obtain a Claim Form for completion and return to the Service Provider along with supporting invoices and any other documentation or information that might be required or requested by the Service Provider.

6. We shall settle or repudiate a Claim within 30 days of the receipt of the last necessary information and documentation set out above. In case of suspected frauds, the last “necessary” documents will include the receipt of the investigation report from our representatives.

7. Documents which are common to interlinked claims may not be insisted again with respect to the same claims

7.5 Claim Settlement (provision for Penal Interest)

i. The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document.

ii. In the case of delay in the payment of a claim, the Company shall be liable to pay interest from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.

iii. However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the Company shall settle the claim within 45 days from the date of receipt of last necessary document.

iv. In case of delay beyond stipulated 45 days the company shall be liable to pay interest at a rate 2% above the bank rate from the date of receipt of last necessary document to the date of payment of claim.

7.6 Services Offered by TPA (To be stated where TPA is involved) (applicable only in case of domestic travel insurance policies with respect to Hospitalisation claims)

Servicing of claims, i.e., claim admissions and assessments, under this Policy by way of pre-authorization of cashless treatment or processing of claims other than cashless claims or both, as per the underlying terms and conditions of the policy.

The services offered by a TPA shall not include (i) claim settlement and claim rejection; and (ii) any services directly to any insured person or to any other person unless such service is in accordance with the terms and conditions of the agreement entered into with the Company.

7.7 Payment of Claim

All claims under the policy shall be payable to the policyholders in Indian currency only. It is applicable for both domestic and overseas travel insurance policies.

8. GENERAL TERMS &CONDITIONS

8.1 Disclosure of Information

The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, mis-description or non-disclosure of any material fact by the policyholder.

8.2 Condition Precedent to Admission of Liability

The terms and conditions of the policy must be fulfilled by the insured person for the Company to make any payment for claim(s) arising under the policy.

8.3 Records to be maintained

The Insured Person shall keep an accurate record containing all relevant medical records and shall allow the Company or its representatives to inspect such records. The Policyholder or Insured Person shall furnish such information as the Company may require for settlement of any claim under the Policy, within reasonable time limit and within the time limit specified in the Policy

8.4 Complete Discharge

Any payment to the policyholder, insured person or his/ her nominees or his/ her legal representative or assignee or to the Hospital, as the case may be, for any benefit under the policy shall be a valid discharge towards payment of claim by the Company to the extent of that amount for the particular claim.

8.5 Notice & Communication

i. Any notice, direction, instruction or any other communication related to the Policy should be made in writing.

ii. Such communication shall be sent to the address of the Company or through any other electronic modes specified in the Policy Schedule.

iii. The Company shall communicate to the Insured at the address or through any other electronic mode mentioned in the schedule.

8.6 Territorial Limit

In case of domestic travel insurance, all medical treatment for the purpose of this insurance will have to be taken in India only.

8.7 Multiple Policies

1. In case of multiple policies taken by an insured during a period from the same or one or more insurers to indemnify treatment costs, the policyholder shall have the right to require a settlement of his/her claim in terms of any of his/her policies. In all such cases the insurer if chosen by the policy holder shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen policy.

2. Policyholder having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed under any other policy / policies, even if the sum insured is not exhausted. Then the Insurer(s) shall independently settle the claim subject to the terms and conditions of this policy.

3. If the amount to be claimed exceeds the sum insured under a single policy, the policyholder shall have the right to choose insurers from whom he/she wants to claim the balance amount.

4. Where an insured has policies from more than one insurer to cover the same risk on indemnity basis, the insured shall only be indemnified the hospitalization costs in accordance with the terms and conditions of the chosen policy.

8.8 Fraud

If any claim made by the insured person, is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof, or if any fraudulent means or devices are used by the insured person or anyone acting on his/her behalf to obtain any benefit under this policy, all benefits under this policy shall be forfeited.

Any amount already paid against claims made under the policy which are found fraudulent later under this policy shall be repaid by all recipient(s)/policyholder(s), who has made that particular claim, who shall be jointly and severally liable for such repayment.

For the purpose of this clause, the expression “fraud” means any of the following acts committed by the Insured Person or by his agent or the hospital/doctor/any other party, with intent to deceive the insurer or to induce the insurer to issue an insurance Policy:

(a) The suggestion, as a fact of that which is not true and which the Insured Person does not believe to be true;

(b) The active concealment of a fact by the Insured Person having knowledge or belief of the fact;

(c) Any other act fitted to deceive; and

(d) Any such act or omission as the law specially declares to be fraudulent

The company shall not repudiate the policy on the ground of fraud, if the insured person / beneficiary can prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of material fact are within the knowledge of the insurer.

8.9 Cancellation of policy by the insurer & Insured

The Company may cancel the Policy at any time on grounds of mis-represenation, non-disclosure of material facts, fraud by the Insured Person, by giving 7 days’ written notice. There would be no refund of premium on cancellation on grounds of mis-represenation, non-disclosure of material facts or fraud.

Cancellation of the Policy by the insured:

a) You at any time before the commencement of the proposed Trip may cancel this Policy by giving notice in writing to Uses long as you are able to establish to our satisfaction that the proposed Period of Insurance has not commenced. In the event of such cancellation of policy, 100% of premium will be refunded to the insured, provided there are no claims incurred on the Policy under any section.

b) In event of cancellation of the Policy after the proposed date of commencement of Trip within 7 days or the expiry date mentioned in the Policy whichever is earlier You shall be entitled to a refund of the premium subject to Our retention of minimum of Rs 150, provided that travel has not commenced. We will verify the passport and ensure that no Trip was undertaken before any refund of premium. The request for cancellation of policy within above stipulated time should be send to the insurer.

Cancellation/termination by Insurer:

Cancellation will not be invoked by us except on ground of fraud, moral hazard or misrepresentation. We will cancel the Policy by giving 15 days notice in writing by Registered Post Acknowledgment Due post to you at your last known address in which case we shall be liable to repay on pro-rata basis for the unexpired term from the date of the cancellation.

Refund of Premium on Early Return – In case of any early return of the Insured prior to expiry of the Policy Period, the company will refund premium at the following rates subject to no claims being incurred on the Policy.

Period of Risk Rate of Premium Retained by Us

  • (Insurers to specify the refund norms subject to pricing)

8.10 Automatic change in Coverage under the policy

The coverage for the Insured Person(s) shall automatically terminate in the case of demise of the insured person. However, the cover shall continue for the remaining Insured Persons till the end of Policy Period. All relevant particulars in respect of such person (including his/her relationship with the insured person) must be submitted to the company along with the application. Provided no claim has been made, and termination takes place on account of death of the insured person, pro-rata refund of premium of the deceased insured person for the balance period of the policy will be effective.

8.11 Territorial Jurisdiction

All disputes or differences under or in relation to the interpretation of the terms, conditions, validity, construct, limitations and/or exclusions contained in the Policy shall be determined by the Indian court and according to Indian law.

8.12 Arbitration

i. If any dispute or difference shall arise as to the quantum to be paid by the Policy, (liability being otherwise admitted) such difference shall independently of all other questions, be referred to the decision of a sole arbitrator to be appointed in writing by the parties here to or if they cannot agree upon a single arbitrator within thirty days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act 1996, as amended by Arbitration and Conciliation (Amendment) Act, 2015 (No. 3 of 2016).

ii. It is clearly agreed and understood that no difference or dispute shall be preferable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of the policy.

iii. It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon the policy that award by such arbitrator/arbitrators of the amount of expenses shall be first obtained.

8.13 Endorsements (Changes in Policy)

i. This policy constitutes the complete contract of insurance. This Policy cannot be modified by anyone (including an insurance agent or broker) except the company. Any change made by the company shall be evidenced by a written endorsement signed and stamped.

ii. The policyholder may be changed during the Policy Period only in case of his/her demise or him/her moving out of India. The new policyholder must be the legal heir/immediate family member. Such change would be subject to acceptance by the company and payment of premium (if any).

8.14 Terms and conditions of the Policy

The terms and conditions contained herein and in the Policy Schedule shall be deemed to form part of the Policy and shall be read together as one document.

8.15 Nomination

The policyholder is required at the inception of the policy to make a nomination for the purpose of payment of claims under the policy in the event of death of the policyholder. Any change of nomination shall be communicated to the company in writing and such change shall be effective only when an endorsement on the policy is made. In the event of death of the policyholder, the Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting nominee, to the legal heirs or legal representatives of the Policyholder whose discharge shall be treated as full and final discharge of its liability under the Policy.

9. REDRESSAL OF GRIEVANCE

In case of any grievance the insured person may contact the company through

Website:

Toll free:

E-mail:

Fax:

Courier:

Insured person may also approach the grievance cell at any of the company’s branches with the details of grievance.

If Insured person is not satisfied with the redressal of grievance through one of the above methods, insured person may contact the grievance officer at ………….

For updated details of grievance officer, kindly refer the link……….

(Link having details of grievance officer on website to be provided)

Grievance may also be lodged at IRDAI Integrated Grievance Management System – https://igms.irda.gov.in/

Insurance Ombudsman –If Insured person is not satisfied with the redressalof grievance through above methods, the insured person may also approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance. The contact details of the Insurance Ombudsman offices have been provided as Annexure-B.[1][Insurers to take note of the change in domain of the email ids mentioned at Annexure – B, the domain may be changed from gbic.co.in to ecoi.co.in. Insurers are further advised to note the revised details of insurance ombudsman as and when amended as available in the website http://ecoi.co.in/ombudsman.html and ensure that updated details are prospectively incorporated in the policy documents for the information of the policyholders.]

11. TABLE OF BENEFITS (for Domestic Travel Insurance cover)

Name Standard Travel Insurance Policy
Product Type Individual/Family Floater/Group
Category of Cover Indemnity/Benefit Based
Policy Period During the period of journey of the policyholder as a fare paying passenger and also during the stay based on the selection of the plan.
Eligibility There are no restrictions on age. All persons travelling as a fare paying passengers in a common carrier or public transport are eligible to be covered under the policy.
Scope of coverage Coverage is available only within India as per the details provided below. The coverage depends on the plan selected.
S N Proposed Plans Sum Insured Claim Type Plan-A Plan-B Plan – C Plan- D Plan-E Plan- F
Taxi (Within City) Taxi (Outside City) Inter-city Bus Travel Train Journey Air-travel Domestic Tours covering Road, Water, Train and Air travel
Tenure (Mini-mum & 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) Boarding to Destin-ation Single trip- Point to Point (PP) Boarding to Destin-ation Single trip- Point to Point (PP) Boarding to Destin-ation Use of several modes of travel. From more than 24 hours up to 1 year.
Man-datory Benefits Rs.
1 Accidental Hospita-lization Expenses Rs. 2 Lakh Indemnity Yes Yes Yes Yes Yes Yes
3 Accidental Death Rs. 10 lakh Benefit Based Yes Yes Yes Yes Yes Yes
4 Permanent Total Disability (PTD) Rs. 10 lakh Benefit Based Yes Yes Yes Yes Yes Yes
5 Permanent Partial Disability (PPD) Rs. 5 lakh Benefit Based Yes Yes Yes Yes Yes Yes
6 Repat-riation Of Mortal Remains Rs. 50,000 Inde-mnity Yes Yes Yes Yes Yes Yes
7 Ambulance Charges Rs. 2000 Inde-mnity Yes Yes Yes Yes Yes Yes
Optional Benefits Rs.
2 Hospital Cash (for a maximum of 7 days2 days deductible) Rs. 1000 per day Benefit Based Yes Yes Yes Yes Yes Yes
8 Compa-ssionate Visit Rs. 10,000 Inde-mnity No No No Yes Yes Yes
9 Compa-ssionate Visit Stay (Maximum of 7 days) Rs. 2000 per day Inde-mnity No No No Yes Yes Yes
10 Missed Flight (applicable only for air travel) Rs. 10,000 Benefit Based No No No No Yes Yes
11 Loss Of Checked-in Baggage (applicable only for air travel) Rs. 10,000 Benefit Based No No No No Yes Yes
12 Trip Delay (applicable only for air travel) (beyond 3 hour) Rs. 1,000 Benefit Based No No No No Yes Yes
13 Carrier Cance-llation (applicable only for air travel) Rs. 10,000 Benefit Based No No No No Yes Yes
14 Trip cancellation due to pandemic/ epidemic & natural calamities No No No No No Yes
15 Automatic trip extension available No No No No No Yes

12. TABLE OF BENEFITS (for Overseas Travel Insurance Cover)

Name Standard Travel Insurance Policy
Product Type Individual/ Family Floater / Group
Category of Cover Indemnity/Benefit Based
Policy Period During the period of journey of the policyholder as a fare paying passenger and also during the stay based on the selection of the plan.
Eligibility There are no restrictions on age. All persons travelling as a fare paying passengers in a common carrier or public transport are eligible to be covered under the policy.
Scope of coverage Coverage is available only outside India as per the details provided below. The coverage depends on the plan selected.
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-G Plan – H Plan- I Plan- J
Mandatory Benefits
16 Hospitalisation (accident+ illness) 1,00,000 Inde-mnity 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 Inde-mnity Yes Yes Yes Yes
23 Ambulance Charges 500 Inde-mnity Yes Yes Yes Yes
Optional Benefits
24 Automatic trip extension available No Yes Yes No
25 Bounced Airline Booking 250 Inde-mnity Yes Yes Yes Yes
26 Bounced Hotel booking 250 Inde-mnity No Yes Yes No
27 Compassionate Visit (2 ways) 5,000 Inde-mnity Yes Yes Yes Yes
28 Continuation of treatment at country of residence 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 Yes Yes Yes No
32 Flight Delay (beyond 3 hour) 500 Benefit Based No Yes Yes Yes
33 Loss of Checked-in Baggage 500 Benefit Based Yes Yes Yes Yes
34 Loss of passport 200 Benefit Based Yes Yes Yes Yes
35 Missed departure/ connecting flight 500 Benefit Based Yes Yes Yes Yes
36 Personal Liability 50,000 inde-mnity Yes Yes Yes No
37 Sponsor Protection 10,000 Benefit Based Yes No No No
38 Trip cancellation due to pandemic/ epidemic and natural calamities Inde-mnity No Yes Yes No

Annexure-A

List I – Items for which coverage is not available in the policy

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

List II – Items that are to be subsumed into Room Charges

SN Item
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED)
2 HAND WASH
3 CRADLE CHARGES
4 COMB
5 EAU-DE-COLOGNE / ROOM FRESHNERS
6 GOWN
7 SLIPPERS
8 TISSUE PAPER
9 TOOTH PASTE
10 TOOTH BRUSH
11 BED PAN
12 FLEXI MASK
13 HAND HOLDER
14 SPUTUM CUP
15 DISINFECTANT LOTIONS
16 LUXURY TAX
17 HVAC
18 HOUSE KEEPING CHARGES
19 AIR CONDITIONER CHARGES
20 IM IV INJECTION CHARGES
21 CLEAN SHEET
22 BLANKET/WARMER BLANKET
23 ADMISSION KIT
24 DIABETIC CHART CHARGES
25 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
26 DISCHARGE PROCEDURE CHARGES
27 DAILY CHART CHARGES
28 ENTRANCE PASS / VISITORS PASS CHARGES
29 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
30 FILE OPENING CHARGES
31 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
32 PATIENT IDENTIFICATION BAND / NAME TAG
33 PULSEOXYMETER CHARGES

List III – Items that are to be subsumed into Procedure Charges

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

List IV – Items that are to be subsumed into costs of treatment

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

Annexure-B

The contact details of the Insurance Ombudsman offices are as below-

Areas of Jurisdiction Office of the Insurance Ombudsman
Gujarat , UT of Dadra and Nagar Haveli, Daman and Diu Office of the Insurance Ombudsman,
JeevanPrakash Building, 6th floor,
TilakMarg, Relief Road,
Ahmedabad – 380 001.
Tel.: 079 – 25501201/02/05/06
Email: [email protected]
Karnataka Office of the Insurance Ombudsman,
JeevanSoudhaBuilding,PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road,JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 – 26652048 / 26652049
Email: [email protected]
Madhya Pradesh and Chhattisgarh Office of the Insurance Ombudsman,
JanakVihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 – 2769201 / 2769202
Fax: 0755 – 2769203
Email: [email protected]
Odisha Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.: 0674 – 2596461 /2596455
Fax: 0674 – 2596429
Email: [email protected]
Punjab , Haryana, Himachal Pradesh, Jammu and Kashmir, UT of Chandigarh Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.: 0172 – 2706196 / 2706468
Fax: 0172 – 2708274
Email: [email protected]
Tamil Nadu, UT–Pondicherry Town and Karaikal (which are part of UT of Pondicherry) Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 – 24333668 / 24335284
Fax: 044 – 24333664
Email: [email protected]
Delhi Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 – 23232481/23213504
Email: [email protected]
Assam , Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura Office of the Insurance Ombudsman,
JeevanNivesh, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.: 0361 – 2632204 / 2602205
Email: [email protected]
Andhra Pradesh, Telangana and UT of Yanam – a part of the UT of Pondicherry Office of the Insurance Ombudsman,
6-2-46, 1st floor, “Moin Court”,
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad – 500 004.
Tel.: 040 – 67504123 / 23312122
Fax: 040 – 23376599
Email: [email protected]
Rajasthan Office of the Insurance Ombudsman,
JeevanNidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur – 302 005.
Tel.: 0141 – 2740363
Email: [email protected]
Kerala , UT of (a) Lakshadweep, (b) Mahe – a part of UT of Pondicherry Office of the Insurance Ombudsman,
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam-682015.
Tel.: 0484 – 2358759/2359338
Fax: 0484-2359336
Email: [email protected]
West Bengal, UT of Andaman and Nicobar Islands, Sikkim Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue,
KOLKATA – 700 072.
Tel.: 033 – 22124339 / 22124340
Fax : 033 – 22124341
Email: [email protected]
Districts of Uttar Pradesh :
Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
Office of the Insurance Ombudsman,
6th Floor, JeevanBhawan, Phase-II,
Nawal Kishore Road, Hazratganj,
Lucknow – 226 001.
Tel.: 0522 – 2231330 / 2231331
Fax: 0522 – 2231310
Email: [email protected]
Goa,
Mumbai Metropolitan Region
excluding Navi Mumbai & Thane
Office of the Insurance Ombudsman,
3rd Floor, JeevanSevaAnnexe,
S. V. Road, Santacruz (W),
Mumbai – 400 054.
Tel.: 022 – 26106552 / 26106960
Fax: 022 – 26106052
Email: [email protected]
State of Uttaranchal and the following Districts of Uttar Pradesh:
Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
Office of the Insurance Ombudsman,
BhagwanSahai Palace
4th Floor, Main Road,
Naya Bans, Sector 15,
Distt: GautamBuddh Nagar,
U.P-201301.
Tel.: 0120-2514250 / 2514252 / 2514253
Email: [email protected]
Bihar,
Jharkhand.
Office of the Insurance Ombudsman,
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road,
Bahadurpur,
Patna 800 006.
Tel.: 0612-2680952
Email: [email protected]
Maharashtra,
Area of Navi Mumbai and Thane
excluding Mumbai Metropolitan Region
Office of the Insurance Ombudsman,
JeevanDarshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020-41312555
Email: [email protected]

[Note to Insurers: Insurers are advised to mention the correct address, e mail Id, phone number etc. of insurance ombudsmen while issuing policy contracts]

Annexure-2

Customer Information Sheet

(Description is illustrative and not exhaustive)

No. TITLE DESCRIPTION Refer to policy clause number
1. Product Name Standard Travel Insurance Policy,<name of the Insurer>.
2. What am I covered for under domestic travel insurance 1)   Hospitalization expenses- Medical expenses incurred on hospitalization due to accident while travelling in a common carrier or public transport as a fare paying passenger. The coverage is admissible if the period of hospitalisation is 24 hours and above
2)   Hospital Cash (for a maximum of 7 days with 2 days deductible). A lump sum amount will be paid for every 24 hours of hospitalisation
3)    Accidental Death – death due to accident occurred while travelling in a common carrier or public transport as a fare paying passenger
4)   Permanent Total Disability (PTD) – disability due to accident occurred while travelling in a common carrier or public transport as a fare paying passenger. The disability shall occur within 365 days of the accident
5)   Permanent Partial Disability (PPD) – disability due to accident occurred while travelling in a common carrier or public transport as a fare paying passenger. The disability shall occur within 365 days of the accident
6)   Repatriation Of Mortal Remains –  the  companyshall pay for repatriation of mortal remains of the insured person from the place of death to the Insured’s place of residence
7)   Ambulance Charges – the  companyshall pay ambulance charges to go to nearest hospital for emergency treatments
8)   Compassionate Visit- the companyshall pay the cost of tickets on a Common Carrier for a family member or an immediate Relative of the Insured Person to travel to the place of Hospitalization in case of hospitalisation of the Insured Person .
9)   Compassionate Visit Stay (Maximum of 7 days) –the  companyshall pay a fixed amount towards accommodation expenses for an immediate relative of the Insured Person to stay at the place of Hospitalization of the Insured Person.
10) Missed Flight (applicable only for air travel) –the  companyshall reimburse the cost of alternative travel 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.
11) Loss of Checked-in Baggage (applicable only for air travel) -The  companyshall indemnity the total loss of check-in baggage upto the sum insured.
12) Trip Delay (applicable only for air travel) (beyond 3 hour)- the companyshall indemnity if the insured person’s journey on a Common Carrier is delayed beyond three hours of its scheduled departure.
13)  Carrier Cancellation (applicable only for air travel) –  the company shall indemnity if the Insured Person’s booked and confirmed journey is cancelled within 48 hours prior to the scheduled departure by the Common Carrier.
14) Trip cancellation due to pandemic/epidemic  & natural calamities- the company shall indemnity the cost incurred by the policyholder towards booking of rooms, events and airfare.
15) Automatic trip extension upto 7 days
3 What am I covered for under overseas travel insurance 16) Hospitalisation due to illness & accident – the Company will up to the Sum Insured for medical expenses incurred by the Insured Person towards hospitalization due to illness or accidental injury occurring during the trip overseas.  
17)  Hospital Cash: the company shall pay a fixed amount for each completed 24 hours of hospitalisation upto 7 days with a deductible of 2 days.
18) Life Threatening Condition Due To PED – the cover is extended for treatment in a Life Threatening Medical Condition due to pre-existing disease while overseas for any sudden, unexpected, unforeseen development attributable to any Pre-Existing Condition(s). The treatment for these emergency measures would be paid till the Insured person becomes Medically Stable or is relieved from acute pain.
19)  Accidental Death/ PA – If the Insured Person suffers Accidental Bodily Injury while Overseas and this is the sole and direct cause of his Death within the period of 365 days, then the Insurer will pay as compensation to the legal heirs / nominee, the amount stated as sum insured in the policy schedule/ Certificate of Insurance.
20)   Permanent Total Disability (PTD) – the Company shall pay to the Insured the Compensation stated in the Table of Benefits, if during the Trip an Insured sustains Bodily Injury which directly and independently of all other causes results in disablement within 365 days from the date of accident.
21) Permanent Partial Disability (PPD) – the insurer shall pay sum insured stated in the Table of Benefits, if during the Trip an Insured sustains Bodily Injury which directly and independently of all other causes results in permanent partial disablement within 365 days from the date of accident.
22) Repatriation Of Mortal Remains – if the Insured Person dies due to Accidental Bodily Injury during an overseas travel, then the Insurer will pay up to the Limit of Indemnity specified in the Policy Schedule towards the cost of transporting the Insured Person’s remains to place of his residence or for the costs of a burial.
23) Ambulance Charges (per trip) – the insurer shall indemnify the Insured up to the Sum Insured specified in the Policy Schedule for Ambulance charges incurred by the Insured Person (s) towards transportation to the nearest Hospital on account of illness or accidental injury.
24) 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 covered events and when no alternative travel arrangement is available.
25) Bounced Airline Booking –  the company shall indemnify the additional expenses incurred by the Insured Person for alternative flight arrangements in the event of the confirmed flight booking for any part of the Trip not getting confirmed at the sole instance of the Common Carrier
26) Bounced Hotel Booking –  the company shall indemnify the Insured Person for the additional expenses incurred by the Insured Person for alternative accommodation in the event of the confirmed accommodation booking at the place of stay not getting confirmed solely at the instance of the accommodation provider
27) Compassionate Visit (2 ways) – the insurer shall reimburse the cost of the economy class flight ticket incurred by the immediate family member of the Insured Person to travel to the place of Hospitalization of the Insured Person.
28) Continuation of treatment at country of residence – on the advise of the treating doctors at overseas hospitals, the treatment for the injury sustained while on a trip overseas can be continued at the country of residence for the period upto 15 days from the date of return.
29) Delay of check-in baggage (beyond 12 hrs) – the insurer shall pay if the arrival of the Insured Person’s checked-in accompanying baggage for a journey Overseas is delayed by the common carrier (sea or air) to whom it was entrusted for more than 12 hours from the scheduled arrival time.
30) Emergency Assistance Services – shall advise the insured person in case of any emergency during the trip overseas.
31) Emergency Medical Evacuation- subject to an admissible claim under Hospitalisation due to Accident, the Company shall pay up to the limits mentioned in the Policy Schedule towards the cost of emergency medical evacuation if the treatment facility is not available in the nearest hospital.
32) Flight Delay (beyond 3 hours) – the insurer shall pay the insured person in the event of flight delayed by more than 3 hours due to the Covered Hazards
33) Total Loss of Checked-in Baggage – 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.
34) Loss of passport – If the Insured Person loses his passport overseas during the policy period, the Insurer will pay the lump sum amount to meet the expenses of the insured to obtain a duplicate or fresh passport either overseas or within 30 days upon return to India.
35) Missed departure/connecting flight- the company will indemnity 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.
36)  Personal Liability – the Insurer will indemnify the Insured Person up to the Limit of Indemnity, against any legal liability he incurs to a third party in his private capacity to pay damages for Accidental Bodily Injury or Accidental property damage happening overseas during the Policy Period.
37) Sponsor Protection – In the event of injury to the Insured Person’s Sponsor as stated in the Enrolment Form resulting in Death or Permanent Disablement as defined in the Policy, the Company shall reimburse the insured person the tuition fee incurred for the remaining period of this education.
38) Trip cancellation due to pandemic/epidemic and natural calamities
3. What are the

Major exclusions in the policy

 

a. Pre-existing illness/disease/ injury/condition.

b. Insured person travelling against doctor’s advice

c. Self-inflicted injury, attempted suicide

d. Insured taking part in naval, military or airforce operations

e. War, invasion, acts of foreign enemy, civil war and similar activities

f. Ionising radiations, contamination by radioactivity, nuclear fuel and similar activities

g. Insured participating in mountaineering, winter sports, manual work, hazardous

h. occupation, etc.

i. HIV,HIV related illness including AIDS

j. Claims arising from Pregnancy

k. Transmission of a communicable disease by insured

l. Sexual Molestation, Corporal Punishment

m. Suits or legal action by insured’s family members

n. Confiscation or detention by custom’s officials

o. Influence of drugs, alcohol or intoxicants

(Note: the above is a partial listing of the policy exclusions. Please refer to the policy clauses for the full listing)

 

 

4. Waiting period There is no initial waiting period under travel insurance policy.
5. Payment basis The claims are payable both on indemnity and benefit based depending the coverage. Cashless payment of covered expenses upto specified limits in the Hospitals under the network of Overseas Service Provider.
6. Renewal Condition The Policy is issued on per trip basis. It is renewable on mutual consent in thecase of annual policies (only for Plan- I)
8. Cancellation The Company may cancel the policy at any time on grounds of misrepresentation, non-disclosure of material facts fraud by the Insured Person by giving 7days’ written notice. It is applicable only in case of policies where the tenure of the policy is more than 15 days.
 

9

Claims a. For Cashless Service:

(Insurer to provide the details /web link from where Hospital Network details can be obtained)

b. For Reimbursement of Claim: For reimbursement of claims the insured person may submit the necessary documents to TPA/Company/ Emergency Service Provider within thirty days of date of discharge from hospital and occurring of insured event.

For more details on claim procedure please refer the policy document.

 

10

Policy Servicing Insurer to provide the details of company officials.
Grievances/Complaints a. Details of Grievance redressal officer (Insurer to provide the link)

b. IRDAI Integrated Grievance Management System – https://igms.irda.gov.in/

c. Insurance Ombudsman – The contact details of the Insurance Ombudsman offices have been provided as Annexure-B of Policy document.

11 Insured’s Rights Insurer to specify the norms on TAT/ESP for Pre-Auth and Settlement of reimbursement.
Insured’s Obligations Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-disclosure may result in claim not being paid.
Legal Disclaimer Note: The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the CIS and the policy document, the terms and conditions mentioned in the policy document shall prevail.

Annexure-3

Form IRDAI-UNF-STIP

[All the items should be filled in properly and carefully. No item must be left blank.]

S No
Item
Particulars (to be filled in by insurer)
Section I: General Information
1.1
 Name of Health / General Insurer
 
1.2
Registration No. allotted by IRDAI
 
1.3
Name of Appointed Actuary [Please note that his/her appointment should be in force as on the date of this application]
 
1.4
Brand Name [Give the name of the product which  will be printed in Sales Literature and known in the market. This name should not be altered/modified in any form after launching in the market. This name shall appear in all returns etc. which would be submitted to  IRDAI
Standard Travel Insurance Policy, <Name of the insurer>
1.5
Date of approval by PMC
 
Section II – Distribution Channels
3
Distribution channels:
3.1
Specify the various distribution channels to be used for distributing the product- [reply shall be specific and can not refer to the replies like “as approved by IRDAI]
3.1
Commission scales to distribution channels—specify the rates which are to be paid-[reply shall be specific]
3.2
Expected proportions of business  to be procured by each channel shall be indicated for the next 5 years.
Distribution Channel
Year 1
Year 2
Year 3
Year 4
Year 5
1. Individual Agents
2. Corporate Agents
3. Insurance Brokers
4.Web Aggregators
5.Micro Insurance Agents
6.CSC
7.PoS
8.Direct – Only Online
9.Direct Marketing – Others
(Incorporate separate line for each distribution channel)
10. Others-specify
11. Total
Section III – Reinsurance arrangements
3.1
Retention limit
3.2
Name of the reinsurer (s)
3.3
Terms of reinsurance(type of reinsurance, commissions, etc.).
3.4
Any recapture provisions shall be described.
3.5
Reinsurance rates provided
3.6
Whether a copy of the reinsurance program and a copy of the Treaty is submitted to the Authority.
Yes/No
3.6.1
Whether reinsurance program and a copy of the treaty enclosed (required only if these are not filed with the Authority previously)
Yes/No
3.6.2
Whether the reisurance proposed for the product is in line with the Board approved reinsurance program filed with the Authority
Yes / No
3.6.3
If no, furnish the particulars
Section IV: Pricing
4
Premium Loadings & Discounts
(Please provide objective and transparent criteria to offer discounts/rebate/Loadings And complete financial justifications by AA to every item referred hereunder.
In case of General and Health Insurers to be also furnished separately in the Technical Note)
4.1
Sum insured rebates/discounts offered, if any
4.2
Rebates/charges for different modes offered:
4.3
Premium rebates/discounts
4.4
Staff rebates
4.5
Any other discounts offered
4.6
Maximum cap on all Discounts for all variables taken together
4.7
Any loadings proposed
4.8
Maximum Cap on all Loading for all variables taken together
4.9
Subrogation (Not applicable to Health Insurance)
 
4.10
Pricing Assumptions and Methodology: The pricing assumptions and the methodology may vary depending on the nature of product. Give details of the following
4.11
 Give the actuarial formulae, if any, used; if not, state how premiums are arrived at briefly explaining the methodology and details:
4.12
Source of data (internal/industry/ reinsurance)
4.13
Rate of morbidity [The tables whereever relevant shall be the prescribed one.]
4.14
Rates of policy terminations. [The rates used must be in accordance with insurer’s experience. If such experience is not available, this can be from the industry/reinsurer’s experience .]
 
4.15
Rate of interest, if any. [The rate or rates must be consistent with the investment policy of the insurer.]
 
4.16
Commission scales  [Give rates of commission. These are explicit items.]
 
4.17
Expenses – Split into First Year, Renewal and Claim related:- [Expense assumptions must be company specific. If such experience is not available, the Appointed Actuary might consider industry experience or make reasonable assumptions.]
4.17.1
First Year expenses by: sum assured related, premium related, per policy related
First Year Expenses
sum assured related
premium related
per policy related
 
 
 
 
4.17.2
Renewal expenses where relevant (including overhead expenses) by : sum assured related, premium related, per policy related
Renewal Expenses
sum assured related
premium related
per policy related
 
 
 
 
4.17.3
Claim expenses
 
4.17.4
Future inflationary increases, if any
 
4.18
Allowance for transfers to shareholder, if any: [Please see section 49 of the Insurance Act, 1938]
 
4.19
Taxation. [Please see the relevant sections of the Income Tax Act, 1961 applicable for payment of taxes by the Insurer]
 
4.20
Any other parameter relevant to pricing of product –specify
 
4.21
Reserving assumptions (please specify all the relevant details)
 
4.22
Base rate (risk premium)-furnish the rate table, if any
 
4.23
Gross premium- furnish the rate table, if any
 
4.24
Annualised Premium
 
4.24.1 Minimum
 
4.24.2 Maximum
 
4.25
Expected loss ratio (for the product) –
 
4.26
Expected combined ratio
 
4.27
Age-wise combined ratio-
 
4.28
Sum insured-wise- combined ratio
 
4.29
Expected cross-subsidy between age/sum insured
 
4.30
Experience of similar products, if any for the preceding Five Financial Years
 
S.No
Exposure
Premium –Rs.
Number of claims
Incurred claims-Rs.
Claim frequency
Average cost per claim
Burning cost-Rs.
Loss ratio
Combined ratio
FY
FY-1
FY-2
FY-3
FY-4
1. Exposure: earned life year (no of life earned during a particular financial year);
2. Premium: premium earned during the financial year;
3.Number of claims: claims occurred during the financial year;
4. Incurred claims: Incurred amount as of today for claims mentioned in “3”;
5. Claim frequency: No. of claims/ Exposure;
6. Average cost per claim: Incurred claims / No. of claims;
7. Burning cost: Claims frequency* Average cost per claim;
8. Loss ratio: Incurred claims/ Premium;
9. Combined ratio: Loss ratio + Expense ratio;
4.31
Results of Financial Projections/Sensitivity Analysis: [The profit margins should be shown for  various model  points  for base,optimistic and pessimistic scenarios  in a tabular format below. The definition of profit margin should be taken as the present value of net profits to the p.v of premiums. Please specify assumptions made in each scenario. For terms less than or equal to one year loss ratio may be used and for terms more than one year, profit margin may be used.]
4.32
Risk discount rate used in the profit margin
 
4.33
 Average Sum Insured Assumed
 
4.44
Assumptions made under pessimistic scenario
 
4.45
Assumptions made under optimistic scenario
 
 Section VI: Enclosures to the Application:
The following specimen documents should be enclosed:
5.1
5.2
5.3
Technical Note on Pricing
5.4
Proposal form, wherever necessary
5.5
Premium Table
5.6
Certificates by Appointed Actuary and Chief Compliance Officer
5.7
CIS

Soft ware used for product design and monitoring — (for information of the Authority)

The Insurer shall enclose a certificate from the Chief Compliance Officer, Appointed Actuary, countersigned by the principal officer of the insurer,  as per specimen given below:(The  language of this should not be altered)

Certification by Chief Compliance Officer:

I——- (Name of Chief Compliance Officer) the undersigned, on behalf of the Insurer named below, hereby affirm and declare as follows:

1. That the details of the (Name of product) filled in above are true and correct and reflect what the policy and other documents indicate.

2. That the product complies with the various provisions of IRDAI (Health Insurance) Regulations, 2016, all other applicable Regulations, Master circular on Standardization of Health Insurance Products (Ref: IRDAI/HLT/REG/CIR/193/07/2020) dated 22ndJuly, 2020, Consolidated Guidelines on Product Filing in Health Insurance Business (Ref: IRDAI/HLT/REG/CIR/194/07/2020) dated 22ndJuly, 2020, and other applicable Guidelines as amended from time to time.

3. That this application and all other documents are complete and have been verified for correctness and consistency not only in respect of each item of each document but also vis-a-vis one another.

4. I certify that the policy wordings and Customer Information sheet filed along with this application is in compliance with of IRDAI (Health Insurance) Regulations, 2016, all other applicable Regulations, Master circular on Standardization of Health Insurance Products (Ref: IRDAI/HLT/REG/CIR/193/07/2020) dated 22ndJuly, 2020, Consolidated Guidelines on Product Filing in Health Insurance Business (Ref: IRDAI/HLT/REG/CIR/194/07/2020) dated 22ndJuly, 2020, and Guidelines on Standard Domestic Travel Insurance – Individual  issued thereon.

5. I further certify that the Prospectus submitted is in compliance with the applicable provisions of Rules, IRDAI Regulations and Guidelines on Product Filing and Insurance Advertisements.

Date:

(Chief Compliance Office)

Certification by Appointed Actuary:

” I, (name of the appointed actuary), the appointed actuary, hereby solemnly declare that the information furnished in this Application Form  is true.  I also certify that, in my opinion, the premium rates, advantages, terms and conditions of the above product are workable and sound, the assumptions are reasonable and premium rates are fair.”

I have carefully studied the requirements of the Product Filing Procedure in relation to the design and rating of insurance products.

The rates, terms and conditions of the above mentioned product are determined on technically sound basis and are sustainable on the basis of the information and claims experience available in the records of the insurer.

An adequate system has been put in place for collection of data on premiums and claims based on every rating factor that will enable review of the rates and terms of the cover from time to time. It is planned to review the rates, terms and conditions of cover (— mention periodicity of review) based on emerging experience.

It is further certified that the underwriting of the product now filed shall be within the Board approved underwriting philosophy of the Company.

The requirements of the Product Filing Procedure have been fully complied with in respect of this product or revision or modification of the product.

I further declare that except the Sections mentioned in S.No., no other feature/benefit/clause is modified in the product (applicable only for revision or modification of the product)

Signature of the Appointed Actuary

Place

Date:

Certification by Principal Officer or CEO

I (name of the Principal Officer or CEO), (mention designation) hereby confirm that:

1. The rates, terms and conditions of the above-mentioned product filed with thiscertificate have been determined in compliance with the IRDA Act, 1999, InsuranceAct, 1938, and the Regulations and guidelines issued there under, including the Fileand Use / Use & File Product Filing guidelines.

2. The prospectus, sales literature, policy and endorsement documents, and the rates, terms and conditions of the product have been prepared on a technically sound basisand on terms that are fair between the insurer and the client and are set out inlanguage that is clear and unambiguous.

3. These documents are also fully in compliance with the underwriting and rating policy approved by the Board of Directors of the insurer.

4. The statements made in the filing Form -IRDAI-UNF-STIP are true and correct.

5. The requirements of the Product Filing Guidelines have been fully complied with in respect of this product.

Date:

Signature of Principal Officer or Designated Officer

Place:

Name and designation along with Company’s seal

More Under Corporate Law

Leave a Comment

Your email address will not be published. Required fields are marked *

Search Posts by Date

January 2021
M T W T F S S
 123
45678910
11121314151617
18192021222324
25262728293031