As per sec 16 of HIR, 2016. (i) Cumulative bonuses offered under policies, shall be stated explicitly in the prospectus and the policy document. (ii) . If a claim is made in any particular year, the cumulative bonus accrued may be reduced at the same rate at which it has accrued.

Any Institution established for day care treatment of sickness and/or injuries or a medical set up within a hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner and must comply with all minimum criteria as (i) has qualified nursing staff under its employment (ii) has qualified medical practitioner(s) in charge (iii) has a fully equip med operation theatre of its own where surgical procedures are carried out and (iv) maintains daily records of patients and will make these accessible to the insurance company’s authorized personnel.

Refers to medical treatment and/or surgical procedure which is (i) undertaken under General or local anesthesia in a hospital/day care in less than 24 hours because of technological advancement, and (ii) which would have otherwise required a hospitalization of more than 24 hours. Treatment normally taken on an out-patient basis is not included in the scope of this definition. Insurers may restrict coverage to a specified list.

A deductible is a cost sharing requirement under a health insurance policy that provides that the insurer will not be liable for a specified rupee amount of the covered expenses, which will apply before any benefits are payable by the insured. A deductible does not reduce the sum insured. Each policy to define whether the deductible is applicable per year, per life or whether per event and specific deductible limits would be applied.

Dental treatment is treatment carried out by a dental practitioner including examinations, fillings (where appropriate), crowns, extractions and surgery excluding any form of cosmetic surgery/implants.

Refers to a child (naturally or legally adopted) who is financial dependent on the primary insured or proposer and does not have his/her independent sources of income. However, insurers are free to add additional criteria relating to age, marital status, education and disablement.

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

means Medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a hospital/nursing home as in-patient but actually taken whilst confined at home in India under any of the following circumstances namely: (i) The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing Home , OR (ii ) The patient cannot be removed to Hospital/Nursing home on account of non-availability of room in a hospital.

Emergency care means management for a severe 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.

New policy should be issued within 15 days of submission of proposal. (i) To keep a check that people don’t try to take a policy where they have been diagnosed with some illness and they require immediate hospitalization, a *30 day waiting period* is kept, where Insurance Company will not pay any kind of claim within the first 30 days of taking the new policy, (*exception is that if policyholder meets an accident* then the claim is payable). (ii) Customer Information Sheet must be part of the policy document, as per sec 26 of HIR, 2016. Policy can be *renewed within 15 days grace period* after expiry of the policy. However coverage is not available for the days for which the premium was not received by the Insurance Company. Premium for individual policies cannot be increased at renewals in an arbitrary way, especially after a claim is made, as per Sec 25(i) of HIR 2016. There will be no change in premiums in individual policies *for 3 years* after initial offering, as per Sec 10(c) of HIR 2016.Cannot force consumer to shift to other product as per Sec 11(c) and 17 of HIR 2016.All policies will be ordinarily renewable as per Sec 13 of HIR 2016.All disclosures as per the new regulations have to be included in the policy document, as per sec 28 of HIR, 2016For multiple policies, claims under other policy can be made after exhaustion of Sum Insured in the earlier policy, as per Sec 24 (ii) 2 of HIR 2016. The option to choose will remain with the insured.Common Clauses Health Insurance : Grace Period : Grace period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting period and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.