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.

All Health Insurance products have a free look period. As per Sec 14 of HIR 2016 (i) All new individual health insurance policies issued by Life Insurers, General Insurers and Health Insurers, except those with tenure of less than a year shall have a free look period. The free look period shall be applicable at the inception of the policy and (1) The insured will be allowed a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable. (2) If the insured has not made any claim during the free look period, the insured shall be entitled to— (a) A refund of the premium paid less any expenses incurred by the insurer on medical examination of the insured persons and the stamp duty charges or; (b) where the risk has already commenced and the option of return of the policy is exercised by the policyholder, a deduction towards the proportionate risk premium for period on cover or; (c) Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period; (d) In respect of unit linked policy, in addition to the above deductions, the insurer shall also be entitled to repurchase the unit at the price of the units as on the date of the return of the policy.

A hospital/Nursing home means any institution established for in- patient care and day care treatment of sickness and/or injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act OR complies with all minimum criteria as under: (a) has at least 10 inpatient beds, in those towns having a population of less than 10,00,000 and 15 inpatient beds in all other places; (b) has qualified nursing staff under its employment round the clock; (c) has qualified medical practitioner (s) in charge round the clock; (d) has a fully equipped operation theatre of its own where surgical procedures are carried out (e) maintains daily records of patients and will make these accessible to the Insurance company’s authorized personnel. Note: In case of Ayurvedic/Homeopathic/Unani treatment, Hospitalization expenses are admissible only when the treatment is taken as in-patient, in a Government Hospital/Medical College Hospital.

Means admission in a Hospital for a minimum period of 24 in patient care consecutive hours except for specified procedures/treatments where such admission could be for a period of less than 24 consecutive hours.

To avail the benefit of cashless facility, insurers shall issue an identification card to the insured within 15 days from the date of issue of a policy. The identification card shall, at the minimum, carry details of the policyholder and the logo of the insurer. ID card to have logo of Insurance company (not of TPA)* and the card may be permanent, as per Sec 30(f) of HIR 2016