This Document is Digitally Signed

The Oriental Insurance Company Limited

Signer: RASHMI RAMAN SINGH
Date: Thu, Apr 27, 2023 12:25:56 IST
Location: NOIDA
Reason: Signing Policy for OICL

GROUP MEDICLAIM TAILORMADE POLICY SHEDULE

UIN : OICHLGP449V022021

Policy No. : 111700/48/2024/21 Prev. Policy : -

No.
Cover Note No. : CVR-MISC27010 Cover Note Date : 02/04/2023
Insured's Code : AC0000004548 Issue Office Code : 111700
Insured's Name : BANK OF MAHARASHTRA (GSTIN: Issue Office Name : CBU-II Mumbai (GSTIN:
27AACCB0774B1Z4) 27AAACT0627R4ZW)

Address : BANK OF MAHARASHTRA, SHIVAJI Address : ORIENTAL BUILDING 3RD FLOOR

NAGAR, PUNE 411005 M G ROAD
-
FLORA FOUNTAIN
-
MUMBAI MAHARASHTRA 400001
PUNE MAHARASHTRA 411005
Tel. /Fax /Email : 0 / / 0 / NA Tel. /Fax /Email : 022-
22821731/22821746/22821459/22821365
/ 022-22821648 /
[email protected],milindp
[email protected]

Agent/Broker Details
Dev.Off.Code :

Agent/Broker : LC0000000041 M/S ANAND RATHI INSURANCE BROKERS LTD

Address : 104, MITTAL TOWER, 'C' WING, 10TH FLOOR,NARIMAN POINT, MUMBAI 400021,MOB
NO9664745169,9930058756 09830330007, 9133300059.022-
49093000/3001,MUMBAI,MAHARASHTRA,400021
Tel/Fax/Email : 022-49093077/9133300059/022-49093000/3001/

Period of Insurance : FROM 00:00 ON 02/04/2023 TO MIDNIGHT OF 01/04/2024

Collection No. & Dt. : CD A/C AC0000004548 GST INVOICE NO :272259052 UIN :0

Gross Premium : 7,84,88,534 GST : 1,41,27,936 Stamp Duty : 1 Total : 9,26,16,470

Co-insurance Details : NIL

TPA Details :
TPA ID : YA0000000335
TPA Name : M/S MEDSAVE HEALTH I
TPA Address : F-701 A, LADO SARAI, MEHRAULI BEHIND GOLF
COURSE
DELHI 110030 Toll Free No : 1800120111234, 011-71221234
Telephone No : Fax No :

Risk Details
As per attached Annexure
Sr No : 1 Emp/Dependant : TOTAL LIVES SI : 1118600000 No Of : 5726

Place : MUMBAI For and on behalf of

Date : 27/04/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 1 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

The Oriental Insurance Company Limited

Signer: RASHMI RAMAN SINGH
Date: Thu, Apr 27, 2023 12:25:56 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 111700/48/2024/21

Name 5726 EMP 3028 Dependants

+ DEP 2698

Particulars of the Persons covered

Sr. No. Name Relationship Sex Age Pre-existing Ailments, If

Any

Total Sum Insured in words : Indian Rupees One Hundred Eleven Crores Eighty-Six Lakhs Only
Total Premium in words : Indian Rupees Nine Crores Twenty-Six Lakhs Sixteen Thousand Four Hundred Seventy Only

Installment Details
Inst. No Installment Installment Installment Tax Total Remarks
Date % Amount

1 02/04/2023 100 7,84,88,534 1,41,27,936 9,26,16,470

The insurance under this policy is subject to conditions, clauses, warranties,endorsements .

The policy shall pay for hospitalization expenses for medical/surgical treatment at any Nursing Home/Hospital in INDIA as
an in-patient defined in the policy
In the event of a claim under the policy exceeding Rs. 1 lac or a claim for refund of premium exceeding Rs. 1 lac,the
insured will comply with the provisions of the AML policy of the Company.The AML policy is available in all our operaing
offices as well as Company's website.
Salient features: policy period : 02.04.2023 to 01.04.2024

Total No. of Persons covered : 5726 (EMP 3028 + DEP 2698)

Sum Insured Slab/s 100000/200000/300000/400000/500000/600000/700000/800000/900000/1000000

Policy Coverages
1. Policy covers hospitalization expenses for medical surgical treatment arising out of any
disease/ailment/illness/accident.
2. Hospitalization and major illness i.e. covered up to overall sum insured.
3. 30 Days Pre & 60 Days Post Hospitalization. No Restrictions on expenses towards Pre-post Hospitalization & Major
illness i.e. covered up to overall Sum Insured.
4. No capping under any head including Room rent/ICU rent.
5. No Co-Pay clause.
a. Sum Insured is on family floater basis i.e. anyone member or all the members put together can avail of hospitalization
benefit during the policy period up to the available sum insured.
6. All pre-existing diseases are covered.
7. For new entrants above 65 years, the existing premium will be loaded by 20%. , New entrants above 70 years age
premium will be loaded by 50%.
8. First 30 days waiting period shall be applicable for New Entrants & Not applicable in case of Accidental Claims.
9. Diseases that are normally not covered during the first year, Second year & Third year under the standard Mediclaim
Insurance policy shall be covered.
10. Maternity Benefit provided - Normal Delivery Rs.35,000/- & Cesarean Section Rs.50,000/- (Up to 2 Deliveries)

11. Spouse of deceases employee cover subject to spouse is cover in last year policy (2022-23)
12. Cover dependent children up to 25 years of age or marriage or getting employed whichever is earlier, crippled and/or
physically challenged children without age restrictions
13. Cashless facility through TPA.

Place : MUMBAI For and on behalf of

Date : 27/04/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 2 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

The Oriental Insurance Company Limited

Signer: RASHMI RAMAN SINGH
Date: Thu, Apr 27, 2023 12:25:56 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 111700/48/2024/21

14. New Born child shall be included after 90 days from the date of birth
15. No Ailment-wise capping is applicable.
16.Midterm alteration of Sum Insured is not permissible.
17. Midterm addition of new employee is permissible. Midterm addition of family member are only allow in event of newly
married spouse or new born child. Full annual premium shall paid for new join employee or for any change of family
definition.
Example ¿ If employee want to add spouse or new born child in midterm then employee need to pay full annual
difference premium for change in plan/family definition ( Such as moving from Self to Self + spouse) (Self to Self +
Parents) ( Self + spouse to Self + Spouse + 2 children)
In other event employee taken policy for family definition Self+ spouse+ 2 children+ 2 parents & want to add new born
child (not more than 2) then employee can add new born child without paying any additional premium.
Example ¿ If employee want to add spouse or new born child in midterm then employee need to pay full annual
difference premium for change in plan/family definition ( Such as moving from Self to Self + spouse) (Self to Self +
Parents) ( Self + spouse to Self + Spouse + 2 children)
In other event employee taken policy for family definition Self+ spouse+ 2 children+ 2 parents & want to add new born
child (not more than 2) then employee can add new born child without paying any additional premium.

18. Road Ambulance Cover

: We will cover the costs incurred up to the limit as specified in the Policy Schedule or Certificate of Insurance on
transportation of the Insured Person by road Ambulance to a Hospital for treatment in an Emergency following an Illness
or Injury which occurs during the Policy Period. It becomes payable if a claim has been admitted under Section II.1 or
II.2 and the expenses are related to the same Illness or Injury. We will also cover the costs incurred on transportation of
the Insured Person by road Ambulance in the following circumstances up to the limits specified in the Policy Schedule or
Certificate of Insurance:
(i) it is medically required to transfer the Insured Person to another Hospital or diagnostic center during the course of
Hospitalization for advanced diagnostic treatment in circumstances where such facility is not available in the existing
Hospital;
(ii) it is medically required to transfer the Insured Person to another Hospital during the course of Hospitalization due to
lack of specialty treatment in the existing Hospital.
All claims under this Benefit can be made as per the process defined under Section V. D

19. Domiciliary Hospitalisation Cover

We will cover Medical Expenses, up to the limit specified in the Policy Schedule/ Certificate of Insurance, incurred for the
Insured Person's Domiciliary Hospitalization during the Policy Period following an Illness or Injury that occurs during the
Policy Period provided
that:
i. The Domiciliary Hospitalisation continues for at least 3 consecutive days in which case We will make payment under
this Benefit in respect of Medical Expenses incurred from the first day of Domiciliary Hospitalisation;
ii. The treating Medical Practitioner confirms in writing that Domiciliary Hospitalization was medically required and the
Insured Person's condition was such that the Insured Person could not be transferred to a Hospital or the Insured
Person satisfies Us that a Hospital bed was unavailable;
iii. We shall not be liable to pay for any claim in connection with:
a. Asthma, bronchitis, tonsillitis and upper respiratory tract infection including laryngitis and pharyngitis, cough and cold,
influenza;
b. Arthritis, gout and rheumatism;
c. Chronic nephritis and nephritic syndrome;
d. Diarrhoea and all type of dysenteries, including gastroenteritis;
e. Diabetes mellitus and insipidus;
f. Epilepsy;
g. Hypertension;
h. Psychiatric or psychosomatic disorders of all kinds;
i. Pyrexia of unknown origin.
All claims under this Benefit can be made as per the process defined under Section V. D

20. Donor Expenses Cover

Place : MUMBAI For and on behalf of

Date : 27/04/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 3 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

The Oriental Insurance Company Limited

Signer: RASHMI RAMAN SINGH
Date: Thu, Apr 27, 2023 12:25:56 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 111700/48/2024/21

We will cover the In-patient Hospitalization Medical Expenses incurred for an organ donor's treatment during the Policy
Period for the harvesting of the organ donated up to the limit as specified in the Policy Schedule or Certificate of
Insurance provided that:
i. The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured
Person;
ii. We have admitted a claim towards In-patient Hospitalisation under the Base Cover and it is related to the same
condition; organ donated is for the use of the Insured Person as certified in writing by a Medical Practitioner;
iii. We will not cover:
a. Pre-hospitalization Medical Expenses or Post-hospitalization Medical Expenses of the organ donor;
b. Screening expenses of the organ donor;
c. Costs associated with the acquisition of the donor's organ;
d. Transplant of any organ/tissue where the transplant is experimental or investigational;
e. Expenses related to organ transportation or preservation;
f. Any other medical treatment or complication in respect of the donor, consequent to harvesting.
All claims under this Benefit can be made as per the process defined under Section V. C and D

21. Provision to claim excess amount after exhausting sum insured and or Corporate Buffer under the IBA Policy if the
employee is a member of such policy and has preferred to claim there under subject to terms and conditions of this
Group Policy. In this event, communication of hospitalization of insured must be made to the TPA within 48 hours of
such hospitalization. To avail this, employee need to submit Declaration in Annexure 1 and other documents as per
Clause 21A f the attached terms, conditions. The Declaration is to be duly certified countersigned by Zonal
Head/Executive of HR Dept of the Bank's Head Office in case of serving employee and Branch Manager or any other
Officer of the Bank in case of retired employee.
22. Option open for employee to claim under this Group Policy up to the sum insured Selected subject to its terms and
conditions and provided no claim has been or would be preferred to under the IBA Policy. In this event, communication
of hospitalization of insured must be made to TPA within 48 hours of such hospitalization and claim documents in
original to be submitted to the TPA within 30 days from discharge.
23. For the purpose of brevity, this Group Health Insurance Mediclaim policy is hereinafter referred to as Group Policy,
while the Group Mediclaim Policy taken by Indian Banks Association for its member banks as a result of the Bipartite
Agreement is hereinafter referred to as IBA Policy.

24. The Policy covers Employee and Family

a. 1 or 1+1 or 1+2 or 1+3 or 1+5 basis i.e.
¿ Employee (1)
¿ Employee + Parents (1+2)
¿ Employee + Spouse (1+1)
¿ Employee + Spouse + 2 dependent children (1+3)
¿ Employee + Spouse + 2 dependent children + Parents (1+5)
b. Spouse of deceased employee can enroll who had got cover under the Policy for 2022-23
c. Retired employee (1) or Retired employee + Spouse (1+1) or Spouse of deceased employee who had got covered in
this Group Policy for 2022-23 shall continue during policy for 2023-24.
25. Every notice or communication regarding hospitalization or claim to be given or made under this Group Policy shall
be communicated to the THIRD PARTY ADMINISTRATOR office- which shall be decided - other matters relating to the
policy may be communicated to the Anand Rathi Insurance Brokers / policy issuing office.

26. Notice of Communication: Upon the happening of any event which may give rise to a claim under this policy notice
with full particulars shall be sent to THIRD PARTY ADMINISTRATOR immediate however maximum within 48 hours
from the time of hospitalization. This is irrespective of whether the claim is preferred to with the TPA under the IBA Policy
and/or under the Group Policy. This is not applicable in the event no claim is desired to be preferred to under this Group
Policy.
(No claim is will be rejected on the ground of Delay Intimation or Submission)

27. Annexure 1 is to be submitted mandatorily for all claims. AII supporting documents in original relating to the claim

Place : MUMBAI For and on behalf of

Date : 27/04/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 4 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

The Oriental Insurance Company Limited

Signer: RASHMI RAMAN SINGH
Date: Thu, Apr 27, 2023 12:25:56 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 111700/48/2024/21

under the Group Policy must be filed with the office of THIRD PARTY ADMINISTRATOR within 15 days from the date of
discharge from the hospital. In case of pre and post hospitalization, treatment (limited to 30 days and 60 days
respectively from the date of hospitalization), all claim documents should be submitted within 30 days after completion of
such treatment.

28. Rest all terms and conditions as per the standard Group Health Insurance Medi-claim Policy.
29. Modern Treatment Methods & Advancement in Technology
1. Uterine Artery Embolization & High Intensity FocussedUltrasound (HIFU) : Up to 20% of Sum Insured subject to a
maximum of Rs. 2 Lacs per policy period for claims involving Uterine Artery Embolization & HIFU
2. Balloon Sinuplasty : Up to 10% of Sum Insured subject to a maximum of Rs.1 Lac per policy period for claims
involving Balloon Sinuplasty
3. Deep Brain Stimulation : Up to 70% of Sum Insured per policy period for claims involving Deep Brain Stimulation
4. Immunotherapy-Monoclonal Antibody to be given as Injection : Up to 20% of Sum Insured subject to a maximum of
Rs.2 Lacs per policy Period
5. Intra vitreal Injections : Up to 10% of Sum Insured subject to a maximum of Rs. 1 Lac per policy Period
6. Robotic Surgeries (Including Robotic AssistedSurgeries) : ¿Up to 75% of Sum Insured per policy period for claims
involving Robotic Surgeries for (i) the treatment of any disease involving Central Nervous System irrespective of
aetiology; (ii) Malignancies
¿Up to 50% of Sum Insured per policy period for claims involving Robotic Surgeries for other diseases

7. Stereotactic Radio Surgeries : Up to 50% of Sum Insured per policy period for claims involving Stereotactic Radio
Surgeries
8. Bronchial Thermoplasty : Up to 30% of Sum Insured subject to a maximum of Rs.3 Lacs per policy period for claims
involving Bronchial Thermoplasty.
9. Vaporisation of the Prostate (Green laser treatment for holmium laser treatment) : Up to 30% of Sum Insured subject
to a maximum of Rs.2 Lacs per policy period.
10. Intra Operative Neuro Monitoring (IONM) : Up to 15% of Sum Insured per policy period for claims involving Intra
Operative Neuro Monitoring subject to a maximum of Rs. 1 Lac per policy period.
11. Stem Cell Therapy: Hematopoietic Stem Cells for bone marrow transplant for hematological conditionsto be covered
only : No additional sub-limit
12. Oral Chemotherapy : Up to 20% of Sum Insured subject to a maximum of Rs.2 Lacs per policy period for claims
involving Oral Chemotherapy

Warranted that in case the person covered under the policy has lodged any claim under the previous policy and the sum
insured is enhanced under the current policy, for a further claim for the same disease during the current policy, the earlier
Limit of Sum Insured shall be applicable and not the enhanced sum insured
Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy
shall be void abinitio (from inception).
"We at Oriental continuously strive to ensure that you get the best possible treatment from our network hospitals.
Please contact your TPA or any of the Oriental offices for our preferred hospitals in your area before going for a
treatment. This will help us serve you in the best possible manner"

In witness whereof the undersigned being authorised by and on behalf of the Company has/have herein to set his/their hands
at CBU-II Mumbai (GSTIN: 27AAACT0627R4ZW) on 27-APR-23

Place : MUMBAI For and on behalf of

Date : 27/04/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 5 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

The Oriental Insurance Company Limited

Signer: RASHMI RAMAN SINGH
Date: Thu, Apr 27, 2023 12:25:56 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 111700/48/2024/21

"In case of grievance related to any issue related to this policy the same may be addressed to the office In-Charge or the Grievance
Officer at above policy address. If the grievance remains pending, it may be escalated to Grievance Officer of the concerned Regional
Office ORIENTAL HOUSE, 2 FLOOR,7,JAMSHEDJI TATA ROAD,CHURCHGATE,MUMBAI. The next escalation in case grievance
remains unresolved is CSD, Head Office, situated at Oriental House, A-25/27, Asaf Ali Road, New Delhi-110002.
If the insured is not satisfied with the resolution/reply provided by the company, he/she may approach the Office of Insurance
Ombudsman, within his/her jurisdiction. The list of offices of Ombudsman is available on Company's portal."

Entered By : BANDIVDEKAR SANDHYA For and on behalf of

The Oriental Insurance Company Limited
Examined By : SHELLEY DHEER

Policy Printed By : 173100 IP :

Policy Printed On : 27-APR-23 12:25:59 MAC :
Authorised Signatory

Place : MUMBAI For and on behalf of

Date : 27/04/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 6 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in