Subject: Policy Number: 0000000021267908-03: Customer - Care@sbigeneral - in

To, Date: 03/02/2024
Mr. PAWAN KUMAR, URN NO:

H NO 146 NEAR DASHMESH NAGAR, AJALI KHURD,HAMBRAN ROAD,
Ludhiana, Ludhiana,
Punjab - 141001,
India.
Contact details: +91-9463406678
Subject: Policy Number: 0000000021267908-03
Dear Customer,
Welcome to SBI General. Thank you for choosing SBI General’s “Arogya Plus Policy”.We are delighted to have you as our esteemed
Customer. With this, we enclose the following documents pertaining to your Policy:
• Policy Schedule
• Policy Clauses & Wordings.
• Premium Receipt.
• Grievance Redressal Letter
We have taken care that the documents reflect details of risk and cover as proposed by you. We request you to verify and confirm that the
documents are in order. Please ensure safety of these documents as they form part of our contract with you. For all your future
correspondence you may have with us, kindly quote your Customer ID and Policy No.
Your Customer ID : 0000000038096827
Your Policy No.: 0000000021267908-03
The Postal Address of your SBI General Branch that will service you in future is:
SBI General Insurance Company Limited

9th Floor, A&B Wing, Fulcrum Building,
Sahar Road, Andheri East,
Mumbai – 400099
In case of any queries or suggestions, please do not hesitate to get in touch with us. You can contact us at
[email protected] or call our Customer Care Number 1800-22-1111 (MTNL/BSNL user) and 1800-102-1111 (for other users)
We look forward to a continuing and mutually beneficial relationship.
Yours sincerely,
Authorised Signatory
SBI General Insurance Company Limited :

Registered and Corporate Office : 9th Floor, A&B Wing, Fulcrum Building, Sahar Road, Andheri East, Mumbai – 400099.
Arogya Plus Policy UIN : SBIHLIP14006V011314
Page 1
SBI General Insurance and SBI are separate legal entities and SBI is working as Corporate Agent of the company for sourcing of insurance
products
SBI General Insurance Company Limited :

Registered and Corporate Office : 9th Floor, A&B Wing, Fulcrum Building, Sahar Road, Andheri East, Mumbai – 400099.
Page 2
Attached to and forming part of the Schedule to the Policy No: 0000000021267908-03
Arogya Plus Policy
POLICY SCHEDULE
Policy No: 0000000021267908-03 Servicing Branch Office:Ludhiana Issue Date: 31/01/2024
Intermediary Details :
Intermediary Name & Code Sbi Pau Ludhiana 1482 0007360
Intermediary Contact Details: Mobile No: Landline No: +91-161-401831
Address:9th Floor,Westport,Pan
Card Club Road,Baner Gaon,Baner,
Pune,Maharashtra,India-411045
Name: SBI General Insurance Contact No:18002106366,
Claims Administrator
18002103366
Email ID - [email protected]
POSP Agent ID
Proposer
Mr.PAWAN KUMAR
H NO 146 NEAR DASHMESH NAGAR, AJALI KHURD,HAMBRAN ROAD,

Address Ludhiana, Ludhiana,
Punjab - 141001,
India.
Period of Insurance
From:03/02/2024 (13:02hrs)To:02/02/2025 (Midnight)
Date of inception first insurance policy

03/02/2021
Cover Opted
Family Floater
Plan Opted
Plan A
Previous Policy No. (if any)
0000000021267908-02
Nominee (Name, Age & Relationship)
SAWROOP RANI,57,Spouse
Appointee (Name & Relationship), if any
NA
Policy printed by: 100001 Date:31/01/2024 Time: 13:02hrs

Page 3
Arogya Plus Policy
Name of the Insured Member ID Gender Date of Date of Age Sum Insured Opted
Relationship with Proposer
Persons member Birth Per Year (in INR)
entry
AMIT KUMAR 0000000038097654 Male 03/02/2021 16/08/1990 33 Son
SAWROOP RANI 0000000038097239 Female 28/01/2021 15/03/1966 57 Spouse 300,000.00
PAWAN KUMAR 0000000038096827 Male 03/02/2021 04/04/1963 60 Self
OPD cover Details

Name of the Insured Persons OPD Limit Year 1 OPD Limit Year 2 OPD Limit Year 3
AMIT KUMAR
SAWROOP RANI 500.0 0.0 0.0
PAWAN KUMAR
Additional loading Details (if any):
Name of the Insured Reason for additional loading

AMIT KUMAR NA
SAWROOP RANI NA
PAWAN KUMAR NA
Premium Details
Particulars Amount (INR)

Gross Premium 8,900.01
Final Premium 10,502.00
Collection Details :-Receipt No:37156861Receipt Date:31/01/2024Amount:Rs10,502.00
P.S. If premium paid through cheque, the policy is void ab-initio in case of dishonour of cheque.
Signed at: Ludhiana For SBI General Insurance Company Limited

This Document is Digitally Signed
Date: 03/02/2024
Signer: VISHWANATHAN SUBRAMANIAN

Date: Wed, Jan 31, 2024 13:50:17 IST
Location: Mumbai
Authorized Signatory
Consolidated Stamp Duty Rs. 30 paid towards Insurance Policy Stamps vide Order No. LOA/ENF-2/CSD/12/2023/(Validity Period Dt.
04/01/2024 to Dt.05/12/2025)/136 Date:- 04/01/2024 Dated 2024-01-31 13:49:15.764 of General Stamp Office, Mumbai
IRDA Registration Number : 144
Company Identity Number: U66000MH2009PLC190546
I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with
the provisions of chapter X and Chapter XI of M.V. Act, 1988. In Case of Claims, please contact us at Toll free numbers 1800 210 3366,
1800 210 6366 through an email – [email protected]
Important Note:
Insurance is a contract of Utmost Good Faith requiring the Insured not only to disclose all information related to his health and which has
a bearing on the acceptance or rejection of the Proposal by the Insurer and also not to suppress any factual information in response to
the questions in the proposal form.

Page 4
Arogya Plus Policy
Please examine this Policy including its attached Schedules/ Annexure if any. In the event of any discrepancy, contact the office of the
Insurer immediately, it being noted that this Policy shall be otherwise considered as being entirely in order.
In case of payment by cheque, in the event of dishonor of cheque for any reason whatsoever, insurance provided under this document
automatically stands cancelled from the inception of the Policy irrespective of whether a separate communication is sent or not.
Any claim arising or related to consequences of the Pre-existing diseases as defined under the Policy is excluded from the scope of Policy
cover unless the insurer specifically accepts the pre-existing disease declared with or without additional premium and coverage terms
specifically mentioned in the schedule.The Policy shall become voidable at the option of Insurer, in the event of any untrue or incorrect
statement, misrepresentation, non-description or non-disclosure in any material particulars declared by the Proposer in the Proposal
form/personal statement, declaration and connected documents or any material information having been withheld by the Proposer or
any one acting on his behalf.
The Policy is not transferable/assignable to any third parties by the Insured. However, if the Insured is permanently incapacitated or
deceased, the nominee/legal heirs of the Insured may represent him/her in respect of claim under the Policy.
PREMIUM CERTIFICATE
Premium certificate for the purpose of deduction under section 80 - (D) of Income Tax (Amendment) Act, 1986
This is to certify that Mr. PAWAN KUMAR has paid Rs. 10,502.00 towards the premium for Health Insurance for the period from:
03/02/2024 to: 02/02/2025.
Policy Number: 0000000021267908-03
For and on behalf of SBI General Insurance Co. Ltd
Date: 03/02/2024
Place: Ludhiana
Applicable Exclusions
Exclusions applicable to “AMIT KUMAR
• First 30 days Waiting Period as defined under V.3 (Excl03) of Policy Wordings
• First Year Exclusion as defined under V.2.f.1 (Excl02) of Policy Wordings
• Pre-Existing diseases as defined under V.1 (Excl01) of Policy Wordings
• First 90 days Waiting Period as defined under V.2.f.2 (Excl02) of Policy Wordings
• Permanent Exclusion as defined under V.35 of Policy Wordings
Exclusions applicable to “SAWROOP RANI
Exclusions applicable to “PAWAN KUMAR

Page 5
Arogya Plus Policy
GST TAX INVOICE
GST Invoice 98108816 GST Invoice Date: 31/01/2024

No:
GSTIN/Unique
No: (SBI 27AAMCS8857L1ZC SBI General State Maharashtra
General)
SBI General SBI General Insurance Company Limited
Branch 9th Floor,A&B Wing, Fulcrum Building, Sahar Road,
Address: Andheri East,Mumbai,Mumbai,
Maharashtra-400099,
1000000108
Details of Policy Holder:
Name: Mr. PAWAN KUMAR
Address: H NO 146 NEAR DASHMESH NAGAR, AJALI KHURD,HAMBRAN ROAD, Ludhiana Head Post Office, Ludhiana, Ludhiana,
Punjab - 141001, India.
Place of supply Punjab
Policy Holder
Punjab
State Whether invoice under Reverse
No
Charge
GSTIN/Unique Policy Number 0000000021267908-03

No:
Insurance HSN Code Premium CGST SGST/ UTGST IGST

Product Name (without
Rate Amount Rate Amount Rate Amount
Taxes)
New Health
Variants 997133 8,900.01 9% 801 9% 801 0% 0
Total Invoice
Value (In 10,502.00
Figures)
Taxes 1,602.00
Applicable
SBI General 37156861 Receipt 31/01/2024

Receipt No: Date:
“I/We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we
are not required to prepare e-invoice in view of exemption provided to insurance companies under
Notification no. 13/2020–Central Tax dated March 21, 2020"

Page 6
Arogya Plus Policy
Annexure A - Day Care List
The following are the listed Day care procedures and such other Surgical Operation that necessitate less than 24 hours Hospitalisation due
to medical/technological advancement / infrastructure facilities and the coverage of which is subject to the terms, conditions and
exclusions of the policy
Microsurgical operations on the middle ear

1. Stapedectomy
2. Revision of a stapedectomy
3. Other operations on the auditory ossicles
4. Myringoplasty (Type -I Tympanoplasty)
5. Tympanoplasty (closure of an eardrum perforation/reconstruction of the auditory ossicles)
6. Revision of a tympanoplasty
7. Other microsurgical operations on the middle ear
Other operations on the middle & internal ear

8. Myringotomy
9. Removal of a tympanic drain
10. Incision of the mastoid process and middle ear
11. Mastoidectomy
12. Reconstruction of the middle ear
13. Other excisions of the middle and inner ear
14. Fenestration of the inner ear
15. Revision of a fenestration of the inner ear
16. Incision (opening) and destruction (elimination) of the inner ear
17. Other operations on the middle and inner ear
Operations on the nose & the nasal sinuses

18. Excision and destruction of diseased tissue of the nose
19. Operations on the turbinates (nasal concha)
20. Other operations on the nose
21. Nasal sinus aspiration
Operations on the eyes

22. Incision of tear glands
23. Other operations on the tear ducts
24. Incision of diseased eyelids
25. Excision and destruction of diseased tissue of the eyelid
27. Operations on the canthus and epicanthus
28. Corrective surgery for entropion and ectropion
29. Corrective surgery for blepharoptosis
30. Removal of a foreign body from the conjunctiva
31. Removal of a foreign body from the cornea
32. Incision of the cornea
33. Operations for pterygium
34. Other operations on the cornea
35. Removal of a foreign body from the lens of the eye
36. Removal of a foreign body from the posterior chamber of the eye
37. Removal of a foreign body from the orbit and eyeball
38. Operation of cataract
Operations on the skin & subcutaneous tissues

39. Incision of a pilonidal sinus
40. Other incisions of the skin and subcutaneous tissues
Page 7
Arogya Plus Policy
41. Surgical wound toilet (wound debridement) and removal of diseased tissue of the skin and subcutaneous tissues
42. Local excision of diseased tissue of the skin and subcutaneous tissues
43. Other excisions of the skin and subcutaneous tissues
44. Simple restoration of surface continuity of the skin and subcutaneous tissues
45. Free skin transplantation, donor site
46. Free skin transplantation, recipient site
47. Revision of skin plasty
48. Other restoration and reconstruction of the skin and subcutaneous tissues
49. Chemosurgery to the skin
50. Destruction of diseased tissue in the skin and subcutaneous tissues
Operations on the tongue

51. Incision, excision and destruction of diseased tissue of the tongue
52. Partial glossectomy
53. Glossectomy
54. Reconstruction of the tongue
55. Other operations on the tongue
Operations on the salivary glands & salivary ducts

56. Incision and lancing of a salivary gland and a salivary duct
57. Excision of diseased tissue of a salivary gland and a salivary duct
58. Resection of a salivary gland
59. Reconstruction of a salivary gland and a salivary duct
60. Other operations on the salivary glands and salivary ducts
Other operations on the mouth & face

61. External incision and drainage in the region of the mouth, jaw and face
62. Incision of the hard and soft palate
63. Excision and destruction of diseased hard and soft palate
64. Incision, excision and destruction in the mouth
65. Plastic surgery to the floor of the mouth
66. Palatoplasty
67. Other operations in the mouth
Operations on the tonsils & adenoids

68. Transoral incision and drainage of a pharyngeal abscess
69. Tonsillectomy without adenoidectomy
70. Tonsillectomy with adenoidectomy
71. Excision and destruction of a lingual tonsil
72. Other operations on the tonsils and adenoids
Trauma surgery and orthopaedics

73. Incision on bone, septic and aseptic
74. Closed reduction on fracture, luxation or epiphyseolysis with osteosynthesis
75. Suture and other operations on tendons and tendon sheath
76. Reduction of dislocation under GA
77. Arthroscopic knee aspiration
Operations on the breast

78. Incision of the breast
79. Operations on the nipple
Operations on the digestive tract

80. Incision and excision of tissue in the perianal region
Page 8
Arogya Plus Policy
81. Surgical treatment of anal fistulas

82. Surgical treatment of haemorrhoids
83. Division of the anal sphincter (sphincterotomy)
84. Other operations on the anus
85. Ultrasound guided aspirations
86. Sclerotherapy etc.
87. Laparoscopic cholecystectomy
Operations on the female sexual organs

88. Incision of the ovary
89. Insufflation of the Fallopian tubes
90. Other operations on the Fallopian tube
91. Dilatation of the cervical canal
92. Conisation of the uterine cervix
93. Other operations on the uterine cervix
94. Incision of the uterus (hysterotomy)
95. Therapeutic curettage
96. Culdotomy
97. Incision of the vagina
98. Local excision and destruction of diseased tissue of the vagina and the pouch of Douglas
99. Incision of the vulva
100. Operations on Bartholin’s glands (cyst)
Operations on the prostate & seminal vesicles

101. Incision of the prostate
102. Transurethral excision and destruction of prostate tissue
103. Transurethral and percutaneous destruction of prostate tissue
104. Open surgical excision and destruction of prostate tissue
105. Radical prostatovesiculectomy
106. Other excision and destruction of prostate tissue
107. Operations on the seminal vesicles
108. Incision and excision of periprostatic tissue
119. Other operations on the prostate
Operations on the scrotum & tunica vaginalis testis

110. Incision of the scrotum and tunica vaginalis testis
111. Operation on a testicular hydrocele
112. Excision and destruction of diseased scrotal tissue
113. Plastic reconstruction of the scrotum and tunica vaginalis testis
114. Other operations on the scrotum and tunica vaginalis testis
Operations on the testes

115. Incision of the testes
116. Excision and destruction of diseased tissue of the testes
117. Unilateral orchidectomy
118. Bilateral orchidectomy
119. Orchidopexy
120. Abdominal exploration in cryptorchidism
121. Surgical repositioning of an abdominal testis
122. Reconstruction of the testis
123. Implantation, exchange and removal of a testicular prosthesis
124. Other operations on the penis
Operations on the spermatic cord, epididymis und ductus deferens

125. Surgical treatment of a varicocele and a hydrocele of the spermatic cord
Page 9
Arogya Plus Policy
126.Excision in the area of the epididymis

127. Epididymectomy
128. Reconstruction of the spermatic cord
129. Reconstruction of the ductus deferens and epididymis
130. Other operations on the spermatic cord, epididymis and ductus deferens
Operations on the penis

131. Operations on the foreskin
132. Local excision and destruction of diseased tissue of the penis
133. Amputation of the penis
134. Plastic reconstruction of the penis
Operations on the urinary system

136. Cystoscopical removal of stones
Other Operations
137. Lithotripsy
138. Coronary angiography
139. Haemodialysis
140. Radiotherapy for Cancer
141. Cancer Chemotherapy
Page 10
Branch Office Address: Reference No: 000051372384
9th Floor,A&B Wing, Fulcrum Building, Sahar Road,Andheri East,
Mumbai, OF Receipt No: 37156861
Maharashtra -400099,
India. Date: 31/01/2024
Branch Code: 00032
Party/Depositor ID: 0000000038096827
RECEIPT
Received with thanks from PAWAN KUMAR
an amount of Rs.10,502.00 (Rupees Ten Thousand Five Hundred and Two)
byInternetbanking
No:
Dated :
Drawn on Bank :
Branch:
Party ID Quote/Policy/Claim No. Name of Party Amount(Rs.)
0000000038096827 0000000021267908-03 PAWAN KUMAR 10,502.00
TOTAL 10,502.00
Disclaimer
1) Receipt subject to realisation of instrument submitted
2) Kindly refer to the policy document for time of commencement of cover
For and on behalf of

SBI General Insurance Co. Ltd.
SBI General Insurance Company Limited
Page 11

Registered and Corporate office: 9th Floor, A&B Wing, Fulcrum Building, Sahar Road, Andheri East,
Mumbai – 400099
Page 12

CUSTOMER INFORMATION SHEET/ KNOW YOUR POLICY
This document provides key information about your policy. You are also advised to go through your policy document.
SL. TITLE DESCRIPTION POLICY CLAUSE

NO (Please refer to applicable policy clause number in next column) NUMBER
1 Name of Insurance Arogya Plus Policy

Product/Policy
2 Policy Number 0000000021267908-03
3 Type of Insurance Both Indemnity and Benefit

Product/Policy
4 Sum Insured(Basis)
Family Floater Sum Insured
Insured Name Base Sum Insured
AMIT KUMAR
SAWROOP RANI 300,000.00
PAWAN KUMAR
Note: This is the base Sum Insured for policy. Please refer the policy schedule
for cover wise limits
5 Policy Coverage Covers Expenses with respect of: IV. Scope of Cover
(What the Policy 1. Eligible Hospitalisation Expenses: Admission in hospital beyond 24
Covers) hours
2. OPD Treatment and Teleconsultation: Expenses for OPD consultation

and treatment up to limit specified in policy schedule on advice of a
medical practitioner
3. Pre-hospitalisation Expenses: Covered prior to 60 days of

hospitalisation
4. Post-hospitalisation Expenses: Covered post 90 days of

hospitalization.
5. Day care Expenses: Medical Expenses for day care procedures up to

sum insured.
6. Ambulance Expenses: Expenses incurred up to Rs. 1500 on Road

Ambulance Services.
7. Alternative Treatment: Treatment taken in a government hospital or

in any institute recognized by government and/or accredited by
quality council of India/national accreditation board on health.
8. Domiciliary Hospitalization: Reasonable and customary charges

towards domiciliary hospitalisation.
Page 13

9. Maternity Expenses: Covered but only under OPD section and up to
OPD Limit specified.
10. Admissibility of certain incidental expenses will be as per Standard

List of Excluded expenses in Hospitalisation indemnity policies.
11. HIV/AIDS Cover: Covered up to Sum Insured.
12. Mental Illness: Cover up to Sum Insured (Sub limit - Rs. 50,000
whichever is lower, applicable for few conditions)
13. Genetic Disorders: Covered up to Rs.50,000
14. Internal Congenital Anomaly: Covered up to Rs. 10% of Sum Insured
15. Specific Procedures: Covered up to 50% of Sum Insured
6 Exclusions Following is a partial list of the policy exclusions. Please refer to the policy V.Exclusions
(What the policy document for the complete list of exclusions:
does not cover)
1. Investigation & Evaluation (Code- Excl04)
2. Rest Cure, rehabilitation and respite care (Code- Excl05)
3. Change of Gender treatments: Code-( Excl07)
4. Cosmetic or plastic Surgery: Code- (Excl08)
5. Hazardous or Adventure sports: Code- (Excl09)
6. Breach of law: Code- (Excl10)
7. Treatment for, Alcoholism, drug or substance abuse or any
addictive condition and consequences thereof Code- (Excl12)
8. Refractive Error: Code- (Excl15)
9. Sterility and Infertility: (Code- Excl17)
7 Waiting period Initial Waiting Period: 30 Days V.Exclusions
Specific Waiting Periods

o 12 months for any types of gastric or duodenal ulcers, Tonsillectomy,
Adenoidectomy, Mastoidectomy, Tympanoplasty, Surgery on all
internal or external tumour /cysts/nodules/polyps of any kind
including breast, Lumps, All types of Hernia and Hydrocele, Anal
Fissures, Fistula and Piles, Benign Prostatic Hypertrophy etc (not
applicable for claims arising due to accident).
o 90 days for Hypertension, Heart Disease and related complications,
Diabetes and related complications.
Pre-Existing diseases:48 months.
8 Financial Limits of The policy will pay only up to the limits specified hereunder for the following IV. SCOPE OF COVER
the Coverage diseases/procedures:
1. Genetic Disorders: Covered up to Rs.50,000

2. Internal Congenital Anomaly: Covered up to Rs. 10% of Sum Insured
3. Specific Procedures: Covered up to 50% of Sum Insured
In case of a claim, this policy requires you to share the following costs:
Sub-Limits
Mental Illness Covered up to Sum Insured (Sub limit - Rs. 50,000 or actual,
whichever is lower, applicable for few conditions).
Page 14

9 Claims /Claims a. For Cashless Service: Insured may refer Pre-Authorization form attached VI. CONDITIONS,
Procedure as Annexure-C to the Policy Wordings and for updated Hospital Network Clause 11
details refer the link https://www.sbigeneral.in/portal/contact-us/hospital
b. For Reimbursement of Claim: For reimbursement of claims the Insured

Person may submit the necessary documents to TPA/Company within the
prescribed time limit as specified hereunder.
Sl Type of Claim Prescribed Time limit

No.
1 Reimbursement of Within fifteen days from

hospitalization, day care and completion of
pre-hospitalization expenses hospitalization
2 Reimbursement of post Within fifteen days from

expenses post hospitalization completion of post-
treatment hospitalization
For details on claim procedure please refer the policy document
• Hospital Network details can be obtained from link: https://www.

sbigeneral.in/portal/contact-us/hospital
• List of Hospitals which are blacklisted or from where no claims will be

accepted by the insurer is available in below link: https://www.
sbigeneral.in/contact-us/hospital
• Claim forms can be downloaded from below link: https://www.

sbigeneral.in/claim/claims-form-download
Note: For cover wise claims procedure, please refer to policy wordings.
10 Policy Servicing
Email: [email protected]
Toll-Free number 1800221111(Monday to Saturday (8 am - 8 pm).
Website: www.sbigeneral.in
11 Grievances • You may send your Appeal addressed to the Grievance Redressal Officer VI.CONDITIONS
/Complaints at: [email protected]. or contact at: 022-45138021
Address: Grievance Redressal Officer, 9th Floor, A & B Wing, Fulcrum
Building, Sahar Road, Andheri (East), Mumbai 400 099
List of Grievance Redressal Officers at Branch:
https://content.sbigeneral.
in/uploads/0449cac1bcd144bbb160d3f6b714fbbd.pdf/
• In case, you are not satisfied with the decision / resolution provided by
above authorities you may register your complaint with IRDAI by visiting
the below site:
https://bimabharosa.irdai.gov.in/Home/Home
• If your grievance remains unresolved from the date of filing your first
complaint or is partially resolved, you may approach the Insurance
Ombudsman falling in your jurisdiction for Redressal of your Grievance.
The details of the Insurance Ombudsman can be accessed at https:
//www.cioins.co.in/Ombudsman
Page 15

12 Things to 1. Free Look Cancellation: The insured will be allowed a period of at least VI.CONDITIONS
remember 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. For
detailed conditions and refund summary, please refer to policy
wordings.
2. Policy renewal: The policy shall ordinarily be renewable except on

misrepresentation by the insured person. grounds of fraud.
3. Migration: The insured person will have the option to migrate the Policy
to other health insurance products/ plans offered by the company by
applying for migration of the policy at least 30 days before the policy
renewal date as per IRDAI guidelines on Migration. For Detailed
Guidelines on Migration, kindly refer the link –
https://content.sbigeneral.
in//uploads/c6a2844dd65446019b130ffbae1fa20f.pdf
4. Portability: The insured person will have the option to port the policy to
other insurers by applying to such insurer to port the entire policy along
with all the members of the family, if any, at least 45 days before, but
not earlier than 60 days from the policy renewal date as per IRDAI
guidelines related to portability. For Detailed Guidelines on portability,
kindly refer the link: https://content.sbigeneral.
in//uploads/c6a2844dd65446019b130ffbae1fa20f.pdf
5. Moratorium Period: After completion of eight continuous years under

the policy no look back to be applied. This period of eight years is called
as moratorium period. The moratorium would be applicable for the
sums insured of the first policy and subsequently completion of 8
continuous years would be applicable from date of enhancement of
sums insured only on the enhanced limits. After the expiry of
Moratorium Period no health insurance claim shall be contestable
except for proven fraud and permanent exclusion specified in the policy
contract. The policies would however be subject to all limits, sub limits,
co-payments, deductibles as per the policy contract.
13 Your Obligations This Policy shall be void and premium paid shall be forfeited to Insurer in the VI.CONDITIONS
event of misrepresentation, mis-description or non-disclosure of any
materials facts pertaining to the proposal form, written declarations or any
other communication exchanged for the sake of obtaining the insurance
policy by the Insured.
Declaration by the Policy Holder: I have read the above and confirm having noted the details
Place
Date: Signature of the Policyholder:
Note: For product related documents including Customer Information Sheet, kindly refer to the below link:
https://www.sbigeneral.in/downloads
Page 16

Benefit illustration:
AROGYA PLUS
Coverage Opted on Coverage opted on individual basis covering Coverage opted on family floater basis with
individual basis multiple members of the family under a overall Sum Insured (Only one Sum Insured is
covering each single policy (Sum Insured is available for available for the entire family)
member of the each member of the family)
family Sepatately (at
single point in time)
Age of Premiu Sum Premiu Discou Premium Sum Premium Floater Premiu Sum
the m (Rs.) Insured m (Rs.) nt, if after Insured or discount m after Insured
member (Rs.) any Discount (Rs.) consolid if any discou (Rs.)
s insured Family (Rs.) ated nt (Rs.)
memb premium
er for all
discou member
nt (Rs.) s of
family
(Rs.)
35 yrs 8900 3,00,000 8900 7.50% 8232.5 3,00,000 8900 0 8900 3,00,000
30 yrs 8900 3,00,000 8900 7.50% 8232.5 3,00,000
15 yrs 8900 3,00,000 8900 7.50% 8232.5 3,00,000
10 yrs 8900 3,00,000 8900 7.50% 8232.5 3,00,000
Total Premium for all members of Total Premium for all members of the Family Total Premium when policy is opted on floater
the Family is Rs. 35600/- when is Rs. 32,930/- when they are covered under a basis is Rs. 8900/- Sum Insured of Rs. 3,00,000
each member is covered single policy. Sum Insured available for each /- is available for the entire family.
separately. Sum Insured available family member is Rs. 3,00,000/-
for each individual is Rs. 3,00,000
/-
Note:
o Premium rates are specified in the above illustration is standard premium rates without
considering any loading. Also, the premium rates are exclusive of taxes applicable.
o The above illustration is for Arogya Plus
o Family size is considered 4 members = 2 A + 2 Dependent Child
o Illustration is given for Sum Insured 3 Lac
o Please note above rates are exclusive GST
(LEGAL DISCLAIMER) NOTE: The information must be read in conjunction with the product brochure and Policy document. In case of any
conflict between the Customer Information Sheet and the Policy document the terms and conditions mentioned in the Policy document
shall prevail.
Page 17

AROGYA PLUS POLICY
I. PREAMBLE
This Policy is issued to the Insured based on the proposal and declaration together with any statement, report or other document
which shall be the basis of this contract and shall be deemed to be incorporated herein, upon payment of the
premium to Insurer and the realisation thereof by the Insurer. This Policy records the agreement between Insurer and Insured and
sets out the terms of Insurance and the obligations of each party.
II. OPERATIVE CLAUSE

Subject to the terms, conditions, exclusions and definitions contained herein or endorsed or otherwise expressed
hereon, Insurer undertakes to indemnify the Insured the medical expenses which are medically necessary and mentioned in scope
of cover up to the Sum Insured for the Insured as mentioned in the schedule of the Policy.
III. DEFINITIONS
The following words or terms shall have the meaning ascribed to them wherever they appear in this Policy, and references to the
singular or to the masculine shall include references to the plural and to the feminine and vice versa, wherever the context so
permits:
1. Accident
An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means.
2. An AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and

interventions are carried out by AYUSH Medical Practitioner(s) comprising of any of the following.
a. Central or State Government AYUSH Hospital or

b. Teaching hospital attached to AYUSH College recognized by the Central Government/Central Council of Indian
Medicine/Central Council for Homeopathy;
Or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine,
registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered
AYUSH Medical Practitioner and must comply with all the following criterion:
i. Having at least 5 in-patient beds;

ii. Having qualified AYUSH Medical Practitioner in charge round the clocks;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical
procedures are to be carried out,
iv. Maintaining daily records of the patients and making them accessible to the insurance company's authorized
representative.
3. AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre (PHC), Dispensary,
Clinic, Polyclinic or any such health centre which is registered with the local authorities, wherever applicable and having
facilities for carrying out treatment procedures and medical or surgical/para-surgical interventions or both under the
supervision of registered AYUSH Medical Practitioner (s) on day care basis without in-patient services and must comply
with all the following criterion:
i. Having qualified registered AYUSH Medical Practitioner(s) in charge;

ii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical
procedures are to be carried out;
iii. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized
representative.
4. Alternative treatments
Alternative treatments are forms of treatments other than treatment "Allopathy" or "modem medicine" and includes
Ayurveda, Unani, Sidha and Homeopathy in the Indian context
5. Any one illness
Any one illness means continuous period of illness and it includes relapse within 45 days from the date of last
consultation with the Hospital/Nursing Home where treatment may have been taken.
6. Cashless facility
"Cashless facility” means a facility extended by the Insurer to the Insured where the payments, of the costs of treatment
undergone by the Insured in accordance with the policy terms and conditions, are directly made to the network provider
by the Insurer to the extent pre-authorization approved.
Page 18

7. Condition Precedent
Condition Precedent shall mean a policy term or condition upon which the Insurer's liability under the Policy is
conditional upon.
8. Congenital Anomaly
Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form,
structure or position.
a. Internal Congenital Anomaly
Congenital anomaly which is not in the visible and accessible parts of the body
b. External Congenital Anomaly
Congenital anomaly which is in the visible and accessible parts of the body
9. Co-payment
A co-payment is a cost-sharing requirement under a health insurance policy that provides that the
policyholder/Insured will bear a specified percentage of the admissible claim amount. A co-payment does not reduce the
Sum Insured.
10. Cumulative Bonus
Cumulative Bonus shall mean any increase in the Sum Insured granted by the Insurer without an associated increase in
premium.
11. Day Care Centre
A day care centre means any institution established for day care treatment of illness and/or injuries or a medical setup
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 under—
a. has qualified nursing staff under its employment;
b. has qualified medical practitioner/s in charge;
c. has a fully equipped operation theatre of its own where surgical procedures are carried out;
d. maintains daily records of patients and will make these accessible to the insurance company’s authorized
personnel
12. Day Care Treatment
Day care treatment refers to medical treatment, and/or surgical procedure which is:
a. undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of
technological advancement, and
b. 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.
13. Deductible
Deductible is cost-sharing requirement under a health insurance policy that provides that the Insurer will not be liable for
a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital daily
cash policy which will apply before any benefits are payable by the Insurer. A deductible does not reduce the
sum Insured.
Deductible will be applicable as specified under the Policy.
14. Dental Treatment
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.
15. Disclosure to information norm
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.
16. Domiciliary Hospitalisation
Domiciliary hospitalisation means medical treatment for an illness/disease/injury which in the normal course would
require care and treatment at a hospital but is actually taken while confined at home under any of the following
circumstances:
a. the condition of tshe patient is such that he/she is not in a condition to be removed to a hospital, or
b. the patient takes treatment at home on account of non availability of room in a hospital.
17. Emergency Care
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.
18. 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 periods and
coverage of pre existing diseases. Coverage is not available for the period for which no premium is received.
19. Hospital
A hospital means any institution established for in-patient care and day care treatment of illness 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:
Page 19

a. has qualified nursing staff under its employment round the clock;
b. has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient
beds in all other places;
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 makes these accessible to the insurance company’s authorized
personnel.
20. Hospitalisation
Means admission in a Hospital for a minimum period of 24 In patient Care consecutive ‘In-patient Care’ hours except for
specified procedures/ treatments, where such admission could be for a period of less than 24 consecutive hours.
21. Illness
Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function
which manifests itself during the Policy Period and requires medical treatment.
a. Acute Condition- Acute condition is a disease, illness or injury that is likely to respond 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.
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the
following characteristics:—
1. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and / or
tests—
2. it needs ongoing or long-term control or relief of symptoms—
3. it requires your rehabilitation or for you to be specially trained to cope with it—
4. it continues indefinitely—
5. it recurs or is likely to recur
22. Injury
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.
23. Inpatient Care
Inpatient care means treatment for which the Insured person has to stay in a hospital for more than 24 hours for a
covered event.
24. Intensive Care Unit
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.
25. Maternity Expenses
Maternity expenses shall include—
a. medical treatment expenses traceable to childbirth ( including complicated deliveries and caesarean sections
incurred during hospitalization).
b. expenses towards lawful medical termination of pregnancy during the Policy Period.
26. Medical Advise
Any consultation or advice from a Medical Practitioner including the issue of any prescription or repeat prescription.
27. Medical expenses
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.
28. Medical Practitioner
A Medical Practitioner is 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 licence.
29. Medically Necessary
Medically necessary treatment is defined as any treatment, tests, medication, or stay in hospital or part of a stay in
hospital which
a. is required for the medical management of the illness or injury suffered by the Insured;
b. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope,
duration, or intensity;
c. must have been prescribed by a medical practitioner,
d. must conform to the professional standards widely accepted in international medical practice or by the
medical community in India.
30. Migration means, the right accorded to health insurance policyholders (including all members under family cover and
members of group health insurance policy), to transfer the credit gained for pre-existing conditions and time bound
exclusions, with the same insurer.
Page 20

31. Newborn baby
Newborn baby means baby born during the Policy Period and is aged between 1 day and 90 days, both days inclusive.
32. Network Provider
"Network Provider” means hospitals or health care providers enlisted by an Insurer or by a TPA and Insurer together to
provide medical services to an Insured on payment by a cashless facility.
33. Non- Network
Any hospital, day care centre or other provider that is not part of the network.
34. Notification of Claim
Notification of claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes
of communication.
35. OPD treatment
OPD treatment is one in which the Insured visits a clinic / hospital or associated facility like a consultation room for
diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day care or in-
patient.
36. Portability
“Portability” means, the right accorded to individual health insurance policyholders (including all members under family
cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another
insurer.
37. Post-hospitalization Medical Expenses
Post-hospitalization Medical Expenses means medical expenses incurred during predefined number of days immediately
after the insured person is discharged from the hospital provided that:
i. Such Medical Expenses are for the same condition for which the insured person’s hospitalization was required,
and
ii. The inpatient hospitalization claim for such hospitalization is admissible by the insurance company.
38. 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 its reinstatement 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 issued by the insurer or its reinstatement.
39. Pre-hospitalization Medical Expenses
Pre-hospitalization Medical Expenses means medical expenses incurred during predefined number of days preceding the
hospitalization of the Insured Person, provided that:
i. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was
required, and
ii. The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
40. Qualified Nurse
Qualified nurse is a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any
state in India.
41. Reasonable and Customary Charges
Reasonable and Customary charges means the charges for services or supplies, which are the standard charges for the
specific provider and consistent with the prevailing charges in the geographical area for identical or similar services,
taking into account the nature of the illness / injury involved .
42. Renewal
Renewal defines the terms on which the contract of insurance can be renewed on mutual consent with a provision of
grace period for treating the renewal continuous for the purpose of gaining credit for pre-existing diseases, time-bound
exclusions and for all waiting periods.
43. Room Rent
Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the
associated medical expenses.
44. Surgery or Surgical Procedure
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 or prolongation of life,
performed in a hospital or day care centre by a medical practitioner
45. Unproven/Experimental treatment
Treatment including drug experimental therapy which is not based on established medical practice in India, is treatment
experimental or unproven.
46. Administrator
means any third party administrator (TPA) engaged by the Insurer for providing policy and claims facilitation services to
the Insured as well as to the Insurer and who is duly licensed by IRDA for the said purpose.
47. Age
means completed years as at the commencement date of the Policy Period.
48. Diagnostic centre
Page 21

means the diagnostic centrewhich have been empanelled by Insurer (or administrator) as per the latest version of the
schedule of diagnostic centre maintained by Insurer, which is available to Insured on request.
49. Epidemic disease
means a disease which occurs when new cases of a certain disease, in a given human population, and during a given
period, substantially exceed what is the normal "expected" incidence rate based on recent experience (the number of
new cases in the population during a specified period of time is called the "incidence rate").
50. Family
means the legal spouse, dependent children, parents and parents in law.
51. Family Cover
Family floater cover means the cover under the Policy which is available in aggregate not separately for all members of
family who are specified as Insureds in policy schedule and which can be used by all or any of them.
Family non floater cover means the cover under the Policy which is available separately for all members of family who
are specified as Insureds in policy schedule.
52. Group
means any association of persons who assemble together with a commonality of purpose or engaging in a common
economic activity like employees of a company. Non-employer-employee groups, like employee associations, holders of
credit cards issued by a specific company, customers of a particular business where Insurance is offered as an add on
benefit, borrowers of a bank, professional associations or societies may also be treated as a group. However, an
association of persons coming together with a purpose of availing an insurance cover, will not be treated as a group for
the purpose of this Policy.
53. Insured
means a person named as Insured in the policy schedule.
54. Insurer
means SBI General Insurance Company Limited.
55. Mental illness/ disease
means any mental disease or bodily condition marked by disorganization of personality, mind, and emotions to impair
the normal psychological, social or work performance of the individual regardless of its cause or origin.
56. Other Insurer
means any of the registered Insurers in India other than SBI General Insurance Company Limited.
57. Package service expenses
means expenses levied by the hospital/nursing home for treatment of specific surgical procedures/medical ailments as a
lump sum amount under agreed package charges based on the room criteria as defined in the tariff schedule of the
hospital.
58. Policy
means the complete documents consisting of the policy wording, schedule and endorsements and attachments if any.
59. Policy period
means the period commencing with the commencement date of the Policy and terminating with the expiry date of
the Policy as stated in the policy schedule.
60. Proposal
means application form which the Insured duly fills in and signs for this insurance and any other information Insured
provides in the said form or otherwise to Insurer.
61. Proposer
means the person furnishing complete details and information in the proposal form for availing the benefits either for
himself and/or towards the person to be covered under the Policy and consents to the terms of the contract of insurance
by way of signing the same.
62. Schedule
means that portion of the Policy which sets out Insured’s details, the type of insurance cover in force, the Policy period
and the sum insured. Any annexure and/or endorsement to the schedule shall also be a part of the schedule.
63. Sum insured
means the specified amount mentioned in the schedule to this policy which represents the Insurer’s maximum liability
for any or all claims under this policy during the currency of the policy subject to terms and conditions.
64. Tele-consultation
means engagement between licensed tele-consultation service provider/ professional and the insured/ covered member
that is provided via a range of technology enabled communication media other than face-to-face interactions, such as
telephone, internet, and others.
IV. SCOPE OF COVER

If the Insured suffers an illness/ disease and/ or injury during the Policy period, this Policy covers below medical expenses incurred
for medical treatment arising out of that illness/ disease and/ or injury:
1. Eligible hospitalisation expenses: - while the Insured was under inpatient care medical expenses incurred for:
a. Room rent, boarding expenses
b. Medical practitioners fees, (including consultation through telemedicine ) Intensive care unit
c. Nursing expenses
Page 22

d. Anesthesia, blood, oxygen, operation theatre expenses, surgical appliances, medicines & consumables,
diagnostic expenses and x-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, prosthesis/internal
implants and any medical expenses incurred which is integral part of the operation
e. Physiotherapy as inpatient care and being part of the treatment.
f. Drugs, medicines and consumables consumed during hospitalization period.
g. Diagnostic procedures
h. Dressing, ordinary splints and plaster casts.
2. OPD treatment and Teleconsultation: - expenses for OPD consultation or Teleconsultation and treatment up to limit
specified in policy schedule on advice of a medical practitioner because of illness/disease and/or injury sustained or
contracted during the Policy.
3. Pre-hospitalisation expenses: - the maximum amount that can be claimed under this head is limited to 60 days for each
of the admitted hospitalisation and domicilary hospitalisation claim under the Policy.
4. Post-hosptalisation expenses: - the maximum amount that can be claimed under this head is limited to 90 days for each
of the admitted hospitalisation and domicilary hospitalisation claim under the Policy.
5. Day care expenses: Insurer shall pay for day care expenses incurred on technological surgeries and procedures requiring
less than 24 hours of hospitalisation up to the sum insured.
6. Ambulance expenses: - Actual ambulance expenses or INR 1500 whichever is lower will be reimbursed for per valid
hospitalization claim for transferring insured to or between Hospitals in the Hospital’s ambulance or in an ambulance
provided by any ambulance service provider.
7. Alternative treatment: - taken in a government hospital or in any institute recognized by government and/or accredited
by quality council of India/national accreditation board on health.
8. Domiciliary hospitalisation: - Insurer will cover reasonable and customary charges towards domiciliary
hospitalisation including pre and post hospitalization expenses.
9. Maternity Expenses: - are covered but only under OPD section and up to OPD Limit specified in policy schedule.
10. Admissibility of certain incidental expenses will be as per Standard List of Excluded expenses in Hospitalisation indemnity
policies ( as per IRDA health Insurance guidelines) - (Annexure B )
11. HIV/AIDS Cover: We will cover expenses incurred for Inpatient treatment due to any condition caused by or associated
with human immunodeficiency virus or variant/mutant viruses and or any syndrome or condition of a similar kind
commonly referred to as AIDS upto Sum Insured as specified in Policy Schedule, except for the conditions which are
permanently excluded.
12. Mental Illness Cover: If Insured is hospitalized for any Mental Illness contracted during the Policy Period, We will pay
Medical Expenses -upto the limit as specified in Policy Schedule, under Section 1 in accordance with The Mental Health
Care Act, 2017, subsequent amendments and other applicable laws and Rules provided that;
i.The Hospitalization is prescribed by a Medical Practitioner for Mental Illness
ii.The Hospitalization is done in Mental Health Establishment
Page 23

Sub-limit:
a. The following disorders / conditions shall be covered only up to Rs. 50,000/-. This sub-limit shall apply for all the following
disorders / conditions on cumulative basis.
b. Pre-hospitalization and Post-hospitalization Medical Expenses are also covered within the overall
benefit sub-limit as specified above in point (a).
Disorder / Condition Description

Severe depression is characterized by a persistent feeling of sadness or a lack of interest in outside
Severe Depression stimuli. It affects the way one feels, thinks, and behaves.
Schizophrenia is mental disorder, that distorts the way a person thinks, acts, expresses emotions,
perceives reality, and relates to others. Schizophrenia result in combination of hallucinations,
Schizophrenia delusions, and extremely disordered thinking and behaviour that impairs daily
functioning,
Bipolar disorder is a mental illness that brings severe high and low moods and changes in sleep,
Bipolar Disorder energy, thinking, and behaviour. It includes periods of extreme mood swings with emotional highs
and lows.
Post-traumatic stress disorder is an anxiety disorder caused by very stressful, frightening, or

Post-traumatic stress disorder distressing events. It includes flashbacks, nightmares, severe anxiety and uncontrollable thoughts
about the event.
Eating disorder is a mental condition where people experience severe

Eating disorder disturbances in their eating behaviours and related thoughts and emotions.
Page 24

Generalized Anxiety Disorder is a mental health disorder characterized by a perpetual state of
Generalized anxiety disorder
worry, fear, apprehension, inability to relax.
Obsessive-compulsive disorder is an anxiety disorder in which people have recurring, unwanted

Obsessive compulsive disorders thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively
(compulsions).
Panic disorder is an anxiety disorder characterized by reoccurring unexpected panic attacks with
sudden periods of intense fear. It may include palpitations, sweating, shaking, shortness of breath,
Panic disorders numbness, or a feeling that something terrible is going to happen.
Personality disorder is a type of mental disorder in which people have a rigid and unhealthy
Personality disorders pattern of thinking, functioning and behaving. It includes trouble in perceiving and relating to
situations and people.
Conversion disorder is a type of mental disorder where mental or emotional distress causes
Conversion disorders physical symptoms without the existence of an actual physical condition.
Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of
Dissociative disorders continuity between thoughts, memories, surroundings, actions and identity
*ICD codes for the above disorders / conditions are provided below.
What is not covered:
a. Treatment related to intentional self-inflicted Injury or attempted suicide by any means.

b. Treatment and complications related to disorders of intoxication, dependence, abuse, and withdrawal caused by drugs and
other substances such as alcohol, opioids or nicotine.
ICD Codes Disorder / Condition
F33.0, F33.1, F33.2, F33.4, F33.5, F33.6, F33.7, F33.8,

F33.9, O90.6, F34.1, F32.81, F32.0, F32.1, F32.2,
Severe Depression
F32.4, F32.5, F32.6, F32.7, 32.8, F32.9, F33.9, F30.0,
F30.1, F30.2, F30.4, F30.5, F30.6, F30.7, F30.8,
F30.9, F32.3, F33.3, F43.21, F32.8, F33.40, F32.9
F20.0, F20.1, F20.2, F20.3, F20.5, F21, F22, F23, F24,

F20.8, F25.0, F25.1, F25.8, F25.9 Schizophrenia
F31.0, F31.1, F31.2, F31.4, F31.5, F31.6, F31.7, F31.8,

F31.9 Bipolar Disorder
F43.0, F43.1, F43.2, F43.8, F43.9 Post-traumatic stress disorder

*
F40.1, F41.0, F40.2, F40.8, F40.9, F41.1, F41.3, F41.8 Generalized anxiety disorder
Page 25

F50.0, F50.2, F50.8, F98.3, F98.21, F50.8 Eating disorder
F42 Obsessive compulsive disorders
F41.1, F40.1, F60.7, F93.0, F94.0 Panic disorders
F60.0, F60.1, F60.2, F60.3, F60.4, F60.8, F60.6, F60.7, F60.5 Personality disorders
F44.4, F44.5, F44.6, F44.7 Conversion disorders
F44.5, F44.8, F48.1, F44.1, F44.2 Dissociative disorders
13. Genetic Disorders or Diseases are covered up to the Limit Rs. 50,000
14. Internal Congenital Diseases are Covered upto the Limit Rs. 10% of Sum Insured.
15. The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care
treatment in a hospital up to 50% of -of Sum Insured, specified in the policy schedule, during the policy period:
A. Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound)
B. Balloon Sinuplasty
C. Deep Brain Stimulation
D. Oral Chemotherapy
E. Immunotherapy - Monoclonal Antibody to be given as injection
F. Intra Vitreal Injections
G. Robotic Surgeries
H. Stereotactic Radio Surgeries
I. Bronchial Thermoplasty
J. Vaporisation of the Prostrate ( Green Laser Treatment or Holmium Laser Treatment)
K. IONM - (lntra Operative Neuro Monitoring)
L. Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be
covered
V. EXCLUSIONS: -
Following exclusions will apply on the claim arising under hospitalisation.
1. Pre-Existing Diseases – (Code- Excl01)
a. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be
excluded until the expiry of 48 months of continuous coverage after the date of inception of the first policy
with insurer.
b. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured
increase.
c. If the Insured Person is continuously covered without any break as defined under the portability norms of the
extant IRDAI (Health Insurance) Regulations, then waiting period for the same would be reduced to the extent
of prior coverage.
d. Coverage under the policy after the expiry of 48 months for any pre-existing disease is subject to the same
being declared at the time of application and accepted byInsurer
2. Specified disease/procedure waiting period- Code- (Excl02)

a. Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the
expiry of 90 Days/12 months of continuous coverage after the date of inception of the first policy with us.
This exclusion shall not be applicable for claims arising due to an accident.
b. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured
increase.
c. If any of the specified disease/procedure falls under the waiting period specified for pre-Existing diseases,
then the longer of the two waiting periods shall apply.
d. The waiting period for listed conditions shall apply even if contracted after the policy or declared and
accepted without a specific exclusion.
e. If the Insured Person is continuously covered without any break as defined under the applicable norms on
portability stipulated by IRDAI, then waiting period for the same would be reduced to the extent of prior
coverage.
Page 26

f. List of specific diseases/procedures
i. 12 Months waiting period
• Any types of gastric or duodenal ulcers;
• Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty;
• Surgery on all internal or external tumor /cysts/nodules/polyps of any kind including breast lumps;
• All types of Hernia and Hydrocele;
• Anal Fissures, Fistula and Piles;
• Cataract;
• Benign Prostatic Hypertrophy;
• Hysterectomy/ myomectomy for menorrhagia or fibromyoma or prolapse of uterus;
• Non infective Arthritis, Treatment of Spondylosis / Spondylitis, Gout & Rheumatism;
• Surgery of Genitourinary tract;
• Calculus Diseases;
• Sinusitis, nasal disorders and related disorders;
• Surgery for prolapsed intervertebral disc unless arising from accident;
• Vertebro-spinal disorders (including disc) and knee conditions;
• Surgery of varicose veins and varicose ulcers;
• Chronic Renal failure;
• Medical Expenses incurred in connection with joint replacement surgery due to Degenerative
condition, Age related osteoarthritis and Osteoporosis unless such Joint replacement surgery
unless necessitated by Accidental Bodily Injury.
ii. 90 Days Waiting Period
• Hypertension, Heart Disease and related complications;
• Diabetes and related complications;
3. 30-day waiting period- Code- (Excl03)
a. Expenses related to the treatment of any illness within 30 days from the first policy commencement date
shall be excluded except claims arising due to an accident, provided the same are covered.
b. This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve
months.
c. The within referred waiting period is made applicable to the enhanced sum insured in the event of granting
higher sum insured subsequently.
4. Treatment taken outside India.

5. 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 nationalisation or requisition of or
damage by or under the order of any government or public local authority.
6. Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
7. Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder, or, as may be
necessitated due to an accident
8. Refractive Error:Code- (Excl15)
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
9. Cosmetic or plastic Surgery:Code- (Excl08)
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an
Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to
the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.hh
10. Cost of spectacles, contact lenses, hearing aids, crutches, wheelchairs, artificial limbs, dentures, artificial teeth and all
other external appliances, prosthesis and/or devices.
11. Expenses incurred on items for personal comfort like television, telephone, etc. Incurred during hospitalization and which
have been specifically charged for in the hospitalisation bills issued by the hospital/nursing home.
12. External medical equipment of any kind used at home as post hospitalisation care including cost of instrument used in
the treatment of sleep apnoea syndrome (C.P.A.P), continuous ambulatory peritoneal dialysis (C.A.P.D) and oxygen
concentrator for bronchial asthmatic condition.
13. Dental treatment or surgery of any kind unless required as a result of accidental bodily injury to natural teeth requiring
hospitalization treatment.
14. Convalescence, general debility, “run-down” condition, rest cure, external congenital anomaly.
15. Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)
16. Breach of law:Code- (Excl10)
Expenses tor treatment directly arising from or consequent upon any Insured Person committing or attempting to
commit a breach of law with criminal intent.
17. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.Code-( Excl12)
18. Venereal disease or any sexually transmitted disease or sickness (excluding HIV / AIDS as mentioned under scope of
cover )
Page 27

19. Sterility and Infertility: (Code- Excl17)
Expenses related to sterility and infertility this includes:
i. Any type of sterilization
ii. Assisted Reproduction services including artificial insemination and advanced reproductive technologies
such as IVF, ZIFT, GIFT ICSI
iii. Gestational Surrogacy
iv. Reversal of sterilization
20. Vaccination or inoculation except as part of post-bite treatment for animal bite.
21. Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins,
minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care
procedure.(Code- Excl14)
22. Surgery to correct deviated septum and hypertrophied turbinate unless necessitated by an accidental body injury.
23. Medical practitioner’s home visit expenses during pre and post hospitalization period, attendant nursing expenses.
24. Change-of-Gendertreatments:Code-( Excl07)
Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the
opposite sex.
25. Hazardous or Adventure sports:Code- (Excl09)
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports,
including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba
diving, hand gliding, sky diving, deep-sea diving.
26. Stay in a hospital without undertaking any active regular treatment by the medical practitioner, which ordinarily cannot
be given without hospitalization.
27. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a
nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
(Code- Excl13)
28. Rest Cure, rehabilitation and respite care (Code- Excl05)
a. Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also
includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of
daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled
persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
29. Investigation & Evaluation (Code- Excl04)
a. Expenses related to any admission primarily tor diagnostics and evaluation purposes.
b. Any diagnostic expenses which are not related or not incidental to the Current diagnosis and treatment
30. Hospitalization for donation of any body organs by an Insured including complications arising from the donation of
organs.
31. Obesity/ Weight Control:Code- (Code-Excl06)
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1. Surgery to be conducted is upon the advice of the Doctor

2. The surgery/Procedure conducted should be supported by clinical protocols
3. The member has to be 18 years of age or older and
4. Body Mass Index (BMI);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following
failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apn
iv. Uncontrolled Type2 Diabetes
32. Unproven Treatments: (Code- Excl16)
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven
treatments are treatments, procedures or supplies that lack significant medical documentation to support their
effectiveness.
33. Disease / illness or injury whilst performing duties as a serving member of a military or police force.
34. Any kind of, surcharges, admission fees / registration charges etc levied by the hospital.
35. In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule (based on insured's
consent), policyholder is not entitled to get the coverage for specified ICD codes.
VI. CONDITIONS:
1. Condition Precedent to Admission of Liability
Page 28

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.
2. 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 ofany material fact by the policyholder.
(Explanation: "Material facts" for the purpose of this policy shall mean all relevant information sought by the company in
the proposal form and other connected documents to enable it to take informed decision in the context of underwriting
the risk)
3. Due care: where this Policy requires Insured to do or not to do something, then the complete satisfaction of that
requirement by Insured or someone claiming on Insured’s behalf is a condition precedent to any obligation under
this Policy. If Insured or someone claiming on Insured’s behalf fails to completely satisfy that requirement, then Insurer
may refuse to consider Insured’s claim. Insured will cooperate with Insurer at all times.
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.
5. Free look period
The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time
of porting/migrating the policy.
The insured person shall be allowed free look period of fifteen days from date of receipt of the policy document to
review the terms and conditions of the policy, and to return the same if not acceptable.
If the insured has not made any claim during the Free Look Period, the insured shall be entitled to
i. a refund of the premium paid less any expenses incurred by the Company on medical examination of the
insured person and the stamp duty charges or
ii. where the risk has already commenced and the option of return of the policy is exercised by
the insured person, a deduction towards the proportionate risk premium for period of coveror
iii. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate
with the insurance coverage during such period;
6. Notices: Any notice, direction or instruction under this Policy shall be in writing and if it is to:
Any Insured, then it shall be sent to Proposer’s address specified in the Schedule to this Policy and Proposer shall act for
all Insureds for these purposes.
Insurer, it shall be delivered to Insurer’s address specified in the Schedule to this Policy. No insurance agents, brokers or
other person or entity is authorised to receive any notice, direction or instruction on Insurer’s behalf unless Insurer has
expressly stated to the contrary in writing.
Insured must notify Insurer of any change in address.
7. Mis-description: - this Policy shall be void and premium paid shall be forfeited to Insurer in the event of
misrepresentation, mis-description or non-disclosure of any materials facts pertaining to the proposal form, written
declarations or any other communication exchanged for the sake of obtaining the insurance policy by the Insured.
Nondisclosure shall include non-intimation of any circumstances which may affect the Insurance cover granted. The
misrepresentation, mis-description and non-disclosure is related to the information provided by the proposer/Insured to
the Insurer at any point of time starting from seeking the insurance cover in the form of submitting the filled in proposal
form, written declarations or any other communication exchanged for the sake of obtaining the insurance policy and
ends only after all the contractual obligations under the Policy are exhausted for both the parties under the contract.
8. Reasonable Care: We are not obliged to make payment for any claim or that part of any claim that could have been
avoided or reduced if the Insured had taken reasonable care, or that is brought about or contributed to by
the Insured failing to follow the directions, advice or guidance provided by a Medical Practitioner.
9. Package service expenses: as defined under the Policy will be payable only if prior approval for the said package service
is provided by administrator / Insurer upon the request of the Insured.
10. Unhindered access: the Insured shall extend all possible support & co-operation including necessary authorisation to
the Insurer for accessing the medical records and medical practitioners who have attended to the patient.
11. Claims Procedures :
a. Claims Procedure for Reimbursement :
i. The Insured shall without any delay consult a doctor and follow the advice and treatment recommended,
take reasonable step to minimize the quantum of any claim that might be made under this Policy and
intimation to this effect must be forwarded to Insurer accordingly.
Insured must provide intimation to Insurer immediately and in any event within 48 hours from the date
of Hospitalisation. However the Insurer at his sole discretion may relax this condition subject to a
justifiable reason/evidence being produced by the Insured on the reasons for such a delay beyond the
stipulated 48 hours up to a maximum period of 7 days.
ii. Insured has to file the claim with all necessary documentation within 15 days of discharge from the
hospital, provide Insurer with written details of the quantum of any claim along with all the original bills,
Page 29

receipts and other documents upon which a claim is based and shall also give Insurer such additional
information and assistance as Insurer may require in dealing with the claim. In case of delayed
submission of claim and in absence of a justified reason for delayed submission of claim, the Insurer
would have the right of not considering the claim for reimbursement.
iii. In respect of post hospitalization claims, the claims must be lodged within 15 days from the completion
of post hospitalisation treatment subject to maximum of 105 days from the date of discharge from
hospital.
iv. The Insured shall submit himself for examination by the Insurer’s medical advisors as often as may be
considered necessary by the Insurer for establishing the liability under the Policy. The Insurer will
reimburse the amount towards the expenses incurred for the said medical examination to the Insured.
v. Insured must submit all original bills, receipts, certificates, information and evidences from the
attending medical practitioner /hospital /diagnostic laboratory as required by Insurer.
vi. On receipt of intimation from Insured regarding a claim under the Policy, Insurer/administrator is
entitled to carry out examination and obtain information on any alleged Injury or disease
requiring hospitalisation if and when Insurer may reasonably require.
b. Claims procedure for Cashless:
i. Prior to taking treatment and/or incurring medical expenses at a network hospital, Insured must
call Insurer and request pre-authorisation by way of the written form Insurer will provide.
ii. After considering Insured’s request and after obtaining any further information or
documentation Insurer has sought, Insurer may if satisfied send Insured or the network hospital, an
authorisation letter. The authorisation letter, the ID card issued to Insured along with this Policy and
any other information or documentation that Insurer has specified must be produced to the network
hospital identified in the pre-authorisation letter at the time of Insured’s admission to the same.
iii. If the procedure above is followed, Insured will not be required to directly pay for the medical expenses
in the network hospital that Insurer is liable to indemnify under cover IV.1 above and the original bills
and evidence of treatment in respect of the same shall be left with the network hospital. Pre-
authorisation does not guarantee that all costs and expenses will be covered. Insurer reserves the right
to review each claim for medical expenses and accordingly coverage will be determined according to
the terms and conditions of this Policy. Insured will, in any event, be required to settle all other
expenses directly.
c. Claims Submission:
Insured will submit the claim documents to administrator. Following is the document list for claim
submission:
i. Duly filled Claim form,
ii. Valid Photo Identity Card, residence proof and 2 recent photos of Insured and/or his nominee.
iii. Original Discharge card/certificate/ death summary
iv. Copies of prescription for diagnostic test, treatment advise, medical references
v. Original set of investigation reports
vi. Itemized original hospital bill and receipts Hospital and related original medical expense receipt
Pharmacy bills in original with prescriptions
d. Claims processing: on receipt of claim documents from Insured, Insurer/administrator shall assess the
admissibility of claim as per policy terms and conditions. Upon satisfactory completion of assessment and
admission of claim, the Insurer will make the payment of claim as per the contract only in Indian Rupees and
within India only. In case if the claim is repudiated Insurer will inform the claimant about the same in writing
with reason for repudiation.
e. Penal interest provision:
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 to the
policyholder 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- ln such cases, the Company shall settle or reject the
claim within 45 days from the date of receipt of last necessary document.
iv. ln case of delay beyond stipulated 45 days, the Company shall be liable to pay interest to the
policyholder at a rate 2% above the bank rate from the date of receipt of last necessary document to
the date of payment of claim.
f. Position after a claim: As from the day of receipt of the claim amount by the Insured, the Sum insured for the
remainder of the Policy Period shall stand reduced by a corresponding amount. In case claim is made for
maternity benefit or OPD, then both Sum insured and OPD limit will get reduced by corresponding amount.
12. Fraud:
Page 30

lf 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 and the premium paid shall be
forfeited.
Any amount already paid against claims made under this policy but which are found fraudulent later 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 to the insurer.
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 pa(y acting on behalf of the insured person, 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 claim and / or forfeit the policy benefits 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 misstatement of or suppression of material fact are within the knowledge of
the insurer.
13. if the Insured or any of their family members make or progress any claim knowing it to be false or fraudulent in any way,
then the coverage for this Insured and his family members will be void and all claims or payments due under it shall be
lost and the premium paid shall become forfeited.
14. 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. ln 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.
15. Multiple Policies
i. In case of multiple policies taken by an insured person during a period from one or more insurers toindemnify
treatment costs, the insured person shall have the right to require a settlement of his/herclaim in terms of any
of his/her policies. In all such cases the insurer chosen by the insured person shall be obliged to settle theclaim
as long as the claim is within the limits of and according to the terms of the chosen policy.
ii. Insured person 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
insurershall independently settle the claim subject to the terms and conditions of this policy.
iii. If the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the
right to choose insurer from whomhe/she wants to claim the balance amount.
iv. Where an insured person has policies from more than one insurer to cover the same risk onindemnity basis,
the insured person shall only be indemnified the treatment costs in accordancewith the terms and conditions
of the chosen policy.
16. Cancellation:
i. The policyholder may cancel this policy by giving 1Sdays'written notice and in such an event, the Company
shall refund premium for the unexpired policy period as detailed below.
Period on risk Rate of premium refunded
Up to one month 75% of annual rate
Up to three months 50%of annual rate
Up to six months 25% of annual rate
Exceeding six months Nil
Notwithstanding anything contained herein or otheruise, no refunds of premium shall be made in respect of Cancellation
where, any claim has been admitted or has been lodged or any benefit has been availed by the insured person under the
policy.
ii. 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 15 days' written notice. There would be no refund of premium on
cancellation on grounds or misrepresentation, non-disclosure of material facts or fraud.
17. Termination of policy: this Policy terminates on earliest of the following events-
a. Cancellation of policy as per the cancellation provision.
b. On the policy expiry date.
18. Renewal:
Page 31

The policy shall ordinarily be renewable except on misrepresentation by the insured person, grounds of fraud,
i. The Company shall endeavor to give notice for renewal. However, the Company is not under obligation to
give any notice for renewal.
ii. Renewal shall not be denied on the ground that the insured person had made a claim or claims in the
preceding policy years.
iii. Request for renewal along with requisite premium shall be received by the Company before the end of the
policy period.
iv. At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30
days to maintain continuity of benefits without break in policy. Coverage is not available during the grace
period.
v. No loading shall apply on renewals based on individual claims experience
19. Withdrawal of product:
i. ln the likelihood of this product being withdrawn in future, the Company will intimate the insured person
about the same 90 days prior to expiry of the policy.
ii. Insured Person will have the option to migrate to similar health insurance product available with the
Company at the time of renewal with all the accrued continuity benefits such as cumulative bonus, waiver of
waiting period, as per IRDAI guidelines, provided the policy has been maintained without a break.
20. Migration
The insured person will have the option to migrate the policy to other health insurance products/plans offered by the
company by applying for migration of the policyatleast30 days before the policy renewal date as per IRDAI guidelineson
Migration. If such person is presently covered and has been continuously covered without any lapses under any health
insurance product/plan offered by the company, the insured person will get the accrued continuity benefits in waiting
periods as per IRDAI guidelines on migration.
For DetailedGuidelines on migration, kindly refer the link
https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1
21. Portability:
The insured person will have the option to port the policy to other insurers by applying to such insurer to port the entire
policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the
policy renewal date as per IRDAI guidelines related to portability. If such person is presently covered and has been
continuously covered without any lapses under any health insurance policy with an lndian General/Health insurer, the
proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on
portability.
For Detailed Guidelines on portability, kindly refer the link
https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1
22. Possibility of Revision of Terms of the Policy lncluding the Premium Rates
The Company, with prior approval of lRDAl, may revise or modify the terms of the policy including the premium rates.
The insured person shall be notified three months before the changes are effected.
23. Moratorium Period

After completion of eight continuous years under the policy no look back to be applied. This period of eight years is
called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and
subsequently completion of 8 continuous years would be applicable from date of enhancement of sums insured only on
the enhanced limits. After the expiry of Moratorium Period no health insurance claim shall be contestable except for
proven fraud and permanent exclusions specified in the policy contract. The policies would however be subject to all
limits, sub limits, co-payments, deductibles as per the policy contract.
24. Disclaimer: if Insurer shall disclaim liability to the Insured for any claim hereunder and if the Insured shall not within 12
calendar months from the date of receipt of the notice of such disclaimer notify Insurer in writing that he does not accept
such disclaimer and intends to recover his claim from Insurer then the claim shall for all purposes be deemed to have
been abandoned and shall not thereafter be recoverable hereunder.
25. Jurisdiction: - The Policy constitutes the complete contract of insurance. No change or alteration shall be valid or
effective unless approved in writing by Insurer, which approval shall be evidenced by an endorsement on the schedule.
The construction, interpretation and meaning of the provisions of this Policy shall be determined in accordance with
Indian law. The section headings of this Policy are included for descriptive purposes only and do not form part of
this Policy for the purpose of its construction or interpretation.
26. Loading and Discount: -In case family is covered on non floater basis maximum 7.5% discount will be given. Maximum
Page 32

7.5% discount will also be given for long term policy. Premium will be loaded by 5% each for habit of smoking, alcohol and
any other type of tobacco including betel nut in any form.
27. Deduction under section 80D income-tax act – deduction under section 80D income-tax act will be allowed on premium
and amount eligible of deduction under section 80D income-tax is separately specified in policy schedule.
28. Redressal of Grievance :
Stage 1
If you are dissatisfied with the resolution provided above or for lack of response, you may write to head.
[email protected] We will look into the matter and decide the same expeditiously within 14 days from the date of
receipt of your complaint.
For Senior Citizens: Senior Citizens can reach us at [email protected]; Toll Free - 1800 22 1111 / 1800 102
1111 Monday to Saturday (8 am - 8 pm)
Stage 2
In case, you are not satisfied with the decision/resolution communicated by the above office, or have not received any
response within 14 days, you may send your Appeal addressed to the Chairman of the Grievance Redressal Committee at :
[email protected]. or contact at: 022-42412070
Address: Grievance Redressal Officer, 9th Floor, A & B Wing, Fulcrum Building, Sahar Road, Andheri (East), Mumbai 400 099
List of Grievance Redressal Officers at Branch:
https://content.sbigeneral.in/uploads/0449cac1bcd144bbb160d3f6b714fbbd.pdf/
Stage 3
In case, you are not satisfied with the decision/resolution communicated by the above office, or have not received any
response within 14 days, you may Register your complaint with IRDAI on the below given link https://bimabharosa.irdai.gov.
in/Home/Home
Stage 4
If your grievance remains unresolved from the date of filing your first complaint or is partially resolved, you may approach the
Insurance Ombudsman falling in your jurisdiction for Redressal of your Grievance. The details of the Insurance Ombudsman can
be accessed at https://www.cioins.co.in/Ombudsman
If Your issue remains unresolved You may approach IRDAI by calling on the Toll-Free no. 155255 or You can register an online
complaint on the website http://igms.irda.gov.in
Page 33

Office of Insurance the Ombudsman Areas of Jurisdiction

AHMEDABAD - Shri Kuldip Singh Gujarat, Dadra & Nagar Haveli,Daman and Diu.
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Tilak Marg, Relief Road,
Ahmedabad – 380 001.
Tel.: 079 - 25501201/02/05/06
BENGALURU - Smt. Neerja Shah Karnataka.

Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
BHOPAL - Shri Guru Saran Shrivastava Madhya Pradesh, Chhattisgarh.

JanakVihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
BHUBANESHWAR - Shri Suresh Chnadra Panda Orissa.

62, Forest park,
Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
CHANDIGARH - Dr. Dinesh Kumar Verma Punjab,Haryana,

Office of the Insurance Ombudsman, Himachal Pradesh,
S.C.O. No. 101, 102 & 103, 2nd Floor, Jammu & Kashmir,
Batra Building, Sector 17 – D, Chandigarh.
Chandigarh – 160 017.
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274
CHENNAI - Shri M. Vasantha Krishna Tamil Nadu,

Office of the Insurance Ombudsman, Pondicherry Town and
Fatima Akhtar Court, 4th Floor, 453, Karaikal (which are part of UT of Pondicherry).
Page 34

Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
DELHI - Shri Sudhir Krishna Delhi.

2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504
GUWAHATI - Shri Kiriti .B. Saha Assam, Meghalaya,

Office of the Insurance Ombudsman, Manipur, Mizoram,
Jeevan Nivesh, 5th Floor, Arunachal Pradesh,
Nr. Panbazar over bridge, S.S. Road, Nagaland and Tripura.
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
HYDERABAD - Shri I. Suresh Babu Andhra Pradesh,

Office of the Insurance Ombudsman, Telangana,
6-2-46, 1st floor, "Moin Court", Yanam and
Lane Opp. Saleem Function Palace, part of Territory of UT of Pondicherry.
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.: 040 - 67504123 / 23312122
Fax: 040 - 23376599
JAIPUR - Smt. Sandhya Baliga Rajasthan.

Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
ERNAKULAM - Ms. Poonam Bodra Kerala, UT of (a) Lakshadweep, (b)

Office of the Insurance Ombudsman, Mahe-a part of UT of Pondicherry.
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Page 35

KOLKATA - Shri P. K. Rath West Bengal,
Office of the Insurance Ombudsman, Sikkim,
Hindustan Bldg. Annexe, 4th Floor, UT of Andaman & Nicobar Islands.
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
LUCKNOW -Shri Justice Anil Kumar Srvastava Districts of Uttar Pradesh :

Office of the Insurance Ombudsman, Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
6th Floor, Jeevan Bhawan, Phase-II, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
Nawal Kishore Road, Hazratganj, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow,
Lucknow - 226 001. Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki,
Tel.: 0522 - 2231330 / 2231331 Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi,
Fax: 0522 - 2231310 Balrampur, Basti, Ambedkarnagar, Sultanpur,
Email: [email protected] Maharajgang, Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar.
MUMBAI - Shri Milind A. Kharat Goa,

Office of the Insurance Ombudsman, Mumbai Metropolitan Region
3rd Floor, Jeevan SevaAnnexe, excluding Navi Mumbai & Thane.
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
NOIDA - Shri Chandra Shekhar Prasad State of Uttaranchal and the following Districts of Uttar
Office of the Insurance Ombudsman, Pradesh:
BhagwanSahai Palace Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun,
4th Floor, Main Road, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut,
Naya Bans, Sector 15, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Distt: Gautam Buddh Nagar, Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad,
U.P-201301. Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
Tel.: 0120-2514250 / 2514252 / 2514253 Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
PATNA - Shri N. K. Singh Bihar,

Office of the Insurance Ombudsman, Jharkhand.
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road,
Bahadurpur,
Patna 800 006.
Tel.: 0612-2680952
PUNE - Shri Vinay Sah Maharashtra,

Office of the Insurance Ombudsman, Area of Navi Mumbai and Thane
Jeevan Darshan Bldg., 3rd Floor, excluding Mumbai Metropolitan Region.
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020-41312555
Grievance may also be lodged at IRDAI Integrated Grievance Management System - https://igms.irda.gov.in/
Page 36

Page 37

Annexure B
List I — Items for which coverage is not available in the policy
Sr No 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 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)
36 SPACER
37 SPIROMETRE
38 NEBULIZER KIT
39 STEAM INHALER
40 ARMSLING
Page 38

41 THERMOMETER
42 CERVICAL COLLAR
43 SPLINT
44 DIABETIC FOOT WEAR
45 KNEE BRACES (LONG/ SHORT/ HINGED)
46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
47 LUMBO SACRAL BELT
48 NIMBUS BED OR WATER OR AIR BED CHARGES
49 AMBULANCE COLLAR
50 AMBULANCE EQUIPMENT
51 ABDOMINAL BINDER
52 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES
53 SUGAR FREE Tablets
54 CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical pharmaceuticals payable)
55 ECG ELECTRODES
56 GLOVES
57 NEBULISATION KIT
58 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC]
59 KIDNEY TRAY
60 MASK
61 OUNCE GLASS
62 OXYGEN MASK
63 PELVIC TRACTION BELT
64 PAN CAN
65 TROLLY COVER
66 UROMETER, URINE JUG
67 AMBULANCE
68 VASOFIX SAFETY
List II— Items that are to be subsumed into Room charges

Sl Item
No
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED)
2 HAND WASH
3 SHOE COVER
4 CAPS
5 CRADLE CHARGES
6 COMB
7 EAU-DE-COLOGNE / ROOM FRESHNERS
8 FOOT COVER
9 GOWN
10 SLIPPERS
11 TISSUE PAPER
12 TOOTH PASTE
Page 39

13 TOOTH BRUSH
14 BED PAN
15 FACE MASK
16 FLEXI MASK
17 HAND HOLDER
18 SPUTUM CUP
19 DISINFECTANT LOTIONS
20 LUXURY TAX
21 HVAC
22 HOUSE KEEPING CHARGES
23 AIR CONDITIONER CHARGES
24 IM IV INJECTION CHARGES
25 CLEAN SHEET
26 BLANKET/WARMER BLANKET
27 ADMISSION KIT
28 DIABETIC CHART CHARGES
29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
30 DISCHARGE PROCEDURE CHARGES
31 DAILY CHART CHARGES
32 ENTRANCE PASS / VISITORS PASS CHARGES
33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
34 FILE OPENING CHARGES
35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
36 PATIENT IDENTIFICATION BAND / NAME TAG
37 PULSEOXYMETER CHARGES
List III. Items that are subsumed into procedure charges.
Sl Item
No.
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
Page 40

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 Cost of Treatment
Sl Item
No.
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
Page 41

Annexure C - Day Care List

The following are the listed Day care procedures and such other Surgical Procedures that necessitate less than 24 hours Hospitalisation
due to medical/technological advancement/ infrastructure facilities and the coverage of which is subject to the terms, conditions and
exclusions of the policy
Microsurgical operations on the middle ear

1. Stapedectomy
2. Revision of a stapedectomy
3. Other operations on the auditory ossicles
4. Myringoplasty (Type -I Tympanoplasty)
5. Tympanoplasty (closure of an eardrum perforation/reconstruction of the auditory ossicles)
6. Revision of a tympanoplasty
7. Other microsurgical operations on the middle ear
Other operations on the middle & internal ear

8. Myringotomy
9. Removal of a tympanic drain
10. Incision of the mastoid process and middle ear
11. Mastoidectomy
12. Reconstruction of the middle ear
13. Other excisions of the middle and inner ear
14. Fenestration of the inner ear
15. Revision of a fenestration of the inner ear
16. Incision (opening) and destruction (elimination) of the inner ear
17. Other operations on the middle and inner ear
Operations on the nose & the nasal sinuses

18. Excision and destruction of diseased tissue of the nose
19. Operations on the turbinates (nasal concha)
20. Other operations on the nose
21. Nasal sinus aspiration
Operations on the eyes

22. Incision of tear glands
23. Other operations on the tear ducts
25. Excision and destruction of diseased tissue of the eyelid
27. Operations on the canthus and epicanthus
28. Corrective surgery for entropion and ectropion
29. Corrective surgery for blepharoptosis
30. Removal of a foreign body from the conjunctiva
31. Removal of a foreign body from the cornea
32. Incision of the cornea
33. Operations for pterygium
34. Other operations on the cornea
35. Removal of a foreign body from the lens of the eye
36. Removal of a foreign body from the posterior chamber of the eye
37. Removal of a foreign body from the orbit and eyeball
38. Operation of cataract
Operations on the skin & subcutaneous tissues

39. Incision of a pilonidal sinus
40. Other incisions of the skin and subcutaneous tissues
41. Surgical wound toilet (wound debridement) and removal of diseased tissue of the skin and subcutaneous tissues
42. Local excision of diseased tissue of the skin and subcutaneous tissues
43. Other excisions of the skin and subcutaneous tissues
44. Simple restoration of surface continuity of the skin and subcutaneous tissues
45. Free skin transplantation, donor site
46. Free skin transplantation, recipient site
47. Revision of skin plasty
48. Other restoration and reconstruction of the skin and subcutaneous tissues
Page 42

49. Chemosurgery to the skin
50. Destruction of diseased tissue in the skin and subcutaneous tissues
Operations on the tongue

51. Incision, excision and destruction of diseased tissue of the tongue
52. Partial glossectomy
53. Glossectomy
54. Reconstruction of the tongue
55. Other operations on the tongue
Operations on the salivary glands & salivary ducts

56. Incision and lancing of a salivary gland and a salivary duct
57. Excision of diseased tissue of a salivary gland and a salivary duct
58. Resection of a salivary gland
59. Reconstruction of a salivary gland and a salivary duct
60. Other operations on the salivary glands and salivary ducts
Other operations on the mouth & face

61. External incision and drainage in the region of the mouth, jaw and face
62. Incision of the hard and soft palate
63. Excision and destruction of diseased hard and soft palate
64. Incision, excision and destruction in the mouth
65. Plastic surgery to the floor of the mouth
66. Palatoplasty
67. Other operations in the mouth
Operations on the tonsils & adenoids

68. Transoral incision and drainage of a pharyngeal abscess
69. Tonsillectomy without adenoidectomy
70. Tonsillectomy with adenoidectomy
71. Excision and destruction of a lingual tonsil
72. Other operations on the tonsils and adenoids
Trauma surgery and orthopaedics

73. Incision on bone, septic and aseptic
74. Closed reduction on fracture, luxation or epiphyseolysis with osteosynthesis
75. Suture and other operations on tendons and tendon sheath
76. Reduction of dislocation under GA
77. Arthroscopic knee aspiration
Operations on the breast

78. Incision of the breast
79. Operations on the nipple
Operations on the digestive tract

80. Incision and excision of tissue in the perianal region
81. Surgical treatment of anal fistulas
82. Surgical treatment of haemorrhoids
83. Division of the anal sphincter (sphincterotomy)
84. Other operations on the anus
85. Ultrasound guided aspirations
86. Sclerotherapy etc.
87. Laparoscopic cholecystectomy
Operations on the female sexual organs

88. Incision of the ovary
89. Insufflation of the Fallopian tubes
90. Other operations on the Fallopian tube
91. Dilatation of the cervical canal
92. Conisation of the uterine cervix
93. Other operations on the uterine cervix
94. Incision of the uterus (hysterotomy)
95. Therapeutic curettage
Page 43

96. Culdotomy
97. Incision of the vagina
98. Local excision and destruction of diseased tissue of the vagina and the pouch of Douglas
99. Incision of the vulva
100. Operations on Bartholin’s glands (cyst)
Operations on the prostate & seminal vesicles

101. Incision of the prostate
102. Transurethral excision and destruction of prostate tissue
103. Transurethral and percutaneous destruction of prostate tissue
104. Open surgical excision and destruction of prostate tissue
105. Radical prostatovesiculectomy
106. Other excision and destruction of prostate tissue
107. Operations on the seminal vesicles
108. Incision and excision of periprostatic tissue
109. Other operations on the prostate
Operations on the scrotum & tunica vaginalis testis

110. Incision of the scrotum and tunica vaginalis testis
111. Operation on a testicular hydrocele
112. Excision and destruction of diseased scrotal tissue
113. Plastic reconstruction of the scrotum and tunica vaginalis testis
114. Other operations on the scrotum and tunica vaginalis testis
Operations on the testes

115. Incision of the testes
116. Excision and destruction of diseased tissue of the testes
117. Unilateral orchidectomy
118. Bilateral orchidectomy
119. Orchidopexy
120. Abdominal exploration in cryptorchidism
121. Surgical repositioning of an abdominal testis
122. Reconstruction of the testis
123. Implantation, exchange and removal of a testicular prosthesis
Operations on the spermatic cord, epididymis und ductus deferens

125. Surgical treatment of a varicocele and a hydrocele of the spermatic cord
126. Excision in the area of the epididymis
127. Epididymectomy
128. Reconstruction of the spermatic cord
129. Reconstruction of the ductus deferens and epididymis
130. Other operations on the spermatic cord, epididymis and ductus deferens
Operations on the penis

131. Operations on the foreskin
132. Local excision and destruction of diseased tissue of the penis
133. Amputation of the penis
134. Plastic reconstruction of the penis
Operations on the urinary system

136. Cystoscopical removal of stones
Other Operations
137. Lithotripsy
138. Coronary angiography
139. Haemodialysis
140. Radiotherapy for Cancer
141. Cancer Chemotherapy
Page 44

Page 45

Subject: Policy Number: 0000000021267908-03: Customer - Care@sbigeneral - in

Uploaded by

Copyright:

Available Formats

Subject: Policy Number: 0000000021267908-03: Customer - Care@sbigeneral - in

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Subject: Policy Number: 0000000021267908-03: Customer - Care@sbigeneral - in

Uploaded by

Copyright:

Available Formats

To, Date: 03/02/2024

Mr. PAWAN KUMAR, URN NO:

Subject: Policy Number: 0000000021267908-03

Your Customer ID : 0000000038096827

Your Policy No.: 0000000021267908-03

SBI General Insurance Company Limited

We look forward to a continuing and mutually beneficial relationship.

SBI General Insurance Company Limited :

SBI General Insurance Company Limited :

Arogya Plus Policy

Policy No: 0000000021267908-03 Servicing Branch Office:Ludhiana Issue Date: 31/01/2024

Intermediary Name & Code Sbi Pau Ludhiana 1482 0007360

Intermediary Contact Details: Mobile No: Landline No: +91-161-401831

H NO 146 NEAR DASHMESH NAGAR, AJALI KHURD,HAMBRAN ROAD,

Date of inception first insurance policy

Policy printed by: 100001 Date:31/01/2024 Time: 13:02hrs

Arogya Plus Policy UIN : SBIHLIP14006V011314

Arogya Plus Policy

SAWROOP RANI 0000000038097239 Female 28/01/2021 15/03/1966 57 Spouse 300,000.00

PAWAN KUMAR 0000000038096827 Male 03/02/2021 04/04/1963 60 Self

OPD cover Details

Additional loading Details (if any):

Name of the Insured Reason for additional loading

Particulars Amount (INR)

Collection Details :-Receipt No:37156861Receipt Date:31/01/2024Amount:Rs10,502.00

Signed at: Ludhiana For SBI General Insurance Company Limited

Signer: VISHWANATHAN SUBRAMANIAN

Policy printed by: 100001 Date:31/01/2024 Time: 13:02hrs

Arogya Plus Policy UIN : SBIHLIP14006V011314

Arogya Plus Policy

Policy Number: 0000000021267908-03

For and on behalf of SBI General Insurance Co. Ltd

Exclusions applicable to “AMIT KUMAR

Policy printed by: 100001 Date:31/01/2024 Time: 13:02hrs

Arogya Plus Policy UIN : SBIHLIP14006V011314

Arogya Plus Policy

GST TAX INVOICE

GST Invoice 98108816 GST Invoice Date: 31/01/2024

GSTIN/Unique Policy Number 0000000021267908-03

Insurance HSN Code Premium CGST SGST/ UTGST IGST

SBI General 37156861 Receipt 31/01/2024

Policy printed by: 100001 Date:31/01/2024 Time: 13:02hrs

Arogya Plus Policy UIN : SBIHLIP14006V011314

Arogya Plus Policy

Annexure A - Day Care List

Microsurgical operations on the middle ear

Other operations on the middle & internal ear

Operations on the nose & the nasal sinuses

Operations on the eyes

Operations on the skin & subcutaneous tissues

Arogya Plus Policy UIN : SBIHLIP14006V011314

Arogya Plus Policy

Operations on the tongue

Operations on the salivary glands & salivary ducts

Other operations on the mouth & face

Operations on the tonsils & adenoids

Trauma surgery and orthopaedics

Operations on the breast

Operations on the digestive tract