TRUTH MUST BE TOLD

ONEHEALTH POLICY WORDING

www.magmahdi.com * customercare@magma-hdi.co.in

Magma HDI General Insurance Co. Ltd. | www.magmahdi.com | E-mail: customercare@magma-hdi.co.in | Toll Free: 1800 266 3202
| Registered Office: Development House, 24 Park Street, Kolkata – 700016. CIN: U66000WB2009PLC136327 | IRDAI Reg. No. 149
OneHealth - MAGHLIP222V032021 | Trade logos displayed above belong to Magma Fincorp Ltd. and HDI Global SE respectively, and
are being used by Magma HDI General Insurance Company Limited, under license. (PW-01-07-21)
 OneHealth
Insurance
Preamble AYUSH Day Care Centre means and includes Community
The insurance cover provided under this Policy up to the Sum Health Centre (CHC), Primary Health Centre (PHC),
Dispensary, Clinic, Polyclinic or any such health center which
Insured is and shall be subject to (a) the terms and conditions
is registered with the local authorities, wherever applicable
of this Policy, (b) the receipt of premium, and (c) Disclosure
and having facilities for carrying out treatment procedures
to information norm (including information and statements
and medical or surgical/ para-surgical interventions or
which the Policyholder has provided in the proposal form or
both under the supervision of registered AYUSH Medical
Information Summary Sheet as applicable) for all persons to
Practitioner(s) on day care basis without in-patient services
be insured. Please inform Us immediately of any change in and must comply with all the following criterion:
the address, nature of job, state of health, or of any other
i. Having qualified registered AYUSH Medical
changes affecting any Insured Person.
Practitioner(s) in charge;
If any claim arising as a result of an Illness or Injury that
ii. Having dedicated AYUSH therapy sections as required
occurred during the Policy Period becomes payable, then
and/or has equipped operation theatre where surgical
We shall pay the Benefits in accordance with the terms,
procedures are to be carried out;
conditions and exclusions of the Policy subject to availability
of Sum Insured and Cumulative Bonus (if any). iii. Maintaining daily records of patient and making them
accessible to the insurance company’s authorized
Section 1. Interpretations & Definitions representative
The terms defined below have the meaning ascribed Any One Illness: Any one illness means continuous period
to them wherever they appear in this Policy and, where of illness and includes relapse within 45 days from the date
appropriate, references to the singular include references to of last consultation with the Hospital/Nursing Home where
the plural, references to male include female and references treatment was taken.
to any statutory enactment include subsequent changes, Cashless facility: Cashless facility means a facility extended
replacements or amendments to the same: by the insurer to the insured where the payments, of the costs
Accident: An accident means sudden, unforeseen and of treatment undergone by the insured in accordance with the
involuntary event caused by external, visible and violent policy terms and conditions, are directly made to the network
means. provider by the insurer to the extent pre-authorization is
approved.
Age or Aged means age as on last birthday.
Condition Precedent: Condition Precedent means a policy
Alternative Treatments or AYUSH are forms of treatments term or condition upon which the Insurer’s liability under the
other than treatment of “Allopathy” or “modern medicine” policy is conditional upon.
and includes Ayurveda, Unani, Siddha and Homeopathy in
Congenital Anomaly: Congenital Anomaly means a
the Indian context.
condition which is present since birth, and which is abnormal
An AYUSH Hospital is a healthcare facility wherein with reference to form, structure or position.
medical/surgical/para-surgical treatment procedures and
a) Internal Congenital Anomaly
interventions are carried out by AYUSH Medical Practitioner(s)
comprising of any of the following: Congenital anomaly which is not in the visible and
accessible parts of the body.
a. Central or State Government AYUSH Hospital or
b. Teaching hospital attached to AYUSH College b) External Congenital Anomaly
recognized by the Central Government/Central Council Congenital anomaly which is in the visible and
of Indian Medicine/ Central Council for Homeopathy; accessible parts of the body
or Co-Payment: Co-payment means a cost sharing requirement
c. AYUSH Hospital, standalone or co-located with in- under a health insurance policy that provides that the
patient healthcare facility of any recognized system of policyholder/insured will bear a specified percentage of the
medicine, registered with the local authorities, wherever admissible claims amount. A co-payment does not reduce
applicable, and is under the supervision of a qualified the Sum Insured.
registered AYUSH Medical Practitioner and must comply Critical Illness means the following:
with the following criterion:
1) Cancer of Specified Severity
i) Having at least 5 in-patient beds;
I. A malignant tumour characterized by the uncontrolled
ii) Having qualified AYUSH Medical Practitioner in growth and spread of malignant cells with invasion
charge round the clock; and destruction of normal tissues. This diagnosis must
iii) Having dedicated AYUSH therapy sections as be supported by histological evidence of malignancy.
required and/or has equipped operation theatre The term cancer includes leukaemia, lymphoma and
where surgical procedures are to be carried out; sarcoma.
iv) Maintaining daily records of the patients and II. The following are excluded-
making them accessible to the insurance i. All tumors which are histologically described
company’s authorized representative. as carcinoma in situ, benign, pre-malignant,

OneHealth - MAGHLIP222V032021 1
 OneHealth
Insurance
borderline malignant, low malignant potential, II. The following are excluded:
neoplasm of unknown behaviour, or non-invasive, i. Angioplasty and/or any other intra-arterial
including but not limited to: Carcinoma in situ of procedures
breasts, Cervical dysplasia CIN-1, CIN - 2 and
CIN-3. 4) Open Heart Replacement or Repair of Heart Valves
ii. Any non-melanoma skin carcinoma unless there is I. The actual undergoing of open-heart valve surgery
evidence of metastases to lymph nodes or beyond; is to replace or repair one or more heart valves,
iii. Malignant melanoma that has not caused invasion as a consequence of defects in, abnormalities of,
beyond the epidermis; or disease-affected cardiac valve(s). The diagnosis
of the valve abnormality must be supported by an
iv. All tumors of the prostate unless histologically
echocardiography and the realization of surgery has
classified as having a Gleason score greater than
to be confirmed by a specialist medical practitioner.
6 or having progressed to at least clinical TNM
Catheter based techniques including but not limited
classification T2N0M0
to, balloon valvotomy/valvuloplasty are excluded.
v. All Thyroid cancers histologically classified as
T1N0M0 (TNM Classification) or below; 5) Coma of Specified Severity
vi. Chronic lymphocytic leukaemia less than RAI I. A state of unconsciousness with no reaction or response
stage 3 to external stimuli or internal needs. This diagnosis must
vii. Non-invasive papillary cancer of the bladder be supported by evidence of all of the following:
histologically described as TaN0M0 or of a lesser i. no response to external stimuli continuously for
classification at least 96 hours;
viii. All Gastro-Intestinal Stromal Tumors histologically ii. life support measures are necessary to sustain life;
classified as T1N0M0 (TNM Classification) or and
below and with mitotic count of less than or equal iii. permanent neurological deficit which must be
to 5/50 HPFs; assessed at least 30 days after the onset of the
ix. All tumors in the presence of HIV infection. coma.
II. The condition has to be confirmed by a specialist
2) Myocardial Infarction (First Heart Attack of specific
medical practitioner. Coma resulting directly from
severity)
alcohol or drug abuse is excluded.
I. The first occurrence of heart attack or myocardial
infarction, which means the death of a portion of the 6) Kidney Failure Requiring Regular Dialysis
heart muscle as a result of inadequate blood supply I. End stage renal disease presenting as chronic
to the relevant area. The diagnosis for Myocardial irreversible failure of both kidneys to function, as a result
Infarction should be evidenced by all of the following of which either regular renal dialysis (haemodialysis or
criteria: peritoneal dialysis) is instituted or renal transplantation
i. A history of typical clinical symptoms consistent is carried out. Diagnosis has to be confirmed by a
with the diagnosis of acute myocardial infarction specialist medical practitioner.
(For e.g. typical chest pain)
7) Stroke Resulting in Permanent Symptoms
ii. New characteristic electrocardiogram changes
Any cerebrovascular incident producing permanent
iii. Elevation of infarction specific enzymes, Troponins neurological sequelae. This includes infarction of
or other specific biochemical markers. brain tissue, thrombosis in an intracranial vessel,
II. The following are excluded: haemorrhage and embolization from an extracranial
i. Other acute Coronary Syndromes source. Diagnosis has to be confirmed by a specialist
medical practitioner and evidenced by typical clinical
ii. Any type of angina pectoris
symptoms as well as typical findings in CT Scan or MRI
iii. A rise in cardiac biomarkers or Troponin T or I of the brain. Evidence of permanent neurological deficit
in absence of overt ischemic heart disease OR lasting for at least 3 months has to be produced.
following an intra-arterial cardiac procedure.
II. The following are excluded:
3) Open Chest CABG i. Transient ischemic attacks (TIA)
I. The actual undergoing of heart surgery to correct ii. Traumatic injury of the brain
blockage or narrowing in one or more coronary iii. Vascular disease affecting only the eye or optic
artery(s), by coronary artery bypass grafting done nerve or vestibular functions.
via a sternotomy (cutting through the breast bone)
or minimally invasive keyhole coronary artery bypass 8) Major Organ/Bone Marrow Transplant
procedures. The diagnosis must be supported by a I. The actual undergoing of a transplant of:
coronary angiography and the realization of surgery i. One of the following human organs: heart,
has to be confirmed by a cardiologist. lung, liver, kidney, pancreas, that resulted from

OneHealth - MAGHLIP222V032021 2
 OneHealth
Insurance
irreversible end-stage failure of the relevant Day Care Treatment: Day care treatment means medical
organ, or treatment, and/or surgical procedure which is:
ii. Human bone marrow using haematopoietic stem i. undertaken under General or Local Anaesthesia in a
cells. The undergoing of a transplant has to be hospital/day care centre in less than 24 hrs because
confirmed by a specialist medical practitioner. of technological advancement, and
II. The following are excluded: ii. which would have otherwise required hospitalization
of more than 24 hours.
i. Other stem-cell transplants
Treatment normally taken on an out-patient basis is not
ii. Where only islets of langerhans are transplanted
included in the scope of this definition.
9) Permanent Paralysis of Limbs Deductible: Deductible means a cost sharing requirement
I. Total and irreversible loss of use of two or more limbs under a health insurance policy that provides that the insurer
as a result of injury or disease of the brain or spinal will not be liable for a specified rupee amount in case of
cord. A specialist medical practitioner must be of the indemnity policies and for a specified number of days/hours
opinion that the paralysis will be permanent with no in case of hospital cash policies which will apply before any
hope of recovery and must be present for more than benefits are payable by the insurer. A deductible does not
3 months. reduce the Sum Insured.
Diagnostic Tests: Investigations, such as X-Ray or blood
10) Motor Neurone Disease with Permanent Symptoms tests, to find the cause of the Insured Person’s symptoms
I. Motor neurone disease diagnosed by a specialist and medical condition.
medical practitioner as spinal muscular atrophy, Dental Treatment: Dental treatment means a treatment
progressive bulbar palsy, amyotrophic lateral sclerosis related to teeth or structures supporting teeth including
or primary lateral sclerosis. There must be progressive examinations, fillings (where appropriate), crowns,
degeneration of corticospinal tracts and anterior horn extractions and surgery.
cells or bulbar efferent neurons. Theremust be current
Disclosure to information norm: The policy shall be
significant and permanent functional neurological
void and all premium paid hereon shall be forfeited to the
impairment with objective evidence of motor dysfunction
Company in the event of misrepresentation, mis-description
that has persisted for a continuous period of at least 3
or non-disclosure of any material fact.
months.
Domiciliary Hospitalization: Domiciliary hospitalization
11) Multiple Sclerosis with Persisting Symptoms means medical treatment for an illness/disease/injury which
I. The unequivocal diagnosis of Definite Multiple Sclerosis in the normal course would require care and treatment at a
confirmed and evidenced by all of the following: hospital but is actually taken while confined at home under
i. investigations including typical MRI findings which any of the following circumstances:
unequivocally confirm the diagnosis to be multiple i) the condition of the patient is such that he/she is not
sclerosis and in a condition to be removed to a hospital, or
ii. there must be current clinical impairment of motor ii) the patient takes treatment at home on account of non-
or sensory function, which must have persisted for availability of room in a hospital.
a continuous period of at least 6 months. Emergency means a severe Illness or Injury which results
II. Other causes of neurological damage such as SLE and in symptoms which occur suddenly and unexpectedly, and
HIV are excluded. requires immediate care by a Medical Practitioner to prevent
Cumulative Bonus: Cumulative Bonus means any increase death or serious long term impairment of the Insured Person’s
or addition in the Sum Insured granted by the insurer without health.
an associated increase in premium. Emergency Care: Emergency care means management for
Day Care Centre: A day care centre means any institution an illness or injury which results in symptoms which occur
established for day care treatment of illness and/or injuries suddenly and unexpectedly, and requires immediate care by
or a medical setup with a hospital and which has been a medical practitioner to prevent death or serious long term
registered with the local authorities, wherever applicable, and impairment of the insured person’s health.
is under supervision of a registered and qualified medical Family Floater Policy means a policy named as a Family
practitioner and must comply with all minimum criteria as Floater Policy in the Policy Schedule in terms of which, two or
under:- more persons of a family are named in the Policy Schedule
i) has qualified nursing staff under its employment; as Insured Persons. In a Family Floater Policy, family means
a unit comprising of up to seven members who are related
ii) has qualified medical practitioner/s in charge; to the Policyholder in the following manner:
iii) has fully equipped operation theatre of its own where 1) Self (ie, the Policyholder); and/or
surgical procedures are carried out;
2) Legally married spouse as long as they continue to be
iv) maintains daily records of patients and will make these married; and/or
accessible to the Insurance company’s authorized
personnel. 3) Up-to three children (children who are up to 25 years

OneHealth - MAGHLIP222V032021 3
 OneHealth
Insurance
of Age on the Policy Start Date shall be considered as Illness: Illness means a sickness or a disease or pathological
dependent children, if Aged 26 and above, they shall condition leading to the impairment of normal physiological
be considered as adults in this Policy); and/or function and requires medical treatment.
4) Natural parents or parents that have legally adopted (a) Acute condition - Acute condition is a disease, illness
the Policyholder; or or injury that is likely to respond quickly to treatment
5) Parents-in-law as long as the Policyholder continues to which aims to return the person to his or her state of
be legally married to the spouse referred above. health immediately before suffering the disease/ illness/
injury which leads to full recovery
6) Grand children
(b) Chronic condition - A chronic condition is defined as
7) Daughter-in-law and Son-in-law
a disease, illness, or injury that has one or more of the
8) Brother(s) and Sister(s) following characteristics:
All parents and parents- in- law referred above must be 1. it needs ongoing or long-term monitoring through
financially dependent on the Policyholder. consultations, examinations, check-ups, and /or
Grace Period: Grace period means the specified period of tests
time immediately following the premium due date during 2. it needs ongoing or long-term control or relief of
which a payment can be made to renew or continue a policy symptoms
in force without loss of continuity benefits such as waiting
3. it requires rehabilitation for the patient or for the
periods and coverage of pre-existing diseases. Coverage is
patient to be specially trained to cope with it
not available for the period for which no premium is received.
4. it continues indefinitely
Hospital: A hospital means any institution established for in-
patient care and day care treatment of illness and / or injuries 5. it recurs or is likely to recur
and which has been registered as a hospital with the local IRDAI means the Insurance Regulatory and Development
authorities under Clinical Establishments (Registration and Authority of India.
Regulation) Act 2010 or under enactments specified under
Injury: Injury means accidental physical bodily harm
the Schedule of Section 56(1) of the said act Or complies
excluding illness or disease solely and directly caused by
with all minimum criteria as under:
external, violent, visible and evident means which is verified
i) Has qualified nursing staff under its employment round and certified by a Medical Practitioner.
the clock;
Information Summary Sheet means the record and
ii) has at least 10 in-patient beds in towns having a confirmation of information provided to Us or Our
population of less than 10,00,000 and at least 15 in- representatives over the telephone for the purposes of
patientbeds in all other places; applying for this Policy.
iii) has qualified medical practitioner(s) in charge round
Inpatient Care: Inpatient care means treatment for which
the clock;
the insured person has to stay in a hospital for more than
iv) has a fully equipped operation theatre of its own where 24 hours for a covered event.
surgical procedures are carried out;
Intensive Care Unit: Intensive care unit means an identified
v) maintains daily records of patients and makes these section, ward or wing of a hospital which is under the constant
accessible to the insurance company’s authorized supervision of a dedicated medical practitioner(s), and which
personnel: is specially equipped for the continuous monitoring and
Only for the purposes of any claim or treatment permitted treatment of patients who are in a critical condition, or
to be made or taken outside India in accordance with require life support facilities and where the level of care and
Section 3.16, Hospital (outside India) means an institution supervision is considerably more sophisticated and intensive
(including nursing homes) established outside India for than in the ordinary and other wards.
indoor medical care and treatment of Illness and/or Injuries
Insured Person/You/Your/Yours means the person(s)
which has been registered and licensed as such with the
named in the Policy Schedule who are covered under this
appropriate local or other authorities in the relevant area,
Policy and in respect of whom the appropriate premium has
wherever applicable, and is under the constant supervision
been received.
of a medical practitioner. The term Hospital shall not include
a clinic, rest home, or convalescent home for the addicted, ICU Charges: ICU (Intensive Care Unit) Charges means the
detoxification centre, sanatorium, and old age home. amount charged by a Hospital towards ICU expenses which
Hospitalization : Hospitalization means admission in a shall include the expenses for ICU bed, general medical
Hospital for a minimum period of 24 consecutive ‘In-patient support services provided to any ICU patient including
Care’ hours except for specified procedures/ treatments, monitoring devices, critical care nursing and intensivist
where such admission could be for a period of less than 24 charges.
consecutive hours. Maternity expenses: Maternity expenses means:
Individual Policy means a policy named as an Individual a) medical treatment expenses traceable to childbirth
Policy in the Policy Schedule in terms of which only one person (including complicated deliveries and caesarean
is named in the Policy Schedule as the Insured Person. sections incurred during hospitalization);

OneHealth - MAGHLIP222V032021 4
 OneHealth
Insurance
b) expenses towards lawful medical termination of Your statements in the proposal form and the Information
pregnancy during the policy period. Summary Sheet as applicable.
Medical Advice: Medical Advice means any consultation or Policy Inception Date means the Policy Start Date of the
advice from a Medical Practitioner including the issuance of first Policy with Us, as specified in the Policy Schedule, and
any prescription or follow-up prescription. renewed with Us continuously thereafter.
Medical Expenses: Medical Expenses means those expenses Policy Start Date means the start date of the Policy as
that an Insured Person has necessarily and actually incurred specified in the Policy Schedule.
for medical treatment on account of Illness or Accident on Policy Expiry Date means the date on which the Policy
the advice of a Medical Practitioner, as long as these are no expires as specified in the Policy Schedule.
more than would have been payable if the Insured Person
had not been insured and no more than other hospitals or Policy Period means the period between the Policy Start Date
doctors in the same locality would have charged for the and the Policy Expiry Date as shown in the Policy Schedule.
same medical treatment. Policy Year means a period of twelve consecutive months
Medical Practitioner: Medical Practitioner means a person commencing from the Policy Start Date as specified in the
who holds a valid registration from the Medical Council of Policy Schedule or any anniversary thereof.
any State or Medical Council of India or Council for Indian Policyholder means the person named in the Policy Schedule
Medicine or for Homeopathy setup by the Government as the policyholder and who has concluded this Policy with
of India or a State Government and is thereby entitled to Us.
practice medicine within its jurisdiction; and is acting within Pre-Existing Disease: Pre-Existing Disease means any
its scope and jurisdiction of licence. condition, ailment , injury or disease:
Medically Necessary Treatment: Medically necessary a) That is/are diagnosed by a physician within 48 months
treatment means any treatment, tests, medication, or stay prior to the effective date of the policy issued by the
in hospital or part of a stay in hospital which: insurer or its reinstateme nt;or
i) is required for the medical management of the illness b) For which medical advice or treatment was recommended
or injury suffered by the insured; by, or received from, a Physician within 48 months prior
ii) must not exceed the level of care necessary to provide to the effective date of the policy issued by the insurer
safe, adequate and appropriate medical care in scope, or its reinstatement.
duration, or intensity; Pre-hospitalization Medical Expenses: Pre- hospitalization
iii) must have been prescribed by a medical practitioner; Medical Expenses means medical expenses incurred during
iv) must conform to the professional standards widely pre-defined number of days preceding the hospitalization
accepted in international medical practice or by the of the Insured Person, provided that:
medical community in India. i. Such Medical Expenses are incurred for the same
Migration means the right accorded to health insurance condition for which the Insured Person’s Hospitalization
policyholders (including all members under family cover and was required, and
members of group health policy), to transfer the credit gained ii. The In-patient Hospitalization claim for such
for pre-existing conditions and time bound exclusions, with Hospitalization is admissible by the Insurance
the same insurer. Company.
Network Provider: Network Provider means hospitals Post-hospitalization Medical Expenses: Post-hospitalization
enlisted by an insurer, TPA or jointly by an Insurer and TPA to Medical Expenses means medical expenses incurred during
provide medical services to an insured by a cashless facility. pre-defined number of days immediately after the insured
New Born Baby: New born baby means baby born during person is discharged from the hospital provided that:
the Policy Period and is aged up to 90 days. i. Such Medical Expenses are for the same condition for
Notification of Claim: Notification of claim means the which the insured person’s hospitalization was required,
process of intimating a claim to the insurer or TPA through and
any of the recognized modes of communication. ii. The inpatient hospitalization claim for such
hospitalization is admissible by the insurance company.
Non-Network Provider: Non-Network means any hospital,
day care centre or other provider that is not part of the Portability means rights accorded to an individual health
network. insurance policyholder (including family cover) to transfer
the credit gained for Pre-Existing conditions and time bound
OPD treatment: OPD treatment means the one in which
exclusions from one insurer to another or from one plan to
the Insured visits a clinic/ hospital or associated facility like a
another plan of the same insurer.
consultation room for diagnosis and treatment based on the
advice of a Medical Practitioner. The Insured is not admitted Product Benefits Table means the Product Benefits Table
as a day care or in-patient. issued by Us and accompanying the sales literatures,
including the prospectus of this product.
Policy means this Policy document, any annexures thereto
and the Policy Schedule including endorsements, if any, Qualified Nurse means a person who holds a valid

OneHealth - MAGHLIP222V032021 5
 OneHealth
Insurance
registration from the Nursing Council of India or the Nursing TPA or Third Party Administrator means a company
Council of any state in India. registered with the Authority, and engaged by an insurer, for
Rehabilitation includes treatment aimed at restoring health a fee, by whatever name called and as may be mentioned
or mobility, or to allow a person to live an independent life, in the agreement, for providing health services.
such as after a stroke. Unproven/Experimental treatment: Unproven/
Experimental treatment means the treatment including
Reasonable and Customary Charges: Reasonable and
drug experimental therapy which is not based on established
Customary charges means the charges for services or
medical practice in India, is treatment experimental or
supplies, which are the standard charges for the specific
unproven.
provider and consistent with the prevailing charges in the
geographical area for identical or similar services, taking We/Our/Us means MAGMA HDI General Insurance
into account the nature of the illness / injury involved. Company Ltd.
Renewal: Renewal means the terms on which the contract
of insurance can be renewed on mutual consent with a
Section 2. Benefits
provision of grace period for treating the renewal continuous The Benefits under this Policy are subject always to the Sum
for the purpose of gaining credit for pre-existing diseases, Insured and Cumulative Bonus, if any, any subsidiary limit
time-bound exclusions and for all waiting periods. specified in the Policy Schedule/Product Benefits Table, the
terms, conditions, limitations and exclusions mentioned in the
Relaxation Period means the specified period of time
Policy and eligibility as per the insurance plan opted for in the
immediately following the premium instalment due date
Product Benefits Table and as shown in the Policy Schedule:
during which a payment can be made to continue a
policy in force without loss of continuity benefits such as Base Covers:
waiting periods and coverage of pre-existing. Coverage 2.1 Inpatient Care
will be available during this period provided instalment is We shall cover the Reasonable and Customary Charges
paid before the Relaxation period gets over. Policy will be for the following Medical Expenses incurred by You if
automatically terminated if the due instalment is not received during the Policy Period, You require Hospitalization on
within this specified time. the written Medical Advice of a Medical Practitioner, for
Room Rent means the amount charged by a Hospital any Illness or Injury which is contracted or sustained by
towards Room and Boarding expenses and shall include the You during the Policy Period and is covered under this
associated medical expenses. Policy:
Policy Schedule means the schedule issued by Us along a) Medical Practitioners’ fees
with this Policy mentioning the details of the Policyholder b) Room Rent and other boarding charges
and Insured person, period of Policy and other details. Any c) ICU Charges
changes made to it shall be issued as Endorsement Schedule
and shall be considered a part of this Policy. d) Operation theatre charges
e) Diagnostic procedures’ charges
Shared Accommodation means a Hospital room with two
or more patient beds f) Medicines, drugs and other consumables as
prescribed by the Medical Practitioner
Single Private room means basic category of Single room
in the Hospital wherein a single patient is accommodated. g) Qualified Nurses’ charges
It may be with or without air conditioning facility. h) Intravenous fluids, blood transfusion, injection
administration charges
Sum Insured means:
i) Anesthesia, Blood, Oxygen, operation theatre
i) For an Individual Policy, the sum shown in the Policy
charges, surgical appliances
Schedule/ Product Benefits Table against an Insured
Person which represents Our maximum, total and j) The cost of prosthetics and other devices or
cumulative liability for any and all claims under the equipment if implanted internally during a
Policy during a Policy Year in respect of that Insured Surgical Procedure
Person. Room Rent Capping:
ii) For a Family Floater Policy, the sum shown in the Policy (1) For Support plan (all Sum Insured):
Schedule/ Product Benefits Table which represents Our
Reimbursement or payment of Room Rent and
maximum, total and cumulative liability for any and all
associated charges incurred at the Hospital shall not
claims under the Policy during a Policy Year in respect
exceed 1% of the Sum Insured per day. In case of
of any and all Insured Persons.
admission to Intensive Care Unit or Intensive Cardiac
Surgery or Surgical Procedure: Surgery or Surgical Care Unit (ICCU), reimbursement or payment of such
Procedure means manual and / or operative procedure (s) Medical Expenses shall not exceed 2% of the Sum
required for treatment of an illness or injury, correction of Insured per day.
deformities and defects, diagnosis and cure of diseases,
relief from suffering and prolongation of life, performed Proportionate Deduction:
in a hospital or day care centre by a medical practitioner. In case of admission to a room at rates exceeding

OneHealth - MAGHLIP222V032021 6
 OneHealth
Insurance
the aforesaid limits, the reimbursement or payment 2.3 Post-Hospitalization Expenses
of all associated Medical Expenses incurred at the We shall, on a reimbursement basis, cover Your Post-
Hospital, shall be effected in the same proportion as hospitalization Medical Expenses incurred due to an
the admissible rate per day bears to the actual rate per Injury or Illness that occurs during the Policy Period,
day of Room Rent. immediately after Your discharge from the Hospital and
(2) For Secure plan (all Sum Insured): up to the limits specified in the Policy Schedule/Product
Reimbursement or payment of Room Rent and other Benefits Table, provided that a claim has been admitted
boarding charges, and Qualified Nurses’ charges by Us under Inpatient Care under Section 2.1 above
incurred at the Hospital shall be as per “Single private and is related to the same Illness/Injury/condition.
room category. In case of admission to Intensive
2.4 Day Care Treatment
Care Unit or Intensive Cardiac Care Unit (ICCU),
reimbursement or payment of such Medical Expenses We will cover the Medical Expenses incurred on Your
shall be as per actual expenses. Day Care Treatment on the recommendation of a
Medical Practitioner following an Illness or Injury
Proportionate Deduction:
which occurs during the Policy Period provided that the
In case of admission to a room category higher than the Medical Expenses incurred are for Medically Necessary
basic Single room category (Deluxe, Super deluxe, Suite Treatment and up to the limits specified in the Policy
room and likewise) of the Hospital, the reimbursement Schedule/Product Benefits Table. Any OPD treatment
or payment of all associated Medical Expenses incurred undertaken in a Hospital/Day Care Centre will not be
at the Hospital, shall be effected in the same proportion covered under this Benefit. Pre- hospitalization Medical
as the Single private room category rate per day Expenses and Post- hospitalization Medical Expenses
bears to the actual rate per day of the room category are not payable under this Benefit. Please refer to
utilized. Such proportionate deductions shall not be Annexure III for list of Day Care Treatments.
applied in respect of the hospitals which do not follow
differential billing or for those expenses in respect of 2.5 Ambulance Cover
which differential billing is not adopted based on the
We will cover the Reasonable and Customary Charges
room category.
up to the limit specified in the Policy Schedule/
(3) For Support Plus plan, Shield and Premium plans, Product Benefits Table that are incurred towards Your
there will not be any cap on the Room Rent and We transportation by road ambulance to the nearest
will reimburse reasonable and necessary Room Rent, Hospital with adequate facilities in an Emergency
other boarding charges and Qualified Nurses’ charges following an Illness or Injury which occurs during the
incurred at the Hospital for treatment of an Illness or Policy Period provided that the ambulance service is
Injury which is admissible and payable under the Policy. offered by a registered healthcare or ambulance service
Associated expenses refer to the medical expenses provider and a claim has been admitted by Us under
which vary as per room category opted in the Hospital. Inpatient Care under Section 2.1 above.
These shall not include Cost of pharmacy and
consumables; cost of implants and medical devices; 2.6 Organ Donor Expenses
cost of diagnostics. We will cover the Medical Expenses incurred towards
For Cataract, following sub-limits shall apply: in- patient Hospitalization of an organ donor for
a) Support Plan- up to Rs. 25,000 per eye per Policy Your organ transplant Surgery during the Policy Year
Year provided that:
b) Secure and Support Plus plan – up to Rs. 35,000 a) the organ donor conforms to the provisions of The
per eye per Policy Year Transplantation of Human Organs Act, 1994 and
c) Shield plan– up to Rs. 50,000 per eye per Policy other applicable laws.
Year b) the organ donated is for the use of the Insured
d) Premium plan– up to Rs. 1,00,000 per eye per Person provided that the Insured Person has
Policy Year undergone an organ transplantation on the basis
of Medical Advice;
2.2 Pre-Hospitalization Expenses
c) A claim has been admitted by Us under Inpatient
We shall, on a reimbursement basis, cover Your Pre- Care under Section 2.1 above.
hospitalization Medical Expenses incurred in respect of
Subject to the above, We will not cover:
an Injury or Illness that occurs during the Policy Period,
immediately prior to Your date of Hospitalization and a) Any Pre-hospitalization Medical Expenses, Post-
up to the limits specified in the Policy Schedule/Product hospitalization Medical Expenses, or screening
Benefits Table, provided that a claim has been admitted expenses of the organ donor, or any other Medical
by Us under Inpatient Care under Section 2.1 above Expenses as a result of the harvesting from the
and is related to the same Illness/Injury/condition. organ donor;

OneHealth - MAGHLIP222V032021 7
 OneHealth
Insurance
b) Costs directly or indirectly associated with the Insured Person during the Policy Period for her IVF
acquisition of the donor’s organ; (in-vitro fertilization) treatment undertaken at a clinic
c) Any other medical treatment or complication duly registered in accordance with applicable law and
in respect of the donor consequent to organ on the written Medical Advice of a specialist Medical
donation. Practitioner, maximum up to the limit as mentioned in
the Policy Schedule/Product Benefits Table, provided
2.7 Domiciliary Hospitalization that the Insured Person undergoes the treatment before
We will on reimbursement basis, cover the Medical 40 years of Age. A waiting period of 3 years from
Expenses incurred for Your Domiciliary Hospitalization the Policy Inception Date shall be applicable for this
during the Policy Period following an Illness or Injury Benefit.
that occurs during the Policy Period provided that
Following shall not be covered under this Benefit:
the Domiciliary Hospitalization continues for an
uninterrupted period of at least 3 days and the condition a) Any expenses with respect to the Insured Person’s
for which treatment is taken would otherwise have use of third party surrogate or gestational carrier
necessitated Hospitalization as long as either in pregnancy
a) the attending Medical Practitioner confirms b) Any expenses for consultation, diagnostic tests
in writing that You cannot be transferred to a or procedure or any such other expenses for
Hospital or diagnosis of infertility
b) You satisfy Us that a Hospital bed was unavailable. 2.10 Bariatric Surgery Cover
If a claim has been admitted by Us under this Benefit, We shall cover the Medical Expenses incurred by the
then claims for Pre-hospitalization Medical Expenses Insured Person during the Policy Period for undergoing
and Post- hospitalization Medical Expenses shall also medically necessary Bariatric Surgery prescribed by a
be payable. specialist Medical Practitioner, maximum up to the limit
2.8 AYUSH Treatment as mentioned in the Policy Schedule/Product Benefits
Table, provided that
We will, on a reimbursement basis, cover Your Medical
Expenses incurred for Inpatient Care during the Policy 1) Surgery to be conducted is upon the advice of the
Period on treatment taken under AYUSH Treatment in: Doctor

– a government Hospital or in any institute recognized 2) The surgery/Procedure conducted should be

by the government and/or accredited by the supported by clinical protocols
Quality Council of India/National Accreditation 3) The member has to be 18 years of age or older
Board on Health and
– Teaching Hospitals of AYUSH colleges recognised 4) Body Mass Index (BMI);
by Central Council of Indian Medicine (CCIM) and a) greater than or equal to 40 or
Central Council of Homeopathy (CCH) b) greater than or equal to 35 in conjunction with
– AYUSH Hospitals having registration with a any of the following severe co-morbidities
Government Authority under appropriate Act in following failure of less invasive methods of
the State/UT and complies with the following as weight loss:
minimum criteria: i. Obesity-related cardiomyopathy
• Has at least fifteen in-patient beds;
ii. Coronary heart disease
• Has minimum five qualified and registered
iii. Severe Sleep Apnea
AYUSH doctors;
iv. Uncontrolled Type2 Diabetes
• has qualified paramedical staff under its
employment round the clock; A waiting period of 3 years from the Policy Inception
Date shall be applicable for this Benefit.
• has dedicated AYUSH therapy sections;
• maintains daily records of patients and make 2.11 Psychiatric treatment Cover
these accessible to the insurance company’s We shall cover Medical Expenses for in-patient
authorized personnel treatment of the Insured Person during the Policy
Our maximum liability will be limited up to the amount Period maximum up to the limit as mentioned in the
provided in the Policy Schedule/Product Benefits Table. Policy Schedule/Product Benefits Table, provided the
Exclusion 3 (d) (3) does not apply to this Benefit. Hospitalization is for Medically Necessary Treatment
and prescribed in writing by a registered mental health
2.9 IVF Treatment Cover specialist or psychiatrist We shall also cover pre & post
We shall cover the Medical Expenses incurred by the hospitalization expenses related to such in-patient

OneHealth - MAGHLIP222V032021 8
 OneHealth
Insurance
psychiatric Hospitalization up to the no. of days as as part of day care treatment in a hospital (Section 2.4)
covered as per section 2.2 and 2.3 respectively. up to the Sum Insured, specified in the policy schedule,
For following mental disorders / conditions, shall be during the policy period:
covered after a waiting period of 36 months from Policy • Uterine Artery Embolization and HIFU (High
inception date and a sub-limit of Rs. 50,000 shall be intensity focused ultrasound)
applicable on cumulative basis. This sub-limit includes • Balloon Sinuplasty
pre and post hospitalization expenses for these specified
• Deep Brain stimulation
disorders.
• Oral chemotherapy
Name of condition/disorder ICD codes
• Immunotherapy- Monoclonal Antibody to be given
Severe Depression F30, F32, F33 as injection

Schizophrenia and Psychosis F20, F21, F22, F23, • Intra vitreal injections
F24, F25, F28, F29 • Robotic surgeries
Bipolar disorder F31, F34 • Stereotactic radio surgeries
• Bronchical Thermoplasty
Post-traumatic stress Disorder F43
• Vaporization of the prostrate (Green laser
Obsessive compulsive disorders F42 treatment or holmium laser treatment)
Panic disorders including anxiety F40, F41, F93, F94 • IONM - (Intra Operative Neuro Monitoring)
• Stem cell therapy: Hematopoietic stem cells for
Personality and related disorders F60, F44, F48
bone marrow transplant for haematological
2.12 Lasik Surgery Cover conditions to be covered.
We shall cover the Medical Expenses incurred by the Additional Benefits:
Insured Person during the Policy Period for undergoing This Policy offers the following additional benefits which
LASIK Surgery for correction of refractive error, shall be applicable to all Insured Persons as per the
maximum up to the limit as mentioned in the Policy Plan opted and mentioned in Policy Schedule. Benefits
Schedule/Product Benefits Table, provided that: under this Section are subject to the terms, conditions
a) the Insured Person has a refractive index of plus/ and exclusions of this Policy. Claims under this Section
minus 7.5 or more; and shall not impact the Sum Insured.
b) the procedure is prescribed as medically
2.15 Cumulative Bonus
necessary by a Medical Practitioner who is an
ophthalmologist. A waiting period of 3 years from In a Policy Year, if there are no claims paid or
the Policy Inception Date shall be applicable for outstanding under Section 2.1 to 2.14 and under
this Benefit. Section 2.26 & 2.31, then at the time of Renewal of the
Policy, We shall apply a Cumulative Bonus on the Sum
2.13 HIV/ AIDS Cover Insured for each such claim free Policy Year provided
We will cover the in-patient Hospitalization, Day care the Policy has been Renewed with Us without a break.
treatment and Pre-post Hospitalization expenses The percentage of the Sum Insured and maximum
incurred by Insured Person during the Policy Period as Cumulative Bonus that can be accrued shall be as per
per the Human Immunodeficiency Virus and Acquired the following:
Immune Deficiency Syndrome (Prevention and Control) a) Support plan: 10% of Sum Insured per claim
Act, 2017 and amendments thereafter due to condition free Policy Year up to a maximum of 50% of Sum
caused by or associated with HIV / AIDS, provided that: Insured
a. A sub-limit of Rs. 50,000 is applicable to this cover. b) Secure plan: 10% of Sum Insured per claim free
b. This benefit is provided subject to a Waiting Period Policy Year up to a maximum of 50% of Sum
of 4 years from Policy Inception date. Insured
such treatment is availed as per written prescription by c) Support Plus plan: 10% of Sum Insured per claim
a registered Medical Practitioner. free Policy Year up to a maximum of 100% of Sum
Pre Hospitalization and Post hospitalization days limit Insured
will be as applicable under section 2.2 and 2.3 of this d) Shield plan: 20% of Sum Insured per claim free
Policy. Policy Year up to a maximum of 100% of Sum
Insured
2.14 Modern treatment Procedures:
e) Premium plan: 33.33% of Sum Insured per claim
The following procedures will be covered (wherever
free Policy Year up to a maximum of 100% of
medically indicated) either as in patient (Section 2.1) or

OneHealth - MAGHLIP222V032021 9
 OneHealth
Insurance
Sum Insured The following conditions shall be e) This Benefit is only a value added service provided
applicable: by Us and does not deem to substitute Your
a) The sub-limits applicable to various Benefits visit or consultation to an independent Medical
will remain the same and shall not increase Practitioner;
proportionately with accrual of Cumulative Bonus f) You are free to choose whether or not to obtain
b) Cumulative Bonus which is accrued during a the e-opinion, and if obtained then whether or
claim free Policy Year shall be available to those not to act on it;
Insured Persons who were insured in such claim g) We shall not, in any event, be responsible for any
free Policy Year and continue to be insured in the actual or alleged errors or representations made
subsequent Policy Year; by any Medical Practitioner (including in any e-
c) If the Sum Insured is increased or decreased, opinion) or for any consequence of actions taken
Cumulative Bonus shall be calculated on the or not taken in reliance thereon;
basis of the Sum Insured of the last completed h) The e-opinion under this Policy shall be limited to
Policy Year and shall be capped to the maximum the covered Critical Illnesses set out below and not
amount of Cumulative Bonus on the Sum Insured be valid for any medical legal purposes;
as permitted under the plan;
i) We do not assume any liability towards any loss
d) Recharge Sum Insured shall not be considered for or damage arising out of or in relation to any
calculating Cumulative Bonus; opinion, Medical Advice, prescription, actual or
e) If a Cumulative Bonus has been applied and alleged errors, omissions and representations
a claim is made in any Policy Year, then in the made by the Medical Practitioner;
subsequent Policy Year We shall not decrease the j) For the purpose of this Benefit, covered Critical
accrued Cumulative Bonus except if, and to the Illness means:
extent, it is utilized as claim payout.
i. Cancer of Specified Severity
f) Cumulative Bonus shall be applicable on an
ii. Myocardial Infarction (First Heart Attack of
annual basis subject to the Renewal of the Policy;
specific severity)
g) The entire Cumulative Bonus shall be forfeited if
iii. Open Chest CABG
the Policy is not continued/Renewed before expiry
of the Grace Period. iv. Open Heart Replacement or Repair of Heart
Valves
h) The Cumulative Bonus shall be available for any
claims under sections 2.1 to 2.14 only, subject v. Coma of Specified Severity
always to any sub-limits mentioned therein. vi. Kidney Failure requiring Regular Dialysis

2.16 E-Opinion for Critical Illness vii. Stroke resulting in Permanent Symptoms

If You are diagnosed with a Critical Illness during the viii. Major Organ/Bone Marrow Transplant
Policy Period, then You may at Your sole discretion ix. Permanent paralysis of Limbs
choose to avail of a second e-opinion from Our panel x. Motor Neurone Disease with Permanent
of Medical Practitioners for the Critical Illness and We Symptoms
shall arrange for and cover the e-opinion, provided
xi. Multiple Sclerosis with Persisting Symptoms
that:
a) We have received a request from You to exercise 2.17 Annual Health Check-up
this option; We will arrange for a health check-up in accordance
b) The e-opinion will be based only on the with the plan specified in the Policy Schedule/Product
information and documentation provided by You Benefits Table, if requested by You. We will cover health
to Us, which shall be shared with the Medical check-ups arranged by Us through Our empanelled
Practitioner; Network Providers, provided that:
c) This Benefit can be availed only once during a a) This Benefit shall be available once per Policy Year
Policy Year and only once during the lifetime of per Insured Person who is Aged 26 and above.
an Insured Person for the same Critical Illness; b) This Benefit will be provided irrespective of any
d) This Benefit shall be available to only those Insured claim being made in the Policy Year.
Persons that are Aged 18 years or above on the
This Benefit is over and above the Sum Insured and
Policy Start Date and such Insured Persons are
cannot be carried forward if the Benefit is not availed
not covered under the Policy as the Policyholder’s
during the period as specified above.
child;

OneHealth - MAGHLIP222V032021 10
 OneHealth
Insurance
Health check-up test list is as below:
Support Plan Secure Plan Support Plus Shield Plan Premium Plan Any Plan with
plan Optional covers
Aggregate
Deductible and/
(If optional Covers Aggregate Deductible and/or Voluntary Co-payment are not opted) or Voluntary Co-
payment opted
CBC CBC CBC CBC CBC CBC
ESR ESR ESR ESR ESR ESR
Urine Routine Urine Routine Urine Routine Urine Routine Urine Routine Urine Routine
MER MER MER MER MER MER
Total Cholesterol Total Cholesterol Total Cholesterol Total Cholesterol Total Cholesterol Total Cholesterol
FBS FBS HbA1c HbA1c HbA1c FBS
Lipid Profile Lipid Profile Lipid Profile
ECG ECG
PSA (for males)/ PSA (for males)/
PAP smear (for PAP smear (for
females) females)
Liver Profile
Kidney Profile
Cardiac Risk Profile
Reference:
CBC- Complete Blood count
ESR- Erythrocyte Sedimentation rate
MER- Medical Examination Report
FBS- Fasting Blood Sugar
HbA1c- Glycated Haemoglobin test
ECG- Electrocardiogram
PSA- Prostate Specific Antigen

2.18 Fitness Rewards and Wellness Services b) Through Fitness Activities: You can also earn
1. Fitness Rewards Fitness Rewards points by engaging in physical
You can earn Fitness Rewards points in the manner set activities to keep Yourself active and healthy. If You
out below. do any of the following activities during the Policy
Year, We shall award you with Fitness Rewards
For Policies with Policy Period of one year, percentages
points equivalent to the percentage of premium
as mentioned in the table below shall apply. For Policies
paid as per the table below. You can take one
with Policy Period of 2 and 3 years, in order to calculate
or more activities amongst these any number of
the Fitness Rewards points, the Policy premium shall be
times in a Policy Year and Fitness Rewards points
divided by 2 and 3 respectively.
shall be awarded to You subject to the maximum
Further, for Individual Policies, percentages as Fitness Reward points as mentioned in the table
mentioned in the tables below would apply and for
below.
Family Floater Policies, percentages as mentioned in the
tables below divided by the number of Insured Persons • Participation and completion of marathon
who are covered other than as dependent children run (at least 10 Km)
under the Policy shall be applicable for the purpose of • Gym/Yoga /Zumba/ Dancing or any other
calculating the Fitness Rewards points. fitness centres’ membership for atleast one
a) Through Medical Check-up: If You avail of our year
Health Check-up Benefit and undergo the medical • Participation and completion of any other
tests at Our Network Providers and thereafter professional sport event
submit the medical test reports to Us, then if all c) You can also earn Fitness Rewards points by
the test results are within the normal range for the
participating in health programs or any health
respective tests, We shall award You with Fitness
initiatives sponsored by Us. Fitness Rewards points
Rewards points equivalent to the percentage of
for an activity can be earned only once per Insured
the premium paid as per the table below.
Person (who is covered other than as dependent

OneHealth - MAGHLIP222V032021 11
 OneHealth
Insurance
children under this Policy) in a Policy Year, under For availing above services, You can call our
this section. customer care number 1800 266 3202 or write
to Us on customercare@magma-hdi.co.in. Our
Activity Points to be earned
executive will help You for availing these services.
as a percentage of
existing Policy premium d) We may provide information on offers related to
healthcare services like consultation, diagnostics,
By availing our Health Check- 1%
medical equipment and pharmacy. Please visit
up Benefit
our website www.magma-hdi.co.in to know about
Participation and completion 1.5% such offers.
of marathon run (at least
10 Km) Terms and conditions under Fitness Rewards and
Wellness Services
Gym/Yoga/Zumba/Dancing 2%
or any other fitness centres’ * All relevant documents, reports, receipts etc for earning
membership for atleast one Fitness Rewards points must be submitted to Us within
year 60 days of undertaking such activity.
Participation and completion 2.5% * Wellness services are provided through empaneled
of any other Professional sport service providers as applicable and We are only acting
event as a facilitator. Therefore, We shall not be liable for any
incremental costs incurred or the services availed.
Participation in any Health 3%
Program sponsored by Us * The decision to utilize these advices/services is solely
and absolutely at Your discretion. You should consult
Maximum Fitness Rewards 10%
Your Medical Practitioner before availing/taking the
Points per Policy Year
Medical Advices/ services. We shall not be liable
In case We do not sponsor any event during the policy towards any loss or damage arising out of or in relation
year, We shall consider multiple claims for reward to any opinion, actual or alleged errors, omissions and
points for other fitness activities as specified above, representations suggested under this Benefit
and provide the points as specified against that activity, * There shall not be any cash redemption against the
subject always to the condition that maximum 10% of wellness points.
points can be earned per Policy Year.
* We, Our group entities, or affiliates, their respective
Redemption of Fitness Reward Points: directors, officers, employees, agents, vendors, shall
You can redeem the earned Fitness Reward points as not be responsible for or liable for, any actions,
discount on premium at the time of Renewal of the claims, demands, losses, damages, costs, charges
Policy. and expenses which any Insured Person claims to have
If You wish to know the present value of Fitness Rewards suffered, sustained or incurred, by way of and / or on
points earned, then You may contact Us at our toll free account of this Benefit.
number or through Our website. In any event, We shall Any wellness services offered hereunder are subject to
send You an updated statement of the value of the the guidelines issued by the IRDAI from time to time.
Fitness Rewards points earned on an annual basis on
We shall send You any notifications/communication
any of the contact details as provided by You.
required to be sent hereunder on your registered email
2.Wellness Services: ID or on Your registered contact number or through any
a) Doctor on call: You can consult with a Medical other mode as decided by Us.
Practitioner from Our panel of Network Providers 2.19 Early Joining Benefit
to discuss any health related query. You can avail
this service maximum 3 times per Policy Year. We shall provide You a one- time amount of Rs.2500
in 6th Policy Year if Policy is claim-free for 5 years from
b) Specialist’s e-opinion: You can avail a specialist
Policy Inception Date and an additional one-time
Medical Practitioner’s opinion on Your health
amount of Rs.5000 in 11th Policy Year if Policy is claim-
queries that require such specialist Medical
free for 10 years from Policy Inception Date provided
Practitioner’s consideration. We have a panel of
that:
specialist Medical
Practitioner in the field of pediatrics, gynaecology, a) The age of senior most member covered in the
cardiology, oncology and other major branches policy at the time of first purchase should be below
of medical science. You can avail this service 40 years, and the policy is renewed continuously
maximum 3 times per Policy Year. with Us;
c) Nutritional e-counselling: On Your request, We b) the Policy is claim-free since the Policy Inception
will provide You with a Dietician and nutritional Date;
e-counselling. You can avail this service maximum c) the amount provided under this Benefit can be
3 times per Policy Year. reimbursed for any out-patient Medical Expenses

OneHealth - MAGHLIP222V032021 12
 OneHealth
Insurance
including pharmacy . No direct cash benefit shall Policy Year, it shall not be carried forward to any
be offered under this Cover; and subsequent Policy Year.
d) the unutilized amount can be carried forwarded For any single claim during a Policy Year the
to the subsequent Policy Years. maximum claim amount payable shall be the sum
e) The benefit amount shall lapse if the Policy is not of:
renewed with Us. i. The Sum Insured
2.20 Green Channel Benefit ii. Cumulative Bonus
If You opt to avail of in-patient treatment on cashless During a Policy Year, the aggregate claim amount
basis in a PPN (preferred provider network) as specified payable, subject to admissibility of the claim, shall
by Us, We shall, in addition to the amount payable not exceed the sum of:
under Section 2.1 (Inpatient Care), provide a one- time i. The Sum Insured
amount for each such Hospitalization as reimbursement ii. Cumulative Bonus
against: iii. Recharge of Sum Insured up to 500% of Sum
a) expenses for any non-payable items with respect Insured
to that particular hospitalization, Or
b) expenses for any health wearable device 2.22 Hospital Cash
purchased by the insured after claim for such If You are Hospitalized during the Policy Period and
hospitalization is accepted if We have accepted an Inpatient Care claim under
Maximum amount provided under this benefit for each Section 2.1, then We shall, in addition, pay the daily
such hospitalization in PPN network is: cash amount specified in the Policy Schedule /Product
Benefits Table for each continuous and completed
– Rs. 1,000, if payable Inpatient Care claim amount
period of 24 hours of Hospitalization provided that:
is up to Rs. 50,000
a. You should have been Hospitalized for a minimum
– Rs. 2,000, if payable Inpatient Care claim amount
period of 48 hours continuously;
is above Rs. 50,000 List of PPN is available on
Our website www.magma-hdi.co.in b. We shall not make any payment under this Benefit
to You for more than 30 days of Hospitalization
2.21 Recharge of Sum Insured in total under any Policy Year.
We will provide 100% Recharge of the Sum Insured up c. We shall not make any payment under this Benefit
to 5 times in a Policy Year, provided that: for any diagnosis or treatment arising from or
a) The Sum Insured and Cumulative Bonus (if any) related to pregnancy (whether uterine or extra
is insufficient for a claim as a result of previous uterine), childbirth including caesarean section,
claims in that Policy Year; medical termination of pregnancy and/or any
b) The Recharge of Sum Insured shall not be treatment related to pre and post-natal care of
available for claims towards an Illness or Injury the New Born Baby.
(including complications) for which a claim has 2.23 Compassionate Visit in case of CI
been paid or accepted as payable in the current
Policy Year for the same Insured Person under If We have accepted Your claim for Hospitalization in
Inpatient Care under Section 2.1. This condition case of Critical Illness as per Section 2.1, then We shall
shall be applicable each time Recharge of Sum reimburse the amount up to the limit specified against
Insured is triggered. For any subsequent Recharge this Benefit in the Policy Schedule/Product Benefits
of Sum Insured, the illness or Injury (including Table, incurred in respect of a maximum of two of
any complications) must be unrelated to illness Your Immediate Family Members for two way airfare or
or injury for which claim has been paid earlier in two way first class railway ticket in a licensed common
the same policy year under In-patient Section or carrier to the place where You are Hospitalized provided
under Recharge of Sum Insured Section ; that:
c) The Recharge of Sum Insured shall be available a) You are Hospitalized in a Hospital which is situated
only in respect of Your future claims that become at a distance of at least 100 kilometres from Your
payable under Section 2 Base Covers of the Policy actual place of residence;
and shall not be applicable to the first claim in b) The attending Medical Practitioner recommends
the Policy Year; the personal attendance of an Immediate Family
d) For any one claim, Recharge of Sum Insured will Member;
be done maximum once. c) Travel by the Immediate Family Member to the
e) If the Policy issued is a Family Floater Policy, place of Hospitalization is commenced during the
then the Recharge of Sum Insured shall also be period of Your Hospitalization
available on a floater basis; d) This Benefit shall be provided only once per Policy
f) If the Recharge of Sum Insured is not utilized in a Year.

OneHealth - MAGHLIP222V032021 13
 OneHealth
Insurance
“Immediate Family Member” would mean spouse, only and will not include income from any other
children and dependent parents of the Insured sources.
Person. 3. In case Policyholder and Insured person are not Income
Tax Assessee: Monthly income will be assessed basis the
2.24 Loss of income benefit
income proof provided on self-declaration basis along
If We have accepted a claim for an Illness or Injury that with bank statements / any other income statements as
results in Permanent Total Disablement, then We shall proof for the past 12 months. However, for such cases
pay the amount (as lump sum) as specified against this income will be considered as lower of self- declared
Benefit in the Policy Schedule/Product Benefits Table.
amount or the income slab up to which individual is not
Permanent total disablement for the purpose of this an Income Tax Assessee (as per prevalent Income Tax
Benefit is defined as any injury or illness due to which act). We will pay up to a maximum of 6 monthly benefits
the Insured Person is disabled from engaging in his/ where each monthly benefit will be equal to 1/12th of
her primary occupation and loses his/her source of the Sum Insured or monthly income as declared by
income generation as a consequence thereof. Such you or 1/12th of the income as defined in the income
state of permanent total disablement must be certified tax slab for which an individual is not an Income Tax
by Medical Practitioner. Assessee.
1. In case of an Individual Policy : This Benefit shall be paid, subject to a valid admissible
a. In case of salaried Insured Persons: Monthly claim, only once during the lifetime of the Insured
amount equal to 1/12th of the Sum Insured or the Person.
Insured Person’s per month salary based on the
average of last 3 months salary slip, whichever is 2.25 Enhanced Daily Cash Benefit
lower shall be paid for a maximum of 6 months. A daily cash amount will be payable per day if You are
Net monthly income (post tax), that is, monthly hospitalized in a shared accommodation at a Network
in hand salary excluding overtime, bonuses, tips, Provider for each continuous and completed period
commissions or any other special compensation of 24 hours if the Hospitalization exceeds 48 hours,
shall be considered for the purpose of payout provided that
under this benefit; a) Our maximum liability shall be restricted to the
b. In case of self-employed Insured Persons: Monthly amount mentioned in the Policy Schedule/Product
amount equal to 1/12th of the Sum Insured or Benefits Table, and
monthly income based on the last income tax b) Complete duration of Hospitalization is in a shared
returns filed with the income tax department, accommodation
whichever is lower; shall be paid for a maximum
c) This Benefit shall not be applicable to the time
of 6 months. This payout shall consider income
spent by You in an Intensive Care Unit, and
from primary occupation only and shall not
include income from any other sources. d) A claim has been admitted by Us under Inpatient
Care under Section 2.1 above.
2. In case of a Family Floater Policy :
This allowance shall be paid in addition to the amount
a. In case of salaried Insured Persons: Monthly paid under Hospital Cash benefit (Section 2.22).
amount equal to 1/12th of the Sum Insured, or per
month salary of the Insured Person based on the 2.26 Home Treatment Additional Daily Cash Benefit
average of last 3 months salary slip of the Insured In case You opt for home care treatment by a service
Person, or per month salary of the Policyholder provider authorized by Us for an Illness or Injury which
based on the average of last 3 months salary slip otherwise would have required Hospitalization as an
of the Policyholder whichever is lower, shall be in-patient, then in addition to coverage for such home
paid for a maximum of 6 months. Net monthly hospitalization treatment expenses and Pre & post
income (post tax), that is, monthly in hand salary home hospitalization expenses up to the Sum Insured,
excluding overtime, bonuses, tips, commissions
We shall pay You a lump sum amount as Daily Cash
or any other special compensation shall be
Benefit for each completed day of such treatment as
considered for the purpose of payout under this
specified in the Product Benefits Table/ Policy Schedule.
benefit;
Such home care treatment shall be authorized and
b. In case of self-employed Insured Persons: Monthly provided by Our authorized service providers on the
amount equal to 1/12th of the Sum Insured, or per basis of Cashless facility. All other conditions and limits
month income of the Insured Person based on the in terms of number of days for Pre & post hospitalization
last income tax return filed with the income tax as specified in section 2.2 and 2.3 shall be applicable.
department, or monthly income of the Policyholder
The Daily Cash Benefit shall not be available for
based on the last income tax returns filed with the
treatment taken at home for following procedures
income tax department; whichever is lower shall
be paid for a maximum of 6 months. This payout - Chemotherapy
shall consider income from primary occupation - Dialysis

OneHealth - MAGHLIP222V032021 14
 OneHealth
Insurance
2.27 Companion Benefit Treatment of Your New Born Baby up to 90 days from
We will pay the amount specified in the Policy Schedule/ birth. Our maximum liability under this Benefit will be
Product Benefits Table for each continuous and subject to the limit specified in the Policy Schedule/
completed period of 24 hours of Hospitalization towards Product Benefits Table.
the expenses incurred by the person accompanying the You can add Your New Born Baby to this Policy after
Insured Person at the Hospital during such Insured 91 days from the date of birth of the New Born Baby,
Person’s treatment for an Illness or Injury provided that: subject to acceptance thereof as per Our underwriting
a. Such Insured Person who is Hospitalized is Aged guidelines and realization of applicable premium for
12 years or below. the remaining Policy Period.
b. The Insured Person should have been Hospitalized 3) Vaccination for New Born Baby
for a minimum period of 48 hours continuously; We will cover Reasonable and Customary Charges for
c. Such Hospitalization claim is payable as per vaccination expenses of the New Born Baby for the
Section 2.1 In-patient care. vaccinations as mentioned below until the New Born
d. We will not make any payment under this Benefit Baby completes one year irrespective of the end of the
for more than 15 days of Hospitalisation in total Policy Period. Our maximum liability under this Benefit is
under any Policy Year. up to the limit as defined in the Product Benefits Table/
Policy Schedule. This limit forms a part of the limit of
Such accompanying person may or may not be an
Benefit defined for Section 2.28- 2) (New Born Baby
Insured person under this Policy.
Cover) above.
2.28 Maternity Benefits Time Interval Vaccine Age
This Benefit is available for You or Your spouse provided
0-3 months BCG Birth to 2 weeks
both are legally married and are covered under the
same Family Floater Policy. If You are a widow, then this OPV Or OPV+ 0, 6, 10 weeks
Benefit can be availed only in respect of a pregnancy 6, 10 weeks
conceived by You when You and Your spouse were both DPT 6, 10 weeks
covered as Insured Persons during the Policy Period or Hepatitis B Birth, 6 weeks
under the immediately preceding Policy with Us.
Haemophilus 6, 10 weeks
A waiting period of 48 months from the Policy Inception inuenzae type B
Date shall be applicable for this Benefit. The following vaccine (Hib)
covers are available under this Benefit:
3- 6 months OPV or OPV+ IPV2 14 weeks
1)Maternity Cover
DPT 14 weeks
a) We shall cover Maternity expenses up to the
limit specified in the Product Benefits Table/ Hepatitis B 14 weeks
Policy Schedule for Hospitalization for the Haemophilus 14 weeks
delivery of Your child or for lawful medically inuenzae type B
necessary termination of pregnancy (including vaccine (Hib)
abortion and miscarriage required or arising due 9 months Measles 9 months
accidental injuries) maximum up to 2 deliveries
12 months Chicken pox 12 months
or termination of pregnancy during Your lifetime.
b) The following Medical Expenses are not covered 2.29 Outpatient Cover
under this Benefit: We will cover the Reasonable and Customary Charges
i) Medical Expenses in respect of the harvesting incurred for medically necessary consultations with a
and storage of stem cells when carried out Medical Practitioner on an out-patient basis to assess
as a preventive measure against possible Your health condition for any Illness. We will also cover
future Illnesses; the Reasonable and Customary Charges incurred
ii) Medical Expenses for ectopic pregnancy for undergoing any Diagnostic Tests prescribed by
which are covered under Inpatient Care the Medical Practitioner and medicines purchased
Benefit. under and supported with a Medical Practitioner’s
prescription. The amount payable under this Benefit
iii) Pre-hospitalization Medical Expenses and
shall be up to the sub-limit shown in the Policy Schedule/
Post- hospitalization Medical Expenses shall
Product Benefits Table.
not be covered under this Benefit.
We will also cover the Reasonable and Customary
2) New Born Baby Cover Charges for Dental Treatment, cost of spectacles,
If Hospitalization of a New Born Baby is required and contact lenses and hearing aids, once in 2 Policy Years
if We have accepted a claim under Maternity Cover with a sublimit of 30% of the annual limit for OPD
as mentioned above, then We will cover the Medical Treatment shown in the Policy Schedule/Product Benefits
Expenses incurred towards the Medically Necessary Table, that is, all the bills for these expenses within the

OneHealth - MAGHLIP222V032021 15
 OneHealth
Insurance
policy periods can be accumulated and claimed at ii) Our service provider will evaluate the request
once. and Your eligibility under the Policy and call
Initial waiting period of 30 days, pre-existing disease for more information or details, if required;
waiting period and specific disease waiting period shall iii) Our service provider will communicate
be applicable as specified in section 3 of the policy. within 24 hours of receiving the complete
information, directly to the Hospital as to
2.30 Convalescence Benefit whether the request for pre-authorization
We will pay a lump sum amount of Rs.20000/- towards has been approved or denied;
convalescence only once per Policy Year provided that iv) If the pre-authorization request is approved,
a claim has been admitted by Us under Inpatient Care Our service provider will directly settle the
under Section 2.1 above for Hospitalization beyond 15 claim with the Hospital. Any additional costs
consecutive and completed days. or expenses incurred by You beyond the
limits pre-authorized by the service provider
2.31 Worldwide Emergency Hospitalization Cover shall be borne by You;
We will cover the Medical Expenses incurred outside v) We shall not cover any costs or expenses
India in relation to You , up to the limits specified in the incurred in relation to any persons
Policy Schedule/Product Benefits Table, provided that: accompanying You during the period of
a) Such Medical Expenses are incurred with respect Hospitalization, even if such persons are
to Medically Necessary Treatment, where such also Insured Persons.
treatment has been certified as an Emergency by Exclusion 3 (d) (38) & 3 (d) 40 do not apply to this
a Medical Practitioner and cannot be postponed Benefit.
until You have returned to India and is payable
as per Section 2.1 of the Policy; 2.32 Air Ambulance Cover
b) The Medical Expenses payable shall be limited to We shall cover the expenses up to the limit specified
Inpatient Care only; in the Policy Schedule/Product Benefits Table that are
incurred towards Your transportation in an airplane
c) Any payment under this Benefit shall be on a
or helicopter certified to be used as an ambulance
cashless basis or reimbursed only in Indian
to the nearest Hospital with adequate facilities in an
rupees; Emergency following an Illness or Injury which occurs
d) The payment of any claim under this Benefit during the Policy Period provided that:
shall be based on the rate of exchange as on a. Such transportation of You cannot be provided by
the date of payment to the Hospital published by a road ambulance;
the Reserve Bank of India (RBI) and shall be used
b. Your claim for Hospitalization in the Hospital You
for conversion of foreign currency into Indian
are transported to is admissible under Section 2.1
rupees for payment of claim. Where, on the date
of this Policy;
of discharge, if RBI rates are not published, the
exchange rate next published by the RBI shall be c. Medically Necessary Treatment is not available at
considered for conversion; the location where You are situated at the time of
the Emergency;
e) Each admissible claim shall be subject to a
Deductible of as specified in Product Benefit Table/ d. Your medical evacuation is prescribed by a
Policy Schedule; Medical Practitioner and is medically necessary;
f) Our overall liability will be limited to 50% of the e. You are situated in India and the treatment is
Sum Insured up to a maximum of Rs.20 lacs; required in India only and not overseas in any
condition whatsoever;
g) This Benefit is available on a worldwide basis;
f. The air ambulance provider is registered in India;
h) Recharge of Sum Insured shall not be available
g. Expenses incurred towards Your return
for this Benefit;
transportation by air ambulance is excluded
i) This Benefit is available as Cashless facility through under this Benefit.
pre-authorization by Our service provider as well
as on a re- imbursement basis through Us. Process Optional Covers
for Cashless facility through pre-authorization by All Optional Covers issued under this Policy shall be
Our service provider is as mentioned below: subject to the terms, conditions and exclusions of this
i) In the event of an Emergency, You shall call Policy. All other Policy terms, conditions and exclusions
Our service provider immediately, maximum shall remain unchanged.
within 24 hours of such hospitalization, on Critical Illness Cover and Personal Accident Cover shall
the helpline number specified in the Policy be applicable for the Insured Person(s) with respect to
Schedule, requesting for a pre- authorization whom these covers are opted by paying additional
for the medical treatment required; premium and upon acceptance by Us and are specified

OneHealth - MAGHLIP222V032021 16
 OneHealth
Insurance
in the Policy Schedule. The limits for these Optional Accident anywhere in the world, and causes any of the
Covers are applicable for each Insured Person. following events, then We shall pay the Insured Person
Optional Covers Aggregate Deductible and Voluntary or his/her nominee as the case may be, the amount(s)
Co-pay, if opted shall be applicable to all the Insured hereinafter set forth.
Persons under the Policy. Events covered:
Other Optional Covers, if opted shall also be applicable a) Accidental Death
to all the Insured Persons under the Policy and claims If such Injury results in the death of the Insured
under any of these optional covers shall impact the Person within twelve calendar months from the
Cumulative Bonus in this Policy. date of the Accident, then We will pay the Sum
1. Critical Illness Cover Insured stated in the Policy Schedule/Product
Benefits Table.
We shall pay the amount as specified in the Policy
Schedule/Product Benefits Table against this Benefit as b) Permanent Total Disablement
a lump sum in addition to payment made by Us under 1. If such Injury, within twelve calendar months from
Section 2.1, if any, provided that: the date of the Accident, results in any of the
i. The Insured Person is first diagnosed as suffering following, then as per the table below, We shall
from a Critical Illness during the Policy Period, and pay a lump sum amount equal to the percentage
of limit as mentioned for Personal Accident Benefit
ii. The Insured Person survives for at least 30 days in the Product Benefits Table /Policy Schedule,
following such diagnosis.
We will not make any payment under this Benefit if the Nature of Disablement Percentage of Limit
Insured Person is first diagnosed as suffering from a for Personal Accident
Critical Illness within 90 days of the Policy Start Date Cover payable
from which this Optional Cover was opted with respect Total and irrecoverable loss of 100%
to that Insured Person. This Benefit can be availed by sight of both eyes
the Insured Person only once during his/her lifetime. No Actual loss by physical separation 100%
claim under this Benefit will be admissible in case any of two entire hands
of the Critical Illnesses is a consequence of or arises Actual loss by physical separation 100%
out of any Pre-Existing Disease within 48 months of of two entire feet
first policy Start date. Such Pre-Existing Illness declared
by You and accepted by Us at the time of first Policy Actual loss by physical separation 100%
issuance. of one entire hand and one
entire foot
For the purpose of this Benefit, covered Critical Illness
means: Total & irrecoverable loss of sight 50%
of one eye
i. Cancer of Specified Severity
Actual loss by physical separation 50%
ii. Myocardial Infarction (First Heart Attack of specific of one entire hand or of one
severity) entire foot
iii. Open Chest CABG Total and irrecoverable loss of 50%
iv. Open Heart Replacement or Repair of Heart Valves use of a hand or a foot without
v. Coma of Specified Severity physicalseparation
vi. Kidney Failure requiring Regular Dialysis If such Injury shall, as a 100%
vii. Stroke resulting in Permanent Symptoms direct consequence thereof,
immediately, permanently, totally
viii. Major Organ/Bone Marrow Transplant
and absolutely, disable the
ix. Permanent paralysis of Limbs Insured Person from engaging in
x. Motor Neurone Disease with Permanent Symptoms any employment or occupation
xi. Multiple Sclerosis with Persisting Symptoms of any description
If a claim becomes admissible under this Benefit, this For the purpose of Clause 1. above, physical separation
Optional Cover shall not be available for that Insured of a hand means separation at or above the wrist and
Person at the time of Renewal. of the foot means separation at or above the ankle.
Any Mandatory Co-Payment, Voluntary Co-Payment, If a claim becomes admissible under this Benefit where
Aggregate Deductible or Zone based Co-Payment shall the claim paid is 100% of the limit under this Optional
not be applicable for claim payment under this Benefit. cover, then this Optional Cover shall not be available
for that Insured Person at the time of Renewal.
2. Personal Accident Cover
Any Mandatory Co-Payment, Voluntary Co-Payment,
If at any time during the Policy Period, the Insured Person Aggregate Deductible or Zone based Co-Payment shall
sustains an Injury resulting solely and directly due to an not be applicable for claim payment under this Benefit.

OneHealth - MAGHLIP222V032021 17
 OneHealth
Insurance
3. Aggregate Deductible a. You should have been Hospitalized for a minimum
If this cover is opted, the Policy becomes a Top-up policy period of 48 hours continuously;
wherein claim in a Policy Year becomes payable by Us b. We shall not make any payment under this Benefit to
only after deductible limit is crossed. A deductible does You for more than 10 days of Hospitalisation in total
not reduce Sum Insured. under any Policy Year.
The Insured Person shall bear on his/her own account Any payment under this optional cover will be in
an amount equal to the Deductible specified in the addition to benefit under section 2.22 (Hospital Cash),
Policy Schedule for any and all claim amounts We if applicable.
assess to be payable by Us in respect of all claims 6. Bonus Booster:
made by the Insured Person under the Policy for a Policy
If this optional cover is in force, the percentage of the
Year. Our liability to make payment under the Policy in
Sum Insured and maximum Cumulative Bonus that can
respect of any claim made in that Policy Year will only
be accrued as defined in Section 2.15 “Cumulative
commence once the Deductible has been exhausted
Bonus” of this Policy, shall be modified as 20% of Sum
during the Policy Year.
Insured per claim free Policy Year up to a maximum of
The Deductible shall apply on individual basis in case of 100% of Sum Insured, for Support, Secure and Support
individual policy and on floater basis in case of floater Plus plans:
policy.
All other terms and conditions as defined in Section 2.15
Only the expenses incurred by You under the following “Cumulative Bonus” of this Policy, remain unchanged.
Sections of this Policy, subject to any sublimit therein and
Zone based Co-Payment as per Section 5 (31), which 7. Maternity Benefits Optional Cover:
otherwise would have been payable under Your Plan, This Benefit is available for You or Your spouse provided
shall be considered for Deductible- Base Covers (i.e. both are legally married and are covered under the
Section 2.1 to Section 2.14), Section 2.28, , Section same Family Floater Policy. If You are a widow, then this
2.31 and Section 2.32. Benefit can be availed only in respect of a pregnancy
conceived by You when You and Your spouse were both
It is further agreed that Mandatory Co-Payment and
covered as Insured Persons during the Policy Period or
Voluntary Co-Payment, if opted under this Policy shall
under the immediately preceding Policy with Us.
be applicable after the Deductible has been exhausted.
If any room rent limit or room type limit is applicable
All claim documents must be submitted even for the
to your plan as per section 2.1 (Inpatient Care), then
claims which are within the Deductible limit.
such limits shall also be applicable for any claims under
If We have admitted a claim under the Policy to which this optional cover as well.
the provisions of Section 5(4) are applicable, then:
A waiting period of 48 months from the Policy Start
a) the provisions in Section 5(4) will apply only to any date of the Policy with which this optional cover was
amounts payable by Us in respect of a claim made opted and renewed continuously thereafter, shall be
by the Insured Person after the Deductible has been applicable for this Benefit.
exhausted; and The following covers are available under this Benefit:
4. Voluntary Co-Payment i) Maternity Cover
For each and every claim You shall bear the percentage a) We shall cover Maternity expenses up to the limit
of admissible claim amount as opted by You under this specified in the Product Benefits Table/ Policy
Optional Cover and mentioned on Your Policy Schedule Schedule for Hospitalization for the delivery
irrespective of the Your Age. of Your child or for lawful medically necessary
Such Voluntary Co-Payment shall not be applicable to termination of pregnancy (including abortion and
any claim amount payable under following Sections of miscarriage required or arising due accidental
this Policy: Section 2.16 to Section 2.20, Section 2.22 injuries) maximum up to 2 deliveries or termination
to Section 2.25 and Section 2.27. of pregnancy during Your lifetime.
Co-payment applicable as per this Cover shall be in b) The following Medical Expenses are not covered
addition to any other Co-payment (Mandatory Co- under this Benefit:
Payment, Co- payment for treatment in higher zone) i) Medical Expenses in respect of the harvesting
applicable under this Policy. and storage of stem cells when carried out as
5. Hospital Cash Optional Cover a preventive measure against possible future
Illnesses;
If You are Hospitalized during the Policy Period and
if We have accepted an Inpatient Care claim under ii) Medical Expenses for ectopic pregnancy which
Section 2.1, then We shall, in addition, pay the daily are covered under Inpatient Care Benefit.
cash amount specified in the Policy Schedule /Product iii) Pre-hospitalization Medical Expenses and Post-
Benefits Table for each continuous and completed hospitalization Medical Expenses shall not be
period of 24 hours of Hospitalization provided that: covered under this Benefit.

OneHealth - MAGHLIP222V032021 18
 OneHealth
Insurance
Our maximum liability under this Benefit will be subject to the The Daily Cash Benefit shall not be available for
limit specified in the Policy Schedule/Product Benefits Table. treatment taken at home for following procedures
ii) New Born Baby Cover - Chemotherapy
If Hospitalization of a New Born Baby is required and - Dialysis
if We have accepted a claim under Maternity Cover 9. Enhanced Pre & Post hospitalization Cover
as mentioned above, then We will cover the Medical
If this optional cover is in force, the limit of coverage in
Expenses incurred towards the Medically Necessary
terms of number of days immediately prior to Your date
Treatment of Your New Born Baby up to 90 days from
of Hospitalization and , the limit of coverage in terms
birth. Our maximum liability under this Benefit will be
of number of days immediately after Your discharge
subject to the limit specified in the Policy Schedule/
from the Hospital as per Section 2.2 and 2.3 of this
Product Benefits Table.
Policy will be 60 days and 90 days respectively.
iii) Vaccination for New Born Baby All other terms and conditions as defined in Section
We will cover Reasonable and Customary Charges for 2.2 and 2.3 i.e. “Pre- Hospitalisation Expenses” and
vaccination expenses of the New Born Baby for the “Post- Hospitalisationl Expenses” of this Policy, remain
vaccinations as mentioned below until the New Born unchanged.
Baby completes one year irrespective of the end of the
10. Worldwide Emergency Hospitalization Optional
Policy Period. Our maximum liability under this Benefit is
up to the limit as defined in the Product Benefits Table/ Cover
Policy Schedule. This limit forms a part of the limit of We will cover the Medical Expenses incurred outside
Benefit defined for New Born Baby Cover under this India in relation to You , up to the limits specified in the
optional cover as stated above. Policy Schedule/Product Benefits Table, provided that:
Time Interval Vaccine Age a) Such Medical Expenses are incurred with respect to
Medically Necessary Treatment, where such treatment
0-3 months BCG Birth to 2 weeks has been certified as an Emergency by a Medical
OPV Or 0,6,10 weeks Practitioner and cannot be postponed until You have
OPV+ 6,10 weeks returned to India and is payable as per Section 2.1 of
DPT 6,10 weeks the Policy;
Hepatitis B Birth, 6 weeks b) The Medical Expenses payable shall be limited to
Haemophilus 6,10 weeks Inpatient Care only;
influenzae type B c) Any payment under this Benefit shall be on a cashless
vaccine(Hib) basis or reimbursed only in Indian rupees;
3-6 months OPV or OPV+ 14 weeks d) The payment of any claim under this Benefit shall
IPV2 be based on the rate of exchange as on the date of
DPT 14 weeks payment to the Hospital published by the Reserve
Hepatitis B 14 weeks Bank of India (RBI) and shall be used for conversion
Haemophilus 14 weeks of foreign currency into Indian rupees for payment of
influenzae type B claim. Where, on the date of discharge, if RBI rates are
vaccine(Hib) not published, the exchange rate next published by the
RBI shall be considered for conversion;
9 months Measels 9 months
e) Each admissible claim shall be subject to a Deductible
12 months Chicken pox 12 months
of Rs. 2 Lakh
8. Home treatment Additional Daily Cash Optional f) Our overall liability will be limited to 50% of the Sum
Cover Insured up to a maximum of Rs.10 lakh;
In case You opt for home care treatment by a service g) This Benefit is available on a worldwide basis;
provider authorised by Us for an Illness or Injury which
h) Recharge of Sum Insured shall not be available for this
otherwise would have required Hospitalization as an
Benefit;
in-patient, then in addition to coverage for such home
hospitalization treatment expenses and Pre & post i) This Benefit is available as Cashless facility through
home hospitalization expenses up to the Sum Insured, pre-authorization by Our service provider as well as
We shall pay You a lump sum amount as Daily Cash on a re-imbursement basis through Us. Process for
Benefit for each completed day of such treatment as Cashless facility through pre-authorization by Our
specified in the Product Benefits Table/ Policy Schedule. service provider is as mentioned below:
Such home care treatment shall be authorized and i) In the event of an Emergency, You shall call Our
provided by Our authorized service providers on the service provider immediately, maximum within 24
basis of Cashless facility. All other conditions and limits hours of such hospitalization, on the helpline number
in terms of number of days for Pre & post hospitalization specified in the Policy Schedule, requesting for a pre-
as specified in section 2.2 and 2.3 shall be applicable. authorization for the medical treatment required;

OneHealth - MAGHLIP222V032021 19
 OneHealth
Insurance
ii) Our service provider will evaluate the request and Your the extant IRDAI (Health Insurance) Regulations then
eligibility under the Policy and call for more information waiting period for the same would be reduced to the
or details, if required; extent of prior coverage.
iii) Our service provider will communicate within 24 hours d) Coverage under the policy after the expiry of above
of receiving the complete information, directly to the defined months for any pre-existing disease is subject
Hospital as to whether the request for pre-authorization to the same being declared at the time of application
has been approved or denied; and accepted by us.
iv) If the pre-authorization request is approved, Our
service provider will directly settle the claim with the 3.1.4) Specific Diseases Waiting Period (Code- Excl02):
Hospital. Any additional costs or expenses incurred a) Expenses related to the treatment of the following listed
by You beyond the limits pre-authorized by the service conditions, surgeries/treatments shall be excluded until
provider shall be borne by You; the expiry of 24 months of continuous coverage, as may
v) We shall not cover any costs or expenses incurred in be the case after the date of inception of the first policy
relation to any persons accompanying You during the with the Insurer. This exclusion shall not be applicable
period of Hospitalization, even if such persons are also for claims arising due to an accident.
Insured Persons. b) In case of enhancement of sum insured the exclusion
Exclusion 4 (d) (38) & 4 (d) 40 do not apply to this Benefit. shall apply afresh to the extent of sum insured increase.
c) If any of the specified disease/procedure falls under
Section 3. Waiting Periods and Exclusions the waiting period specified for pre-Existing diseases,
3.1 Waiting Periods: then the longer of the two waiting periods shall apply.
We shall not be liable to make any payment under d) The waiting period for listed conditions shall apply even
this Policy for any claim in connection with, caused by, if contracted after the policy or declared and accepted
arising out of, or in respect of, or howsoever attributable without a specific exclusion.
to the following expenses till the expiry of waiting period e) If the Insured Person is continuously covered without
mentioned below: any break as defined under the applicable norms on
portability stipulated by IRDAI, then waiting period
3.1.1) First Thirty Days Waiting Period (Code- Excl03) for the same would be reduced to the extent of prior
i. Expenses related to the treatment of any illness within coverage.
30 days from the first policy commencement date shall List of these diseases is:
be excluded except claims arising due to an accident,
1. Cataract
provided the same are covered.
2. Stones in biliary and urinary systems
ii. This exclusion shall not, however, apply if the Insured
Person has Continuous Coverage for more than twelve 3. Hernia / Hydrocele
months. 4. Hysterectomy for any benign disorder
iii. The within referred waiting period is made applicable 5. Lumps / cysts / nodules / polyps / internal tumours
to the enhanced sum insured in the event of granting 6. Gastric and Duodenal Ulcers
higher sum insured subsequently. 7. Surgery on tonsils / adenoids
3.1.2) 90 days Initial Waiting Period for Optional Cover- 8. Osteoarthrosis / Arthritis / Gout / Rheumatism
Critical Illness Cover / Spondylosis / Spondylitis / Intervertebral Disc
Prolapse
The lump sum benefit shall not be payable for any
Critical Illness claims arising in the first 90 days from the 9. Fissure / Fistula / Haemorrhoid
Policy Start Date from which the Critical Illness optional 10. Sinusitis / Deviated Nasal Septum / Tympanoplasty
cover was opted and Renewed continuously thereafter. / Chronic Suppurative Otitis Media
11. Benign Prostatic Hypertrophy
3.1.3) Pre-Existing Diseases (Code- Excl01):
12. Knee/Hip Joint replacement and any ligament,
a) Expenses related to the treatment of a pre-existing
tendon or muscle tear
Disease (PED) and its direct complications shall be
excluded until the expiry of 48 months (for Support 13. Dilatation and Curettage
Plan) ; 36 months (for Secure, Support Plus and Shield 14. Varicose veins
Plan) ; 24 months (for Premium Plan); of continuous 15. Dysfunctional Uterine Bleeding / Fibroids /
coverage after the date of inception of the first policy Prolapse Uterus / Endometriosis
with us. 16. Chronic Renal Failure or end stage Renal Failure
b) In case of enhancement of sum insured the exclusion 17. Internal congenital anomalies/diseases/defects
shall apply afresh to the extent of sum insured increase.
c) If the Insured Person is continuously covered without 3.1.5) A special waiting period, not exceeding 48 months,
any break as defined under the portability norms of may be applied to individual Insured Persons depending

OneHealth - MAGHLIP222V032021 20
 OneHealth
Insurance
upon the declarations made in the proposal form and immediate health risk to the insured. For
existing health conditions. Such waiting periods shall this to be considered a medical necessity, it
be specifically stated in the Policy Schedule and will must be certified by the attending Medical
be applied only after receiving the Insured Person’s Practitioner.
specific consent. Any special waiting period in respect 11. Dental Treatment including Surgical Procedures
of Pre- Existing diseases shall not exceed 48 months. for the treatment of bone disease when related
to gum disease or damage, or treatment for,
3.2 Permanent Exclusions or treatment arising from, disorders of the
We will not be liable to make any payment under this temporomandibular joint. This exclusion does not
Policy under any circumstances, for any claim in respect apply for Outpatient Cover (Section2.29)
of any Insured Person, directly or indirectly for, caused EXCEPTION: We will pay for a Surgical Procedure
by or arising from or in any way attributable to any of wherein the Insured Person Hospitalized as a
the following permanent exclusions:- result of an Accident and which is undertaken for
1. Treatment for, Alcoholism, drug or substance abuse Inpatient Care in a Hospital and carried out by a
or any addictive condition and consequences Medical Practitioner.
thereof. (Code- Excl12) 12. Any drugs or Surgical dressings that are provided
2. Hazardous or Adventure sports: (Code- or prescribed in the case of OPD treatment, or for
Excl09): Expenses related to any treatment the Insured Person to take home on leaving the
necessitated due to participation as a professional Hospital, for any condition, except as included
in hazardous or adventure sports, including but in Post- hospitalization Medical Expenses under
not limited to, para-jumping, rock climbing, Section 2.3 above. This exclusion does not apply
mountaineering, rafting, motor racing, horse to Outpatient Cover (Section 2.29)
racing or scuba diving, hand gliding, sky diving, 13. Refractive Error (Code Excl15)
deep-sea diving. Expenses related to the treatment for correction
3. Any Alternative Treatment except for the Benefits of eye sight due to refractive error less than 7.5
under Section 2.8 (AYUSH Treatment) dioptres
4. Charges related to a Hospital stay not expressly 14. We will not pay for routine eye examinations,
mentioned as being covered. ]. Service charges contact lenses spectacles, hearing aids, dentures
levied by the Hospital under whatever head. and artificial teeth. This exclusion does not apply
Complete list of these excluded expenses are for Outpatient Cover (Section 2.29)
mentioned in Annexure II of this Policy The list is 15. Treatment received in heath hydros, nature cure
available on our website www.magma hdi.com. clinics, spas or similar establishments or private
This exclusion does not apply for Section 2.20 beds registered as a nursing home attached
(Green Channel Benefit) to such establishments or where admission is
5. Expenses for Artificial life maintenance, including arranged wholly or partly for domestic reasons.
life support machine used to sustain a person, Code- Excl13
incurred after confirmation by the treating doctor 16. Any treatment arising from and/or taken for
that the patient is in vegetative state Crohn’s Disease, Ulcerative colitis, Cystic
kidneys, Neurofibromatosis, Factor V Leiden
6. Any charges incurred to procure any medical
Thrombophilia, Familial Hypercholesterolemia,
certificate, medical records, treatment or Illness/
Haemophilia, Hereditary Fructose Intolerance,
Injury related documents pertaining to any
Hereditary Hemochromatosis, Hereditary
period of Hospitalization/Day Care Treatment
Spherocytosis.
undertaken for any Illness or Injury.
17. Private nursing/attendant’s charges incurred
7. Circumcision unless necessary for the treatment
during pre-hospitalization or post-hospitalization.
of an Illness or disease or necessitated by an
Accident. 18. Drugs or treatment not supported by prescription.
8. Treatment for any Illness or Injury resulting from 19. Issue of fitness certificate and fitness examinations.
nuclear or chemical contamination, war, riot, 20. Any charges incurred to procure any treatment/
revolution or acts of terrorism (other than natural Illness related documents pertaining to any period
disaster or calamity). of Hospitalization/Illness.
9. Treatment for any External Congenital Anomaly. 21. External and/ or durable medical/non-medical
equipment used for diagnosis and/ or treatment,
10. Cosmetic or Plastic Surgery (Code Excl08)
CPAP, CAPD, infusion pump.
i. Expenses for cosmetic or plastic surgery or
22. Ambulatory devices, walkers, crutches, belts,
any treatment to change appearance unless collars, caps, splints, slings, braces, stockings
for reconstruction following an Accident, of any kind, diabetic foot wear, glucometer/
Burn(s) or Cancer or as part of medically thermometer and also any medical equipment
necessary treatment to remove a direct and which is subsequently used at home.

OneHealth - MAGHLIP222V032021 21
 OneHealth
Insurance
23. OPD treatment is not covered. 34. Treatment provided by a Medical Practitioner who
However this exclusion does not apply for: is not recognized by the Medical Council of India.
a. Outpatient Cover (Section 2.29) 35. Excluded Providers (Code Excl11)
b. Vaccination for New Born Baby (Section Expenses incurred towards treatment in any
2.28 (3)) hospital or by any Medical Practitioner or any
24. All preventive care, vaccination including other provider specifically excluded by the Insurer
inoculation and immunisations except in case of and disclosed in its website / notified to the
Vaccination for New Born Baby (Section 2.28 (3)) policyholders are not admissible. However, in
case of life threatening situations or following an
25. Sterility and Infertility (Code Excl17)
accident, expenses up to the stage of stabilization
ii. Expenses related to sterility and infertility. This are payable but not the complete claim.
includes:
List of these have been provided on Our website.
(i) Any type of contraception, sterilization
36. Treatment provided by anyone with the same
(ii) Assisted Reproduction services including
residence as the Insured Person or who is a
artificial insemination and advanced
member of the Insured Person’s immediate family.
reproductive technologies such as IVF, ZIFT,
GIFT, ICSI 37. Investigation & Evaluation (Code Excl04):
(iii) Gestational Surrogacy a) Expenses related to any admission primarily
(iv) Reversal of sterilization for diagnostics and evaluation purposes only
Note: This exclusion shall not apply for IVF are excluded.
treatment (as per Section 2.9 IVF Treatment Cover). b) Any diagnostic expenses which are not
26. Maternity expenses (Code Excl18) related or not incidental to the current
diagnosis and treatment are excluded.
i. Medical treatment expenses traceable to childbirth
(including complicated deliveries and caesarean 38. X-Ray or laboratory examinations or other
sections incurred during hospitalization) except diagnostic studies, not consistent with or incidental
ectopic pregnancy; to the diagnosis and treatment of the positive
ii. Expenses towards miscarriage (unless due to existence or presence of any Illness or Injury,
an accident) and lawful medical termination of whether or not requiring Hospitalization.
pregnancy during the policy period. 39. Rest Cure, Rehabilitation and respite Care
Note: This exclusion does not apply to Maternity (Code Excl05)
Benefits (Section 2.28) Expenses related to any admission primarily for
27. Treatment for, or arising from, an Injury that is enforced bed rest and not for receiving treatment.
intentionally self-inflicted, including attempted This also includes:
suicide. i. Custodial care either at home or in a nursing
28. Change of Gender treatment (Code Excl07) facility for personal care such as help with
Expenses related to any treatment, including activities of daily living such as bathing,
surgical management, to change characteristics dressing, moving around either by skilled
of the body to those of the opposite sex. nurses or assistant or non-skilled persons.
29. Treatment of any sexual problem including ii. Any services for people who are terminally
impotence (irrespective of the cause) or erectile ill to address physical, social, emotional and
dysfunction. spiritual needs.
30. Treatment for any sexually transmitted disease, 40. Breach of law (Code Excl10)
including Genital Warts, Syphilis, Gonorrhoea, iii. Expenses for treatment directly arising from or
Genital Herpes, Chlamydia, Pubic Lice and consequent upon any Insured Person committing
Trichomoniasis. or attempting to commit a breach of law with
31. Treatment for sleep apnea, snoring, or any other criminal intent.
sleep-related breathing problem. 41. Dietary supplements and substances that can
32. Any treatment received outside India. This be purchased without prescription including but
exclusion does not apply for Section 2.31 not limited to Vitamins, minerals and organic
(Worldwide Emergency Hospitalization Cover). substances unless prescribed by a medical
33. Unproven treatments (Code Excl16) practitioner as part of hospitalization claim or day
Expenses related to any unproven treatment, care procedure. Code- Excl14
services and supplies for or in connection
with any treatment. Unproven treatments are Section 4 Claim Procedure
treatments, procedures or supplies that lack Provided that due adherence/observance and fulfilment of
significant medical documentation to support their the terms and conditions of this Policy (conditions and all
effectiveness endorsements hereon are to be read as part of this Policy)

OneHealth - MAGHLIP222V032021 22
 OneHealth
Insurance
shall so far as they relate to anything to be done or not to 2. For admission in Non-Network Provider or into
be done by You and / or any Insured Person be a Condition Network Provider if Cashless facility is not availed
Precedent to admission of Our liability under this Policy. (Re- imbursement Claims) (For Domestic Claims
On the occurrence or the discovery of any Illness or Injury as well as Worldwide Emergency Hospitalization)
that may give rise to a claim under this Policy, then as a a. Intimation of claim: Preliminary intimation of
Condition Precedent to Our liability under the Policy, the claim with particulars relating to Policy Number,
following procedure shall be complied with: name of the Insured Person in respect of whom
1. a) For Availing Cashless Facility (Procedure for claim is made, nature of Illness/Injury and name
Domestic Claims ) and address of the attending Hospital, must be
provided to Us at least 72 hours before admission
Cashless facility can be availed only at Our Network to the Hospital in case of planned Hospitalization,
Providers. The complete list of Network Providers is and within 24 hours of admission in the Hospital,
available on Our website and at Our branches and can in case of Emergency Hospitalization.
also be obtained by contacting Us over the telephone.
3. Submission of claim: The claim form along with the
The updated list of TPA containing complete details is
attending Medical Practitioner’s certificate duly filled
available on Our website www.magma-hdi.co.in and
and signed in all respects with the following claim
is also attached as [Annexure IV].
documents will be submitted to Us not later than 30
Cashless facility will be availed through the TPA. The TPA days from the date of discharge from the Hospital.
will be contacted on its helpline and must be provided
Mandatory documents
with the membership number, Policy Number and the
name of the Insured Person at least 72 hours before a. Duly completed claim form
admission to the Hospital for planned Hospitalization b. Test reports and prescriptions relating to first /
and within 24 hours of admission to the Hospital in case previous consultations for the same or related
of Emergency Hospitalization. The TPA will also, by fax illness.
or e-mail, be provided with details of Hospitalization c. Case history / admission-discharge summary
like diagnosis, name of the Hospital, duration of stay describing the nature of the complaints and its
in the Hospital, estimated expenses of Hospitalization duration, treatment given, advice on discharge
etc. in the prescribed form available with the insurance etc. issued by the Hospital.
help desk at the Hospital. Any additional information as d. Death summary in case of death of the Insured
may be required by the medical panel of the TPA must Person at the Hospital.
also be furnished. After establishing the admissibility of
e. Post Mortem Report, if applicable & if conducted
the claim under the Policy, the TPA shall provide a pre-
authorisation to the Hospital guaranteeing payment of f. Hospital receipts / bills / cash memos in original
the Hospitalization expenses subject to the Sum Insured, (including advance and final Hospital settlement
terms conditions and limitations of the Policy. The receipts).
authorization shall be issued to the Network Provider g. All test reports for X-rays, ECG, Scan, MRI,
within 24 hours of receiving the complete information. Pathology etc., including the Medical Practitioner’s
prescription advising such tests/investigations
For availing Home treatment, You can contact Our
(CDs of angiogram, surgery etc. need not be sent
Authorized Home care provider. The updated list of
unless specifically sought).
Our authorized Home care provider is available on
Our website www.magmahdi.com. You can also call h. Medical Practitioner’s prescriptions with cash
at our customer care number 1800 3002 3202 for bills for medicines purchased from outside the
information and assistance. The Home care provider Hospital.
shall evaluate Your eligibility and, if Home care is i. F.I.R/MLC. in the case of Accidental Injury and
assessed to be advisable for Your health condition, English translation of the same, if in any other
will contact Our TPA. The TPA shall provide a pre- language.
authorization to Home care provider within 24 hours j. Legal heir certificate in the absence of nomination
of receiving the complete information. under the Policy, in case of death of the Insured
In case as per Our authorized Home care provider, Person. In the absence of legal heir certificate,
Home care is not found to be advisable for Your health evidence establishing legal heirship may be
condition, You can avail the treatment at a Hospital as provided as required by Us.
an in-patient and the claim for the same on Cashless k. For a) maternity claims, discharge summary
or reimbursement process. mentioning LMP, EDD & Gravida b) Cataract
o For Availing cashless facility (Procedure for claims - IOL sticker c) PTCA claims - Stent sticker.
Worldwide Emergency Cover) l. Copies of health insurance policies held with any
Please follow the procedure as mentioned in other insurer covering the Insured Person(s).
Section 2.31 (i) to avail Cashless facility in case of m. If a claim is partially settled by any other insurer,
Hospitalization outside India. a certificate from the other insurer confirming the

OneHealth - MAGHLIP222V032021 23
 OneHealth
Insurance
final claim amount settled by them and that original c) If required, the Insured Person or any person acting
claim documents are retained at their end. on behalf of the Insured Person, as the case may
n. For Domiciliary Hospitalization claims, a certificate be, must give consent to obtain medical reports
from the attending Medical Practitioner confirming from the Medical Practitioner at Our expense.
that the condition of the Insured Person is such d) If requested by Us, the Insured Person must agree
that he/she is not in a condition to be removed to be examined by a Medical Practitioner of Our
to a Hospital. choice and at Our expense.
o. Additional documents for Air Ambulance Cover: e) All claims under this Policy shall be payable in
i. Certification by the treating Medical Indian Currency. All medical treatments for the
Practitioner of such life threatening purpose of this Policy will be required to be taken
Emergency condition and confirming that in India only except for Worldwide Emergency
current Hospital does not have suitable Hospitalization.
medical equipment and technology for the f) Claims under this Policy shall be settled or rejected,
life threatening condition. as the case may be, within 30 days of the receipt
ii. Bills/receipts of transportation agency/ of the last necessary document.
ambulance company/air ambulance receipts. Section 5. Standard Terms and Conditions
p. Additional documents for Worldwide Emergency 1. Disclosure to Information
Hospitalization– the Insured Person’s passport,
The policy shall be void and all premium paid thereon
visa, tickets and boarding passes.
shall be forfeited to the Company in the event of
q. Additional documents for Compassionate visit– misrepresentation, mis-description or non-disclosure
tickets and boarding passes, if applicable of any material fact by the policyholder.
Documents to be submitted if specifically sought: (Explanation: “Material facts” for the purpose of this
a. Copy of indoor case records (including Qualified policy shall mean all relevant information sought by
Nurse’s notes, OT notes and anaesthetists’ notes, the company in the proposal form and other connected
vitals chart). documents to enable it to take informed decision in the
b. Copy of extract of inpatient register. context of underwriting the risk)
c. Attendance records of employer/educational 2. Condition Precedent to admission of Liability
institution.
The terms and conditions of the policy must be fulfilled
d. Complete medical records (including indoor case by the insured person for the Company to make any
records and OP records) of past Hospitalization/ payment for claim(s) arising under the policy.
treatment, if any.
e. Attending Medical Practitioner’s certificate 3. Claim Settlement (Provision for penal interest)
clarifying. (i) The Company shall settle or reject a claim, as
i. reason for Hospitalization and duration of may be the case, within 30 days from the date of
Hospitalization receipt of last necessary document.
ii. history of any self-inflicted Injury (ii) In the case of delay in the payment of a claim,
iii. history of alcoholism, smoking the Company shall be liable to pay interest to
the policyholder from the date of receipt of last
iv. history of associated medical conditions, if
necessary document to the date of payment of
any
claim at a rate 2% above the bank rate.
f. Previous master health check-up records/pre-
(iii) However, where the circumstances of a claim
employment medical records, if any.
warrant an investigation in the opinion of the
g. Any other document necessary in support of the Company, it shall initiate and complete such
claim on case to case basis. The claim documents investigation at the earliest, in any case not later
should be sent to the address mentioned in Claim than 30 days from the date of receipt of last
form. necessary document. In such cases, the Company
Payment of Claim shall settle or reject the claim within 45 days from
a) No liability under the Policy will be admitted, if the date of receipt of last necessary document.
the claim is fraudulent or supported by fraudulent (iv) In case of delay beyond stipulated 45 days, the
means. Company shall be liable to pay interest to the
b) The Insured Person or any person acting on behalf Policyholder at a rate 2% above the bank rate from
of the Insured Person, as the case may be, must the date of receipt of last necessary document to
provide at his/her expense, all the information the date of payment of claim.
asked by Us in relation to the claim and he/she (Explanation: “Bank rate” shall mean the rate fixed by
must provide all reasonable cooperation and the Reserve Bank of India (RBI) at the beginning of the
assistance to Us as may be required. financial year in which claim has fallen due.

OneHealth - MAGHLIP222V032021 24
 OneHealth
Insurance
4. Material Change 8. No Constructive Notice
It is a Condition Precedent to the Our liability under the Any knowledge or information of any circumstances or
Policy that the Policyholder shall immediately notify Us condition in relation to the Policyholder/Insured Person
in writing of any material change in the risk on account which is in Our possession and not specifically informed
of change in the nature of occupation or business by the Policyholder/ Insured Person shall not be held
at his/her own expense. We may, in Our discretion, to bind or prejudicially affect Us notwithstanding
adjust the scope of cover and/or the premium payable, subsequent acceptance of any premium.
accordingly. The Policyholder/You must exercise the 9. Free Look Provision
same duty to disclose those matters to Us before
The Free Look Period shall be applicable on new
the Renewal, extension, variation, endorsement or
individual health insurance policies and not on
reinstatement of the Policy. The Policy terms and
renewals or at the time of porting/migrating the policy.
conditions shall not be altered.
The insured shall be allowed a free look provision of
5. Multiple Policies fifteen days from date of receipt of the Policy document
to review the terms and conditions of the Policy, and to
1. In case of multiple policies taken by an Insured
return the same if not acceptable.
Person during a period from one or more insurers
to indemnify treatment costs, the Insured Person If the insured has not made any claim during the Free
shall have the right to require a settlement of his/ Look Period, the insured shall be entitled to
her claim in terms of any of his/her policies. In i. a refund of the premium paid less any expenses
all such cases the insurer chosen by the Insured incurred by the Company on medical examination
Person shall be obliged to settle the claim as long of the insured person and the stamp duty charges;
as the claim is within the limits of and according or
to the terms of the chosen policy. ii. where the risk has already commenced and
2. Insured Person having multiple policies shall also the option of return of the Policy is exercised
by the insured person, a deduction towards the
have the right to prefer claims under this policy for
proportionate risk premium for period of cover or
the amounts disallowed under any other policy/
policies, even if the sum insured is not exhausted. iii. Where only a part of the insurance coverage
Then the insurer shall independently settle the has commenced, such proportionate premium
claim subject to the terms and conditions this commensurate with the insurance coverage
during such period;
Policy.
3. If the amount to be claimed exceeds the sum 10. Cancellation/ Termination (other than Free Look
insured under a single policy, the Insured Person cancellation)
shall have the right to choose insurer from whom a. The Policyholder may cancel this Policy by giving
he/she wants to claim the balance amount. 15 days’ written notice and in such an event, the
4. Where an Insured Person has policies from Company shall refund premium for the unexpired
more than one insurer to cover the same risk on policy period as detailed below.:
indemnity basis, the Insured Person shall only be We shall cancel the Policy and refund the premium
indemnified the treatment costs in accordance with for the balance of the Policy Period in accordance
the terms and conditions of the chosen policy. with the table below, after deducting the amount
spent on pre-policy medical check up by Us,
6. Alteration to the Policy provided that no claim has been made under the
This Policy constitutes the complete contract of Policy by or on behalf of any Insured Person.
insurance. Subject to the provisions of applicable law, Cancellation date up Refund of Premium
no change or alteration will be effective or valid unless to (x months) from (basis Policy Period)
approved in writing which will be evidenced by a written the Policy Start Date 1 Year 2 Year 3 Year
endorsement signed and stamped by Us. No one except
Us can change or vary this Policy. Up to 1 month 75.00% 87.50% 91.50%
1 month to 3 months 50.00% 75.00% 88.50%
7. Change of Policyholder
3 months to 6 months 25.00% 62.50% 75.00%
The Policyholder may be changed only at the time of
Renewal of the Policy. The new Policyholder must be 6 months to 12 months 0.00% 50.00% 66.50%
a member of the original Policyholder’s immediate 12 months to 15 months NA 25.00% 50.00%
family. The Renewed Policy shall be treated as having
15 months to 18 months NA 12.50% 41.50%
been Renewed without break.
18 months to 24 months NA 0.00% 33.00%
The Policyholder may be changed upon request in
situations like Policyholder’s demise, moving out of 24 months to 30 months NA NA 8.00%
India or in case of divorce Beyond 30 months NA NA 0.00%

OneHealth - MAGHLIP222V032021 25
 OneHealth
Insurance
Notwithstanding anything contained herein or 13. Records to be maintained
otherwise, no refunds of premium shall be made The Policyholder or the Insured Person, as the case
in respect of Cancellation where, any claim has may be shall keep an accurate record containing all
been admitted or has been lodged or any Benefit relevant and accurate medical records like in-patient
has been availed by the Insured person under the records, Discharge summary , medical certificates,
Policy. medical prescriptions, diagnostic reports and reports
(ii) The Company may cancel the policy at any time confirming the need for treatment (if any) and shall
on grounds of misrepresentation, non-disclosure allow Us or our representative(s) to inspect such records.
The Policyholder or the Insured Person as the case may
of material facts, fraud by the Insured Person, by
be, shall furnish such information as may be required
giving 15 days’ written notice. There would be no
by Us under this Policy at any time during the Policy
refund of premium on cancellation on grounds
Period or until final adjustment (if any) and resolution
of misrepresentation, non-disclosure of material of all claims under this Policy.
facts or fraud.
14. Geographical Scope
11. Fraud
The geographical scope of this Policy applies to events
If any claim made by the insured person, is in any within India other than for Worldwide
respect fraudulent, or if any false statement, or Emergency Hospitalization Cover and for Personal
declaration is made or used in support thereof, or if any Accident Optional Covers. However, all admitted or
fraudulent means or devices are used by the Insured payable claims shall be settled in India in Indian rupees
Person or anyone acting on his/her behalf to obtain any other than for Worldwide Emergency Hospitalization.
Benefit under this Policy, all benefits under this Policy
and the premium paid shall be forfeited. . 15. Policy Disputes
Any amount already paid against claims made under Any and all disputes or differences under or in relation
to this Policy herein shall be determined by Indian law
this Policy but which are found fraudulent later shall
and shall be subject to the jurisdiction of the Indian
be repaid by all recipient(s)/ policyholder(s), who has
Courts.
made that particular claim, who shall be jointly and
severally liable for such repayment to the insurer. 16. Loading
For the purpose of this clause, the expression “fraud” We shall apply a risk loading on the premium payable
means any of the following acts committed by the as per Our board approved underwriting policy
insured person or by his agent, or the hospital/doctor/ (based upon the declarations made in the proposal
any other party acting on behalf of the insured person form and the health status of the persons proposed
with intent to deceive the insurer or to induce the insurer for insurance), which shall be mentioned specifically
to issue an insurance policy: in the Policy Schedule. The maximum risk loading
a) the suggestion, as a fact of that which is not true applicable shall not exceed 100% per diagnosis /
and which the insured person does not believe to medical condition and an overall risk loading of
200%. These loadings are applied from the Policy
be true;
Inception Date including subsequent Renewal(s) with
b) the active concealment of a fact by the insured Us or on the receipt of a request for increase in Sum
person having knowledge or belief of the fact; Insured (for which the loading shall be applied on the
c) any other act fitted to deceive; and increased Sum Insured).
d) any such act or omission as the law specially We will inform the Policyholder about the applicable
declares to be fraudulent risk loading through post/courier/email/phone. The
The Company shall not repudiate the claim and/or Policyholder shall revert to Us with his/her written
forfeit the policy benefits, on the ground of Fraud, if consent and additional premium (if any), within 15
the insured person / beneficiary can prove that the days of the issuance of such counter offer. In case,
misstatement was true to the best of his knowledge and the Policyholder neither accepts the counter offer nor
reverts to Us within 15 days, We shall cancel his/her
there was no deliberate intention to suppress the fact or
application and refund the premium paid within the
that such mis-statement of or suppression of material
next 15 days.
fact are within the knowledge of the insurer.
No loading shall be applied at the time of Renewal on
12. Limitation of Liability the basis of individual claim experience.
If a claim is rejected or partially settled and is not the 17. Mandatory Co –Payment
subject of any pending suit or other proceeding or
A 20% Co-Payment on admissible claim amount shall
arbitration, as the case may be, within twelve months
be applicable for each claim if the Insured Person is
from the date of such rejection or settlement the
Aged 61 years or more at the Policy Inception Date.
claim shall be deemed to have been abandoned and
This Mandatory Co-Payment shall apply in addition to
Our liability shall be extinguished and shall not be
any other Co-Payment, if applicable as per the Optional
recoverable thereafter.

OneHealth - MAGHLIP222V032021 26
 OneHealth
Insurance
Cover “Voluntary Co-Payment” chosen by the Insured the Policy.
under this Policy. ii. Insured person will have the option to migrate
to similar health insurance product available
18. Migration
with the Company at the time of renewal with
The insured person will have the option to migrate the all the accrued continuity benefits such as
policy to other health insurance products/plans offered cumulative bonus, waiver of waiting period, as
by the company by applying for migration of the Policy per IRDAI guidelines, provided the policy has been
at least 30 days before the policy renewal date as maintained without a break.
per IRDAI guidelines on Migration. If such person is
presently covered and has been continuously covered 22. Possibility of Revision of Terms of the Policy
without any lapses under any health insurance product/ including the Premium Rates
plan offered by the company, the insured person will The Company, with prior approval of IRDAI, may revise
get the accrued continuity benefits in waiting periods or modify the terms of the policy including the premium
as per IRDAI guidelines on migration. rates. The insured person shall be notified three months
For Detailed Guidelines on migration, kindly refer before the changes are effected.
the link https://www.irdai.gov.in/ADMINCMS/cms/
23. Moratorium Period:
whatsNew_Layout.aspx?page=PageNo3987&flag=1
After completion of eight continuous years under the
19. Portability policy no look back would be applied. This period
The insured person will have the option to port the of eight years is called as moratorium period. The
policy to other insurers by applying to such insurer moratorium would be applicable for the sums insured
to port the entire policy along with all the members of the first policy and subsequently completion of eight
of the family, if any, at least 45 days before, but not continuous years would be applicable from date of
earlier than 60 days from the policy renewal date enhancement of sums insured only on the enhanced
as per IRDAI Guidelines related to portability. If such limits. After the expiry of Moratorium Period no claim
person is presently covered and has been continuously under this policy shall be contestable except for proven
covered without any lapses under any health insurance fraud and permanent exclusions specified in the policy
policy with an Indian General/Health insurer, the contract. The policies would however be subject to all
proposed insured person will get the accrued continuity limits, sub limits, co-payments, deductible as per the
benefits in waiting periods as per IRDAI guidelines on policy contract.
portability.
24. Endorsements
For Detailed Guidelines on portability, kindly refer
We may allow the following endorsements. You/the
the link https://www.irdai.gov.in/ADMINCMS/cms/
Policyholder should request for any endorsement in
whatsNew_Layout.aspx?page=PageNo3987&flag=1
writing. Any endorsement that is accepted by Us shall
20. Renewal of Policy be effective from the date of the request as received
The policy shall ordinarily be renewable except on from You/the Policyholder, or the date of receipt of
grounds of fraud, misrepresentation by the insured premium, whichever is later.
person. (i) Non-Financial Endorsements – which do not affect the
a) The Company shall endeavour to give notice for premium.
renewal. However, the Company is not under (1) Minor rectification/correction in name of the
obligation to give any notice for renewal. Policyholder/ Insured Person)
b) Renewal shall not be denied on the ground that (2) Rectification in gender
the insured had made a claim or claims in the (3) Rectification in relationship of the Insured Person
preceding policy years with the Policyholder
c) Request for renewal along with requisite premium (4) Rectification of date of birth of the Insured Person
shall be received by the Company before the end (if this does not impact the premium)
of the Policy Period. (5) Change in the address of the Policyholder
d) At the end of the Policy Period, the policy shall (6) Change/Updation in the contact details
terminate and can be renewed within the Grace (7) Change in Nominee Details
Period of 30 days to maintain continuity of benefits
with Break in Policy. Coverage is not available (ii) Financial Endorsements – which result in alteration in
during the grace period. premium
e) No loading shall apply on renewals based on (1) Addition of Insured Person (New Born Baby or
individual claim experience. newly wedded spouse)
21. Withdrawal of the Policy (2) Addition of any Insured Person
i. In the likelihood of this product being withdrawn (3) Deletion of Insured Person
in future, the Company will intimate the insured (4) Change in Age/Date of Birth (if this impacts the
person about the same 90 days prior to expiry of premium)

OneHealth - MAGHLIP222V032021 27
 OneHealth
Insurance
(5) Change in address (if this impacts zone and hence shall be recoverable from the admissible claim
premium) amount payable.
(6) Change in plan and/or Sum Insured c) If the instalment premium due is not received
(7) Addition/removal of Optional Cover(s) within the above relaxation period, the Policy will
Financial endorsements (1), as mentioned above, can be cancelled. We may issue a fresh Policy with
all waiting periods applicable subject to Our
be allowed during the term of Policy, all other financial
underwriting guidelines.
endorsements are allowed at the time of renewal only.
d) If the claim amount is lesser than the balance
We reserve the rights to do underwriting in case of any
premium payable, then no claims would be
such endorsement requests.
payable till the applicable premium is recovered.
Fresh waiting period shall be applicable with respect to
We may also allow premium instalment payment
the Insured person added after Policy Inception Date.
through ECS mode.
Where the Policy is Renewed for enhanced Sum Insured,
all waiting periods would start and apply afresh for the You must ensure that there are sufficient funds in Your
amount of increase in Sum Insured. bank account, through which You have opted ECS
facility for payment of premium for this Policy. In case of
25. Premium Payment in Instalments (Wherever failure of transactions in ECS mode and non-payment
applicable) of premium instalment maximum within Relaxation
If the Insured Person has opted for Payment of Premium period, the Policy will be terminated. We reserve the
on an instalment basis i.e. Half Yearly, Quarterly or rights to do fresh underwriting for issuance of new
Monthly, as mentioned in the Policy Schedule/Certificate Policy, in such cases.
of Insurance, the following Conditions shall apply In case there is change either in the terms and
(notwithstanding any terms contrary elsewhere in the conditions of the policy contract or in the premium rate,
Policy) the ECS authorization shall be obtained afresh. You
i. Grace Period of 15 Days would be given to Pay may withdraw from the ECS mode by giving Us a notice
the instalment premium due for the Policy. at least fifteen days prior to the due date of instalment
premium payable as per Your ECS mandate form.
ii. During such grace period, coverage will not
be available from the due date of instalment You should carefully take note of the procedures and
premium till the date of receipt of premium by timelines to be adhered to in connection with the ECS
Company. mandate as specified in the ECS mandate form duly
filled by You at the time of opting this mode of payment.
iii. The insured person will get the accrued continuity
benefits in respect of the “Waiting Periods”, 27. Communications & Notices
“Specific Waiting Periods” in the event of payment Any communication or notice or instruction under this
of premium within the stipulated grace Period. Policy shall be in writing and will be sent to:
iv. No interest will be charged If the instalment a) To Us, at the address as specified in Policy
premium is not paid on due date. Schedule
v. In case of instalment premium due not received b) The Policyholder’s, at the address as specified in
within the grace period, the policy will get Policy Schedule
cancelled
c) No insurance agents, brokers, other person or
vi. In the event of a claim, all subsequent premium entity is authorized to receive any notice on behalf
instalments shall immediately become due and of Us unless explicitly stated in writing by Us
payable.
d) Notice and instructions will be deemed served 10
vii The company has the right to recover and deduct days after posting or immediately upon receipt in
all the pending instalments from the claim amount the case of hand delivery, facsimile or e-mail.
due under the policy.
28. Redressal of Grievance
26. Special Conditions Applicable for Policies Issued
In case of any grievance, the insured person may contact
With Premium Payment on Instalment Basis
the Company through Website: www.magmahdi.com
Notwithstanding the provision of Grace period as stated
Toll free: 1800 266 3202
in the clause “ Premium Payment in Instalments” above,
we shall provide, Relaxation period instead of Grace E –mail: Gro@magma hdi.co.in
period as below: Fax: 91 033 4401 7471
a) A relaxation period of maximum 15 days from Courier: Any of Our branch offices or corporate office
the due date of the instalment payable shall be during business hours
provided. Coverage will be available during such Insured person may also approach the grievance cell
Relaxation period. at any of the company’s branches with the details of
b) In case of any claim during the relaxation period, grievance.
an amount equivalent to the balance of the If Insured Person is not satisfied with the redressal of
instalment premiums payable in the Policy Period grievance through one of the above methods, insured

OneHealth - MAGHLIP222V032021 28
 OneHealth
Insurance
person may contact the grievance officer at: Policy shall be a valid discharge towards payment of
Magma HDI General Insurance Co. Ltd., claim by the Company to the extent of that amount for
Rustomjee Aspiree, 4th Floor, the particular claim.
Sion-Wadala link road, 31. Zone Classification, Premium and Zone based
Off Eastern Express Highway Everard Nagar, Co-pay
Sion (East), Mumbai – 400 022 For the purpose of Policy issuance, the premium
For updated details of grievance officer, kindly refer the will be computed basis the zone of residence of the
link https://www.magmahdi.com/grievance-redressal. Policyholder. The premium would be applicable zone
If Insured Person is not satisfied with the redressal of wise and the cities defined in each zone are as under:
grievance through above methods, insured person may a. Zone 1 means Delhi including National Capital
may also approach the office of Insurance Ombudsman Region, Mumbai including Thane, Navi Mumbai,
of the respective area/region for redressal of grievance Vasai- Virar, Bangalore and Gujarat,
as per Insurance Ombudsman Rules, 2017. The contact b. Zone 2 means Coimbatore, Pune, Hyderabad,
details of the Insurance Ombudsman offices have been Chandigarh, Chennai, Kolkata and Kerala
provided as Annexure-I c. Zone 3 means Rest of India excluding areas falling
Grievance may also be lodged at IRDAI Integrated under Zone 1 and Zone 2
Grievance management System: https://igms.irda.gov. Zone classification can be changed by Us after
in/ informing the Policyholder at least 3 months in advance,
29. Nominee subject to approval from the IRDAI.
The Policyholder is mandatorily required at the Policy In case You opt to take treatment in a zone higher than
Inception Date to make a nomination for the purpose the applicable zone as mentioned in Policy Schedule,
of payment of claims under the Policy in the event of You shall bear a Co-Payment on admissible claim
death of the Policyholder. amount as mentioned below:
Any change of nomination shall be communicated a. Zone 2 to Zone 1: 25% for every claim made
to the Company in writing and such change shall be b. Zone 3 to Zone 2: 20% for every claim made
effective only when an endorsement on the Policy is c. Zone 3 to Zone 1: 35% for every claim made
made. For claim settlement under reimbursement,
Such co-pay shall not be applicable for Emergency
the Company will pay the policyholder. In the event
Hospitalization and Emergency treatment required due
of death of the policyholder, the Company will pay
to Accident that happens whilst the Insured Person was
the nominee {as named in Policy Schedule/Policy
outside the zone as applicable in the Policy Schedule.
certificate/Endorsement, (if any)} and in case there
is no subsisting nominee, to the legal heirs or legal In case You opt to take treatment in a zone lower than
representatives of the policyholder whose discharge the applicable zone as mentioned in Policy Schedule,
shall be treated as full and final discharge of its liability no Co-Payment shall be applicable. Such Co-Payment
under the Policy. shall be in addition to the Mandatory Co-payment
and Voluntary Co-Payment, as applicable under the
30. Complete Discharge Policy. Zone shall be based on city of residence of the
Any payment to the Insured Person or his/ her nominees Policyholder. We also provide the Policyholder an option
or his/ her legal representative or assignee or to the to choose a zone higher or lower than this zone based
Hospital, as the case may be, for any benefit under the on residence of the Insured Person(s).

OneHealth - MAGHLIP222V032021 29
 OneHealth
Insurance
Annexure I
The contact details of the Insurance Ombudsman offices are as below-
Areas of Jurisdiction Office of the Insurance Ombudsman
Gujarat , UT of Dadra and Nagar Haveli, Daman Office of the Insurance Ombudsman,
and Diu 2nd floor, Ambica House, Near C.U. Shah College,
5, Navyug Colony, Ashram Road, Ahmedabad – 380 014.
Tel.: 079 - 27546150 / 27546139, Fax: 079 - 27546142
Email: bimalokpal.ahmedabad@ecoi.co.in
Karnataka Office of the Insurance Ombudsman,
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
Email: bimalokpal.bengaluru@ecoi.co.in
Madhya Pradesh and Chhattisgarh Office of the Insurance Ombudsman,
Janak Vihar Complex, 2nd Floor,6, Malviya Nagar,
Opp. Airtel Office, Near New Market, Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202, Fax: 0755 - 2769203
Email: bimalokpal.bhopal@ecoi.co.in
Odisha Office of the Insurance Ombudsman,
62, Forest park,Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455, Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@ecoi.co.in
Punjab , Haryana, Himachal Pradesh, Jammu and Office of the Insurance Ombudsman,
Kashmir, UT of Chandigarh S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building,
Sector 17 – D, Chandigarh – 160 017.
Tel.: 0172 - 2706196 / 2706468, Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@gbic.co.in
Tamil Nadu, UT–Pondicherry Town and Karaikal Office of the Insurance Ombudsman,
(which are part of UT of Pondicherry) Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284, Fax: 044 - 24333664
Email: bimalokpal.chennai@ecoi.co.in
Delhi Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building, Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 - 23239633 / 23237532, Fax: 011 - 23230858
Email: bimalokpal.delhi@ecoi.co.in
Assam , Meghalaya, Manipur, Mizoram, Office of the Insurance Ombudsman,
Arunachal Pradesh, Nagaland and Tripura Jeevan Nivesh, 5th Floor,Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2132204 / 2132205, Fax: 0361 - 2732937
Email: bimalokpal.guwahati@ecoi.co.in
Andhra Pradesh, Telangana and UT of Yanam – Office of the Insurance Ombudsman,
a part of the UT of Pondicherry 6-2-46, 1st floor, “Moin Court”,Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.
Tel.: 040 - 65504123 / 23312122, Fax: 040 - 23376599
Email: bimalokpal.hyderabad@ecoi.co.in
Rajasthan Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363,
Email: Bimalokpal.jaipur@ecoi.co.in

OneHealth - MAGHLIP222V032021 30
 OneHealth
Insurance
Areas of Jurisdiction Office of the Insurance Ombudsman
Kerala, UT of (a) Lakshadweep, (b) Mahe – a part Office of the Insurance Ombudsman,
of UT of Pondicherry 2nd Floor, Pulinat Bldg.,Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338, Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@ecoi.co.in
West Bengal, UT of Andaman and Nicobar Office of the Insurance Ombudsman,
Islands, Sikkim Hindustan Bldg. Annexe, 4th Floor, 4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340, Fax : 033 - 22124341
Email: bimalokpal.kolkata@ecoi.co.in
Districts of Uttar Pradesh : Laitpur, Jhansi, Office of the Insurance Ombudsman,
Mahoba, Hamirpur, Banda, Chitrakoot, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road,
Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Hazratganj, Lucknow - 226 001.
Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Tel.: 0522 - 2231330 / 2231331, Fax: 0522 - 2231310
Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Email: bimalokpal.lucknow@ecoi.co.in
Bahraich, Barabanki, Raebareli, Sravasti, Gonda,
Faizabad, Amethi, Kaushambi, Balrampur, Basti,
Ambedkarnagar, Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur, Chandauli,
Ballia, Sidharathnagar.
Goa,Mumbai Metropolitan Region excluding Navi Office of the Insurance Ombudsman,
Mumbai & Thane 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 - 26106552 / 26106960, Fax: 022 - 26106052
Email: bimalokpal.mumbai@ecoi.co.in
State of Uttaranchal and the following Districts Office of the Insurance Ombudsman,
of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bhagwan Sahai Palace, 4th Floor, Main Road, Naya Bans,
Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301.
Mainpuri, Mathura, Meerut, Moradabad, Tel.: 0120-2514250 / 2514251 / 2514253
Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Email: bimalokpal.noida@ecoi.co.in
Farrukhabad, Firozbad, Gautambodhanagar,
Ghaziabad, Hardoi, Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj, Sambhal, Amroha,
Hathras, Kanshiramnagar, Saharanpur
Bihar, Jharkhand. Office of the Insurance Ombudsman,
1st Floor, Kalpana Arcade Building,, Bazar Samiti Road,
Bahadurpur, Patna 800 006.
Email: bimalokpal.patna@ecoi.co.in
Maharashtra, Area of Navi Mumbai and Thane Office of the Insurance Ombudsman,
excluding Mumbai Metropolitan Region JeevanDarshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth, Pune – 411 030.
Tel.: 020 - 32341320,
Email: bimalokpal.pune@ecoi.co.in

OneHealth - MAGHLIP222V032021 31
 OneHealth
Insurance
Annexure II Sl. Item
List I – Item for which coverage in not available in No.
the policy
31 MEDICAL RECORDS
Sl. Item
No. 32 PHOTOCOPIES CHARGES
1 BABY FOOD 33 MORTUARY CHARGES
2 BABY UTILITIES CHARGES 34 WALKING AIDS CHARGES
3 BEAUTY SERVICES 35 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE
HOSPITAL)
4 BELTS/ BRACES
36 SPACER
5 BUDS
37 SPIROMETRE
6 COLD PACK/HOT PACK
38 NEBULIZER KIT
7 CARRY BAGS
39 STEAM INHALER
8 EMAIL / INTERNET CHARGES
40 ARMSLING
9 FOOD CHARGES (OTHER THAN PATIENT’s DIET
PROVIDED BY HOSPITAL) 41 THERMOMETER
10 LEGGINGS 42 CERVICAL COLLAR
11 LAUNDRY CHARGES 43 SPLINT
12 MINERAL WATER 44 DIABETIC FOOT WEAR
13 SANITARY PAD 45 KNEE BRACES (LONG/ SHORT/ HINGED)
14 TELEPHONE CHARGES 46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
15 GUEST SERVICES 47 LUMBO SACRAL BELT
16 CREPE BANDAGE 48 NIMBUS BED OR WATER OR AIR BED CHARGES
17 DIAPER OF ANY TYPE 49 AMBULANCE COLLAR
18 EYELET COLLAR 50 AMBULANCE EQUIPMENT
19 SLINGS 51 ABDOMINAL BINDER
20 BLOOD GROUPING AND CROSS MATCHING 52 PRIVATE NURSES CHARGES- SPECIAL NURSING
OF DONORS SAMPLES CHARGES
21 SERVICE CHARGES WHERE NURSING CHARGE 53 SUGAR FREE Tablets
ALSO CHARGED
54 CREAMS POWDERS LOTIONS (Toiletries are not
22 TELEVISION CHARGES payable, only prescribed medical pharmaceuticals
payable)
23 SURCHARGES
55 ECG ELECTRODES
24 ATTENDANT CHARGES
56 GLOVES
25 EXTRA DIET OF PATIENT (OTHER THAN THAT
WHICH FORMS PART OF BED CHARGE) 57 NEBULISATION KIT
26 BIRTH CERTIFICATE 58 ANY KIT WITH NO DETAILS MENTIONED
[DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC]
27 CERTIFICATE CHARGES
59 KIDNEY TRAY
28 COURIER CHARGES
60 MASK
29 CONVEYANCE CHARGES
61 OUNCE GLASS
30 MEDICAL CERTIFICATE

OneHealth - MAGHLIP222V032021 32
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
62 OXYGEN MASK 26 BLANKET/WARMER BLANKET

63 PELVIC TRACTION BELT 27 ADMISSION KIT

64 PAN CAN 28 DIABETIC CHART CHARGES

65 TROLLY COVER 29 DOCUMENTATION CHARGES / ADMINISTRATIVE

EXPENSES
66 UROMETER, URINE JUG
30 DISCHARGE PROCEDURE CHARGES
67 AMBULANCE
31 DAILY CHART CHARGES
68 VASOFIX SAFETY
32 ENTRANCE PASS / VISITORS PASS CHARGES
List II – Items that are to be subsumed into Room
Charges 33 EXPENSES RELATED TO PRESCRIPTION ON
DISCHARGE
Sl. Item
No. 34 FILE OPENING CHARGES
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED) 35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT
EXPLAINED)
2 HAND WASH
3 SHOE COVER 36 PATIENT IDENTIFICATION BAND / NAME TAG

4 CAPS 37 PULSEOXYMETER CHARGES

5 CRADLE CHARGES
List III – Items that are to be subsumed into Procedure
6 COMB Charges
7 EAU-DE-COLOGNE / ROOM FRESHNERS Sl. Item
8 FOOT COVER No.

9 GOWN 1 HAIR REMOVAL CREAM

10 SLIPPERS 2 DISPOSABLES RAZORS CHARGES (for site

preparations)
11 TISSUE PAPER
12 TOOTH PASTE 3 EYE PAD

13 TOOTH BRUSH 4 EYE SHEILD

14 BED PAN 5 CAMERA COVER
15 FACE MASK 6 DVD, CD CHARGES
16 FLEXI MASK
7 GAUSE SOFT
17 HAND HOLDER
8 GAUZE
18 SPUTUM CUP
9 WARD AND THEATRE BOOKING CHARGES
19 DISINFECTANT LOTIONS
20 LUXURY TAX 10 ARTHROSCOPY AND ENDOSCOPY
INSTRUMENTS
21 HVAC
11 MICROSCOPE COVER
22 HOUSE KEEPING CHARGES
23 AIR CONDITIONER CHARGES 12 SURGICAL BLADES, HARMONICSCALPEL,SHAVER

24 IM IV INJECTION CHARGES 13 SURGICAL DRILL

25 CLEAN SHEET 14 EYE KIT

OneHealth - MAGHLIP222V032021 33
 OneHealth
Insurance
Sl. Item Annexure III
No. List of Day Care Surgeries

15 EYE DRAPE Sl. Item

No.
16 X-RAY FILM
CARDIOLOGY RELATED
17 BOYLES APPARATUS CHARGES
1 CORONARY ANGIOGRAPHY
18 COTTON
CRITICAL CARE RELATED
19 COTTON BANDAGE 2 INSERT NON- TUNNEL CV CATH
20 SURGICAL TAPE 3 INSERT PICC CATH ( PERIPHERALLY INSERTED
CENTRAL CATHETER )
21 APRON
4 REPLACE PICC CATH ( PERIPHERALLY INSERTED
22 TORNIQUET CENTRAL CATHETER )
23 ORTHOBUNDLE, GYNAEC BUNDLE 5 INSERTION CATHETER, INTRA ANTERIOR
6 INSERTION OF PORTACATH
List IV – Items that are to be subsumed into costs of
treatment DENTAL RELATED

Sl. Item 7 SPLINTING OF AVULSED TEETH

No. 8 SUTURING LACERATED LIP
1 ADMISSION/REGISTRATION CHARGES 9 SUTURING ORAL MUCOSA
2 HOSPITALISATION FOR EVALUATION/ 10 ORAL BIOPSY IN CASE OF ABNORMAL TISSUE
DIAGNOSTIC PURPOSE PRESENTATION
3 URINE CONTAINER 11 FNAC

4 BLOOD RESERVATION CHARGES AND ANTE 12 SMEAR FROM ORAL CAVITY

NATAL BOOKING CHARGES 13 MYRINGOTOMY WITH GROMMET INSERTION
5 BIPAP MACHINE 14 TYMPANO PLASTY (CLOSURE OF ANEARDRUM
PERFORATION/RECONSTRUCTION OF THE
6 CPAP/ CAPD EQUIPMENTS
AUDITORY OSSICLES)
7 INFUSION PUMP– COST 15 REMOVAL OF A TYMPANIC DRAIN
8 HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS 16 KERATOSIS REMOVAL UNDER GA
ETC
17 OPERATIONS ON THE TURBINATES (NASAL
9 NUTRITION PLANNING CHARGES - DIETICIAN CONCHA)
CHARGES- DIET CHARGES
18 TYMPANO PLASTY (CLOSURE OF ANEARDRUM
10 HIV KIT PERFORATION/RECONSTRUCTION OF THE
AUDITORY OSSICLES)
11 ANTISEPTIC MOUTHWASH
19 REMOVAL OF KERATOSIS OBTURANS
12 LOZENGES
20 STAPEDOTOMY TO TREAT VARIOUS LESIONS IN
13 MOUTH PAINT MIDDLE EAR
21 REVISION OF A STAPEDECTOMY
14 VACCINATION CHARGES
22 OTHER OPERATIONS ON THE AUDITORY
15 ALCOHOL SWABES OSSICLES
16 SCRUB SOLUTION/STERILLIUM 23 MYRINGOPLASTY (POST-AURA/ENDAURAL
APPROACH AS WELL AS SIMPLE TYPE -I
17 Glucometer& Strips
TYMPANOPLASTY)
18 URINE BAG 24 FENESTRATION OF THE INNER EAR

OneHealth - MAGHLIP222V032021 34
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
25 REVISION OF A FENESTRATION OF THE INNER 54 VESTIBULAR NERVE SECTION
EAR
55 THYROPLASTY TYPE I
26 PALATOPLASTY
56 PSEUDOCYST OF THE PINNA - EXCISION
27 TRANSORAL INCISION AND DRAINAGE OF A
57 INCISION AND DRAINAGE - HAEMATOMA
PHARYNGEAL ABSCESS
AURICLE
28 TONSILLECTOMY WITHOUT ADENOIDECTOMY
58 TYMPANOPLASTY (TYPE II)
29 TONSILLECTOMY WITH ADENOIDECTOMY
59 REDUCTION OF FRACTURE OF NASAL BONE
30 EXCISION AND DESTRUCTION OF A LINGUAL
60 THYROPLASTY TYPE II
TONSIL
61 TRACHEOSTOMY
31 REVISION OF A TYMPANOPLASTY
62 EXCISION OF ANGIOMA SEPTUM
32 OTHER MICROSURGICAL OPERATIONS ON THE
MIDDLE EAR 63 TURBINOPLASTY
33 INCISION OF THE MASTOID PROCESS AND 64 INCISION & DRAINAGE OF RETRO PHARYNGEAL
MIDDLE EAR ABSCESS
34 MASTOIDECTOMY 65 UVULO PALATO PHARYNGO PLASTY
35 RECONSTRUCTION OF THE MIDDLE EAR 66 ADENOIDECTOMY WITH GROMMET INSERTION
36 OTHER EXCISIONS OF THE MIDDLE AND INNER 67 ADENOIDECTOMY WITHOUT GROMMET
EAR INSERTION
37 INCISION (OPENING) AND DESTRUCTION 68 VOCAL CORD LATERALISATION PROCEDURE
(ELIMINATION) OF THE INNER EAR
69 INCISION & DRAINAGE OF PARA PHARYNGEAL
38 OTHER OPERATIONS ON THE MIDDLE AND ABSCESS
INNER EAR
70 TRACHEOPLASTY
39 EXCISION AND DESTRUCTION OF DISEASED
TISSUE OF THE NOSE GASTROENTEROLOGY RELATED

40 OTHER OPERATIONS ON THE NOSE 71 CHOLECYSTECTOMY AND CHOLEDOCHO-

JEJUNOSTOMY/DUODENOSTOMY/
41 NASAL SINUS ASPIRATION GASTROSTOMY/EXPLORATION COMMON BILE
DUCT
42 FOREIGN BODY REMOVAL FROM NOSE
72 ESOPHAGOSCOPY, GASTROSCOPY,
43 OTHER OPERATIONS ON THE TONSILS AND
DUODENOSCOPY WITH POLYPECTOMY/
ADENOIDS
REMOVAL OF FOREIGNBODY/DIATHERMY OF
44 ADENOIDECTOMY BLEEDING LESIONS
45 LABYRINTHECTOMY FOR SEVERE VERTIGO 73 PANCREATIC PSEUDOCYST EUS & DRAINAGE
46 STAPEDECTOMY UNDER GA 74 RF ABLATION FOR BARRETT’S OESOPHAGUS
47 STAPEDECTOMY UNDER LA 75 ERCP AND PAPILLOTOMY
48 TYMPANOPLASTY (TYPE IV) 76 ESOPHAGOSCOPE AND SCLEROSANT
INJECTION
49 ENDOLYMPHATIC SAC SURGERY FOR MENIERE’S
DISEASE 77 EUS + SUBMUCOSAL RESECTION
50 TURBINECTOMY 78 CONSTRUCTION OF GASTROSTOMY TUBE
51 ENDOSCOPIC STAPEDECTOMY 79 EUS + ASPIRATION PANCREATIC CYST
52 INCISION AND DRAINAGE OF PERICHONDRITIS 80 SMALL BOWEL ENDOSCOPY (THERAPEUTIC)
53 SEPTOPLASTY 81 COLONOSCOPY ,LESION REMOVAL

OneHealth - MAGHLIP222V032021 35
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
82 ERCP 111 THERAPEUTIC LAPAROSCOPY WITH LASER
83 COLONSCOPY STENTING OF STRICTURE 112 APPENDICECTOMY WITH/WITHOUT DRAINAGE
84 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY 113 INFECTED KELOID EXCISION
85 EUS AND PANCREATIC PSEUDO CYST 114 AXILLARY LYMPHADENECTOMY
DRAINAGE
115 WOUND DEBRIDEMENT AND COVER
86 ERCP AND CHOLEDOCHOSCOPY
116 ABSCESS-DECOMPRESSION
87 PROCTOSIGMOIDOSCOPY VOLVULUS
117 CERVICAL LYMPHADENECTOMY
DETORSION
118 INFECTED SEBACEOUS CYST
88 ERCP AND SPHINCTEROTOMY
119 INGUINAL LYMPHADENECTOMY
89 ESOPHAGEAL STENT PLACEMENT
120 INCISION AND DRAINAGE OF ABSCESS
90 ERCP + PLACEMENT OF BILIARY STENTS
121 SUTURING OF LACERATIONS
91 SIGMOIDOSCOPY W / STENT
122 SCALP SUTURING
92 EUS + COELIAC NODE BIOPSY
123 INFECTED LIPOMA EXCISION
93 UGI SCOPY AND INJECTION OF ADRENALINE,
SCLEROSANTS BLEEDING ULCERS 124 MAXIMAL ANAL DILATATION
GENERAL SURGERY RELATED 125 PILES
94 INCISION OF A PILONIDAL SINUS / ABSCESS 126 A)INJECTION SCLEROTHERAPY
95 FISSURE IN ANO SPHINCTEROTOMY 127 B)PILES BANDING
96 SURGICAL TREATMENT OF A VARICOCELE AND 128 LIVER ABSCESS- CATHETER DRAINAGE
A HYDROCELE OF THE SPERMATIC CORD
129 FISSURE IN ANO- FISSURECTOMY
97 ORCHIDOPEXY
130 FIBROADENOMA BREAST EXCISION
98 ABDOMINAL EXPLORATION IN
CRYPTORCHIDISM 131 OESOPHAGEAL VARICES SCLEROTHERAPY

99 SURGICAL TREATMENT OF ANAL FISTULAS 132 ERCP - PANCREATIC DUCT STONE REMOVAL

100 DIVISION OF THE ANAL SPHINCTER 133 PERIANAL ABSCESS I&D

(SPHINCTEROTOMY) 134 PERIANAL HEMATOMA EVACUATION
101 EPIDIDYMECTOMY 135 UGI SCOPY AND POLYPECTOMY OESOPHAGUS
102 INCISION OF THE BREAST ABSCESS 136 BREAST ABSCESS I& D
103 OPERATIONS ON THE NIPPLE 137 FEEDING GASTROSTOMY
104 EXCISION OF SINGLE BREAST LUMP 138 OESOPHAGOSCOPY AND BIOPSY OF GROWTH
105 INCISION AND EXCISION OF TISSUE IN THE OESOPHAGUS
PERIANAL REGION 139 ERCP - BILE DUCT STONE REMOVAL
106 SURGICAL TREATMENT OF HEMORRHOIDS 140 ILEOSTOMY CLOSURE
107 OTHER OPERATIONS ON THE ANUS 141 COLONOSCOPY
108 ULTRASOUND GUIDED ASPIRATIONS 142 POLYPECTOMY COLON
109 SCLEROTHERAPY, ETC. 143 SPLENIC ABSCESSES LAPAROSCOPIC DRAINAGE
110 LAPAROTO MY FOR GRADINGLY MPHOMA 144 UGI SCOPY AND POLYPECTOMY STOMACH
WITH SPLENECTOMY/LIVER/LYMPH NODE
BIOPSY 145 RIGID OESOPHAGOSCOPY FOR FB REMOVAL

OneHealth - MAGHLIP222V032021 36
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
146 FEEDING JEJUNOSTOMY 175 EXCISION OF CERVICAL RIB
147 COLOSTOMY 176 LAPAROSCOPIC REDUCTION OF
INTUSSUSCEPTION
148 ILEOSTOMY
177 MICRODOCHECTOMY BREAST
149 COLOSTOMY CLOSURE
178 SURGERY FOR FRACTURE PENIS
150 SUBMANDIBULAR SALIVARY DUCT STONE
REMOVAL 179 SENTINEL NODE BIOPSY
151 PNEUMATIC REDUCTION OF 180 PARASTOMAL HERNIA
INTUSSUSCEPTION
181 REVISION COLOSTOMY
152 VARICOSE VEINS LEGS - INJECTION
SCLEROTHERAPY 182 PROLAPSED COLOSTOMY- CORRECTION

153 RIGID OESOPHAGOSCOPY FOR PLUMMER 183 TESTICULAR BIOPSY

VINSON SYNDROME
184 LAPAROSCOPIC CARDIOMYOTOMY (HELLERS)
154 PANCREATIC PSEUDOCYSTS ENDOSCOPIC
DRAINAGE 185 SENTINEL NODE BIOPSY MALIGNANT
MELANOMA
155 ZADEK’S NAIL BED EXCISION
186 LAPAROSCOPIC PYLOROMYOTOMY (RAMSTEDT)
156 SUBCUTANEOUS MASTECTOMY
GYNAECOLOGY RELATED
157 EXCISION OF RANULA UNDER GA
187 OPERATIONS ON BARTHOLIN’S GLANDS (CYST)
158 RIGID OESOPHAGOSCOPY FOR DILATION OF
BENIGN STRICTURES 188 INCISION OF THE OVARY

159 EVERSION OF SAC 189 INSUFFLATIONS OF THE FALLOPIAN TUBES

160 UNILATERAL 190 OTHER OPERATIONS ON THE FALLOPIAN TUBE

161 ILATERAL 191 DILATATION OF THE CERVICAL CANAL

162 LORD’S PLICATION 192 CONISATION OF THE UTERINE CERVIX

163 JABOULAY’S PROCEDURE 193 THERAPEUTIC CURETTAGE WITH COLPOSCOPY

/ BIOPSY / DIATHERMY / CRYOSURGERY
164 SCROTOPLASTY
194 LASER THERAPY OF CERVIX FOR VARIOUS
165 CIRCUMCISION FOR TRAUMA LESIONS OF UTERUS
166 MEATOPLASTY 195 OTHER OPERATIONS ON THE UTERINE CERVIX
167 INTERSPHINCTERIC ABSCESS INCISION AND 196 INCISION OF THE UTERUS (HYSTERECTOMY)
DRAINAGE
197 LOCAL EXCISION AND DESTRUCTION OF
168 PSOAS ABSCESS INCISION AND DRAINAGE DISEASED TISSUE OF THE VAGINA AND THE
POUCH OFDOUGLAS
169 THYROID ABSCESS INCISION AND DRAINAGE
198 INCISION OF VAGINA
170 TIPS PROCEDURE FOR PORTAL HYPERTENSION

171 ESOPHAGEAL GROWTH STENT 199 INCISION OF VULVA

172 PAIR PROCEDURE OF HYDATID CYST LIVER 200 CULDOTOMY

173 TRU CUT LIVER BIOPSY 201 SALPINGO-OOPHORECTOMY VIA LAPAROTOMY

174 PHOTODYNAMIC THERAPY OR ESOPHAGEAL 202 ENDOSCOPIC POLYPECTOMY

TUMOUR AND LUNG TUMOUR 203 HYSTEROSCOPIC REMOVAL OF MYOMA

OneHealth - MAGHLIP222V032021 37
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
204 D&C 235 URS + LL

205 HYSTEROSCOPIC RESECTION OF SEPTUM 236 LAPAROSCOPIC OOPHORECTOMY

206 THERMAL CAUTERISATION OF CERVIX 237 NORMAL VAGINAL DELIVERY AND VARIANTS

207 MIRENA INSERTION NEUROLOGY RELATED

208 HYSTEROSCOPIC ADHESIOLYSIS 238 FACIAL NERVE PHYSIOTHERAPY

209 LEEP 239 NERVE BIOPSY

210 CRYOCAUTERISATION OF CERVIX 240 MUSCLE BIOPSY

211 POLYPECTOMY ENDOMETRIUM 241 EPIDURAL STEROID INJECTION

242 GLYCEROL RHIZOTOMY
212 HYSTEROSCOPIC RESECTION OF FIBROID
243 SPINAL CORD STIMULATION
213 LLETZ
244 MOTOR CORTEX STIMULATION
214 CONIZATION
245 STEREOTACTIC RADIOSURGERY
215 POLYPECTOMY CERVIX
246 PERCUTANEOUS CORDOTOMY
216 HYSTEROSCOPIC RESECTION OF
247 INTRATHECAL BACLOFEN THERAPY
ENDOMETRIAL POLYP
248 ENTRAPMENT NEUROPATHY RELEASE
217 VULVAL WART EXCISION
249 DIAGNOSTIC CEREBRAL ANGIOGRAPHY
218 LAPAROSCOPIC PARAOVARIAN CYST EXCISION
250 VP SHUNT
219 UTERINE ARTERY EMBOLIZATION
251 VENTRICULOATRIAL SHUNT
220 LAPAROSCOPIC CYSTECTOMY
252 RADIOTHERAPY FOR CANCER
221 HYMENECTOMY( IMPERFORATE HYMEN)
253 CANCER CHEMOTHERAPY
222 ENDOMETRIAL ABLATION 254 IV PUSH CHEMOTHERAPY
223 VAGINAL WALL CYST EXCISION 255 HBI-HEMIBODY RADIOTHERAPY
224 VULVAL CYST EXCISION 256 INFUSIONAL TARGETED THERAPY

225 LAPAROSCOPIC PARATUBAL CYST EXCISION 257 SRT-STEREOTACTIC ARC THERAPY

226 REPAIR OF VAGINA ( VAGINAL ATRESIA ) 258 SC ADMINISTRATION OF GROWTH FACTORS

227 HYSTEROSCOPY, REMOVAL OF MYOMA 259 CONTINUOUS INFUSIONAL CHEMOTHERAPY

260 INFUSIONAL CHEMOTHERAPY
228 TURBT
261 CCRT-CONCURRENT CHEMO + RT
229 URETEROCOELE REPAIR - CONGENITAL
INTERNAL 262 2D RADIOTHERAPY

230 VAGINAL MESH FOR POP 263 3D CONFORMAL RADIOTHERAPY

231 LAPAROSCOPIC MYOMECTOMY 264 IGRT- IMAGE GUIDED RADIOTHERAPY

265 IMRT- STEP & SHOOT
232 SURGERY FOR SUI
266 INFUSIONAL BISPHOSPHONATES
233 REPAIR RECTO- VAGINA FISTULA
267 IMRT- DMLC
234 PELVIC FLOOR REPAIR( EXCLUDING FISTULA
REPAIR) 268 ROTATIONAL ARC THERAPY

OneHealth - MAGHLIP222V032021 38
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
269 TELE GAMMA THERAPY 304 CONSOLIDATION CHEMOTHERAPY
270 FSRT-FRACTIONATED SRT 305 MAINTENANCE CHEMOTHERAPY
271 VMAT-VOLUMETRIC MODULATED ARC THERAPY 306 HDR BRACHYTHERAPY
272 SBRT-STEREOTACTIC BODY RADIOTHERAPY OPERATIONS ON THE SALIVARY GLANDS AND
273 HELICAL TOMOTHERAPY SALIVARY DUCTS

274 SRS-STEREOTACTIC RADIOSURGERY 307 INCISION AND LANCING OF A SALIVARY

GLAND AND A SALIVARY DUCT
275 X-KNIFE SRS
308 EXCISION OF DISEASED TISSUE OF A SALIVARY
276 GAMMAKNIFE SRS GLAND AND A SALIVARY DUCT
277 TBI- TOTAL BODY RADIOTHERAPY
309 RESECTION OF A SALIVARY GLAND
278 INTRALUMINAL BRACHYTHERAPY
310 RECONSTRUCTION OF A SALIVARY GLAND
279 ELECTRON THERAPY AND A SALIVARY DUCT
280 TSET-TOTAL ELECTRON SKIN THERAPY 311 OTHER OPERATIONS ON THE SALIVARY
GLANDS AND SALIVARY DUCTS
281 EXTRACORPOREAL IRRADIATION OF BLOOD
PRODUCTS OPERATIONS ON THE SKIN &
SUBCUTANEOUS TISSUE
282 TELECOBALT THERAPY
283 TELECESIUM THERAPY 312 OTHER INCISIONS OF THE SKIN AND
SUBCUTANEOUS TISSUES
284 EXTERNAL MOULD BRACHYTHERAPY
313 SURGICAL WOUND TOILET (WOUND
285 INTERSTITIAL BRACHYTHERAPY DEBRIDEMENT) AND REMOVAL OF DISEASED
286 INTRACAVITY BRACHYTHERAPY TISSUE OF THESKIN AND SUBCUTANEOUS
TISSUES
287 3D BRACHYTHERAPY
314 LOCAL EXCISION OF DISEASED TISSUE OF THE
288 IMPLANT BRACHYTHERAPY SKIN AND SUBCUTANEOUS TISSUES
289 INTRAVESICAL BRACHYTHERAPY 315 OTHER EXCISIONS OF THE SKIN AND
290 ADJUVANT RADIOTHERAPY SUBCUTANEOUS TISSUES

291 AFTERLOADING CATHETER BRACHYTHERAPY 316 SIMPLE RESTORATION OF SURFACE

CONTINUITY OF THE SKIN AND
292 CONDITIONING RADIOTHEARPY FOR BMT SUBCUTANEOUS TISSUES
293 EXTRACORPOREAL IRRADIATION TO THE 317 FREE SKIN TRANSPLANTATION, DONOR SITE
HOMOLOGOUS BONE GRAFTS
318 FREE SKIN TRANSPLANTATION, RECIPIENT SITE
294 RADICAL CHEMOTHERAPY
319 REVISION OF SKIN PLASTY
295 NEOADJUVANT RADIOTHERAPY
320 OTHER RESTORATION AND RECONSTRUCTION
296 LDR BRACHYTHERAPY
OF THE SKIN AND SUBCUTANEOUS TISSUES.
297 PALLIATIVE RADIOTHERAPY
321 CHEMOSURGERY TO THE SKIN.
298 RADICAL RADIOTHERAPY
322 DESTRUCTION OF DISEASED TISSUE IN THE
299 PALLIATIVE CHEMOTHERAPY SKIN AND SUBCUTANEOUS TISSUES
300 TEMPLATE BRACHYTHERAPY 323 RECONSTRUCTION OF DEFORMITY/DEFECT IN
301 NEOADJUVANT CHEMOTHERAPY NAIL BED

302 ADJUVANT CHEMOTHERAPY 324 EXCISION OF BURSIRTIS

303 INDUCTION CHEMOTHERAPY 325 TENNIS ELBOW RELEASE

OneHealth - MAGHLIP222V032021 39
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
OPERATIONS ON THE TONGUE 350 ANTERIOR CHAMBER PARACENTESIS /
CYCLODIATHERMY / CYCLOCRYOTHERAPY
326 INCISION, EXCISION AND DESTRUCTION OF / GONIOTOMY /TRABECULOTOMY AND
DISEASED TISSUE OF THE TONGUE FILTERING AND ALLIED OPERATIONS TO TREAT
GLAUCOMA
327 PARTIAL GLOSSECTOMY
351 ENUCLEATION OF EYE WITHOUT IMPLANT
328 GLOSSECTOMY
352 DACRYOCYSTORHINOSTOMY FOR VARIOUS
329 RECONSTRUCTION OF THE TONGUE LESIONS OF LACRIMAL GLAND
330 OTHER OPERATIONS ON THE TONGUE 353 LASER PHOTOCOAGULATION TO TREAT
RATINAL TEAR
OPTHALMOLOGY RELATED
354 BIOPSY OF TEAR GLAND
331 SURGERY FOR CATARACT
355 TREATMENT OF RETINAL LESION
332 INCISION OF TEAR GLANDS
ORTHOPAEDICS RELATED
333 OTHER OPERATIONS ON THE TEAR DUCTS
356 SURGERY FOR MENISCUS TEAR
334 INCISION OF DISEASED EYELIDS 357 INCISION ON BONE, SEPTIC AND ASEPTIC
335 EXCISION AND DESTRUCTION OF DISEASED 358 CLOSED REDUCTION ON FRACTURE, LUXATION
TISSUE OF THE EYELID OR EPIPHYSEOLYSIS WITH OSTEOSYNTHESIS
336 OPERATIONS ON THE CANTHUS AND 359 SUTURE AND OTHER OPERATIONS ON
EPICANTHUS TENDONS AND TENDON SHEATH

337 CORRECTIVE SURGERY FOR ENTROPION AND 360 REDUCTION OF DISLOCATION UNDER GA
ECTROPION
361 ARTHROSCOPIC KNEE ASPIRATION
338 CORRECTIVE SURGERY FOR BLEPHAROPTOSIS 362 SURGERY FOR LIGAMENT TEAR
339 REMOVAL OF A FOREIGN BODY FROM THE 363 SURGERY FOR HEMOARTHROSIS/
CONJUNCTIVA PYOARTHROSIS
340 REMOVAL OF A FOREIGN BODY FROM THE 364 REMOVAL OF FRACTURE PINS/NAILS
CORNEA
365 REMOVAL OF METAL WIRE
341 INCISION OF THE CORNEA
366 CLOSED REDUCTION ON FRACTURE, LUXATION
342 OPERATIONS FOR PTERYGIUM 367 REDUCTION OF DISLOCATION UNDER GA
343 OTHER OPERATIONS ON THE CORNEA 368 EPIPHYSEOLYSIS WITH OSTEOSYNTHESIS
344 REMOVAL OF A FOREIGN BODY FROM THE 369 EXCISION OF VARIOUS LESIONS IN COCCYX
LENS OF THE EYE
370 ARTHROSCOPIC REPAIR OF ACL TEAR KNEE
345 REMOVAL OF A FOREIGN BODY FROM THE
371 CLOSED REDUCTION OF MINOR FRACTURES
POSTERIOR CHAMBER OF THE EYE
372 ARTHROSCOPIC REPAIR OF PCL TEAR KNEE
346 REMOVAL OF A FOREIGN BODY FROM THE
ORBIT AND EYEBALL 373 TENDON SHORTENING

347 CORRECTION OF EYELID PTOSIS BY LEVATOR 374 ARTHROSCOPIC MENISCECTOMY - KNEE

PALPEBRAE SUPERIORIS RESECTION (BILATERAL)
375 TREATMENT OF CLAVICLE DISLOCATION
348 CORRECTION OF EYELID PTOSIS BY FASCIA 376 HAEMARTHROSIS KNEE- LAVAGE
LATA GRAFT (BILATERAL)
377 ABSCESS KNEE JOINT DRAINAGE
349 DIATHERMY/CRYOTHERAPY TO TREAT RETINAL
TEAR 378 CARPAL TUNNEL RELEASE

OneHealth - MAGHLIP222V032021 40
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
379 CLOSED REDUCTION OF MINOR DISLOCATION 415 FIXATION OF KNEE JOINT
380 REPAIR OF KNEE CAP TENDON 416 TREATMENT OF FOOT DISLOCATION
381 ORIF WITH K WIRE FIXATION- SMALL BONES 417 SURGERY OF BUNION
382 RELEASE OF MIDFOOT JOINT 418 INTRA ARTICULAR STEROID INJECTION
383 ORIF WITH PLATING- SMALL LONG BONES 419 TENDON TRANSFER PROCEDURE
384 IMPLANT REMOVAL MINOR 420 REMOVAL OF KNEE CAP BURSA
385 K WIRE REMOVAL 421 TREATMENT OF FRACTURE OF ULNA
386 POP APPLICATION 422 TREATMENT OF SCAPULA FRACTURE
387 CLOSED REDUCTION AND EXTERNAL FIXATION 423 REMOVAL OF TUMOR OF ARM/ ELBOW UNDER
388 ARTHROTOMY HIP JOINT RA/GA

389 SYME’S AMPUTATION 424 REPAIR OF RUPTURED TENDON

390 ARTHROPLASTY 425 DECOMPRESS FOREARM SPACE

391 PARTIAL REMOVAL OF RIB 426 REVISION OF NECK MUSCLE (TORTICOLLIS

RELEASE )
392 TREATMENT OF SESAMOID BONE FRACTURE
427 LENGTHENING OF THIGH TENDONS
393 SHOULDER ARTHROSCOPY / SURGERY
428 TREATMENT FRACTURE OF RADIUS & ULNA
394 ELBOW ARTHROSCOPY
429 REPAIR OF KNEE JOINT
395 AMPUTATION OF METACARPAL BONE
OTHER OPERATIONS ON THE MOUTH & FACE
396 RELEASE OF THUMB CONTRACTURE
397 INCISION OF FOOT FASCIA 430 EXTERNAL INCISION AND DRAINAGE IN THE
REGION OF THE MOUTH, JAW AND FACE
398 CALCANEUM SPUR HYDROCORT INJECTION
431 INCISION OF THE HARD AND SOFT PALATE
399 GANGLION WRIST HYALASE INJECTION
432 EXCISION AND DESTRUCTION OF DISEASED
400 PARTIAL REMOVAL OF METATARSAL HARD AND SOFT PALATE
401 REPAIR / GRAFT OF FOOT TENDON 433 INCISION, EXCISION AND DESTRUCTION IN
402 REVISION/REMOVAL OF KNEE CAP THE MOUTH

403 AMPUTATION FOLLOW-UP SURGERY 434 OTHER OPERATIONS IN THE MOUTH

404 EXPLORATION OF ANKLE JOINT PAEDIATRIC SURGERY RELATED

405 REMOVE/GRAFT LEG BONE LESION 435 EXCISION OF FISTULA-IN-ANO

406 REPAIR/GRAFT ACHILLES TENDON 436 EXCISION JUVENILE POLYPS RECTUM

407 REMOVE OF TISSUE EXPANDER 437 VAGINOPLASTY

408 BIOPSY ELBOW JOINT LINING 438 DILATATION OF ACCIDENTAL C AUSTIC

STRICTURE OESOPHAGEAL
409 REMOVAL OF WRIST PROSTHESIS
439 PRESACRAL TERATOMAS EXCISION
410 BIOPSY FINGER JOINT LINING
440 REMOVAL OF VESICAL STONE
411 TENDON LENGTHENING
441 EXCISION SIGMOID POLYP
412 TREATMENT OF SHOULDER DISLOCATION
442 STERNOMASTOID TENOTOMY
413 LENGTHENING OF HAND TENDON
443 INFANTILE HYPERTROPHIC PYLORIC STENOSIS
414 REMOVAL OF ELBOW BURSA
PYLOROMYOTOMY

OneHealth - MAGHLIP222V032021 41
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.
444 EXCISION OF SOFT TISSUE UROLOGY RELATED
RHABDOMYOSARCOMA
474 HAEMODIALYSIS
445 MEDIASTINAL LYMPH NODE BIOPSY
475 LITHOTRIPSY/NEPHROLITHOTOMY FOR RENAL
446 HIGH ORCHIDECTOMY FOR TESTIS TUMOURS CALCULUS

447 EXCISION OF CERVICAL TERATOMA 476 EXCISION OF RENAL CYST

448 RECTAL-MYOMECTOMY 477 DRAINAGE OF PYONEPHROSIS/PERINEPHRIC

ABSCESS
449 RECTAL PROLAPSE (DELORME’S PROCEDURE)
478 INCISION OF THE PROSTATE
450 DETORSION OF TORSION TESTIS
479 TRANSURETHRAL EXCISION AND DESTRUCTION
451 EUA + BIOPSY MULTIPLE FISTULA IN ANO OF PROSTATE TISSUE
452 CYSTIC HYGROMA - INJECTION TREATMENT 480 TRANSURETHRAL AND PERCUTANEOUS
DESTRUCTION OF PROSTATE TISSUE
PLASTIC SURGERY RELATED
481 OPEN SURGICAL EXCISION AND DESTRUCTION
453 CONSTRUCTION SKIN PEDICLE FLAP OF PROSTATE TISSUE
454 GLUTEAL PRESSURE ULCER-EXCISION 482 RADICAL PROSTATOVESICULECTOMY
455 MUSCLE-SKIN GRAFT, LEG 483 OTHER EXCISION AND DESTRUCTION OF
456 REMOVAL OF BONE FOR GRAFT PROSTATE TISSUE

457 MUSCLE-SKIN GRAFT DUCT FISTULA 484 OPERATIONS ON THE SEMINAL VESICLES

458 REMOVAL CARTILAGE GRAFT 485 INCISION AND EXCISION OF PERIPROSTATIC

TISSUE
459 MYOCUTANEOUS FLAP
486 OTHER OPERATIONS ON THE PROSTATE
460 FIBRO MYOCUTANEOUS FLAP
487 INCISION OF THE SCROTUM AND TUNICA
461 BREAST RECONSTRUCTION SURGERY AFTER VAGINALIS TESTIS
MASTECTOMY
488 OPERATION ON A TESTICULAR HYDROCELE
462 SLING OPERATION FOR FACIAL PALSY 489 EXCISION AND DESTRUCTION OF DISEASED
463 SPLIT SKIN GRAFTING UNDER RA SCROTAL TISSUE

464 WOLFE SKIN GRAFT 490 OTHER OPERATIONS ON THE SCROTUM AND
TUNICA VAGINALIS TESTIS
465 PLASTIC SURGERY TO THE FLOOR OF THE
MOUTH UNDER GA 491 INCISION OF THE TESTES

THORACIC SURGERY RELATED 492 EXCISION AND DESTRUCTION OF DISEASED

TISSUE OF THE TESTES
466 THORACOSCOPY AND LUNG BIOPSY
493 UNILATERAL ORCHIDECTOMY
467 EXCISION OF CERVICAL SYMPATHETIC CHAIN
THORACOSCOPIC 494 BILATERAL ORCHIDECTOMY

468 LASER ABLATION OF BARRETT’S OESOPHAGUS 495 SURGICAL REPOSITIONING OF AN ABDOMINAL

TESTIS
469 PLEURODESIS
496 RECONSTRUCTION OF THE TESTIS
470 THORACOSCOPY AND PLEURAL BIOPSY
497 IMPLANTATION, EXCHANGE AND REMOVAL OF
471 EBUS + BIOPSY A TESTICULAR PROSTHESIS
472 THORACOSCOPY LIGATION THORACIC DUCT 498 OTHER OPERATIONS ON THE TESTIS

473 THORACOSCOPY ASSISTED EMPYAEMA 499 EXCISION IN THE AREA OF THE EPIDIDYMIS
DRAINAGE
500 OPERATIONS ON THE FORESKIN

OneHealth - MAGHLIP222V032021 42
 OneHealth
Insurance
Sl. Item Sl. Item
No. No.

501 LOCAL EXCISION AND DESTRUCTION OF 522 REMOVAL OF URETHRAL STONE

DISEASED TISSUE OF THE PENIS
523 EXCISION OF URETHRAL PROLAPSE
502 AMPUTATION OF THE PENIS
524 MEGA-URETER RECONSTRUCTION
503 OTHER OPERATIONS ON THE PENIS
525 KIDNEY RENOSCOPY AND BIOPSY
504 CYSTOSCOPICAL REMOVAL OF STONES
526 URETER ENDOSCOPY AND TREATMENT
505 CATHETERISATION OF BLADDER
527 VESICO URETERIC REFLUX CORRECTION
506 LITHOTRIPSY
528 SURGERY FOR PELVI URETERIC JUNCTION
507 BIOPSY OFTEMPORAL ARTERY FOR VARIOUS OBSTRUCTION
LESIONS
529 ANDERSON HYNES OPERATION
508 EXTERNAL ARTERIO-VENOUS SHUNT
530 KIDNEY ENDOSCOPY AND BIOPSY
509 AV FISTULA - WRIST
531 PARAPHIMOSIS SURGERY
510 URSL WITH STENTING
532 INJURY PREPUCE- CIRCUMCISION
511 URSL WITH LITHOTRIPSY
533 FRENULAR TEAR REPAIR
512 CYSTOSCOPIC LITHOLAPAXY
534 MEATOTOMY FOR MEATAL STENOSIS
513 ESWL
535 SURGERY FOR FOURNIER’S GANGRENE
514 BLADDER NECK INCISION SCROTUM

515 CYSTOSCOPY & BIOPSY 536 SURGERY FILARIAL SCROTUM

516 CYSTOSCOPY AND REMOVAL OF POLYP 537 SURGERY FOR WATERING CAN PERINEUM

517 SUPRAPUBIC CYSTOSTOMY 538 REPAIR OF PENILE TORSION

518 PERCUTANEOUS NEPHROSTOMY 539 DRAINAGE OF PROSTATE ABSCESS

519 CYSTOSCOPY AND “SLING” PROCEDURE. 540 ORCHIECTOMY

520 TUNA- PROSTATE 541 CYSTOSCOPY AND REMOVAL OF FB

521 EXCISION OF URETHRAL DIVERTICULUM

Magma HDI General Insurance Co. Ltd. | www.magmahdi.com | E-mail: customercare@magma-hdi.co.in | Toll Free: 1800 266 3202
| Registered Office: Development House, 24 Park Street, Kolkata – 700016. CIN: U66000WB2009PLC136327 | IRDAI Reg. No. 149
OneHealth - MAGHLIP222V032021 | Trade logos displayed above belong to Magma Fincorp Ltd. and HDI Global SE respectively, and
are being used by Magma HDI General Insurance Company Limited, under license. (PW-01-07-21)

OneHealth - MAGHLIP222V032021 43