INDIAN BANK HEALTH CARE PLUS

POLICY WORDING

A. SCHEDULE

B. PREAMBLE

This policy is an evidence of the contract between you and Universal Sompo General Insurance
Company Limited. The information furnished by you in the proposal form and the declaration
signed by you forms the basis of this contract.
The Policy, the Schedule and any Endorsement shall be read together and any word or expression
to which a specific meaning has been attached in any part of this Policy or of Schedule shall bear
such meaning whenever it may appear.
This Policy witnesses that in consideration of Your having paid the premium, We undertake that if
during the period of insurance or during the continuance of this policy by renewal You contract
any disease or suffer from any illness or sustain any bodily injury through accident and if such
disease or injury shall require, upon the advices of a qualified Medical Practitioner, hospitalization
for medical/surgical treatment in any Nursing Home/ Hospital in India as defined in the policy, We
will pay to YOU the amount of such expenses as may be reasonably and necessarily incurred in
respect thereof as stated in the schedule but not exceeding the sum insured in aggregate in any
one period of insurance provided that all the terms, conditions and exceptions of this Policy in so
far as they relate to anything to be done or complied with by You have been met.

C. DEFINITIONS

C.1. Standard Definition:

The terms defined below and at other junctures in the Policy have the meanings ascribed to them
wherever they appear in this Policy and, where, the context so requires, references to the singular
include references to the plural; references to the male includes the female and references to any
statutory enactment includes subsequent changes to the same.

Accident means a sudden unforeseen and involuntary event caused by external, visible and violent
means.
Any one illness means continuous Period of illness and it includes relapse within 45 days from the
date of last consultation with the Hospital/Nursing Home where treatment was taken.

AYUSH Hospital - An AYUSH Hospital is a healthcare facility wherein medical/surgical/ para-

surgical treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s)
comprising of any of the following:

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 a. Central or State Government AYUSH Hospital; or
b. Teaching hospital attached to AYUSH College recognized by the Central
Government/Central Council of Indian Medicine/Central Council for Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any
recognized system of medicine, registered with the local authorities, wherever applicable,
and is under the supervision of a qualified registered AYUSH Medical Practitioner and must
comply with all the following criterion:
i. Having at least 5 in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation
theatre where surgical procedures are to be carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance
company’s authorized representative.

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

AYUSH Treatment refers to the medical and / or hospitalization treatments given under Ayurveda,
Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.

Break in Policy means the period of gap that occurs at the end of the existing policy term/installment
premium due date, when the premium due for renewal on a given policy or installment premium
due is not paid on or before the premium renewal date or grace period.

Cashless Facility means a facility extended by the insurer to the insured where the payments, of the
costs of treatment undergone by the insured in accordance with the Policy terms and conditions,
are directly made to the Network Provider by the insurer to the extent pre- authorization is
approved.

Condition Precedent means a Policy term or condition upon which the Insurer's liability under the
Policy is conditional upon.

Congenital Anomaly means a condition(s) which is present since birth, and which is abnormal with
reference to form, structure or position.
a) Internal Congenital Anomaly: means which is not in the visible and accessible parts of the
body
b) External Congenital Anomaly: means which is in the visible and accessible parts of the
body

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 Co-payment means a cost sharing requirement under a health insurance Policy that provides that
the Policy holder/Insured will bear a specified percentage of the admissible claim amount. A co-
payment does not reduce the Sum Insured.

Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer
without an associated increase in premium.

Dental Treatment means a treatment related to teeth or structures supporting teeth including
examinations, fillings (where appropriate), crowns, extractions and Surgery.

Day Care Centre means any institution established for Day Care Treatment of Illness and/or Injuries
or a medical setup within a Hospital and which has been registered with the local authorities,
wherever applicable, and is under the supervision of a registered and qualified Medical Practitioner
AND must comply with all minimum criteria as under

• has qualified nursing staff under its employment;

• has qualified Medical Practitioner/s in charge;
• has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
• maintains daily records of patients and will make these accessible to the insurance Company’s
authorized personnel

Day Care Treatment means medical treatment, and/or surgical procedure which is:

i. undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24
hrs because of technological advancement, and
ii. which would have otherwise required hospitalization of more than 24 hours.
iii. Treatment normally taken on an out-patient basis is not included in the scope of this
definition.

Disclosure to information norm means the Policy shall be void and all premium paid thereon shall
be forfeited to the Company, in the event of misrepresentation, mis-description or non- disclosure
of any material fact.

Domiciliary Hospitalization means medical treatment for an Illness/disease/Injury which in the

normal course would require care and treatment at a Hospital but is actually taken while confined
at home under any of the following circumstances:
• the condition of the patient is such that he/she is not in a condition to be removed to
a Hospital, or
• the patient takes treatment at home on account of non-availability of room in a
Hospital.

Emergency Care means management for an illness or injury which results in symptoms which
occur suddenly and unexpectedly, and requires immediate care by a Medical Practitioner to
prevent death or serious long term impairment of the Insured Person’s health.

Grace period the specified period of time, immediately following the premium due date during
which premium payment can be made to renew or continue a policy in force without loss of
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 continuity benefits pertaining to waiting periods and coverage of pre-existing diseases. Coverage
need not be available during the period for which no premium is received. The grace period for
payment of the premium for all types of insurance policies shall be: fifteen days where premium
payment mode is monthly and thirty days in all other cases.

Hospitalization means admission in a Hospital for a minimum period of 24 consecutive ‘In- patient
Care’ hours except for specified procedures/ treatments, where such admission could be for a
period of less than 24 consecutive hours.

Hospital means any institution established for in-patient care and Day Care Treatment of Illness
and/or Injuries and which has been registered as a Hospital with the local authorities under the
Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified
under the Schedule of Section 56(1) of the said Act OR complies with all minimum criteria as
under:

• has qualified nursing staff under its employment round the clock;
• has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at
least 15 in-patient beds in all other places;

• has qualified Medical Practitioner(s) in charge round the clock;

• has a fully equipped operation theatre of its own where Surgical Procedures are carried
out;
• maintains daily records of patients and makes these accessible to the insurance
Company’s authorized personnel.
Inpatient Care means treatment for which the Insured Person has to stay in a Hospital for more
than 24 hours for a covered event.

Intensive Care Unit means an identified section, ward or wing of a Hospital which is under the
constant supervision of a dedicated Medical Practitioner(s), and which is specially equipped for
the continuous monitoring treatment of patients who are in a critical condition, or require life
support facilities and where the level of care and supervision is considerably more sophisticated
and intensive than in the ordinary and other wards.

ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses
which shall include the expenses for ICU bed, general medical support services provided to any
ICU patient including monitoring devices, critical care nursing and intensivist charges.

Injury means accidental physical bodily harm excluding Illness or disease solely and directly caused
by external, violent, visible and evident means which is verified and certified by a Medical
Practitioner.

Illness means a sickness or a disease or pathological condition leading to the impairment of normal
physiological function which manifests itself during the Policy Period and requires medical
treatment.

a) Acute Condition is a disease, Illness or Injury that is likely to respond quickly to treatment which
aims to return the person to his or her state of health immediately before suffering the
disease/Illness/Injury which leads to full recovery.

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 b) Chronic condition is defined as a disease, Illness, or Injury that has one or more of the
following characteristics

• it needs on-going or long-term monitoring through consultations, examinations, check-

ups, and/or tests
• it needs on-going or long-term control or relief of symptoms
• it requires rehabilitation for the patient or for the patient to be specially trained to cope
with it
• it continues indefinitely
• it recurs or is likely to recur.

Maternity Expenses means:

• Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during Hospitalization).
• Expenses towards lawful medical termination of pregnancy during the Policy Period.

Medical Advice means any consultation or advice from a Medical Practitioner including the
issuance of any prescription or follow-up prescription

Medical Expenses means those expenses that an Insured Person has necessarily and actually
incurred for medical treatment on account of Illness or Accident on the advice of a Medical
Practitioner, as long as these are no more than would have been payable if the Insured Person had
not been insured and no more than other Hospitals or doctors in the same locality would have
charged for the same medical treatment.

Medical Practitioner is a person who holds a valid registration from the Medical Council of any
State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the
Government of India or a State Government and is thereby entitled to practice medicine within
its jurisdiction; and is acting within the scope and jurisdiction of licence.

Medically Necessary Treatment means any treatment, tests, medication, or stay in Hospital or
part of a stay in Hospital which

• is required for the medical management of the Illness or Injury suffered by the insured;
• must not exceed the level of care necessary to provide safe, adequate and appropriate
medical care in scope, duration, or intensity;
• must have been prescribed by a Medical Practitioner,
• must conform to the professional standards widely accepted in international medical
practice or by the medical community in India.

Migration means a facility provided to policyholders (including all members under family cover
and group policies), to transfer the credits gained for pre-existing diseases and specific waiting
periods from one health insurance policy to another with the same insurer.

Network Provider means Hospitals or health care providers enlisted by an insurer, TPA or jointly
by an insurer and TPA to provide medical services to an insured on payment by a cashless facility.

New Born Baby means baby born during the Policy Period and is aged upto 90 days.
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 Non-Network means any Hospital, day care centre or other provider that is not part of the
network.
OPD Treatment is one in which the Insured visits a clinic / Hospital or associated facility like a
consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The
Insured is not admitted as a day care or in-patient.

Pre-Hospitalization Medical Expenses means the Medical Expenses incurred during pre- defined
number of days preceding the hospitalization of the Insured Person, provided that:
• Such Medical Expenses are incurred for the same condition for which the Insured
Person’s Hospitalisation was required, and
• The In-patient Hospitalization claim for such Hospitalization is admissible by the
Insurance Company.

Pre- Existing Diseases means any condition, ailment, injury or disease:

a) that is/are diagnosed by a physician not more than 36 months prior to the date of
commencement of the policy issued by the insurer; or

b) for which medical advice or treatment was recommended by, or received from, a physician, not
more than 36 months prior to the date of commencement of the policy.

Portability means a facility provided to the health insurance policyholders (including all members
under family cover), to transfer the credits gained for, pre-existing diseases and specific waiting
periods from one insurer to another insurer.

Post-Hospitalization Medical Expenses means the Medical Expenses incurred during pre- defined
number of days immediately after the Insured Person is discharged from the Hospital provided
that:
• Such Medical Expenses are incurred for the same condition for which the Insured Person’s
Hospitalization was required and
• The inpatient Hospitalization claim for such Hospitalization is admissible by the
Insurance Company.

Qualified Nurse means a person who holds a valid registration from the Nursing Council of India
or the Nursing Council of any state in India .

Renewal means the terms on which the contract of insurance can be renewed on mutual consent
with a provision of Grace Period for treating the Renewal continuous for the purpose of gaining
credit for pre-existing diseases, time-bound exclusions and all waiting periods.

Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and
shall include associated Medical Expenses.

Surgery or Surgical Procedure means manual and / or operative procedure (s) required for
treatment of an Illness or Injury, correction of deformities and defects, diagnosis and cure of
diseases, relief of suffering or prolongation of life, performed in a Hospital or day care centre by a
Medical Practitioner.

Unproven/Experimental Treatment means the treatment including drug experimental therapy,

which is not based on established medical practice in India, is treatment experimental or
unproven.
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 C.2. Specific Definition:

Accidental Bodily Injury means any accidental physical bodily harm solely and directly caused by
external, violent and visible means which is verified and certified by a Medical Practitioner but
does not include any sickness or disease.
Adventure Sports means participation in sports activities such as bungee jumping, sky diving,
white water canoeing/rafting and engaging in racing, hunting, mountaineering, ice hockey, winter
sports and the like.

Alternative Treatment means forms of treatments other than treatment "Allopathy" or "modem
medicine" and includes Ayurveda, Unani, Sidha and Homeopathy in the Indian context.

Company means “Universal Sompo General Insurance Company Limited.”

Dependent Child refers to a child (natural or legally adopted), who is financially dependent on You
and does not have his/her independent sources of income and is up to 21 years of age (male child)
and 25 years of age or till she marries (female child).

Family Member means person(s) whose names are specifically appearing in the Schedule and are
related to You as spouse, Dependent Children and / or Dependent Parents.

Insured means the individual whose name is specifically appearing in the Schedule herein after
referred as “You”/”Your”/”Yours”/”Yourself”.

Nominee means the person(s) nominated by the Insured Person to receive the insurance benefits
under this Policy payable on his/her death.

Notification of Claim is the process of notifying a claim to the insurer or TPA through any of the
recognized modes of communication.
Policy means Our contract of insurance with the Insured providing cover as detailed in this
document.

Policy Period means the Policy Period as set out in the Schedule for which the insurance cover will
remain valid.
Premium means an agreed amount to be paid by the Policyholder to Us in full and in advance for
the purpose of coverage under the Policy. The due payment of Premium and observance of all
terms and conditions shall be a condition precedent for acceptance of liability by Us under the
Policy.

Reasonable and Customary Charges means the charges for services or supplies, which are the
standard charges for the specific provider and consistent with the prevailing charges in the
geographical area for identical or similar services, taking into account the nature of the Illness /
Injury involved.

Service Providers means any person, institution or organisation that has been empanelled by the
Company to provide services to the Insured Person specified in the Policy.

Schedule means Schedule attached to and forming part of this Policy mentioning the details of the
Insured/Insured Persons, the Sum Insured, the period and the limits to which benefits under the
Policy would be payable.
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 TPA means the third party administrator that the Company appoints from time to time as specified
in the Schedule.

You/Your/Yours/Yourself means the person(s) that We insure and is/are specifically named

as Insured in the Schedule.

We/Our/Ours/Us mean Universal Sompo General Insurance Company Limited.

War means War, whether declared or not, or any warlike activities, including use of military force
by any sovereign nation to achieve economic, geographic, nationalistic, political, racial, religious
or other ends.

D. BENEFITS:

D.1. WHAT WE COVER:

The Hospitalization expenses of the insured when he/she sustains any injury or contracts any disease
and is advised hospitalization by a Medical Practitioner
We will pay Reasonable and Customary charges of the following Hospitalization expenses:
1. The Medical Expenses incurred on Room, Boarding and Nursing Expense as provided in the
Hospital/ Nursing Home
2. The Medical Expenses incurred on Medical Practitioner/ Anesthetist, Consultant fees, Surgeons
fees and similar expenses
3. The Medical Expenses incurred on Anesthesia, Blood, Oxygen, Operation Theatre, Surgical
Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy,
Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Organ harvesting and similar expenses.
4. The medical expenses on treatment arising from or traceable to pregnancy, childbirth and
expenses on the treatment of the newly born child up to 5% of the sum insured, subject to such
treatment not being carried out before the completion of 9 months from the commencement of
the policy.
5. The Medical Expenses incurred in the 30 days immediately prior before the date You were
Hospitalized, provided that any Nursing expenses during Pre Hospitalization will be considered
only if Qualified Nurse is employed on the advice of the attending Medical Practitioner for the
duration specified
6. The Medical Expenses incurred in the 60 days immediately after Your date of discharge from
Hospital provided that any Nursing expenses during Pre Hospitalization will be considered only if
Qualified Nurse is employed on the advice of the attending Medical Practitioner for the duration
specified
7. Cost of Health Checkup: Insured Person shall be entitled for reimbursement of cost of medical
checkup once at the end of a block of every three claim free Policies. The reimbursement shall not
exceed the amount equal to 1% of the average Basic Sum Insured during the block of four claim
free Policies.
Additional benefits
1. In case of hospitalization of children below 12 years, a lump sum amount of Rs.1000/ as Out of
Expenses to any of the parents during the policy period
2. Ambulance charges in connection with any admissible claim limited to Rupees 1000/- per policy
period.
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 3. In case of death in hospital, funeral expenses are reimbursed up to Rs.1000/ over and above the
sum insured subject to the original illness/accident claim admitted under the policy.

NB:

a) Expenses on Vitamins and Tonics only if forming part of treatment as certified by the attending
Medical Practitioner.
b) The Hospitalization expenses incurred for treatment of any one illness under agreed package
charges of the Hospital/Nursing Home will be restricted to 75% of the Sum Insured.
c) Cashless facility for the medical treatment carried out in Network Hospital/ Nursing home is
available through our nominated Third Party Administrator (TPA)
d) A co-payment of 20% shall be applicable on each and every claim of Insured Person who is
above 55 years of age under the Policy
e) If medical expenses are incurred under two Policy Periods, the total liability shall not exceed
the Sum Insured of the Policy during which the Insured Person’s medical treatment commenced
and the entire claim will be considered under that Policy only
f) Expenses on hospitalization for a minimum period of 24 hours are admissible. However, this
time limit is not applied to specific treatments, i.e. Dialysis, Chemotherapy, Radiotherapy, Eye
Surgery, Lithotripsy (Kidney stone removal), D&C, Tonsillectomy taken in the Hospital / Nursing
Home and where in the insured is discharged on the same day, such treatment will be considered
to have been taken under hospitalization benefit. This condition will also not apply in case of
stay in Hospital for less than 24 hours provided (a) the treatment is such that it necessitates
hospitalization and the procedure involves specialized infrastructural facilities available in
hospitals (b) due to technological advances hospitalization is required for less than 24 hours only.

E. EXCLUSIONS:

E.1.Standard Exclusions:

a) Waiting Period:

The Company shall not be liable to make any payment under the policy in connection with or in
respect of following expenses till the expiry of waiting period mentioned below:

1. Pre-Existing Diseases (Code- Excl01)

a) Expenses related to the treatment of a pre-existing Disease (PED) and its direct
complications shall be excluded until the expiry of 36 months of continuous coverage after
the date of inception of the first policy with us.
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of
sum insured increase.
c) If the Insured Person is continuously covered without any break as defined under the
portability norms of the extant IRDAI (Health Insurance) Regulations then waiting period
for the same would be reduced to the extent of prior coverage.
d) Coverage under the policy after the expiry of 36 months for any pre-existing disease is
subject to the same being declared at the time of application and accepted by us.
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 2. Specific Waiting Period: (Code- Excl02)

a) Expenses related to the treatment of the following listed conditions, surgeries/treatments

shall be excluded until the expiry of 12 months of continuous coverage, as may be the case
after the date of inception of the first policy with us. This exclusion shall not be applicable
for claims arising due to an accident.
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of
sum insured increase.
c) If any of the specified disease/procedure falls under the waiting period specified for pre-
existing diseases, then the longer of the two waiting periods shall apply.
d) The waiting period for listed conditions shall apply even if contracted after the policy or
declared and accepted without a specific exclusion.
e) If the Insured Person is continuously covered without any break under the policy, then
waiting period for the same would be reduced to the extent of prior coverage.
f) List of specific diseases/procedures:
• Cataract
• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy
• Hernia, Hydrocele
• Fistula in anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation and Curettage
• Skin and all internal tumors/cysts/nodules/polyps of any kind, including breast
lumps unless malignant, adenoids and hemorrhoids
• Dialysis required for rental failure
• Surgery on tonsils and sinuses Gastric and duodenal ulcers

3. First Thirty Days Waiting Period (Code- Excl03)

i Expenses related to the treatment of any illness within 30 days from the first policy
commencement date shall be excluded except claims arising due to an accident, provided the
same are covered. ii This exclusion shall not, however, apply if the Insured Person has Continuous
Coverage for more than twelve months.
iii The within referred waiting period is made applicable to the enhanced sum insured in the
event of granting higher sum insured subsequently.

4. Maternity Expenses (Code – Excl 18):

(Excluded until the expiry of 9 months after the date of inception of the first policy with us) i
Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during hospitalization) except ectopic pregnancy;
i Expenses towards miscarriage (unless due to an accident) and lawful medical termination of
pregnancy during the policy period.

c) Exclusions:

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 The Company shall not be liable to make any payment under the policy, in respect of any
expenses incurred in connection with or in respect of:
1. Investigation & Evaluation(Code- Excl04)
a) Expenses related to any admission primarily for diagnostics and evaluation purposes.
b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and
treatment
2. Rest Cure, Rehabilitation and Respite Care (Code- Excl05)

a) Expenses related to any admission primarily for enforced bed rest and not for receiving
treatment. This also includes:

i Custodial care either at home or in a nursing facility for personal care such as help with
activities of daily living such as bathing, dressing, moving around either by skilled nurses or
assistant or
non-skilled persons. ii Any services for people who are terminally ill to address physical,
social, emotional and spiritual needs.

3. Obesity/ Weight Control (Code- Excl06)

Expenses related to the surgical treatment of obesity that does not fulfil all the below
conditions:

1) Surgery to be conducted is upon the advice of the Doctor

2) The surgery/Procedure conducted should be supported by clinical protocols
3) The member has to be 18 years of age or older and
4) Body Mass Index (BMl);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co-
morbidities following failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea iv. Uncontrolled Type2 Diabetes

4. Change-of-Gender Treatments: (Code- Excl07)

Expenses related to any treatment, including surgical management, to change

characteristics of the body to those of the opposite sex.

5. Cosmetic or plastic Surgery: (Code- Excl08)

Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for
reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary
treatment to remove a direct and immediate health risk to the insured. For this to be
considered a medical necessity, it must be certified by the attending Medical Practitioner.

6. Hazardous or Adventure sports: (Code- Excl09)

Expenses related to any treatment necessitated due to participation as a professional in

hazardous or adventure sports, including but not limited to, para-jumping, rock climbing,

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 mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving,
deep-sea diving.

7. Breach of law: (Code- Excl10)

Expenses for treatment directly arising from or consequent upon any Insured Person
committing or attempting to commit a breach of law with criminal intent.

8. Excluded Providers: (Code-Excl11)

Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any
other provider specifically excluded by the Insurer and disclosed in its website / notified to
the policyholders are not admissible. However, in case of life threatening situations or
following an accident, expenses up to the stage of stabilization are payable but not the
complete claim.

9. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and
consequences thereof.(Code- Excl12)
10. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or
private beds registered as a nursing home attached to such establishments or where admission
is arranged wholly or partly for domestic reasons. (Code- Excl13)
11. Dietary supplements and substances that can be purchased without prescription, including but
not limited to Vitamins, minerals and organic substances unless prescribed by a medical
practitioner as part of hospitalization claim or day care procedure (Code- Excl14)

12. Refractive Error:(Code- Excl15)

Expenses related to the treatment for correction of eye sight due to refractive error less
than 7.5 dioptres.

13. Unproven Treatments:(Code- Excl16)

Expenses related to any unproven treatment, services and supplies for or in connection
with any treatment. Unproven treatments are treatments, procedures or supplies that lack
significant medical documentation to support their effectiveness.

14. Sterility and Infertility: (Code- Excl17)

Expenses related to sterility and infertility. This includes:

(i) Any type of contraception, sterilization
(ii) Assisted Reproduction services including artificial insemination and advanced
reproductive technologies such as IVF, ZIFT, GIFT, ICSI
(iii) Gestational Surrogacy
(iv) Reversal of sterilization

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 E.2. Specific Exclusions:
Exclusions:

1. Treatment taken outside the geographical limits of India

2. In respect of the existing diseases, disclosed by the insured and mentioned in the policy
schedule (based on insured’s consent), policyholder is not entitled to get the coverage
for specified ICD codes.
3. War (whether declared or not) and war like occurrence or invasion, acts of foreign
enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or
usurped power, seizure, capture, arrest, restraints and detainment of all kinds.

4. Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting
from or from any other cause or event contributing concurrently or in any other
sequence to the loss, claim or expense. For the purpose of this exclusion:

a) Nuclear attack or weapons means the use of any nuclear weapon or device or
waste or combustion of nuclear fuel or the emission, discharge, dispersal, release
or escape of fissile/ fusion material emitting a level of radioactivity capable of
causing any Illness, incapacitating disablement or death.
b) Chemical attack or weapons means the emission, discharge, dispersal, release or
escape of any solid, liquid or gaseous chemical compound which, when suitably
distributed, is capable of causing any Illness, incapacitating disablement or death.
c) Biological attack or weapons means the emission, discharge, dispersal, release
or escape of any pathogenic (disease producing) micro-organisms and/or biologically
produced toxins (including genetically modified organisms and chemically
synthesized toxins) which are capable of causing any Illness, incapacitating
disablement or death.

F. GENERAL TERMS AND CLAUSES:

F.1. Standard General Terms and Clauses

i. Disclosure of Information
The policy shall be void and all premium paid thereon shall be forfeited to the Company
in the event of misrepresentation, misdescription or non-disclosure of any material fact
by the policyholder.

ii. Condition Precedent to Admission of Liability

The terms and conditions of the policy must be fulfilled by the insured person for
the Company to make any payment for claim(s) arising under the policy.

iv. Claim Settlement (provision for Penal Interest)

v. The Company shall settle or reject a claim, as the case may be, within 15 days from the date
of submission of the claim.
vi. In the case of delay in the payment of a claim, the Company shall be liable to pay interest
from the date of receipt date of receipt of intimation to till the date of payment.

Policy Wordings – Indian Bank Health Care Plus

UIN: UNIHLIP25016V042425 Page 13 of 38
 vii. However, where the circumstances of a claim warrant an investigation in the opinion of the
Company, it shall initiate and complete such investigation at the earliest in any case not later
than 15 days from the date of submission of claim.
viii. In case of delay beyond stipulated 15 days the company shall be liable to pay interest at a
rate 2% above the bank rate from the date of receipt of intimation to till the date of payment.
iv. Complete Discharge
Any payment to the policyholder, insured person or his/ her nominees or his/ her legal
representative or assignee or to the Hospital, as the case may be, for any benefit under the
policy shall be a valid discharge towards payment of claim by the Company to the extent of
that amount for the particular claim.

v. Multiple Policies

i. In case of multiple policies taken by an insured person during a period from one or more
insurers to indemnify treatment costs, the insured person shall have the right to require
a settlement of his/her claim in terms of any of his/her policies. In all such cases the
insurer chosen by the insured person shall be obliged to settle the claim as long as the
claim is within the limits of and according to the terms of the chosen policy.
ii. Insured person having multiple policies shall also have the right to prefer claims under this
policy for the amounts disallowed under any other policy / policies even if the sum insured
is not exhausted. Then the insurer shall independently settle the claim subject to the
terms and conditions of this policy.
iii. If the amount to be claimed exceeds the sum insured under a single policy, the insured
person shall have the right to choose insurer from whom he/she wants to claim the
balance amount.
iv. Where an insured person has policies from more than one insurer to cover the same
risk on indemnity basis, the insured person shall only be indemnified the treatment costs
in accordance with the terms and conditions of the chosen policy.

vi. Fraud
If any claim made by the insured person, is in any respect fraudulent, or if any false
statement, or declaration is made or used in support thereof, or if any fraudulent means or
devices are used by the insured person or anyone acting on his/her behalf to obtain any
benefit under this policy, all benefits under this policy and the premium paid shall be
forfeited.
Any amount already paid against claims made under this policy but which are found
fraudulent later shall be repaid by all recipient(s)/policyholder(s), who has made that
particular claim, who shall be jointly and severally liable for such repayment to the insurer.

For the purpose of this clause, the expression "fraud" means any of the following acts
committed by the insured person or by his agent or the hospital/doctor/any other party
acting on behalf of the insured person, with intent to deceive the insurer or to induce the
insurer to issue an insurance policy:

a) the suggestion, as a fact of that which is not true and which the insured person does not
believe to be true;
b) the active concealment of a fact by the insured person having knowledge or belief of
the fact;
c) any other act fitted to deceive; and
Policy Wordings – Indian Bank Health Care Plus
UIN: UNIHLIP25016V042425 Page 14 of 38
 d) any such act or omission as the law specially declares to be fraudulent

The Company shall not repudiate the claim and / or forfeit the policy benefits on the
ground of Fraud, if the insured person / beneficiary can prove that the misstatement was true
to the best of his knowledge and there was no deliberate intention to suppress the fact or that
such misstatement of or suppression of material fact are within the knowledge of the insurer.

vii. Cancellation

The Insured may cancel this Policy by giving 7 days’ written notice, and in such an event, the
Company shall refund premium for the unexpired Policy Period as per the rates detailed below.

a) If no claim has been made during the policy period, a proportionate refund of the premium
will be issued based on the number of unexpired days. The date of cancellation request will
be considered as expiry date of coverage

b) If the claim has been made in the current policy year, the premium for the remaining policy
year(s) will be refunded on cancellation

viii. Migration
The Insured Person will have the option to migrate the Policy to other health insurance
products/plans offered by the company as per the IRDAI guidelines on Migration at
least 30 days before the policy renewal date as per IRDAI guidelines on Migration. lf
such person is presently covered and has been continuously covered without any
lapses under any health insurance product/plan offered by the company, the insured
person will get the accrued continuity benefits in waiting periods as per IRDAI
guidelines on migration. The insurer may underwrite the proposal in case of migration,
if the insured is not continuously covered for 36 months

ix. Portability
The insured person will have the option to port the policy to other insurers as per IRDAI
guidelines related to portability at least 30 days before, but not earlier than 60 days from
the policy renewal date as per IRDAI guidelines related to portability. lf such person is
presently covered and has been continuously covered without any lapses under any health
insurance policy with an lndian General/Health insurer, the proposed insured person will
get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.

x. Renewal of Policy
The policy shall ordinarily be renewable except on grounds of established fraud or non-
disclosure or misrepresentation by the insured person.

I. The Company will endeavour to give notice for renewal.

II. Renewal shall not be denied on the ground that the insured had made a claim or
claims in the preceding policy years
III. At the end of the Policy Period, the policy shall terminate and can be renewed within
the Grace Period to maintain continuity of benefits without Break in Policy. Coverage
is not available during the grace period.
IV. No loading shall apply on renewals based on individual claims experience
Policy Wordings – Indian Bank Health Care Plus
UIN: UNIHLIP25016V042425 Page 15 of 38
 xi. Withdrawal of Policy
i. In the likelihood of this product being withdrawn in future, the Company will intimate the
insured person about the same 90 days prior to expiry of the policy.
ii. Insured Person will have the option to migrate to similar health insurance product
available with the Company at the time of renewal with all the accrued continuity
benefits such as cumulative bonus, waiver of waiting period. as per IRDAI guidelines,
provided the policy has been maintained without a break.

xii. Moratorium Period

After completion of Sixty Continuous Months under the policy no look back to be applied.
This period of Sixty Months is called as moratorium period. The moratorium would be
applicable for the sums insured of the first policy and subsequently completion of Sixty
Continuous Months would be applicable from date of enhancement of sums insured only
on the enhanced limits. After the expiry of Moratorium Period no health insurance claim
shall be contestable except for proven fraud and permanent exclusions specified in the
policy contract. The policies would however be subject to all limits, sub limits, co-
payments, deductibles as per the policy contract.

xiii. Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the policy
including the premium rates. The insured person shall be notified three months before the
changes are effected.

xiv. Free look period

The Free Look Period shall be applicable on new individual health insurance
policies and not on renewals or at the time of porting/migrating the policy.

The insured person shall be allowed free look period of Thirty days from date of receipt of
the policy document to review the terms and conditions of the policy, and to return the
same if not acceptable.

If the insured has not made any claim during the Free Look Period, the insured shall be
entitled to

i. a refund of the premium paid less any expenses incurred by the Company on medical
examination of the insured person and the stamp duty charges or
ii. where the risk has already commenced and the option of return of the policy is
exercised by the insured person, a deduction towards the proportionate risk
premium for period of cover or

iii. Where only a part of the insurance coverage has commenced, such proportionate
premium commensurate with the insurance coverage during such period;

xv. Redressal of Grievance

If You have a grievance about any matter relating to the Policy, or Our decision on any
matter, or the claim, you can address Your grievance as follows:
Policy Wordings – Indian Bank Health Care Plus
UIN: UNIHLIP25016V042425 Page 16 of 38
Step 1: Contact us
Write us at:
E- mail Address - contactus@universalsompo.com
Customer Service Universal Sompo General Insurance Co. Ltd.
Unit No. 601 & 602, 6th Floor, Reliable Tech Park, Thane- Belapur Road, Airoli, Navi Mumbai,
Maharashtra – 400708
Toll Free Numbers: 1800-22-4030 or 1800-200-4030
Senior Citizen toll free number: 1800-267-4030
For more details: www.universalsompo.com

Step 2: Grievance Cell

If the resolution you received, does not meet your expectations, you can directly write to our
Grievance Id. After examining the matter, the final response would be conveyed within two weeks
from the date of receipt of your complaint on this email id.
Customer Service Universal Sompo General Insurance Co. Ltd.
Unit No. 601 & 602, 6th Floor, Reliable Tech Park, Thane- Belapur Road, Airoli, Navi Mumbai,
Maharashtra – 400708
E- mail Address: grievance@universalsompo.com
For more details: www.universalsompo.com

Visit Branch Grievance Redressal Officer (GRO) - Walk into any of our nearest branches and request
to meet the GRO.
• We will acknowledge receipt of your concern Immediately
• Seek and obtain further details, if any, from the complainant (permitted only once) Within
one week
• Within 2 weeks of receiving your grievance, we will respond to you with the best solution.
• We shall regard the complaint as closed incase on non-receipt of reply from the complainant
Within 8 weeks from the date of registration of the grievance

Step 3: Chief Grievance Redressal Officer

In case, you are not satisfied with the decision/resolution of the above office or have not received
any response within 15 working days, you may write or email to:

Customer Service
Universal Sompo General Insurance Co. Ltd.
Unit No. 601 & 602, 6th Floor, Reliable Tech Park, Thane- Belapur Road, Airoli, Navi Mumbai,
Maharashtra – 400708
E- mail Address: gro@universalsompo.com
For more details: www.universalsompo.com
For updated details of grievance officer, kindly refer the link
https://www.universalsompo.com/resourse-grievance-redressal

Policy Wordings – Indian Bank Health Care Plus

UIN: UNIHLIP25016V042425 Page 17 of 38
Step 4: Insurance Ombudsman

Bima Bharosa Portal link: https://bimabharosa.irdai.gov.in/

You can approach the Insurance Ombudsman depending on the nature of grievance and financial
implication, if any.
Information about Insurance Ombudsmen, their jurisdiction and powers is available on the
website of the Insurance Regulatory and Development Authority of India (IRDAI) at
www.irdai.gov.in, or of the General Insurance Council at https://www.gicouncil.in/, the
Consumer Education Website of the IRDAI at http://www.policyholder.gov.in, or from any of Our
Offices.
The updated contact details of the Insurance Ombudsman offices can be referred by clicking on the
Insurance ombudsman official site: https://www.cioins.co.in/Ombudsman.
Note: Grievance may also be lodged at IRDAI- https://bimabharosa.irdai.gov.in/.

Note: Please refer the Contact details of the Insurance Ombudsman mentioned in Annexure B.

For updated details of grievance officer, kindly refer the link www.universalsompo.com

If Insured person is not satisfied with the redressal of grievance through above methods, the insured
person may also approach the office of Insurance Ombudsman of the respective area/region for
redressal of grievance as per Insurance Ombudsman Rules 2017.
Grievance may also be lodged at IRDAI Integrated Grievance Management System –
https://igms.irda.gov.in/

xvi. Nomination:
The policyholder is required at the inception of the policy to make a nomination for the
purpose of payment of claims under the policy in the event of death of the policyholder.
Any change of nomination shall be communicated to the company in writing and such
change shall be effective only when an endorsement on the policy is made. In the event of
death of the policyholder, the Company will pay the nominee {as named in the Policy
Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting
nominee, to the legal heirs or legal representatives of the policyholder whose discharge
shall be treated as full and final discharge of its liability under the policy.

G. CLAIMS PROCEDURE:

Procedure for Cashless claims:

Claim Intimation

Claim intimation can be done online on our Health Serve Web Portal or by calling at our toll free
number 1800 200 4030 or by emailing us at healthserve@universalsompo.com.
Policy Wordings – Indian Bank Health Care Plus
UIN: UNIHLIP25016V042425 Page 18 of 38
i. Within 24 hours from the date of emergency hospitalization required

ii At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.

Cashless Process

Follow below steps to avail Cashless facility through our In house Health Claims Management:

Step I: Locate nearest Hospital by visiting our website or web portal or call our Health Helpline 1800
200 4030.

Step II: Visit Network hospital and show your Health Serve Card issued by the company along with
Valid Photo ID proof and get 'Cashless Request Form' from Insurance helpdesk of the hospital.

Step III: Fill your details in the 'Cashless Request Form' & submit it to the Hospital Insurance
helpdesk.

Step IV: Hospital verifies the patient details and sends duly filled Cashless Request Form to Universal
Sompo

Step V: Universal Sompo Health team will review and judge the admissibility of the Cashless Request
as per Policy Terms &Conditions and the same will be communicated to Insured and Hospital with
in 60 mins for Initial Cashless request & 3 hrs for discharge request on their registered mobile
number & Email ID respectively.

Cashless Anywhere

You can now avail cashless facility from non-network hospitals.

To avail the treatment under cashless from non-network hospitals, please find the below steps.

Prior Intimation is required for processing cashless from non-network hospitals:

Inform us (Toll Free Helpline – 1800 200 4030) minimum 48 hours before admission for planned
hospitalization and with 24 hours of admission for emergency hospitalization across India.

Mail us at healthserve@universalsompo.com

Reimbursement Process

Follow below steps to avail reimbursement facility through our In house Health Claims
Management:

Step I: Visit our Web Portal to register claim or Call our Health Helpline 1800 200 4030 or email us
at healthserve@universalsompo.com and inform about your claim.

Step II: Visit hospital and undergo your treatment. Settle your hospitalization bill and collect all the
documents after discharge from the hospital.

Policy Wordings – Indian Bank Health Care Plus

UIN: UNIHLIP25016V042425 Page 19 of 38
Step III: Fill in Reimbursement Claim Form and submit all original documents to our below mention
office for reimbursement.

Universal Sompo General Insurance Company Limited,

Health Claims Management Office, 1st FloorC-56- A/13, Block- C Sector- 62, Noida, Uttar Pradesh,
Pincode: 201309

Step IV: On receipt of document your claim will processed as per Terms & Conditions of policy and
the same will be communicated over SMS & Email.

Step V: Outcome of the claim will be communicated within 15 days from date of Submission of claim

Claim Documents submission checklist:

I. Claim form duly filled and signed by the Insured

II. Certificate from attending medical practitioner mentioning the first symptoms and date of
occurrence of ailment.

III. All treatment papers of current ailment including previous treatment papers if any.

IV. Original Discharge Card from the hospital, Indoor Case Papers.

V. All original medical Investigation reports (viz. X-ray, ECG, Blood test etc).

VI. Original hospital bill and receipts.

VII. Original bills of chemist, medical practitioner, medical investigation, etc. supported by the
doctor’s prescription.

VIII. NEFT details and Personalized cancelled cheque/ Passbook copy in the name of proposer for
electronic fund transfer.

IX. Valid Photo ID Proof of the patient.

X. For accident Cases: MLC (Medico Legal Certificate) / FIR (First Information report).

XI. Copy of latest valid address proof of proposer like electricity bill, water bill or telephone bill or
updated bank statement along with copy of PAN card & Aadhaar Card as per AML/KYC Norms.

The above list of documents is indicative. In case of any further document requirement, our team
shall contact you on receipt of your claim documents by us.

Policy Wordings – Indian Bank Health Care Plus

UIN: UNIHLIP25016V042425 Page 20 of 38
ANNEXURE-A

List I — Items for which coverage is not available in the policy

List of Expenses Generally Excluded ("Non-Medical") in Hospital Indemnity Policy

-
Serial no Toiletries/ cosmetics/ personal comfort or convenience items
1. HAIR REMOVAL CREAM Not Payable
2. BABY CHARGES (UNLESS SPECIFIED/INDICATED) Not Payable

3. BABY FOOD Not Payable

4. BABY UTILITES CHARGES Not Payable
5. BABY SET Not Payable
6. BABY BOTTLES Not Payable
7. BRUSH Not Payable
8. COSY TOWEL Not Payable
9. HAND WASH Not Payable
10. MOISTURISER PASTE BRUSH Not Payable
11. POWDER Not Payable
12. RAZOR Payable
13. SHOE COVER Not Payable
14. BEAUTY SERVICES Not Payable
15. BELTS/ BRACES Essential and should be paid at
least specifically for cases who
have undergone surgery of thoracic
or lumbar spine
16. BUDS Not Payable
17. BARBER CHARGES Not Payable
18. CAPS Not Payable
19. COLD PACK/HOT PACK Not Payable
20. CARRY BAGS Not Payable
21. CRADLE CHARGES Not Payable
22. COMB Not Payable

Policy Wordings – Indian Bank Health Care Plus

UIN: UNIHLIP25016V042425 Page 21 of 38
 DISPOSABLES RAZORS CHARGES for site Payable
23. (preparations)

24. EAU-DE-COLOGNE / ROOM Not Payable

FRESHNERS
25. EYE PAD Not Payable
26. EYE SHEILD Not Payable
27. EMAIL / INTERNET CHARGES Not Payable
FOOD CHARGES (OTHER THAN PATIENT's DIET Not Payable
28. PROVIDED BY HOSPITAL)

29. FOOT COVER Not Payable

30. GOWN Not Payable
31. LEGGINGS Essential in bariatric
and
32. LAUNDRY CHARGES Not Payable
varicose vein surgery and may
33. MINERAL WATER Not Payable
be considered for at
34. OIL CHARGES Not Payable
least
35. SANITARY PAD Not Payable
these conditions where
surgery itself is payable.

Policy Wordings – Indian Bank Health Care Plus

UIN: UNIHLIP25016V042425 Page 22 of 38
36. SLIPPERS Not Payable
37. TELEPHONE CHARGES Not Payable
38. TISSUE PAPER Not Payable
39. TOOTH PASTE Not Payable
40. TOOTH BRUSH Not Payable
41. GUEST SERVICES Not Payable
42. BED PAN Not Payable
43. BED UNDER PAD CHARGES Not Payable
44. CAMERA COVER Not Payable
45. CLINIPLAST Not Payable
CREPE BANDAGE Not Payable/ Payable by the
46.
patient
47. CURAPORE Not Payable
48. DIAPER OF ANY TYPE Not Payable
49. DVD, CD CHARGES Not Payable (However if CD is
specifically sought by Insurer/TPA
then payable)
50. EYELET COLLAR Not Payable
51. FACE MASK Not Payable
52. FLEXI MASK Not Payable
53. GAUSE SOFT Not Payable
54. GAUZE Not Payable
55. HAND HOLDER Not Payable
56. HANSAPLAST/ ADHESIVE BANDAGES Not Payable
57. INFANT FOOD Not Payable
58. SLINGS Reasonable costs for one
sling in case of upper arm
fractures may be considered
Items specifically excluded in the policies
WEIGHT CONTROL PROGRAMS/ Exclusion in policy unless
59.
SUPPLIES/ otherwise specified

Policy Wordings – Indian Bank Health Care Plus

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 SERVICES

COST OF SPECTACLES/ CONTACT LENSES/ HEARING Exclusion in policy unless

60.
AIDS ETC., otherwise specified
61. DENTAL TREATMENT EXPENSES THAT DO NOT Exclusion in policy unless

62. REQUIRE HOSPITALISATION otherwise specified

HORMONE REPLACEMENT THERAPY Exclusion in unless

63.
HOME VISIT CHARGES policy
Exclusion in unless otherwise
64. specified
INFERTILITY/ SUBFERTILITY/ policy
Exclusion in unless otherwise
65. ASSISTED CONCEPTION PROCEDURE specified
OBESITY (INCLUDING MORBID OBESITY) policy
Exclusion in unless otherwise
66. TREATMENT IF EXCLUDED IN POLICY specified
CORRECTIVE SURGERY FOR REFRACTIVE ERROR policy
Exclusion in unless otherwise
67. specified
DONOR SCREENING CHARGES policy
Exclusion in unless otherwise
68. specified
ADMISSION/REGISTRATION CHARGES policy
Exclusion in unless otherwise
69. specified
HOSPITALISATION FOR EVALUATION/ policy
Exclusion in unless otherwise
70. DIAGNOSTIC PURPOSE specified
71. EXPENSES FOR INVESTIGATION/ TREATMENT policy
Not Payable otherwise
IRRELEVANT TO THE DISEASE FOR WHICH ADMITTED specified - Exclusion in
Items whichORform part of hospital services where separate consumables are not payable
DIAGNOSED
but the service is policy unless otherwise
WARD AND THEATRE BOOKING CHARGES specified
Payable under OT Charges, not
72.
payable separately

Policy Wordings – Indian Bank Health Care Plus

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72. ARTHROSCOPY & ENDOSCOPY INSTRUMENTS Rental charged by the
hospital payable. Purchase of
Instruments not payable.
MICROSCOPE COVER Payable under OT Charges, not
73.
payable separately
SURGICAL BLADES,HARMONIC SCALPEL,SHAVER Payable under OT Charges, not
74.
payable separately
SURGICAL DRILL Payable under OT Charges, not
75.
payable separately
EYE KIT Payable under OT Charges, not
76.
payable separately
EYE DRAPE Payable under OT Charges, not
77.
payable separately
X-RAY FILM Payable under Radiology
78.
Charges, not as consumable
SPUTUM CUP Payable under Investigation
79.
Charges, not as consumable
BOYLES APPARATUS CHARGES Part of OT Charges, not
80.
separately
BLOOD GROUPING AND CROSS MATCHING OF Part of Cost of Blood, not
81.
DONORS SAMPLES payable
ANTISEPTIC OR DISINFECTANT LOTIONS Not Payable-Part of
82.
Dressing Charges
83. BAND AIDS, BANDAGES, STERLILE Not Payable - Part of Dressing
INJECTIONS, NEEDLES, SYRINGES charges
COTTON Not Payable-Part of Dressing
84.
COTTON BANDAGE Charges
Not Payable- Part of Dressing
85.
Charges
86. MICROPORE/ SURGICAL TAPE Not Payable-Payable by the
patient when prescribed,
87. BLADE otherwise
Not Payableincluded as Dressing
Charges
88. APRON Not Payable -Part of Hospital
Services/ Disposable linen to be
89. TORNIQUET part ofPayable
Not OT/ICU chatges
(service
is

charged by hospitals,

Policy Wordings – Indian Bank Health Care Plus

UIN: UNIHLIP25016V042425 Page 25 of 38
 consumables cannot be
separately charged)

90. ORTHOBUNDLE, GYNAEC BUNDLE Part of Dressing Charges

91. URINE CONTAINER Not Payable
ELEMENTS OF ROOM CHARGE
92. LUXURY TAX Actual tax levied by
government is payable. Part of
room charge for sub limits
HVAC Part of room charge not payable
93.
separately
HOUSE KEEPING CHARGES Part of room charge not payable
94.
separately
SERVICE CHARGES WHERE NURSING Part of room charge not payable
95.
CHARGE ALSO CHARGED separately
TELEVISION & AIR CONDITIONER Payable under room charges not if
96.
CHARGES separately levied
SURCHARGES Part of Room Charge, Not
97.
payable separately
ATTENDANT CHARGES Not Payable - Part of Room Charges
98.

IM IV INJECTION CHARGES Part of nursing charges,

99.
not payable
CLEAN SHEET Part of Laundry/Housekeeping not
100.
payable separately
EXTRA DIET OF PATIENT (OTHER THAN Patient Diet provided by hospital is
101. THAT WHICH FORMS PART OF BED payable
CHARGE)
BLANKET/WARMER BLANKET Not Payable- part of room
102.
charges
ADMINISTRATIVE OR NON-MEDICAL CHARGES
103. ADMISSION KIT Not Payable
104. BIRTH CERTIFICATE Not Payable
BLOOD RESERVATION CHARGES AND ANTE NATAL Not Payable
105.
BOOKING CHARGES
106. CERTIFICATE CHARGES Not Payable
107. COURIER CHARGES Not Payable
108. CONVENYANCE CHARGES Not Payable
109. DIABETIC CHART CHARGES Not Payable
DOCUMENTATION CHARGES / ADMINISTRATIVE
110. Not Payable
EXPENSES

Policy Wordings – Indian Bank Health Care Plus

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111. DISCHARGE PROCEDURE CHARGES Not Payable
112. DAILY CHART CHARGES Not Payable
113. ENTRANCE PASS / VISITORS PASS CHARGES Not Payable

EXPENSES RELATED TO PRESCRIPTION ON To be claimed by patient under

114. DISCHARGE Post Hosp where admissible
115. FILE OPENING CHARGES Not Payable
INCIDENTAL EXPENSES / MISC. CHARGES (NOT Not Payable
116.
EXPLAINED)
117. MEDICAL CERTIFICATE Not Payable
118. MAINTAINANCE CHARGES Not Payable
119. MEDICAL RECORDS Not Payable
120. PREPARATION CHARGES Not Payable
121. PHOTOCOPIES CHARGES Not Payable
122. PATIENT IDENTIFICATION BAND / NAME TAG Not Payable

123. WASHING CHARGES Not Payable

124. MEDICINE BOX Not Payable
MORTUARY CHARGES Payable up to 24 hrs, shifting
125.
charges not payable
126. MEDICO LEGAL CASE CHARGES (MLC CHARGES) Not Payable

EXTERNAL DURABLE DEVICES

127. WALKING AIDS CHARGES Not Payable
128. BIPAP MACHINE Not Payable
129. COMMODE Not Payable
130. CPAP/ CAPD EQUIPMENTS Device not payable
131. INFUSION PUMP - COST Device not payable
OXYGEN CYLINDER (FOR USAGE OUTSIDE THE Not Payable
132.
HOSPITAL)
133. PULSEOXYMETER CHARGES Device not payable
134. SPACER Not Payable
135. SPIROMETRE Device not payable
136. SPO2 PROBE Not Payable
137. NEBULIZER KIT Not Payable
138. STEAM INHALER Not Payable
139. ARMSLING Not Payable
140. THERMOMETER Not Payable (paid by patient)
141. CERVICAL COLLAR Not Payable
142. SPLINT Not Payable
143. DIABETIC FOOT WEAR Not Payable
144. KNEE BRACES ( LONG/ SHORT/ HINGED) Not Payable

Policy Wordings – Indian Bank Health Care Plus

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145. KNEE IMMOBILIZER/SHOULDER IMMOBILIZER Not Payable

146. LUMBO SACRAL BELT Essential and should be paid at

least specifically for cases who
have undergone surgery of
lumbar spine.
147. NIMBUS BED OR WATER OR AIR BED CHARGES Payable for any ICU patient
requiring more than 3 days in ICU,
all patients with
paraplegia/quadriplegia for any
reason and at reasonable cost of
approximately Rs 200/ day
148. AMBULANCE COLLAR Not Payable

149. AMBULANCE EQUIPMENT Not Payable

150. MICROSHEILD Not Payable

151. ABDOMINAL BINDER Essential and should be paid at

least specifically for cases who
have undergone surgery of lumbar
spine.
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
152. BETADINE \ HYDROGEN PEROXIDE\ SPIRIT \ DETTOL\ Payable when prescribed for
SAVLON\ DISINFECTANTS ETC patient, not payable for hospital
Use in OT or ward or for dressings
in hospital
PRIVATE NURSES CHARGES- SPECIAL NURSING Post hospitalization nursing
153.
CHARGES charges not Payable
NUTRITION PLANNING CHARGES - DIETICIAN Patient Diet provided by hospital is
154.
CHARGES - DIET CHARGES payable
155. SUGAR FREE TABLETS Payable -Sugar free variants of
admissible medicines are not
excluded
156. CREAMS POWDERS LOTIONS (Toiletries Payable when prescribed
are not payable, only prescribed medical
pharmaceuticals payable)
157. DIGESTION GELS Payable when prescribed

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158. ECG ELECTRODES Upto 5 electrodes are required for
every case visiting OT or
ICU. For longer stay in ICU,
may require a change and at least
one set every second day must be
payable.
GLOVES Sterilized Gloves payable /
159.
unsterilized gloves not payable
HIV KIT Payable - payable Pre-operative
160.
screening
161. LISTERINE/ ANTISEPTIC MOUTHWASH Payable when prescribed
162. LOZENGES Payable when prescribed
163. MOUTH PAINT Payable when prescribed
NEBULISATION KIT If used during hospitalization is
164.
payable reasonably
165. NOVARAPID Payable when prescribed
166. VOLINI GEL/ ANALGESIC GEL Payable when prescribed
167. ZYTEE GEL Payable when prescribed
VACCINATION CHARGES Routine Vaccination not Payable /
168.
Post Bite Vaccination Payable
PART OF HOSPITAL'S OWN COSTS AND NOT PAYABLE
Not Payable - Part of Hospital's
169. AHD internal Cost

Not Payable - Part of Hospital's

170. ALCOHOL SWABES
internal Cost

Not Payable - Part of Hospital's

171. SCRUB SOLUTION/STERILLIUM
internal Cost
OTHERS
172. VACCINE CHARGES FOR BABY Not Payable
173. AESTHETIC TREATMENT / SURGERY Not Payable
174. TPA CHARGES Not Payable
175. VISCO BELT CHARGES Not Payable
ANY KIT WITH NO DETAILS MENTIONED [DELIVERY Not Payable
176. KIT, ORTHOKIT, RECOVERY KIT, ETC]

177. EXAMINATION GLOVES Not payable

178. KIDNEY TRAY Not Payable
179. MASK Not Payable
180. OUNCE GLASS Not Payable

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181. OUTSTATION CONSULTANT'S/ SURGEON'S FEES Not payable, except for
telemedicine consultations where
covered by policy
182. OXYGEN MASK Not Payable

183. PAPER GLOVES Not Payable

184. PELVIC TRACTION BELT Should be payable in case of PIVD

requiring traction as
this is
185. REFERAL DOCTOR'S FEES generally not
Not Payable reused

186. ACCU CHECK (Glucometery/ Strips) Not payable pre hospitilasation or

post hospitalisation / Reports and
Charts required/ Device not
187. PAN CAN payable
Not Payable

188. SOFNET Not Payable

189. TROLLY COVER Not Payable

190. UROMETER, URINE JUG Not Payable

191. AMBULANCE Payable-Ambulance from home to

hospital or inter hospital shifts is
payable/ RTA as specific
requirement is payable
TEGADERM / VASOFIX SAFETY Payable - maximum of 3 in 48 hrs
192. and then 1 in 24 hrs

193. URINE BAG Payable where medically

necessary till a reasonable cost -
maximum 1 per 24 hrs
194. SOFTOVAC Not Payable

STOCKINGS Essential for case like CABG etc.

195. Where it should be paid.

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UIN: UNIHLIP25016V042425 Page 30 of 38
 List II — Items that are to be subsumed into Room Charges

SI Item
No
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED)
2 HAND WASH
3 SHOE COVER
4 CAPS
5 CRADLE CHARGES
6 COMB
7 EAU-DE-COLOGNE / ROOM FRESHNERS
8 FOOT COVER
9 GOWN
10 SLIPPERS
11 TISSUE PAPER
12 TOOTH PASTE
13 TOOTH BRUSH
14 BED PAN
15 FACE MASK
16 FLEXI MASK
17 HAND HOLDER
18 SPUTUM CUP
19 DISINFECTANT LOTIONS
20 LUXURY TAX
21 HVAC
22 HOUSE KEEPING CHARGES
23 AIR CONDITIONER CHARGES
24 IM IV INJECTION CHARGES
25 CLEAN SHEET
26 BLANKET/WARMER BLANKET
27 ADMISSION KIT
28 DIABETIC CHART CHARGES
29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
30 DISCHARGE PROCEDURE CHARGES

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 31 DAILY CHART CHARGES
32 ENTRANCE PASS / VISITORS PASS CHARGES
33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
34 FILE OPENING CHARGES
35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
36 PATIENT IDENTIFICATION BAND / NAME TAG
37 PULSEOXYMETER CHARGES

List III — Items that are to be subsumed into Procedure Charges

SI No. Item
1 HAIR REMOVAL CREAM
2 DISPOSABLES RAZORS
3 CHARGES
EYE PAD (for site
preparations)
4 EYE SHEILD
5 CAMERA COVER
6 DVD, CD CHARGES
7 GAUSE SOFT
8 GAUZE
9 WARD AND THEATRE
10 BOOKING CHARGES
ARTHROSCOPY AND
11 ENDOSCOPY
MICROSCOPEINSTRUMENTS
COVER
12 SURGICALHARMONICSCALPEL,
13 SHAVER
SURGICAL DRILL
14 EYE KIT
15 EYE DRAPE
16 X-RAY FILM
17 BOYLES APPARATUS CHARGES
18 COTTON
19 COTTON BANDAGE
20 SURGICAL TAPE
21 APRON
22 TORNIQUET
23 ORTHOBUNDLE, GYNAEC
BUNDLE

List IV — Items that are to be subsumed into costs of treatment

SI No. Item
1 ADMISSION/REGISTRATION CHARGES
2 HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE

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UIN: UNIHLIP22139V032122 Page 33 of 38
 3 URINE CONTAINER
4 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES

5 BIPAP MACHINE
6 CPAP/ CAPD EQUIPMENTS
7 INFUSION PUMP— COST
8 HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC
9 NUTRITION PLANNING CHARGES – DIETICIAN CHARGES- DIET CHARGES
10 HIV KIT
11 ANTISEPTIC MOUTHWASH
12 LOZENGES
13 MOUTH PAINT
14 VACCINATION CHARGES
15 ALCOHOL SWABES
16 SCRUB SOLUTION/STERILLIUM
17 Glucometer& Strips
18 URINE BAG

ANNEXURE B

The contact details of the Insurance Ombudsman offices are as

below-

Areas of Jurisdiction Office of the Insurance Ombudsman

Gujarat, Dadra & Nagar AHMEDABAD

Haveli, Daman and Diu Shri Collu Vikas Rao
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Tilak Marg, Relief Road,
AHMEDABAD – 380 001.
Tel.: 079 - 25501201/02
Email: bimalokpal.ahmedabad@cioins.co.in

Karnataka. BENGALURU
Mr Vipin Anand
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19

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UIN: UNIHLIP22139V032122 Page 34 of 38
 Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in

Madhya Pradesh BHOPAL

Chattisgarh. Shri R. M. Singh
Insurance Ombudsman
Office of the Insurance Ombudsman,
1st floor,"Jeevan Shikha",
60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills
Bhopal – 462 011.
Tel.: 0755 - 2769201 / 2769202 / 2769203
Email: bimalokpal.bhopal@cioins.co.in

Odisha BHUBANESHWAR
Shri Manoj Kumar Parida
Insurance Ombudsman
Office of the Insurance Ombudsman,
62, Forest park,
Bhubaneswar – 751 009.
Tel.: 0674 - 2596461 /2596455/2596429/2596003
Email: bimalokpal.bhubaneswar@cioins.co.in

Punjab, Haryana (excluding CHANDIGARH

Gurugram, Faridabad, Mr Atul Jerath
Sonepat and Bahadurgarh), Insurance Ombudsman
Himachal Pradesh, Union Office Of The Insurance Ombudsman,
Territories of Jammu & Jeevan Deep Building SCO 20-27,
Kashmir,Ladakh & Ground Floor Sector- 17 A,
Chandigarh. Chandigarh – 160 017.
Tel.: 0172-2706468
Email: bimalokpal.chandigarh@cioins.co.in

Tamil Nadu, CHENNAI

PuducherryTown and Insurance Ombudsman
Karaikal (which are part of Office of the Insurance Ombudsman,
Puducherry). Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24333678
Email: bimalokpal.chennai@cioins.co.in

Delhi & following Districts of DELHI

Haryana - Gurugram, Insurance Ombudsman
Office of the Insurance Ombudsman,

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UIN: UNIHLIP22139V032122 Page 35 of 38
 Faridabad, Sonepat & 2/2 A, Universal Insurance Building,
Bahadurgarh. Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 - 46013992/23213504/23232481
Email: bimalokpal.delhi@cioins.co.in

Assam, Meghalaya, Manipur, GUWAHATI

Mizoram, Arunachal Insurance Ombudsman
Pradesh, Nagaland and Office of the Insurance Ombudsman,
Tripura Jeevan Nivesh, 5th Floor,
Near Pan Bazar , S.S. Road,
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205 / 2631307
Email: bimalokpal.guwahati@cioins.co.in

Andhra Pradesh, HYDERABAD

Telangana, Insurance Ombudsman
Yanam and Office of the Insurance Ombudsman,
part of Territory of 6-2-46, 1st floor, "Moin Court",
Pondicherry. Lane Opp.Hyundai Showroom ,
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.
Tel.: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325
Email: bimalokpal.hyderabad@cioins.co.in

Rajasthan. JAIPUR
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141- 2740363
Email: bimalokpal.jaipur@cioins.co.in

Kerala, Lakshadweep, Mahe- KOCHI

a part of Union Territory of Insurance Ombudsman
Puducherry Office of the Insurance Ombudsman,
10th Floor, Jeevan Prakash,LIC Building,
Opp to Maharaja's College Ground,M.G.Road,
Kochi - 682 011.
Tel.: 0484 - 2358759
Email: bimalokpal.ernakulam@cioins.co.in

West Bengal, Sikkim, KOLKATA

Andaman & Nicobar Islands. Insurance Ombudsman
Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 7th Floor,

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UIN: UNIHLIP22139V032122 Page 36 of 38
 4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124341
Email: bimalokpal.kolkata@cioins.co.in

Districts of Uttar Pradesh : LUCKNOW

Lalitpur, Jhansi, Mahoba, Insurance Ombudsman
Hamirpur, Banda, Office of the Insurance Ombudsman,
Chitrakoot, Allahabad, 6th Floor, Jeevan Bhawan, Phase-II,
Mirzapur, Sonbhabdra, Nawal Kishore Road, Hazratganj,
Fatehpur, Pratapgarh, Lucknow - 226 001.
Jaunpur,Varanasi, Gazipur, Tel.: 0522 - 4002082 / 3500613
Jalaun, Kanpur, Lucknow, Email: bimalokpal.lucknow@cioins.co.in
Unnao, Sitapur, Lakhimpur,
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 MUMBAI

Region (excluding Navi Insurance Ombudsman
Mumbai & Thane) Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 - 69038800/27/29/31/32/33
Email: bimalokpal.mumbai@cioins.co.in

State of Uttaranchal and the NOIDA

following Districts of Uttar Insurance Ombudsman
Pradesh: Office of the Insurance Ombudsman,
Agra, Aligarh, Bagpat, Bhagwan Sahai Palace
Bareilly, Bijnor, Budaun, 4th Floor, Main Road, Naya Bans, Sector 15,
Bulandshehar, Etah, Kanooj, Distt: Gautam Buddh Nagar, U.P-201301.
Mainpuri, Mathura, Meerut, Tel.: 0120-2514252 / 2514253
Moradabad, Muzaffarnagar, Email: bimalokpal.noida@cioins.co.in
Oraiyya, Pilibhit, Etawah,

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UIN: UNIHLIP22139V032122 Page 37 of 38
 Farrukhabad, Firozbad,
Gautambodhanagar,
Ghaziabad, Hardoi,
Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj,
Sambhal, Amroha, Hathras,
Kanshiramnagar,
Saharanpur.

Bihar, PATNA
Jharkhand. Insurance Ombudsman
Office of the Insurance Ombudsman,
2nd Floor, Lalit Bhawan,
Bailey Road,
Patna 800 001.
Tel.: 0612-2547068
Email: bimalokpal.patna@cioins.co.in

Maharashtra, Areas of Navi PUNE

Mumbai and Thane Insurance Ombudsman
(excluding Mumbai Office of the Insurance Ombudsman,
Metropolitan Region) Jeevan Darshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198, N.C. Kelkar Road,
Narayan Peth, Pune – 411 030.
Tel.: 020-24471175
Email: bimalokpal.pune@cioins.co.in

Policy Wordings – India Bank Healthcare Plus

UIN: UNIHLIP22139V032122 Page 38 of 38
ADDITIONAL EXTENSION

Personal Accident Death Cover:

In case you have opted for additional cover against Personal Accident- Death only benefit and have paid
additional premium, We will pay a lump sum amount as mentioned in the table below in the event of
Accidental Death of the Insured whose name is appearing in the Schedule forming part of this Policy
The Sum Insured as under shall be applicable as below.

Insured Person % of Sum Insured

In case of Death of Account Holder 100% of the Sum Insured
In case of Death of Spouse 50% of the Sum Insured
In case of Death of Children above 12 20% of the Sum Insured
years of age
In case of Death of Children upto 12 years of 10% of the Sum Insured
age

WHAT WE EXCLUDE
1. Natural Death
2. Payment of compensation in respect of death as a consequence of/resulting from
A. Committing or attempting suicide, intentional self-injury.
B. Whilst under influence of intoxicating liquor or drugs.
C. Due to Drug addiction or Alcoholism. D. Whilst engaged in any adventurous sports like hand gliding,
mountaineering, rock climbing, sky diving, professional or amateur racing, parachuting, skiing, ice
skating, ballooning, river rafting, polo playing, horse racing or sports of similar nature and/or
hazardous activities like persons working in underground mines, explosives, workers involved in
electrical installations with High–tension supply, jockeys, circus personnel or activities of similar nature
D. Committing any breach of law with criminal intent.
E. War, Civil War, invasion, act of foreign enemies, revolution, insurrection, mutiny, military or usurped
power, seizure, capture, arrest, restraint, or detainment, confiscation, or nationalization or requisition by or
under the order of any government or public authority.
3. Consequential loss of any kind and/or any legal liability
4. Pregnancy including child birth, miscarriage, abortion or complication arising there from.
5. Participation in any naval, military or air force operations.

Registered & Corp Office: Universal Sompo General Insurance Company Ltd. 8th Floor & 9th Floor (South Side),
Commerz International Business Park, Oberoi Garden City, Off Western Express Highway, Goregaon East, Mumbai
400063, Toll free no: 1800-22-4030/1800-200-4030, IRDAI Reg no: 134, CIN# U66010MH2007PLC166770 E-mail:
contactus@universalsompo.com, website link www.universalsompo.com

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UIN: UNIHLIP22139V032122 Page 39 of 38