GALAXY HEALTH INSURANCE COMPANY LIMITED

( Formerly known as Galaxy Health and Allied Insurance Company Limited )

Registered Office: “Prestige Polygon”, 12th Top Floor (P), #471, Anna Salai,
Nandanam, Chennai - 600 035  T: 044 - 4001 7227  Website: www.galaxyhealth.com
IRDAI Registration No.167  CIN: U65120TN2023PLC165765

GALAXY PROMISE
UIN: GHIHLIP25035V012425

POLICY WORDING
I Preamble i. Having at least 5 in-patient beds.
This Insurance contract between the Proposer and Galaxy Health ii. Having qualified AYUSH Medical Practitioner in charge
Insurance Company Limited (hereinafter referred to as the round the clock.
‘Company’) is based on the details contained in the Proposal given iii. Having dedicated AYUSH therapy sections as required
by the Proposer to the Company. and/or has equipped operation theatre where surgical
This insurance contract is drawn based on the material facts and procedures are to be carried out.
particulars with regard to the health condition including the
iv. Maintaining daily records of the patients and making them
relevant diagnostic tests carried and observations made based on
accessible to the insurance company's authorized
such test results as given with the Proposal. The Proposer confirms
representative.
that the details contained in the Proposal are true and correct and
that the Proposer has provided all the details about his/her/their "Ayush Treatment" refers to the medical and / or hospitalisation
health condition proposed for insurance and the policy is issued treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani,
based on the principles of uberrimae fidei. Siddha and Homeopathy systems.
In consideration of receipt of premium and subject to the applicable “Break in policy” means the period of gap that occurs at the end
laws and regulations of IRDAI in force and the policy terms and of the existing policy term / instalment premium due date, when
conditions, the Company will pay the claim reasonably and the premium due for renewal on a given policy or instalment
necessarily incurred up to the limits specified against the respective premium due is not paid on or before the premium renewal date or
benefit in any Policy Year. grace period.
"Cashless facility" means a facility extended by the Insurer to the
II Definitions
Insured where, the payments of the costs of treatment undergone
Standard Definitions
by the Insured in accordance with the Policy terms and conditions
"Accident" means a sudden, unforeseen and involuntary event are directly made to the network provider by the Insurer to the
caused by external, visible and violent means. extent preauthorization approved.
"Anyone Illness" means continuous period of Illness and it "Condition Precedent" means a Policy term or conditions upon
includes a relapse within 45 days from the date of last which the Insurer's liability under the Policy is conditional upon.
consultation with the Hospital/Nursing Home where treatment
may have been taken. "Congenital Anomaly" refers to a condition(s) which is present
since birth, and which is abnormal with reference to form,
“Authority” means the Insurance Regulatory and Development structure or position.
Authority of India.
a. Internal Congenital Anomaly - Congenital Anomaly which is
“AYUSH Day Care Centre” means and includes Community not in the visible and accessible parts of the body is called
Health Centre (CHC), Primary Health Centre (PHC), Dispensary Internal Congenital Anomaly.
Clinic, Polyclinic or any such health centre which is registered with
the local authorities, wherever applicable and having facilities for b. External Congenital Anomaly - Congenital Anomaly which is
carrying out treatment procedures and medical or surgical/para in the visible and accessible parts of the body is called
surgical interventions or both under the supervision of registered External Congenital Anomaly.
AYUSH Medical Practitioner (s) on day care basis without "Cumulative Bonus" means any increase or addition in the Sum
In-patient services and must comply with all the following Insured granted by the Insurer without an associated increase in
criterion; the premium.
i. Having qualified registered AYUSH Medical Practitioner(s) in "Day care Centre" means any institution established for day care
charge. treatment of Illness and / or injuries or a medical setup with a
ii. Having dedicated AYUSH therapy sections as required and/or hospital and which has been registered with the local authorities,
has equipped operation theatre where surgical procedures wherever applicable, and is under the supervision of a registered
are to be carried out. and qualified medical practitioner and must comply with all
minimum criteria as under:
iii. Maintaining daily records of the patients and making them
accessible to the insurance company's authorized i. Has qualified nursing staff under its employment.
representative. ii. Has qualified medical practitioner/s in charge.
“AYUSH Hospital” is a healthcare facility wherein iii. Has a fully equipped operation theatre of its own where
medical/surgical/para-surgical treatment procedures and surgical procedures are carried out.
interventions are carried out by AYUSH Medical Practitioner(s) iv. Maintains daily records of patients and will make these
comprising of any of the following: accessible to the Insurance Company’s authorized personnel.
a. Central or State Government AYUSH Hospital; or "Day Care treatment" means medical treatment, and / or surgical
b. Teaching hospital attached to AYUSH College recognized by procedure which is:
the Central Government/Central Council of Indian i. Undertaken under general or local anesthesia in a
Medicine/Central Council for Homeopathy; or hospital/day care centre in less than 24 hours because of
c. AYUSH Hospital, standalone or co-located with in-patient technological advancement, and.
healthcare facility of any recognized system of medicine, ii. Which would have otherwise required a hospitalisation of
registered with the local authorities, wherever applicable, and more than 24 hours.
is under the supervision of a qualified registered AYUSH Treatment normally taken on an out-patient basis is not included
Medical Practitioner and must comply with all the following in the scope of this definition.
criterion:

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 1/39
"Deductible" means a cost-sharing requirement under a  All other facilities required as per Clinical Establishment
health insurance Policy that provides, that the Insurer will not Act
be liable for a specified Rupee amount in case of indemnity "Hospitalisation" means admission in a hospital for a minimum
policies and for a specified number of days/hours in case of period of 24 consecutive “in-patient care” hours except for
hospital cash policies which will apply before any benefits are specified procedures/ treatments, where such admission could
payable by the Insurer. A deductible does not reduce the Sum be for a period of less than 24 consecutive hours.
Insured. “Illness" means a sickness or a disease or pathological
"Disclosure to information norm" means the Policy shall be condition leading to the impairment of normal physiological
void and all premium paid hereon shall be forfeited to the function and requires medical treatment.
Company, in the event of misrepresentation, misdescription or a. Acute condition - Acute condition is a disease, Illness or
non-disclosure of any material fact. Injury that is likely to respond quickly to treatment which
"Domiciliary hospitalisation" means medical treatment for an aims to return the person to his or her state of health
Illness/Disease/Injury which in the normal course would immediately before suffering the disease/Illness/ Injury
require care and treatment at a hospital but is actually taken which leads to full recovery.
while confined at home under any of the following b. Chronic condition - A chronic condition is defined as a
circumstances: disease, Illness, or Injury that has one or more of the
i. The condition of the patient is such that he/she is not in a following characteristics:
condition to be removed to a hospital, or 1. It needs ongoing or long-term monitoring through
ii. The patient takes treatment at home on account of consultations, examinations, check-ups, and / or tests.
non-availability of room in a hospital. 2. It needs ongoing or long-term control or relief of
"Emergency care" means management for an Illness or Injury symptoms.
which results in symptoms which occur suddenly and 3. It requires rehabilitation for the patient or for the patient
unexpectedly, and requires immediate care by a medical to be specially trained to cope with it
practitioner to prevent death or serious long term impairment 4. It continues in definitely.
of the Insured person's health.
5. It recurs or is likely to recur.
“Grace Period” means the specified period of time,
immediately following the premium due date during which "Injury" means accidental physical bodily harm excluding
premium payment can be made to renew or continue a policy in Illness or disease solely and directly caused by external,
force without loss of continuity benefits pertaining to waiting violent, visible and evident means which is verified and
periods and coverage of pre-existing diseases. Coverage need certified by a Medical Practitioner.
not be available during the period for which no premium is "Inpatient care" means treatment for which the Insured person
received. The grace period for payment of the premium for all has to stay in a hospital for more than 24 hours for a covered
types of insurance policies shall be: fifteen days where event.
premium payment mode is monthly and thirty days in all other "Intensive Care Unit" means an identified section, ward or
cases. wing of a Hospital which is under the constant supervision of a
If the policy is renewed during grace period, all the credits (sum dedicated Medical Practitioner(s), and which is specially
insured, No Claim Bonus, Specific Waiting periods, waiting equipped for the continuous monitoring and treatment of
periods for pre-existing diseases, Moratorium period etc.) patients who are in a critical condition or require life support
accrued under the policy shall be protected. The same is facilities and where the level of care and supervision is
applicable for both Indemnity and Benefit products. considerably more sophisticated and intensive than in the
Availability of insurance coverage during grace period: If the ordinary and other wards.
premium is paid in instalments during the policy period, “ICU (Intensive Care Unit) Charges” means the amount
coverage will be available for the grace period also. charged by a Hospital towards ICU expenses which shall
"Hospital" A hospital means any institution established for include the expenses for ICU bed, general medical support
in-patient care and day care treatment of Illness and/ or injuries services provided to any ICU patient including monitoring
and which has been registered as a hospital with the local devices, critical care nursing and intensivist charges.
authorities under the Clinical Establishments (Registration and "Maternity expense" means
Regulation) Act, 2010 or under the enactments specified under a. Medical treatment expenses traceable to childbirth
the Schedule of Section 56(1) of the said Act or complies with (including complicated deliveries and caesarean sections
all minimum criteria as under: incurred during hospitalisation).
i. Minimum 10 beds for multi-speciality and 5 beds for b. Expenses towards lawful medical termination of
Single Speciality. pregnancy during the Policy period.
ii. 24 hours Medical Practitioner & Nursing Staffs. “Medical Advice” means any consultation or advice from a
iii. Medical Records Department (MRD). Medical Practitioner including the issue of any prescription or
iv. IT Solutions - Minimum System Requirements with follow up prescription.
internet facility. "Medical expenses" means those expenses that an Insured
v. Pollution Control Board Certificate or Any Government Person has necessarily and actually incurred for medical
Registration certificate. treatment on account of Illness or Accident on the advice of a
vi. Operation Theatre with basic Requirements - Surgical Medical Practitioner, as long as these are no more than would
Facility have been payable if the Insured Person had not been Insured
 ICU (or) HDU is Mandatory - Surgical facility and no more than other hospitals or doctors in the same
 Ventilator is Mandatory, if the number of beds is >50 locality would have charged for the same medical treatment.
 C-ARM is Mandatory for Orthopaedic Speciality “Medical Practitioner” Medical Practitioner means a person
who holds a valid registration from the Medical Council of any

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 2/39
State or Medical Council of India or Council for Indian Medicine a. Such Medical Expenses are incurred for the same
or for Homeopathy set up by the Government of India or a condition for which the Insured Person’s Hospitalisation
State Government and is thereby entitled to practice medicine was required, and.
within its jurisdiction; and is acting within its scope and b. The In-patient Hospitalisation claim for such
jurisdiction of license. Hospitalisation is admissible by the Insurance Company.
“Medically Necessary Treatment” means any treatment, tests, “Qualified Nurse” means a person who holds a valid
medication, or stay in hospital or part of a stay in hospital registration from the Nursing Council of India or the Nursing
which: Council of any state in India.
i) is required for the medical management of the illness or "Reasonable and Customary charges" means the charges for
injury suffered by the insured. services or supplies, which are the standard charges for the
ii) must not exceed the level of care necessary to provide specific provider and consistent with the prevailing charges in
safe, adequate and appropriate medical care in scope, the geographical area for identical or similar services, taking
duration, or intensity. into account the nature of the Illness / Injury involved.
iii) must have been prescribed by a medical practitioner. "Renewal" means the terms on which the contract of
iv) must conform to the professional standards widely insurance can be renewed on mutual consent with a provision
accepted in international medical practice or by the of grace period for treating the renewal continuous for the
medical community in India. purpose of gaining credit for pre-existing diseases,
time-bound exclusions and for all waiting periods.
“Migration” means a facility provided to policyholders
(including all members under family cover and group policies), "Room rent" means the amount charged by a hospital towards
to transfer the credits gained for pre-existing diseases and room and boarding expenses and shall include associated
specific waiting periods from one health insurance policy to medical expenses.
another with the same insurer. “Specific waiting period” means a period up to 36 months
"Network Provider" means hospitals or health care providers from the commencement of a health insurance policy during
enlisted by an Insurer, TPA or jointly by an insurer and TPA to which period specified diseases/treatments (except due to an
provide medical services to an Insured by a cashless facility. accident) are not covered. On completion of the period,
diseases/treatments shall be covered provided the policy has
“Newborn Baby” means baby born during the Policy Period been continuously renewed without any break.
and is aged upto 90 days.
"Subrogation" means the right of the insurer to assume the
"Non- Network Provider" means any hospital, day care centre rights of the Insured person to recover expenses paid out
or other provider that is not part of the network. under the Policy that may be recovered from any other source.
"Notification of claims" means the process of intimating a "Surgery” or "Surgical Procedure" means manual and / or
claim to the Insurer or TPA through any of the recognized operative procedure (s) required for treatment of an Illness or
modes of communication. Injury, correction of deformities and defects, diagnosis and
“OPD treatment” means the one in which the Insured visits a cure of diseases, relief of suffering or prolongation of life,
clinic / hospital or associated facility like a consultation room performed in a hospital or day care centre by a medical
for diagnosis and treatment based on the advice of a Medical practitioner.
Practitioner. The Insured is not admitted as a day care or "Unproven/Experimental treatment" means the treatment,
in-patient. including drug Experimental therapy, which is not based on
"Post-hospitalisation Medical Expenses" means Medical established medical practice in India, is treatment
Expenses incurred during predefined number of days experimental or unproven.
immediately after the Insured Person is discharged from the
Specific Definitions
hospital provided that:
“Admission” means admission in a hospital as an inpatient for
i. Such Medical Expenses are for the same condition for
the purpose of medical treatment of an Injury and/or Illness.
which the Insured Person's Hospitalisation was required,
and. “Advanced Medicine” means targeted therapy with
Monoclonal antibodies such as NUCALA (Mepoluzimab) which
ii. The In-patient Hospitalisation claim for such
are Proven and are used to treat Chronic severe refractory
Hospitalisation is admissible by the Insurance Company.
asthma.
“Portability” means a facility provided to the health insurance
“Accidental Emergency” means a traumatic bodily injury
policyholders (including all members under family cover), to
which, if not immediately diagnosed and treated, could
transfer the credits gained for pre-existing diseases and
reasonably be expected to seriously jeopardize a person’s
specific waiting periods from one insurer to another insurer.
health or result in loss of life.
“Pre-existing Disease” means any condition, ailment, injury or
“Any Room” any category room in a hospital.
disease:
“Age” or “Aged” shall mean the completed age as on last
a. that is/are diagnosed by a physician not more than 36
birthday, and which means completed years as at the Policy
months prior to the date of commencement of the policy
Start date.
issued by the insurer; or
“Altruistic Surrogacy” means the surrogacy in which no
b. for which medical advice or treatment was recommended
charges, expenses, fees, remuneration or monetary incentive
by, or received from, a physician, not more than 36
of whatever nature, except the medical expenses incurred on
months prior to the date of commencement of the policy.
surrogate mother are only indemnified.
"Pre-hospitalisation Medical Expenses" means medical
“Assisted Reproduction Treatment” means Intra Uterine
expenses incurred during predefined number of days
Insemination (IUI), Intra-Cytoplasmic Sperm Injection (ICSI),
preceding the hospitalisation of the Insured Person provided
In-Vitro Fertilization (IVF) and TESA / TESE (Testicular /
that:
Epididymal Sperm Aspiration / Extraction).

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 3/39
"Assisted Reproductive Technology (ART) Act” means the ill patients in real-time. It enables remote intensivists and
Assisted Reproductive Technology (Regulation) Act, 2021 and critical care specialists to collaborate with on-site clinicians to
its amendments. provide high-quality, evidence-based care.
“Assisted Reproductive Technology Clinic” means any “Disease of Spine” includes injuries to the spine and/or
premises equipped with requisite facilities and medical Infections to the spine and/or a blocked blood supply and/or
practitioners registered with the National Medical Commission compression by a fractured bone and/or a tumour resulting in
for carrying out the procedures related to the assisted neurological sequelae.
reproductive technology. “Donor” means a person who gives an organ for use in another
“Associated Medical Expenses” means medical expenses such person.
as Professional fees, OT charges, Procedure charges, etc., which “Emergency” shall mean a serious medical condition or
vary based on the room category occupied by the insured symptom resulting from Injury or Illness which arises suddenly
person whilst undergoing treatment in some of the hospitals. If and unexpectedly, and requires immediate care and treatment
Policy Holder chooses a higher room category above the by a Medical Practitioner, generally received within 24 hours of
eligibility defined in policy, then proportionate deduction will onset to avoid jeopardy to life or serious long-term impairment
apply on the Associated Medical Expenses in addition to the of the Insured Person’s health, until stabilization at which time
difference in room rent. Such associated medical expenses do this medical condition or symptom is not considered an
not include Cost of pharmacy, Consumables, Cost of implants, Emergency anymore.
medical devices, Cost of diagnostics and ICU charges. Hence
Proportionate deduction will not be applicable on these items. “Family” includes Insured Person, Spouse, dependent children
between 16 days and 25 years of age not exceeding 3 in
“Commercial Surrogacy” means commercialization of number and Dependent Parent / Parents in law.
surrogacy services or procedures or its component services or
component procedures including selling or buying of human “Hazardous Sport / Hazardous Activities” means engaging
embryo or trading in the sale or purchase of human embryo or whether professionally or otherwise in any sport or activity,
gametes or selling or buying or trading the services of which is potentially dangerous to the Insured Person (whether
surrogate motherhood by way of giving payment, reward, trained, or not). Such Sport/Activity including but not limited to
benefit, fees, remuneration or monetary incentive in cash or Winter sports, Ice hockey, Skiing, Skydiving, Parachuting,
kind, to the surrogate mother or her dependents or her Ballooning, Scuba Diving, Bungee Jumping, Mountain
representative, except the medical expenses and such other Climbing, Riding or Driving in Races or Rallies, caving or pot
prescribed expenses incurred on the surrogate mother and the holing, hunting or equestrian activities, diving or under-water
insurance coverage for the surrogate mother. activity, rafting or canoeing involving rapid waters, yachting or
boating outside coastal waters, jockeys, horseback, Polo,
“Company/Insurer”means Galaxy Health Insurance Company Circus personnel, army/navy/air force personnel and policemen
Limited. whilst on duty, persons working in underground mines,
"Commissioning Couple" means an infertile married couple explosives, magazines, workers whilst involved in electrical
who approach an assisted reproductive technology clinic or installation with high-tension supply, nuclear installations,
assisted reproductive technology bank for obtaining the handling hazardous chemicals.
services authorized of the said clinic or bank. “Head Injury” If a person sustained traumatic injury to brain /
“Couple” means the legally married Indian man and woman skull with (or) without loss of consciousness.
above the age of 21 years and 18 years respectively. “Home” means the Insured Person's place of residence.
“Contribution” is essentially the right of an insurer to call upon “Home Care Treatment” means treatment availed by the
other insurers, liable to the same Insured, to share the cost of an Insured Person at home, which in normal course would require
indemnity claim on a rateable proportion of Sum Insured. This care and treatment at a hospital but is actually taken at home
clause shall not apply to any Benefit offered on fixed benefit provided that:
basis.
a) The Medical practitioner advice the Insured person to
“Claim” means a demand made by Insured/Policyholders or on undergo treatment at home,
Insured/Policyholders behalf for payment of Medical Expenses
or any other expenses or benefits, as covered under the Policy. b) There is a continuous active line of treatment with
monitoring of the health status by a medical practitioner
"Dependent Child" means a child (natural or legally adopted), for each day through the duration of the home care
who is unmarried, aged between 16 days and 25 years, treatment,
financially dependent on the Insured and does not have his / her
independent sources of income. c) Daily monitoring chart including records of treatment
administered duly signed by the treating doctor is
"Disease" means an alteration in the state of the body or of maintained,
some of its organs, interrupting or disturbing the performance
of the functions, and causing or threatening pain and weakness “Hospice Care” is defined as Care given for patients with
or physical or mental disorder and certified by a Medical terminal diseases, advanced Chronic Medical conditions who
Practitioner. are estimated to live for few months, if the natural history of
the disease follows its usual course. Hospice Care begins
"Diagnostic Tests" Investigations, such as X-Ray or blood tests, when curative treatment is no longer deemed possible for the
to find the cause of symptoms and medical condition. terminally ill medical conditions Hospice Care benefits include
“Diagnosis” shall mean diagnosis by a Medical Practitioner, access to a multidisciplinary treatment team specialized in
supported by clinical, radiological, histological, end-of-life care, can be accessed at the company Network
histo-pathological and laboratory evidence and surgical facility.
evidence wherever applicable. “Immediate Family” means spouse, dependent children and
“Digital ICU (Intensive Care Unit)” is a healthcare delivery dependent parent(s) of the Insured.
model that leverages advanced technologies, such as “Insured Person” means the name/s of persons named in the
telemedicine, artificial intelligence, and data analytics, to schedule of the Policy.
remotely monitor, manage, and coordinate the care of critically

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 4/39
 or taxes thereon) called proportionate deductions
“Instalment” means frequency of Premium amount paid
through Monthly / Quarterly / Half-yearly/Annual/2 “Rehabilitation” is defined as “a set of interventions designed
instalment/4 instalment/12 instalment mode by the Policy to optimize functioning and reduce disability in individuals with
Holder/ Insured. health conditions in interaction with their environment”.
“In-Patient” means an Insured Person who is admitted to “Stroke” Any cerebrovascular incident producing permanent
Hospital and stays there for a minimum period of 24 hours for neurological sequelae.
the sole purpose of receiving treatment. “Sum Insured” Sum Insured means the Sum Insured Opted for
“Intending couple” means a couple who have a medical and for which the premium is paid.
indication necessitating gestational surrogacy and who intend “Surrogacy” means a practice whereby one woman bears and
to become parents through surrogacy. gives birth to a child for an intending couple with the intention
“Intending woman” means an Indian woman who is a widow of handing over such child to the intending couple after the
or divorcee between the age of 35 to 45 years and who intends birth.
to avail the surrogacy. "Surrogacy Act" means the Surrogacy (Regulation) Act, 2021
“Limit of Coverage” means Sum Insured plus Cumulative and its amendments.
bonus earned wherever applicable. “Surrogacy clinic” means surrogacy clinic, centre or
“Limit of Indemnity” The maximum amount the insurer will laboratory, conducting assisted reproductive technology
pay under a policy during the policy year. services, invitro fertilization services, genetic counselling
centre, genetic laboratory, Assisted Reproductive Technology
“Oocyte” means naturally ovulating oocyte in the female
Banks conducting surrogacy procedure or any clinical
genital tract.
establishment, by whatsoever name called, conducting
“Oocyte donor” means a person who provides oocyte with the surrogacy procedures in any form.
objective of enabling an infertile intending couple or intending
woman to have a child. “Surrogate mother” means a woman who agrees to bear a
child (who is genetically related to the intending couple or
“Oocyte retrieval” means a procedure of removing oocytes
intending woman) through surrogacy from the implantation of
from the ovaries of a woman.
embryo in her womb and fulfils the conditions as specified in
“Period of Insurance” means the period as specifically the surrogacy (regulation) act, 2021.
appearing in the Policy Schedule and commencing from the
Policy Period Start Date of the first Policy taken by the Insured “Surrogacy procedures” means all gynecological, obstetrical
Person from the company and then, running concurrent to or medical procedures, techniques, tests, practices or services
current Policy subject to continuous renewal of such Policy involving handling of human gametes and human embryo in
with us. surrogacy.
“Policy” means these Policy wordings, the Policy Schedule and “Valuable Service provider” means organization, institution, or
any applicable endorsements or extensions attaching to or
hospital that has been empaneled with the company to provide
forming part thereof. The Policy contains details of the extent
of cover available, what is excluded from the cover and the services specified under the benefits (including add-ons) to the
terms & conditions on which the Policy is issued. Insured person. These shall also include all healthcare providers
empaneled to form a part of network other than hospitals. The
"Policy period" means the period commencing from the Policy
list of the Valuable Service Providers is available in the company
Period Start Date, Time and ending at the Policy Period End
Date, Time of the Policy and as specifically appearing in the website www.galaxyhealth.com and is subject to amendment
Policy Schedule. from time to time.
"Policy Year" means a period of twelve months beginning from Zones:
the Policy Period Start Date and ending on the last day of such
Zone A: Gujarat, Haryana, Rajasthan, Punjab, Chandigarh, NCR
twelve-month period. For the purpose of subsequent years,
of Delhi, Mumbai, Thane, Ghaziabad and Noida.
“Policy Year” shall mean a period of twelve months beginning
from the end of the previous Policy Year and lapsing on the last Zone B: Tirupati, Hyderabad including K V Ranga Reddy and
day of such twelve-month period, till the Policy Period End Medchal Malkajgiri, Secunderabad, Vijayawada, Patna, Goa,
Date, as specified in the Policy Schedule. Himachal Pradesh, Bengaluru, Thiruvananthapuram,
“Policy term” means the period between the commencement Ernakulam, Bhopal, Indore, Pune, Nashik, Chennai,
date and expiry date specified in the schedule. Chengalpattu, Kanchipuram, Tiruvallur, Lucknow and Kolkata.
“Poly Trauma” If a person sustained two or more severe Zone C: Rest of India.
injuries/ fractures in two or more areas of the body.
III. COVERAGE
“Polysomnography” is a comprehensive diagnostic test used
to evaluate and diagnose sleep disorders. It involves recording In consideration of the premium paid, subject to the terms,
multiple physiological parameters during sleep to provide a conditions, exclusions and definitions contained herein the
detailed assessment of sleep quality and various aspects of Company agrees as under.
sleep health. The parameters typically monitored include: EEG, The coverage provided varies among plan offerings and only
EOG, EMG, ECG, Respiratory monitoring, Saturation monitoring applies to the relevant covers opted by the insured person, as
through pulse oximeter. The test conducted at a speciality specified in the policy schedule and if during the period stated in
hospital. the Policy Schedule the insured person sustains bodily injury or
“Proportionate deductions” If the Insured Person is admitted contracts any disease or suffer from any illness requiring
in a room category/limit that is higher than the one that is Hospitalisation and incurs expenses at any Nursing Home /
specified in the Policy Schedule/ Product benefit table of this Hospital in India as an In-patient, the Company will indemnify
policy, then the Insured Person shall bear a ratable proportion the Insured Person such expenses as are reasonably and
of the total Associated medical expenses (including surcharges necessarily incurred under the heads given below but not
exceeding the Limit of Coverage stated in the Policy schedule.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 5/39
1. In-patient Treatment 5. Road Ambulance: Expenses incurred as per the table
a. Room rent inclusive of boarding, nursing charges, given below in respect of the following are payable,
Residential/Duty Medical Officer charges during provided that the hospitalisation claim is admissible.
Hospitalisation as charged by the Hospital where the i. For transportation of the insured person by private
Insured Person availed medical treatment as per the limits ambulance service to go to hospital when this is needed
given below;
for medical reasons or.
ii. For transportation of the insured person by private
Sum Insured Premier Plan – Per Day Elite Plan– Per Day Signature Plan
Limit (Rs) Limit (Rs) – Per Day ambulance service from one hospital to another hospital
(Rs.)
Limit (Rs) for better medical treatment or.
3,00,000
Upto 1% of Sum Insured Not Applicable Not Applicable iii. For transportation of the insured person from the
4,00,000
hospital where treatment is taken to their place of
5,00,000 residence (if it is in same city) provided the requirement of
7,50,000 Upto 1% of Sum Insured an ambulance to the residence is certified by the medical
maximum up to Rs.7,500/- Up to
10,00,000 Up to practitioner.
Deluxe Room Deluxe Room
15,00,000
20,00,000 Maximum up to Premier Plan Elite Plan Signature Plan
Rs.10,000/-
25,00,000 Any room Limit Per Upto Upto
50,00,000 Hospitalisa�on (Rs) Rs.2,500/- Rs.5,000/-
Not Applicable Any room Actuals
1,00,00,000 Not Applicable Limit Per Policy Upto Upto
Period (Rs) Rs.5,000/- Rs.10,000/-

Note: Associated Medical expenses which vary based on the

room occupied by the insured person will be considered in 6. Air Ambulance: Air ambulance expenses are payable
subject to an admissible hospitalisation claim, the Insured
proportion to the room rent stated in the policy schedule or
Person(s) is/are eligible for reimbursement of expenses
actuals whichever is less. Proportionate deductions are not
incurred towards the cost of air ambulance service as per
applied in respect of the hospitals which do not follow
the table given below, provided that.
differential billing or for those expenses in respect of which
a) It is for emergency care of the insured person which
differential billing is not adopted based on the room rent.
requires immediate and rapid ambulance transportation to
b. Surgeon, Anesthetist, Medical Practitioner, Consultants, the hospital/medical centre that ground transportation
Specialist Fees. cannot be provided.
c. Anesthesia, Blood, Oxygen, Operation theatre charges, b) Necessary medical treatment not being available at the
ICU charges, Digital ICU, Surgical appliances, Medicines location where the Insured Person is situated at the time of
and Drugs, Diagnostic materials and X-ray, Diagnostic Emergency.
imaging modalities, investigation test, dialysis, c) It is prescribed by a Medical Practitioner and is Medically
chemotherapy, radiotherapy, cost of pacemaker, stent and Necessary;
similar expenses with regard to coronary stenting, d) The insured person is in India and the treatment is in India
medicines, Implants and other similar items the Company only.
will pay cost of stent as per the Drug Price Control Order e) Such Air ambulance should have been duly licensed to
(DPCO) / National Pharmaceuticals Pricing Authority operate as such by Competent Authorities of the
(NPPA) Capping. Government/s.
2. Day Care Procedures/Treatment: All day care Procedures
/ Treatment are covered upto sum insured. Limit Per Policy Year
3. Pre- Hospitalisation Expenses: Medical expenses incurred Premier Plan Elite Plan Signature Plan
immediately before the insured person is hospitalized as Upto 10% of the Sum Insured or
per the table given below. Not Covered maximum upto Upto 10% of the
Rs.2.5 Lakhs whichever is less Sum Insured

Premier Plan Elite Plan Signature Plan

Not exceeding 30 days Not exceeding 60 days Not exceeding 90 days Note: The Company will not cover the following expenses:
a) Any transportation of the Insured Person from Hospital to
4. Post - Hospitalisation Expenses: Medical Expenses
the Insured Person’s residence after he/she has been
incurred in respect of the Insured Person immediately
discharged from the Hospital.
following the Insured Person’s discharge from Hospital as
per the table given below. b) Any transportation or Air Ambulance expenses incurred
outside the geographical territory of India.
Premier Plan Elite Plan Signature Plan
Not exceeding 60 days Not exceeding 90 days Not exceeding 180 days

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 6/39
7. Treatment of Cataract: Expenses incurred on treatment of Note:
Cataract is subject to the limit as per the following table: i. The customer should opt for either cumulative bonus or
No claims discount during the first purchase of this
Limit per policy period (in Rs.) policy and the same will be maintained throughout the
lifetime.
Sum Insured (Rs.) Premier Plan Elite Plan Signature Plan
ii. This discount will be provided on renewal premium of
3,00,000 Upto 25,000/- each claim free year and it is not cumulative in nature.
Not Applicable Not Applicable
4,00,000 Upto 25,000/- Illustration: If the insured opts for higher sum insured at the
5,00,000 Upto 35,000/- Upto 60,000/- time of renewal, the discount shall be calculated on the
7,50,000 previous year premium, and the same discounted amount shall
be applied on the renewed premium. Illustration is given below
10,00,000
for better understanding.
15,00,000 Upto 50,000/- Upto 75,000/- Actuals
Policy Type Fresh
20,00,000
Sum Insured (Rs.) 5,00,000
25,00,000
Family Size 2A
50,00,000
Not Applicable Zone A
1,00,00,000 Not Applicable
Plan Signature
Note: The above limit is inclusive of pre and post hospitalisation Self and Spouse Age 36 and 31
expenses. Base Premium (Rs.) 18,408 A
8. a. Cumulative Bonus: The Company will provide a Add: GST at 18% (Rs.) 3,313 B = A * 18
Cumulative Bonus at the end of each claim free year as per Total Premium (Rs.) 21,721 C = A+B
the table given below, if the Policy is continuously renewed During Renewal, Insured enhanced
with the Company. sum Insured to Rs.10,00,000/- and
opted No Claim discount
Premier Plan Elite Plan Signature Plan
Policy Type Renewal
25% of the sum 50% of the sum 100% of the sum
insured will be insured will be insured will be Sum Insured Enhanced to (Rs.) 10,00,000
provided, if no provided, if no provided, if no Family Size 2A
claims are made in claims are made in claims are made in Zone A
the first year of the the first year of the the first year of the
policy. 10% of sum policy. 25% of sum policy. 25% of sum Plan Signature
insured will be insured will be insured will be Self and Spouse Age 37 and 32
provided for every provided for every provided for every
subsequent claim subsequent claim subsequent claim Base Premium (Rs.) 23,443 D
free year subject to free year subject to free year subject to Less: No Claims Discount at 4% (Rs.) 736 E = A*4%
maximum of 100%. maximum of 150%. maximum of 500%.
Sub-total (Rs.) 22,707 F = D-E
Add: GST at 18% (Rs.) 4087 G = F*18%
Condi�ons
1. The Cumulative bonus will be calculated on the expiring Total Premium (Rs.) 26,794 H = F+G
Sum Insured.
9. AYUSH Treatment: Medical expenses for Inpatient
2. If the insured opts to reduce the sum insured at the Hospitalisation incurred on treatment under Ayurveda, Yoga
subsequent renewal, the limit of indemnity by way of and Naturopathy, Unani, Sidha and Homeopathy systems of
such Bonus shall not exceed such reduced sum insured. medicines in a AYUSH Hospital is payable upto the sum
3. For Elite and Premier Plan: In the event of a claim, such insured.
bonus so granted will be reduced at the same rate at
Note: Claims under Yoga and Naturopathy system of treatment
which it has accrued.
will be payable subject to prior approval from the Company.
4. For Signature Plan: Bonus will not be reduced untill the
same is utilized in the event of Claim. During renewal, 10. Domiciliary Hospitalisation: Coverage for medical
Cumulative bonus will be reduced only to the extent of treatment (Including AYUSH) for a period exceeding three
utilised portion and the unutilised Cumulative bonus days, for an illness/disease/injury, which in the normal course,
will be carried forward to the next policy year. would require care and treatment at a Hospital but, on the
advice of the attending Medical Practitioner, is taken whilst
8. b. No Claim Discount (in lieu of Cumulative Bonus): confined at home under any of the following circumstances.
Policy is eligible for no claim discount in lieu of no claim • The condition of the patient is such that he/she is not in
bonus as per the table given below: a condition to be moved to a Hospital, or
15 and • The patient takes treatment at home on account of
Sum Insured in Lakhs (Rs.) 3 4 5 7.5 10 above non-availability of room/bed in a hospital.
Discount for Premier Plan 4% 4% 2% 2% 1% 1% However, this benefit shall not cover Asthma, Bronchitis,
Chronic Nephritis and Nephritic Syndrome, Diarrhoea and all
Discount for Elite Plan NA 3% 3% 1% 1%
types of Dysenteries including Gastroenteritis, Diabetes
Discount for Signature Plan NA 4% 4% 2% 2% Mellitus and Insipidus, Epilepsy, Hypertension, Influenza,
Cough and Cold, all Psychiatric or Psychosomatic Disorders,
Pyrexia of unknown origin for less than 10 days, Tonsillitis and
Upper Respiratory Tract infection including Laryngitis and
Pharyngitis, Arthritis, Gout and Rheumatism.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 7/39
11. Modern Treatment: The following procedures will be covered (wherever medically indicated) either as in patient or as part of
day care treatment in a hospital as per the table given below (including Pre and Post hospitalisation expenses) during the policy
year;

Limits Per Policy Year

Premier Plan Elite Plan Signature Plan

I Robotic Surgeries Maximum upto Rs.4,00,000/-
a Total Knee Replacement & Total or upto sum insured whichever
Hip Replacement is less, (Including the Costs of
Implants)
Radical Prostatectomy
Wipples Procedure Maximum upto Rs.5,00,000/-
b or upto sum insured whichever
For treatment of Thoracic &
Abdominal Malignancies is less
Complex Intra-Abdominal Surgeries
For treatment of Laryngeal &
Pharyngeal Cancers Maximum upto Rs.7,00,000/-
c or upto sum insured whichever
Staging Laparotomy (including the
cost of instruments) is less
Cyto-reduction Surgeries
d For all other Robotic procedures Upto 30% sum insured
Immunotherapy – a For Cancer Treatment Upto sum insured Covered upto Covered upto
II Monoclonal Antibody
Sum Insured Sum Insured
to be given as injection b Other than treatment of Cancer Upto 30% sum insured
III Stem Cell Therapy
a For Cancer Treatment Upto sum insured
Hematopoietic stem
cells for bone
marrow transplant b Other than Treatment of Cancer Upto 30% sum insured
for haematological
conditions
Allowed Maximum 3 injections per
IV Intravitreal Injection a eye (6 injection both eyes) per Upto 30% sum insured
policy period
V Deep Brain Stimulation a Maximum upto Rs.7,00,000/- or upto sum insured whichever is less
a Balloon Sinuplasty
Upto 30% sum insured
b Bronchial Thermoplasty

c IONM – (Intra Operative

VI Other Modern Neuro Monitoring)
Treatment
d Stereotactic Radio Surgeries
e Vaporisation of Prostate
f Oral Chemotherapy

g Uterine Artery Embolization &

High-Intensity Focussed Ultrasound

12. Organ Transplantation Expenses: Hospitalisation medical 2. The organ transplant is certified in writing by a Medical
expenses incurred to the Insured Person for inpatient organ Practitioner as Medically Necessary Treatment for the
transplantation treatment, including the harvesting of the Insured Person.
donated organ will be covered upto sum insured subject to a 3. A waiting period of 24 months from the date of first
waiting period of 24 months from the date of first inception of commencement of this policy.
this policy with the Company. Note :
Note : Organ transplant on the Insured Person shall satisfy the i. The coverage limit under this benefit is over and above
requirements of the Transplantation of Human Organs Act of the Limit of Coverage and upto the Sum Insured.
1994 and any amendments there to. ii. This additional Sum Insured can be utilized by the Donor
and not by the Insured.
13. a. Organ Donor Expenses (This coverage is available only
in Signature Plan): For Insured:
If the Insured person donates organ, In-patient hospitalisation
For Donor:
expenses incurred for organ transplantation are payable upto
The expenses incurred by the Donor, (if any) for the the sum insured, subject to the following,
complications that necessitate a Redo Surgery / ICU admission a. The donation conforms to the Transplantation of Human
will be covered, subject to the following, Organs Act 1994 and any amendments thereafter and
1. The donation confirms to the Transplantation of Human the organ is for the use of the Insured Person.
Organs Act 1994 and any amendments thereafter and
the organ is for the use of the Insured Person.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 8/39
 b. The organ transplant is certified in writing by a Medical Premier Plan Elite Plan Signature Plan
Practitioner as Medically Necessary Treatment for the
Insured Person. The sum insured will The sum insured will
c. A waiting period of 24 months from the date of first be reset one time of be reset unlimited
commencement of this policy. 100% sum insured times for any
The following are not covered (applicable for both Donor during the policy illness/disease/injury
and Insured): period This reset is allowed
a. Stem cell donation is considered medically necessary Not This reset sum maximum up to 100%
treatment, except for bone marrow transplant. Covered insured can be each time, which can
utilized / for be utilized for a
b. Pre-hospitalisation or Post-hospitalisation Medical
Expenses of the organ donor. subsequent subsequent
hospitalisation only hospitalisation for
c. Screening or any other Medical Expenses related to the
for illness / disease same illness and
organ donor, which are not incurred during the duration
of Insured Person’s Hospitalisation for organ unrelated to the different illness,
transplant. illness / diseases for including modern
which claim/s was / treatments and
d. Transplant of any organ/tissue where the transplant is
Unproven / experimental treatment or investigational in were made. accidents.
nature.
Conditions applicable for Elite Plan
e. Expenses related to organ transportation or
preservation. a) Available immediately upon exhaustion of the limit of
coverage, during the policy period.
f. Any other medical treatment for the donor, which is
directly or indirectly consequence to harvesting. b) Any unutilized Reset Benefit will not be carried forward
to any subsequent Policy Years.
13. b. Premium waiver for Voluntary organ donor:
c) Modern treatment and accidents are not covered under
This benefit gives a 2-year premium waiver on the renewal this benefit
policy of an insured person who donates organs, subject to
the following, Conditions applicable for Signature Plan
1. Upon confirmation by the company medical team and a) Available immediately upon partial/ full utilization of
subject to admissible claim the sum insured
2. Proof of donation should be submitted to avail the b) On partial utilization of the Sum Insured, it will be reset
waiver of premiums up to extent of utilization.
c) On full utilization of the Sum Insured, it will be reset to
14. Health Check-up: Expenses incurred towards cost of health 100%.
check-up is payable upto the limits mentioned in the table d) The maximum payable amount for a single claim under
given below: reset benefit shall not be more than the Sum Insured.
Upto the Limits per policy year e) Any unutilized Reset Benefit will not be carried forward
to any subsequent Policy Years.
Premier Elite Signature
Sum Plan Plan Plan Note: The Order of utilization is as follows:
Insured a) Sum Insured
(Rs.) Individual Floater Individual Floater Individual Floater
(Rs.) (Rs.) (Rs.) (Rs.) (Rs.) (Rs.) b) Cumulative Bonus
3,00,000 750/- 1500/- c) Automatic Restoration
Not Applicable Not Applicable
4,00,000 750/- 1500/- Illustration 1: Automatic Restoration: Elite Plan
5,00,000 750/- 1,500/- 1,500/- 2,500/- 1,500/- 2,500/- Scenario 1 Scenario 2
7,50,000 1,500/- 2,500/- 2,000/- 5,000/- 2,000/- 5,000/- (First Year) (Renewal)
10,00,000 1,500/- 2,500/- 2,000/- 5,000/- 2,000/- 5,000/- Sum Insured (SI) Rs.10 Lakhs Rs.10 Lakhs
Cumulative Bonus (CB) 0 Rs.5 Lakhs
15,00,000 1,500/- 2,500/- 4,000/- 8,000/- 4,000/- 8,000/-
Total Cover Available Rs.10 Lakhs Rs.15 Lakhs
20,00,000 1,500/- 2,500/- 5,000/- 10,000/- 5,000/- 10,000/-
25,00,000 1,500/- 2,500/- 5,000/- 10,000/- 5,000/- 10,000/- 1st Hospital Bill Amount Rs.5 Lakhs Rs.5 Lakhs
50,00,000 5,000/- 10,000/- 5,000/- 10,000/- Claim Settled Rs.5 Lakhs Rs.5 Lakhs
Not Applicable
1st Claim

1,00,00,000 Not Applicable 8,000/- 15,000/- Rs.10 Lakhs

Rs.5 Lakhs
(Available from
Available at Available at Available at Total Coverage available (Available from
sum insured Rs.5
network hospital network hospital network hospital sum insured
Lakhs + Bonus
for every block for every claim for every year Rs.5 Lakhs)
Rs.5Lakhs)
of two claim free year at the (irrespective
free years of claims) from 2nd Hospital Bill Amount
time of renewal. Rs.10 Lakhs Rs.15 Lakhs
first purchase of for different illness
this policy. Rs.5 Lakhs Rs.10 Lakhs
(Available (Available Sum
Note : Claim Settled Sum insured insured Rs.5 Lakhs +
i. Any unutilized health check-up limit cannot be carried Rs.5 Lakhs) Bonus
2nd Claim

forward to the next Policy Year. Rs.5 Lakhs)

ii. Payment under this cover will not have an impact on Rs.10 Lakhs
(Automatic Rs.10 Lakhs
Premium Promise and Cumulative Bonus/No Claim
Discount. restoration will be (Automatic restoration
Total Coverage available triggered for will be triggered for
15. Automatic Restoration : The policy provides automatic subsequent unrelated subsequent unrelated
restoration of sum insured as per the table given below hospitalisation) hospitalisation)

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 9/39
 16. a. Assisted Reproduction Treatment (This cover is
Illustration 1: Automatic Restoration: Elite Plan applicable only in Signature plan): The Company will
reimburse medical expenses incurred on Assisted
Scenario 1 Scenario 2
(First Year) (Renewal) Reproduction Treatment as per the table given below,
where indicated, for sub-fertility subject to:
Hospital Bill Amount
(For Same Illness) Rs.5 Lakhs Rs.5 Lakhs a) For the purpose of claiming under this benefit, in-
3 rd Claim

patient treatment is not mandatory.

Will the restoration kick in?
0
b) Automatic Restoration of Sum Insured shall not be
No, because claim for same 0
applicable for this benefit.
illness is not payable
c) Both self and spouse should be covered under this
Hospital Bill Amount policy for a minimum period of 2 years continuously
Rs.5 Lakhs Rs.5 Lakhs
without break either individual or floater sum insured.
4th Claim

(For different illness)

Claim settled Rs.5 Lakhs Rs.5 Lakhs d) Company will pay for one Assisted Reproduction
Total Coverage available Rs.5 Lakhs (Available Rs.5 Lakhs (Available Treatment cycle in a policy year.
for next claim (Available from Automatic from Automatic Upto the Limit
for different illness) Restoration Restoration Sum Insured (Rs.)
Rs.5 Lakhs ) Rs.5 Lakhs )
Per policy Year (Rs.)
5,00,000 1,00,000
Illustration 2: Automatic Restoration: Signature Plan 7,50,000 2,00,000
Scenario 1 Scenario 2 10,00,000 2,00,000
(First Year) (Renewal)
15,00,000 2,00,000
Sum Insured (SI) Rs.10 Lakhs Rs.10 Lakhs
20,00,000 2,00,000
Cumulative Bonus (CB) 0 Rs.10 Lakhs
Total Cover Available Rs.10 Lakhs Rs.20 Lakhs 25,00,000 2,00,000
50,00,000 5,00,000
Claim Settled Rs.5 Lakhs Rs.5 Lakhs
1,00,00,000 5,00,000
Rs.10 Lakhs (Balance Rs.20 Lakhs
1st Claim

Total Coverage available Sum Insured Rs.5 (Balance SI Rs.5 Lakhs + 16. b. Surrogacy (This cover is applicable only in Signature
for next claim Lakhs + Automatic Automatic sum insured plan): The company will indemnify Inpatient
Sum Insured Rs.5 Lakhs + Bonus
hospitalisation expenses covering post-partum delivery
Rs.5 Lakhs) Rs.10 Lakhs)
complications for a period of 36 months incurred for the
2nd Hospital Bill Amount Rs.10 Lakhs Rs.10 Lakhs Surrogate mother upto the sub-limits specified under
(For same illness) “Assisted Reproduction Treatment”.
Rs.10 Lakhs (Balance
Sum Insured Rs.10 Lakhs The cover will commence from the date of initiation of the
Rs.5 Lakhs + (Balance SI
2nd Claim

treatment/procedure.
Claim Settled Automatic Restoration Rs.5 Lakhs
Rs.5 Lakhs triggered + Automatic restored Miscarriage due to Accident for the Surrogate Mother (This
for subsequent SI Rs.5 Lakhs) cover is applicable only in Signature plan): The company will
hospitalisation) pay lump sum amount (once in lifetime) in case of “Miscarriage
Rs.10 Lakhs Rs.20 lakhs( Balance SI due to Accident” for surrogate mother as per table given below
(Automatic restoration Rs. 5 Lakhs + Automatic and waiting period mentioned under this cover is not
Total Coverage will be triggered for restored sum Insured
available for next claim subsequent Rs.5 Lakhs + Bonus applicable.
hospitalisation) Rs.10 Lakhs)
Sum Insured (Rs.) Limit of liability (Rs.)
Hospital Bill Amount
(For different illness) Rs.5 Lakhs Rs.5 Lakhs Up to 15,00,000/- 25,000/-
Rs.5 Lakhs Rs.5 Lakhs 20,00,000/- and 25,00,000/- 35,000/-
3rd Claim

Claim Settled (From Automatic (Automatic Restored

restoration) SI Rs. 5 Lakhs) 50,00,000/- and 1,00,00,000/- 40,000/-
Total Coverage available for Rs.20 lakhs (Balance SI Rs. 5
next claim Lakhs + Automatic restored Note:
Rs.10 Lakhs
(Available for different sum Insured Rs.5 Lakhs +
illness) Bonus Rs.10 Lakhs)
i. Pre & Post Natal Care and Delivery Expenses for
Surrogate Mother are not payable.
Hospital Bill Amount Rs.8 Lakhs Rs.8 Lakhs ii. Intending couple, the Surrogate mother and the
(For same illness)
Surrogacy clinic must comply with Surrogacy Act and
Rs.8 Lakhs Rs.8 Lakhs
(From Automatic (Automatic restored SI ART Act.
4th Claim

Claim Settled
restoration) Rs. 8 Lakhs) iii. Surrogacy and Oocyte donation should be carried out
Total Coverage available Rs.20 Lakhs (Balance SI Rs. in recognized Centre registered with the National ART
for next claim (Available Rs.10 Lakhs 2 Lakhs + Auto restored
and Surrogacy Registry at
for different illness) sum insured Rs. 8 Lakhs +
Bonus Rs. 10 Lakhs) https://registry.artsurrogacy.gov.in/
iv. Waiting periods mentioned under IV (1 and 2) are not
Hospital Bill Amount Rs.9.50 Lakhs Rs.11 Lakhs applicable under Surrogacy Cover.
(For different illness)
Rs.11 Lakhs v. For coverage under III i.e., for treatments other than
5th Claim

Rs.9.50 Lakhs (Automatic Restored SI Surrogacy Cover, all waiting periods are applicable.
Claim Settled (From Automatic Rs. 10 Lakhs + Bonus
restoration) 1 Lakh) vi. Treatment under Day Care are not covered .
Rs.19 Lakhs (Auto 16.c. Oocyte Donor(This cover is applicable only in
Total Coverage available Restored sum insured Rs.
for next claim Rs.10 Lakhs Signature plan): The company will indemnify the inpatient
10 Lakhs + Balance
Bonus Rs. 9 Lakhs)
hospitalisation expenses for the complications arising out of

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 10/39
Assisted Reproduction Treatment Procedures, for the Oocyte Note: The waiting period will not apply for treatment related
donor upto the sub-limits specified under “Assisted to congenital Internal disease / defects for the Unborn.
Reproduction Treatment” for a period of 12 months. The cover
Types of In-Utero Surgeries covered
will commence from the date of initiation of the
treatment/procedure and coverage is applicable. 1) Open Fetal Surgery
Note : 2) Fetendo Fetal Surgery
a) The Intending couple, the Oocyte donor and the ART 3) Fetal Image-Guided Surgery (FIGS-IT)
Clinic must comply with Surrogacy Act and ART Act 4) EXIT procedure
b) Surrogacy and Oocyte donation should be carried out Types of In-Utero Surgeries/Procedures covered
in recognized centres registered with the National ART
and Surrogacy Registry at TYPE OF DESCRIPTION SURGERIES
https://registry.artsurrogacy.gov.in/. INTERVENTION
c) Waiting periods under IV (1 & 2) are not applicable OPEN SURGERY Hysterotomy CPAM - Lobectomy
under Oocyte Donor Cover. SCT - Resection
d) For coverage under III i.e., for treatments other than MMC – Repair
Oocyte Donor Cover, all waiting periods are applicable. Cervical Teratoma-
Resection EXIT
Conditions applicable for Surrogacy Cover and Oocyte Donor
Cover: Tracheal occlusion
Neck tumors
i. The Proposal for insurance must be made 30 days
before the embryo transfer for the surrogate mother CDH (EXIT to ECMO)
and /or 30 days before ovarian stimulation for oocyte FETENDO Fetoscopic Balloon Occlusion of
donor. Surgery Trachea (for CDH)
ii. Proposer must be one of the intending couples. Laser Ablation of
iii. For Surrogate Mother: After completion of 36 months Vessels (for TTTS)
period, Surrogacy cover will be excluded for the Cord Ligation/Division
Surrogate Mother and all other coverage under III Cystoscopic Ablation
(except Surrogacy cover) will continue. Valves (Urinary Obstruction)
iv. For Oocyte Donor: After completion of a 12-months Amniotic Bands Release
period, Oocyte Donor cover will be excluded for the
Oocyte Donor and all other coverage under III (except FIGS Fetal Image Amnioreduction/Infusion
Oocyte cover) will continue. Guided Surgery Fetal Blood Sampling

Special Exclusions: RFA Anomalous Twins

Vesico/Pleuro Amniotic
The Company shall not be liable to make any payments under
Shunts
this policy in respect of any expenses incurred by the insured
person in connection with or in respect of: Balloon Dilation Aortic
Stenosis
1. Pre and Post treatment expenses.
EXIT procedure Planned CHAOS
2. Sub-fertility services that are deemed to be unproven, Specialized Removal of the CDH
experimental or investigational. Delivery Tracheal Occlusion Balloon
3. Services not in accordance with standards of good
Pulmonary Sequestration
medical practice and not uniformly recognized and
professionally endorsed by the general medical CCAM
community at the time it is to be provided.
4. Reversal of voluntary sterilization. List of procedures covered under In-Utero Surgeries
5. Treatment undergone for second or subsequent a) Amniotic band syndrome
pregnancies except where the child from the first
b) Bronchopulmonary sequestration of the lung
delivery / previous deliveries is/are not alive at the time
of treatment. c) Congenital cystic adenomatoid malformation (CCAM)
6. Payment for services rendered to a surrogate. of the lung
7. Costs associated with cryopreservation and storage of d) Congenital diaphragmatic hernia (CDH)
sperm, eggs and embryos.
e) Congenital high airway obstruction syndrome (CHAOS)
8. Selective termination of an embryo.
f) Fetal anemia
9. Services done at unrecognized centre.
g) Lower urinary tract obstruction (LUTO)
10. Surgery / procedures that enhances fertility like Tubal
Occlusion, Bariatric Surgery, Diagnostic Laparoscopy h) Mediastinal teratoma
with Ovarian Drilling and such other similar surgery /
i) Neck mass
procedures.
j) Sacrococcygeal teratoma (SCT)
17. In-Utero Fetal Surgery/Intervention (This cover is
applicable only in Signature plan): The Company will pay the k) Spina bifida (myelomeningocele)
expenses incurred for In Utero Fetal Surgeries and Procedures l) Twin reversed arterial perfusion (TRAP) sequence
covered upto the sum insured. The following surgeries /
procedures only are covered. m) Twin-twin transfusion syndrome (TTTS)

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 11/39
 18. Delivery Expenses (This coverage is applicable only for d) There is no waiting period for subsequent deliveries.
Signature Plan):
19. Newborn Baby cover: Hospitalisation expenses for
a) Expenses for a Delivery including Normal Delivery or
treatment of new born is covered up to the limits
Caesarean section (Pre-natal and Postnatal expenses
(including for twins/ triplets/ quadruplets) specified
are also covered) upto 10% of Sum Insured or upto
below incurred in a hospital/ nursing home for Any
Maximum of Rs.2 Lakhs, whichever is less.
disease, illness or accidental injuries are payable as
b) Antenatal Scan: During pregnancy both 12th and 20th follows.
week of Antenatal scan are covered (Maximum 2
a) For one year policy term: The coverage for newborn
Scans per delivery) within the above mentioned
baby starts from day-1 after its birth till the expiry date
delivery limit.
of the policy year, as per the table given below subject
Note: to availability of the sum insured.
a) Maximum 2 deliveries are allowed in the lifetime. b) For Long term policies (For 2 years policy term and 3
b) Pre-hospitalisation and Post Hospitalisation expenses years policy term): The coverage for Newborn Baby
are not applicable for this cover. starts from day-1 after its birth till the expiry date of
c) Both self and spouse should be covered under this the policy year. Further, newborn will be covered under
policy for a minimum period of 2 years continuously this policy by paying additional premium for
without break either individual or floater sum insured subsequent years.
(or) insured women alone should be covered under this
policy for 4 years continuously without break.

Coverage for Newborn

Premier Plan – limit per Elite Plan – limit per Signature Plan
policy year (Rs) policy year (Rs) Sum Insured (Rs.) Limit per policy year (Rs)

5,00,000
Covered upto 10% of
7,50,000
Sum Insured or
10,00,000
maximum upto
Covered upto 10% of Sum Covered upto 10% of Sum
15,00,000
Insured or maximum upto Insured or maximum upto Rs.2,50,000/-
Rs.50,000/- whichever is less Rs.1,00,000/- whichever is less 20,00,000
whichever is less
25,00,000
50,00,000 Covered upto 10% of Sum
Insured or maximum upto
1,00,00,000 Rs.5,00,000/- whichever is less
Waiting Period: Provided this cover is available only if
Waiting Period: Waiting Period: delivery expenses claim is paid under this policy or the
Provided the insured women is Provided the insured women is insured women is under the policy for a continuous period
under the policy for a continuous under the policy for a continuous of 12 months without break in this policy or if the insured
period of 12 months without period of 12 months without women submits the Antenatal scan in 12th week and 20th
break in this policy. break in this policy week of the pregnancy, the newborn will be covered from
day 1 (Subject to underwriting).

Note: Note:
1. Intimation about the birth of the Newborn Baby should • This should be specifically requested by the Insured
be given to the company and policy has to be endorsed Person.
for this cover to commence.
• This opinion is given based only on the medical records
2. Exclusion no. 3 initial waiting period (Code Excl 03) as submitted without examining the patient.
stated under this policy shall not apply for the
• The second opinion should be only for medical reasons
Newborn Baby.
and not for medico-legal purposes.
3. All other terms, conditions and exclusions shall apply • Any liability due to any errors or omission or
for the Newborn Baby. consequences of any action taken in reliance of the
4. The Exclusion No.1: Pre-Existing disease (Code Excl second opinion provided by the Medical Practitioner is
01), Exclusion No.2: Specified disease (Code Excl 02), outside the scope of this policy.
and the above-mentioned sub-limit will not apply for
• Utilizing this facility alone will not be considered as a claim
treatment related to Congenital Internal
disease/defects for the newborn. • Medical Records / Documents submitted for utilizing
this facility will not prejudice the company’s right to
20. Second Medical Opinion : To avail this service, the insured reject a claim in terms of policy.
must provide complete medical records. Upon receiving the
• Utilisation of this cover will not have an impact on
request, the company inhouse medical team will review the
Premium Promise and Cumulative Bonus / No Claim
information and advise the member on their medical condition.
Discount.
The medical opinion will be made available directly to the
Insured by the Doctor. To utilize this benefit, all medical 21. Emergency Domestic Medical Evacuation (This cover is
records should be forwarded through Post/Courier. applicable only in Signature plan): The Company will
reimburse reasonable and necessary expenses incurred

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 12/39
 towards transportation of the insured person from the hospital c) The Medical practitioner advises the Insured person to
where the insured person is currently undergoing treatment to undergo treatment
another hospital for further treatment provided.
d) A waiting period of 24 months from the date of first
Upto the Limit inception of this policy with the Company for the insured
Sum Insured (Rs.) person.
Per policy Year (Rs.)
5,00,000 7,500 24. Gala Fit-Pro Active Care (Wellness Engaging Program)
7,50,000 7,500 The Company insurance program integrates a comprehensive
10,00,000 7,500 wellness initiative. Unlike traditional wellness programs that
focus solely on exercise and regular health check-ups to earn
15,00,000 7,500
rewards and discounts, the company program goes a step
20,00,000 10,000 further. The Company promote interactive care that seamlessly
25,00,000 10,000 integrates into the insured person daily activities, recognizing
50,00,000 10,000 even the smallest efforts towards a healthier lifestyle. This
1,00,00,000 10,000 wellness program offer a diverse range of activities designed to
enhance physical health, provide psychological enrichment,
Note: encourage social engagement, and foster community building.
Additionally, improve the Insured Person overall lifestyle.
a. The medical condition of the Insured Person is a
life-threatening emergency. The Company recognize and reward the Insured Person
activities with certificates and coins. These activities are
b. Further treatment facilities are not available in the tracked and monitored by the Company, and the accumulated
current hospital. reward coins can be used to receive discounts on policy
c. The Medical Evacuation is recommended by the treating renewals for the following year. By enrolling and connecting
Medical Practitioner. the Insured Person health gadgets with the company mobile
application, the Company promote healthy lifestyles through
d. Claim for Hospitalisation is admissible under the policy. preventive care coverage. These initiatives aim to help insured
individuals reduce the risk of chronic and lifestyle diseases. The
e. Payment under this benefit does not form part of the sum
company program is designed to be interactive and motivating,
insured but will impact the Bonus.
encouraging the Insured Person to always maintain best
22. Repatriation of Mortal Remains : Following an admissible health.
claim for hospitalisation under the policy, the Company shall This Wellness Program is enabled and administered online
reimburse upto the limits mentioned in the below table in a through Galaxy Health Mobile Applications. The Company
policy year towards the cost of repatriation of mortal remains have the wellness program available based on the age. One is
of the insured person (including the cost of embalming and for adults and dependent child above 18 years and other one is
coffin charges) to the residence of the Insured as recorded in for children above 7 years to below 18 years of age. The
the policy. following table shows the discount on premium available
Limit Per Policy Year under the Wellness Program, applicable for all plans viz
Premier Plan, Elite Plan and Signature Plan. Both on Individual
Premier Plan Elite Plan Signature Plan or Floater Plans available.
Not Covered Upto Rs.15,000/- Upto Rs.25,000/-
Gala Fit - Pro Active Care (Wellness Engaging Program)
Note: Payment under this benefit does not form part of the
Wellness Coins Earned Discount in Premium
sum insured but will impact the Bonus.
Above 251- 400 Coins 4%
23. Treatment for Sleep disorders (This cover is applicable
only in Signature plan): The Company will cover any condition 401-550 Coins 8%
that disrupts the normal sleep pattern, affecting the quality, 551-700 Coins 12%
timing, or duration of sleep as per the table given below. 701- 850 Coins 16%
Upto the Limit Above 850 Coins 20%
Sum Insured (Rs.) Per policy Year (Rs.)
5,00,000 10,000 Distribution of discount can avail as per members in a floater policy
7,50,000 10,000
Family size Weightage
10,00,000 15,000
2A - Self / Spouse 1:1
15,00,000 15,000
2A +1C - Self / Spouse / Dependent Children
20,00,000 15,000 1:1:1
from 18 years of age
25,00,000 15,000 2A + 2C - Self / Spouse / Two Dependent
50,00,000 25,000 Children above 7 years of age to below 18 1:1:1:1
years of age
1,00,00,000 25,000
2A +3C - Self / Spouse / Two Dependent
Conditions : Children above 7 years of age to below 18 1:1:1:1:0
years of age / one child below 7 years of age.
a) Treatment for Sleep disorders such as Insomnia, Sleep
apnea, narcolepsy, Circadian rhythm disorders are
covered Note: In case of two-year policy, total number of wellness points
earned in two-year period will be divided by two.
b) Costs for Polysomnography are covered

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 13/39
 Please refer the illustrations to understand the weightage and calculation of discount in premium
Gala Fit – Pro Active Care Program for Adults + Dependent child age from 18 years and above

Yearly
S.No. Activity - For Each Insured Monthly Coins Coins

1 Enrolling in Wellness Program, in mobile application by individual mobile number with ID proof 10

2 Register under organ donation plan (share details) 10

3 Sleep pattern - Having minimum of 7 hours of sleep / day -monitored monthly basis 5 / month 60

4 Blood donation (maximum twice per year allowed) (10 coins*2) 20

Participation in physical activities
5 / activity)
5 a) Wellness program (like Gym / Health club subscription) 120
* (2/ month)
b) Marathon, cycling, Trekking and similar activities, Indoor and outdoor sports
Target Steps count / per day (monitored monthly basis) 10 for 5000+ steps
6 Recognise with Galaxy team certificate via E-mail or 180
 >5,000 steps  >8,000 steps 15 for 8000+ steps
Preventive check-up
1. ENT check-up (20 coins)
7 50
2. Eye check-up (including Glaucoma test for 40+years. members) (20 coins)
3. Dental check up with reports (10 coins)
Condition Management Program (CMP): (per policy period) –
To record BMI, general health checks up by physician (only 60 coins)
8  Member with Lifestyle disease – can provide once every four month 180
(thrice a policy period) (3*60 coins) assessment records
 Wellness team analysis– if progression noted then coins credited

Only for members who have submitted wellness assistance last policy year.
9 1. Reduce in BMI from obese to normal compared to previous year reports (25 coins ) 30
2. Sharing a success story (5 coins)
10 Submission of Vaccination
100
 100 Coins – HPV  10 Coins - Other vaccine

Provide the standard medical test

1. Complete blood test with haemoglobin 9. Thyroid profile
2. Urine routine 10. Bone density
3. USG abdomen 11. (HHH) serology test (20 coins)
11 4. S.creatinine 12. PSA (M) (20 coins) 220
5. ECG 13. Mammogram test (F) (20 coins)
6. HbA1C 14. PAP smear test (F) (20 coins)
7. Pulmonary function 15. ECHO (20 coins)
8. Cholesterol 16. Cancer profile markers (20 coins)

12 Enrolling with program in Galaxy health app and successful completion of the program 20

Total 1000
Additional benefits available in the wellness via app
● Domain for complete medical records of the members (Digital Vault)
● Access to health gadgets
● Water intake alarm
● Diet program including calories
● Location detectors for blood bank, hospital (with label for network and non-network), Rehabilitation centre,
Pharmacy, diagnostic centre, physiotherapy centre and clinics
Under S.No 12 (wellness program – in app) - attending Counselling / workshop for the following
● Pregnancy
● Postpartum condition
● Emotional & Mental Health
● Menopausal syndrome
● Stress management
● Life balance management

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY

GALAXY HEALTH
HEALTH INSURANCE
INSURANCE  Policy
 Policy Wording
Wording 14/39
14/39
 The following list of activity for Dependent children

Gala Fit – Pro Active Care – Integrated Health Program for Dependent children above 7 to below 18 years of age

Activity Monthly Yearly

S. No. Coins Coins

1. Avail coins for Enrolling in Wellness Program, by parent’s mobile number & Dependent 50
Children photo proof
Submission of Vaccination 70
2.  As per Indian government vaccination chart (50 coins)
 Preventive vaccines as per medical board suggestions (20 coins)
3. Engaging in mental enrichment program (10 / activity) 240
 Singing / dancing program / Story telling / drawing *(2 / month)

4. Engaging in physical activities

(15 / activity)
 Indoor and outdoor sports, Swimming, Trekking and similar activities. 360
* (2/ month)
 Sharing certificate of participating in sports
5. Preventive check-up
1. ENT check-up (50 coins) 50 180
2. Eye check-up (50 coins) 50
3. Dental check up with reports once in every Six month (40*2 coins) 40*2
6. Interactive program in Galaxy health app - *Two Programs minimum and maximum of 5 programs 20*5 100

Total 1000
Additional benefits available in the wellness via app
 Domain for complete medical records of the members (Digital Vault)
 Access to health gadgets
 Water intake alarm
 Diet program including calories

Under S.No 6 (wellness program – in app) - attending Counselling / workshop for the following
 Emotional & Mental Health
 Child behaviour care
 Stress management
 Life balance management
 Drawing and Painting Competition
 Co-Curricular Activities Participation
 Participation in Quiz

Enrolling to Wellness Program Participation in physical activities

To enrol in the wellness program, participants must provide a Engaging in physical activity is essential for health care,
photo ID proof and policy details via the mobile application. providing numerous benefits for both physical and mental
Upon activation, they will receive coins for the program, which well-being, and helping to prevent lifestyle diseases. The
ends on the policy expiring date of the current year. Company program includes a variety of activities such as
Register under organ donation plan trekking, marathons, cycling, and both indoor and outdoor
Organ donation involves a person to donate their organs for sports. Participants who have engaged in these activities are
transplantation to someone in need. This registration of required to submit valid certificates. One or two activity
voluntary organ donation for Nobel cause is acknowledged by certificates per month can be uploaded via the mobile
us. Once registered with a standard organ donor bank, the application to earn coins.
insured can share their registration details and upload the Target Steps count
certificate to earn wellness coins. Regular walking offers numerous benefits for both physical
Sleep pattern and mental health. Aiming for over 8,000 steps per day can
Sleep is crucial for physical and mental health, enhancing significantly contribute to maintaining good health. The
emotional wellbeing, hormonal balance, physical health, and Company program, available at monthly, rewards members
brain function. A minimum of 7 hours of sleep per day is who meet specific step targets. If a member walks 5,000 or
required, and members who achieve 25 days of over 7 hours of more steps per day for at least 25 days in a month, they can
sleep receive monthly coins. The cumulation of monthly points earn 10 coins. Achieving 8,000 or more steps per day for at
is used at the end for discount during policy renewal. least 25 days in a month will earn them 15 coins. Members
who meet these targets for more than 20 days in a month will
Blood donation receive 80% of the monthly coins, i.e., 8 coins for surpassing
Blood donation is a vital process where individuals voluntarily 5,000 steps and 12 coins for surpassing 8,000 steps.
have blood drawn to help those in need of transfusions or
Preventive check-up
medical treatments. The insured can provide their blood
donation certificate details every six months. For every Basic medical consultation for ENT, eye and dental. The
submission, the insured will receive the coins. insured persons must undergo checkup under these specific

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 15/39
specialists and provide the OP consultation papers to avail Under adult
coins. If the Insured Person submit the vaccine certificate as per the
suggested list of vaccine guided by the Indian Ministry of
Condition Management Program (CMP) Health. Coins will be awarded to acknowledge participation,
This is categorised as basic plan and chronic disease with the coins varying based on the type of vaccine
management plan administered. For example, if the Insured Person receives the
HPV vaccine (a three-stage vaccine), 100 coins will be given.
The basic plan includes a general physician conducting a While if, insured person administrated with Hepatitis B vaccine
routine health check-up of the insured, covering BMI, blood or any other list of vaccine guided by the Indian Ministry of
pressure, and other vital signs. The results of this check-up can Health, then 10 coins will be rewarded.
be recorded and shared with the company via the Company
For the other type of coins provided in children wellness plan
mobile application. As an incentive, members will receive coins
for completing this one-time activity. The Company urge all parents and guardians to ensure their
children participate in this vaccination program. Please
For the chronic disease management plan. administer the recommended vaccines, as advised by the
Individuals diagnosed with lifestyle diseases, or any other Ministry of Health, to the Insured Person children and provide
medical conditions are eligible to participate in this three-part an updated list of completed vaccinations. In line with current
integrated activity. Participants must undergo consultations medical advancements, if a physician recommends any
and medical evaluations related to their diagnosed conditions. additional preventive vaccines and the Insured Person child
Activity reports must be uploaded once every four months. has received them, the Company will acknowledge those as
well. As a token of appreciation for completing this activity,
Participants are required to follow prescribed treatments and
the Company will distribute coins.
engage in lifestyle programs and activities to improve their
health. Progress is monitored every four months through Provide the standard medical test
follow-up doctor visits and relevant medical investigations. The Company wellness program offers a variety of diagnostic
Based on the consolidation of these three reports, coins may be tests to evaluate the health status of the insured and screen
granted based on health progression. for age-related diseases. Participants can choose from a basic
list of tests and have the option to select additional specific
Example 1:
tests. Wellness coins are awarded based on their selections.
If a member is suffering from uncontrolled hypertension, they Any 8 tests from first 10 tests are required to accumulate the
must provide the first consultation paper, along with the coins under this activity. From 11 test to 16 test are optional.
requested investigations suggested by the treating doctor,
Enrolling with program in Galaxy health app
during the first month of the current policy period (e.g., April).
These records should be uploaded to the system. The Company mobile application features an interactive
wellness program with activities for disease prevention,
After four months, a second set of records, including the psychological enhancement, social awareness, child
consultation taken (e.g., August) and the corresponding community enrichment, and intellectual development. The
investigations, should be uploaded via the mobile application. program is gender and age-based, and insured participants
This is the second part of the activity. Then after another four receive coins to add to their wellness bucket.
months, the third part of the activity is taken, a third set of
documents, including the consultation form (e.g., December) Wellness for Kids
and the suggested investigations, should be uploaded. Three categories for children participating in the following
categories
The Company will evaluate the uploaded documents to assess
any progression or reduction in the member’s health condition.  Mental enrichment program
If there is a noted improvement, the insured will be awarded  Physical health activity
coins. Additionally, the medical team will review the  Community interactive activities
consultation papers to check for any progression in the
insured’s condition. If no progression is noted, they will guide The program is designed for children above 7 years of age
the insured to subscribe to certain wellness programs. below 18 years of age are eligible to participate in the
following program to enhance their wellness.
BMI management
Mental enrichment program
This activity is for insured individuals who participated last year
and requires them to provide their current BMI. If their BMI is This aims to improve mental well-being and cognitive
within the healthy range, they will receive coins. Participants functioning through various activities. Participants earn coins
are also encouraged to submit a feedback video sharing their based on the uploaded certificates, which can be uploaded up
success with the wellness program. Coins are also available for to two per month.
this activity.  Pottery, arts and Crafting, Drawing, Painting
S.No. Name of the Ailment Criteria to get the Wellness points competitions
 Music therapy, playing musical instruments, Singing
1. Obesity (If BMI is Reducing BMI by three
and dancing performances
above 29) points and maintaining the
same BMI in policy year  Cooking classes
 Participation in Role-playing in one act plays (drama),
2. Overweight (If BMI is Reducing BMI by two points
Quiz, skits on social issues,
between 25 and 29) and maintaining the same
BMI in policy year  Storytelling / narrating, debate meet at zonal level or
above.
Submission of Vaccination certificate  Creative Article writing, publications article in
newspapers.
There are two type coins provided under this activity.
 Participation in Science exhibition competition
One under adult activity and other one under children above 7 (Science Olympiad, zonal level, State level &
years of age to below 18 years of age. National level)

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY

GALAXYHEALTH INSURANCE  Policy
HEALTHINSURANCE PolicyWording
Wording 10/27
16/39
  Meditation sessions, vipassana, puzzle-solving, chess,
 If the member completes 20 days can avail partial coins
abacus, motivation counselling, memory exercises.
for that month.
Physical health activity  The uploaded certificates and reports are validated and
Engaging in physical activity helps children become more then only the coins are added.
active and healthy individuals in the future. List of physical  The reward coins are not carried forward to next year (for
activity kids engaged will be eligible to avail these benefits. annual renewal of policy).
 Team sports (Cricket, Football, Hockey, Basketball and  The wellness coins are not transferable to other members
Volleyball) in the policy.
 Individual sports (Athletics, Swimming, Archery,
Terms and conditions under wellness activity
Boxing, Gymnastics, Tennis, Badminton, Cycling)
 Any information provided by the Insured in this regard
 Enrolling in Gym/Yoga/ Health club subscription
shall be kept confidential.
 Trekking, Marathon and similar activities
 There will not be any cash redemption against the
 Traditional self-defence martial arts, Martial arts wellness reward points.
(Karate/ Taekwondo/Judo/ Kickboxing)
 Insured should notify and submit relevant documents,
Community interactive activities reports, receipts etc for various wellness activities within
There are many engaging community activities that can bring one month of undertaking such activity/test.
younger citizens together and foster a sense of connection.  For services that are provided through empanelled service
 Scouts & Guides provider, Galaxy Health is only acting as a facilitator;
hence would not be liable for any incremental costs or the
 NCC (National Cadet Corps) or NSS (National Service services.
Scheme)
 Insured should consult his/her doctor before
 Volunteer interactive activities (animal shelters, availing/taking the medical advice/services. The decision
clean-ups in park, river, seashore and similar activities, to utilize these advice/services is solely at Insured
food banks, natural calamities, old-age camp) person’s discretion.
 Blood donation camps  The Company reserve the right to remove the wellness
 Health and wellness seminars (State level & National reward points if found to be achieved in unfair manner.
level)  Galaxy Health, its group entities, or affiliates, their
Note: Points will be accumulated based on the submission of respective directors, officers, employees, agents, vendors,
proof of Engaging or award/prize winning certification are not responsible or liable for, any actions, claims,
demands, losses, damages, costs, charges and expenses
Important Note: which a Member claims to have suffered, sustained or
 Member must download the application within 30 days incurred, by way of and / or on account of the Wellness
from the inception date of the policy. Program.
 The investigation requested and OPD consultation and  Services offered are subject to guidelines issued by IRDAI
preventive health check-up must be made from registered from time to time.
diagnostic laboratories and physician.
Illustration of benefits two models proposed
 The Participants in the Interactive program must complete
 First for two adult model
the program, to get the monthly coin.
 Second is for two adult and one child below 18 years of age.
 The app based pre recordings must be seen without
skipping the videos.
 To get coins, for monthly basis, minimum 25 days in a
month must be achieved the target step count.
61 years old 49 years old
S. No. 2A Model (Male) (Female)
1 Enrolling to Wellness Program 10 10
2 Register under organ donation plan 0 10
3 Sleep pattern 0 35
4 Blood donation 10 0
5 Participation in physical activities 0 60
6 Target Steps count 180 120
7 Preventive check-up 20 10
8 Condition Management Program (CMP) 180 60
9 Old participants 0 0
10 Submission of Vaccination certificate 10 (Hepatitis B) 100
11 Provide the standard medical test 0 100
12 Enrolling with program in Galaxy health app 10 20
Total 420 505
Note: cumulation of coins (420 + 505) /2 = 462 = 8% discount applicable during the renewal of the policy.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 17/39
 50 years old 41 years old 9 years old
S. No. 2A +1C Model (Male) (Female) (Kid)
1 Enrolling to Wellness Program 10 10 50
2 Register under organ donation plan 10 10 N/A
3 Sleep pattern 50 0 N/A
4 Blood donation 10 0 N/A
5 Participation in physical activities 120 0 210
6 Target Steps count 100 120 N/A
7 Preventive check-up 40 40 90
8 Condition Management Program (CMP) 60 180 N/A
9 Old participants 30 0 N/A
10 Submission of Vaccination certificate 10 0 50
11 Provide the standard medical test 100 100 N/A
12 Enrolling with program in Galaxy health app 20 0 60
13 Participation in mental enrichment program N/A N/A 120
Total 560 460 580

Note: Cumulation of coins (560 + 460 + 580) /3 = 533 = 8% discount applicable during renewal of the policy.

25. Home Care Treatment (This cover is available only in d. Insured can avail ‘'Home Care Treatment'' service, if
Signature plan) availed from the list of Network service provider given in
The Company will pay for expenses towards treatment availed the Company website ''www.galaxyhealth.com''
by the Insured Person at home upto 10% of Sum Insured or e. Exclusion No.1: Pre-Existing disease (Code Excl 01),
upto Rs.5,00,000/- whichever is less in a policy year. It is Exclusion No.2: Specified disease (Code Excl 02),
available only for the specified conditions mentioned below, Exclusion No.3: Initial waiting period (Code Excl 03) are
which in normal course would require care and treatment at a applicable and the above mentioned sub-limit will apply.
hospital but is actually taken at home. f. Insured claiming under this cover for Post CVA Care at
The below listed are covered Home after discharge, will not be eligible to claim under
Rehabilitation and Pain Management for Stroke.
1. Fever and Infectious diseases which can be managed as
In-patient. 26. Treatment for Chronic severe Refractory Asthma (This
cover is applicable only in Signature plan): In-patient
2. Uncomplicated Urinary tract infections but needing
hospitalisation / Day Care treatment / Home Care
Parenteral Antibiotics.
Treatment/ Out-patient treatment expenses incurred for
3. Asthma and COPD -Mild Exacerbations needing Home treatment of Chronic Severe Refractory Asthma by
Nebulization. Advanced Medicine, is payable upto 10% of sum insured
4. Acute Gastritis/Gastroenteritis. or maximum upto Rs.5,00,000/- whichever is less.
5. I.V. Chemotherapy [Where advised by the doctor]. Note: To avail this benefit, the treatment must be
6. Palliative Cancer care requiring medical assistance. recommended by the treating Pulmonologist.
7. Acute Vertigo. 27. Compassionate Travel: In the event of the insured person
8. Diabetic foot and Cellulitis. being hospitalized for a life-threatening emergency at a
9. IVDP [Cervical and Lumbar disc diseases]. place away from his usual place of residence as recorded
in the policy, the Company will reimburse the
10. Major Surgeries / Arthroplasties needing IV Antibiotics
transportation expenses by air and train incurred as per
Post Discharge.
the table given below for one immediate family member
11. Care for Brain and Spinal Injury Cases Post Discharge. and for travel towards the place where hospital is located.
12. Post CVA Care at Home after Discharge.
13. Chronic Severe Refractory Asthma (by Limit Per Policy Year
Advanced Medicine) (Coverage as per Treatment for Premier Plan Elite Plan Signature Plan
Chronic severe Refractory Asthma sub-limit will apply).
Not Covered Upto Rs.10,000/- Upto Rs.25,000/-
14. Multi-drug resistance TB treatment.
Note: Note:
a. The Medical practitioner advises the Insured person to a) This benefit is payable if the claim for hospitalisation is
undergo treatment at home . admissible.
b. There is a continuous active line of treatment with b) Payment under this benefit does not form part of the sum
monitoring of the health status by a medical practitioner insured but will impact the Bonus.
for each day through the duration of the home care
28. Treatment in Valuable Service Provider Network (VSP): In
treatment .
the event of a medical contingency requiring hospitalisation, if
c. Daily monitoring chart including records of treatment the insured seeks advice from the Company. Further, the
administered duly signed by the treating doctor is Company may suggest an appropriate hospital from the
maintained.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 18/39
network for treatment. Where the insured accepts the same Conditions:
and undergoes treatment in the suggested hospital, the a) This benefit is subject to a waiting period of 24 months
amount mentioned below is payable as lump sum. from the date of first commencement of this policy and
continuous renewal thereof with the Company
Limit Per Policy Year
b) The minimum age of the insured at the time of surgery
Premier Plan Elite Plan Signature Plan should be above 18 years
1% of Sum Insured or 1% of Sum Insured or c) This benefit shall not apply where the surgery is
Not Covered maximum of Rs.5,000/- maximum of Rs.5,000/- performed for
whichever is less whichever is less i. Reversible endocrine or other disorders that can cause
obesity
Note:
ii. Current drug or alcohol abuse
a) Payable only if there is an admissible claim for iii. Uncontrolled, severe psychiatric illness
hospitalisation under the policy.
iv. Lack of comprehension of risks, benefits, expected outcome,
b) Claim is admissible, if a hospital is a part of the VSP list alterna�ves and lifestyle changes required with bariatric
as on date of admission surgery
c) Payment under this benefit does not form part of the sum v. Bariatric surgery performed for Cosme�c reasons
insured but will impact the Bonus
d) The indication for the procedure should be found
d) The Company shall not be responsible for the quality of appropriate by two qualified surgeons and the insured
the treatment in the Valuable Service Providers Network. person shall obtain prior approval for cashless treatment
e) For list of valuable service providers, please visit the from the Company.
company website: www.galaxyhealth.com
e) To make a claim, the insured person should satisfy the
29. Consumables: If there is an admissible claim under following criteria as devised by NIH (National Institute of
inpatient / day care under this policy, then Items as per List I Health)
will become payable upto sum insured. Further, the Company
i. The BMI should be greater than 40 or greater than 35 with
also covers Admission /Registration charges, Record charges
co-morbidi�es (like Diabetes, High Blood Pressure etc.)
and Insurance Processing charges will be payable upto the
ii. The insured person is unable to lose weight through
sum insured.
tradi�onal methods like diet and exercise
Note: This cover is available only in Signature plan as
inbuilt. However, as optional cover under Elite plan. 31. Rehabilitation and Pain Management: The company will
30. Bariatric Surgery: Expenses incurred on hospitalisation pay the medical expenses for Rehabilitation and Pain
including pre-hospitalisation and post-hospitalisation for Management as per the table given below:
bariatric surgical procedure and its complications thereof are
payable subject to limits as per the table given below. Limit Per Policy Year
Premier Plan Elite Plan Signature Plan
Upto the Limit Per Policy Year (Rs.)
Covered upto Covered upto Sub-limit as per
Signature Not Covered
Sum Insured Premier Plan Elite Plan Rs.25,000/- the table given below (or)
Plan
maximum upto 20% of the
3,00,000 2,00,000 sum insured, whichever is less
Not Applicable Not Applicable
4,00,000 2,00,000
5,00,000 2,00,000 2,50,000 3,00,000 Rehabilitation: The company will pay the expenses for
rehabilitation, if availed at authorized centres as an
7,50,000 2,00,000 2,50,000 3,00,000
In-patient/Out-patient, and if there is an admissible claim for
10,00,000 2,00,000 2,50,000 3,00,000 In-patient hospitalisation for an injury, disease or illness
15,00,000 2,00,000 2,50,000 3,00,000 specified below.
20,00,000 3,00,000 5,00,000 6,00,000 1. Poly Trauma
25,00,000 3,00,000 5,00,000 6,00,000 2. Head injury
50,00,000 5,00,000 6,00,000 3. Diseases of the spine
Not Applicable 4. Stroke
1,00,00,000 Not Applicable 6,00,000

Pain Management Treatment - Up to the Limit Per Policy year (Rs.)

S.No. Name of the covered pain management treatment Elite Plan Signature Plan
Sum Insured (Rs.) (in Lakhs) 5/7.5/10/15/20/25/50 5/7.5/10/15/20 25/50/100
1 Lumbar and cervical medial branch block with RF ablation for lumbar and cervical 25,000 65,000 75,000
facet joint arthritis
2 Caudal epidural injection for Discogenic pain 25,000 40,000 50,000
3 Lumbar and cervical selective nerve root block for Lumbar and Cervical radicular pain 25,000 50,000 60,000
4 Caudal Neuroplasty for Failed back spine surgery 25,000 85,000 1,00,000
5 Stellate ganglion ablation for upper limb CRPS 25,000 65,000 75,000
6 Occipital nerve Pulsed RF lesioning for Migraines, Cluster headache and cervicogenic headaches 25,000 65,000 75,000
7 Lumbar sympathetic chain RF ablation for lower limb CRPS, diabetic periphery 25,000 65,000 75,000
painful neuropathy and Ischaemic limb pain
8 Gasserian ganglion ablation for Trigeminal neuralgia 25,000 65,000 75,000

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 19/39
 Pain Management Treatment - Up to the Limit Per Policy year (Rs.)
S.No. Name of the covered pain management treatment Elite Plan Signature Plan
Sum Insured (Rs.) (in Lakhs) 5/7.5/10/15/20/25/50 5/7.5/10/15/20 25/50/100
9 Intercostal nerve Ablation for post thoracotomy pain and Thoracic malignancy pain 25,000 65,000 75,000
10 Coeliac plexus ablation for upper gastrointestinal malignancies pain 25,000 65,000 75,000
11 Superior hypogastric plexus ablation for lower Gastro intestinal malignancies pain 25,000 65,000 75,000
12 Ganglion impar ablation for perineal cancer pain and coccydynia 25,000 65,000 75,000
13 Cooled RF ablation of genicular nerve for grade 1 and 2 osteoarthritis knee and hip 25,000 1,00,000 1,25,000
14 Suprascapular nerve RF ablation for rotator cuff partial tear and peri arthritis shoulder pain 25,000 65,000 75,000
15 Physiotherapy maximum 10 session will be allowed per policy period 25,000 50,000 60,000

Important Note: remaining members during the renewal of this policy and
1. Rehabilitation and/or Pain management treatment can be lock the premium at that age, till a claim is paid.
taken only at the Authorized centres mentioned in the company • If a floater plan, splits into multiple policies, then the
website – www.galaxyhealth.com Company will carry forward the locked age at which the
2. Insured claiming under this cover for Stroke, will not be floater policies were taken by individuals in the policies
eligible to claim under Home Care Treatment for Post CVA Care carried forward, till a claim is paid.
at Home after discharge. • Once insured crosses the age of 55 years irrespective of
claim, premium will be charged as per Insured’s current
age and the Company will continue to charge as per the
32. Hospice Care (This coverage is applicable only for
age at renewal.
Signature Plan): The Company will pay medical expenses upto
10% of the sum insured or maximum upto Rs.5,00,000/- • In the event of price change due to product revision, the
whichever is less once in lifetime for each Insured person for premium will be charged based on the original age slab of
Hospice care availed at Networked facility, which is mentioned the revised product.
in the Company website www.galaxyhealth.com. • Claims under Personal Accident and Hospital Cash
Note : optional covers will not have an impact on Premium
a) Available after a waiting period of 24 months from the Promise.
inception of this policy. Enhanced (Optional Covers)
34. Accidental Death and Permanent Total Disablement
b) The admissibility of claim under Hospice Care is based on
(Optional cover applicable only for Elite and Signature Plan)
the decision of the medical panel by the company will be
final. On payment of additional premium, at any time during the
Period of Insurance, if the Insured Person shall sustain any
33. Premium Promise: The insured premium is locked at entry bodily injury resulting solely and directly from Accident caused
when a policy is purchased. The same premium will be charged by external, violent and visible means then the Company will
for subsequent renewals until a claim is paid or completion of pay as under:
age 55 years whichever is earlier.
1. Accidental Death of Insured Person: If following an
Premium Promise Accident that causes death of the Insured Person within
12 Calendar months from the date of Accident, then the
Premier Plan Elite Plan Signature Plan
Company will pay an amount as compensation the Sum
Not Applicable as Applicable as Insured mentioned in the Schedule
Applicable an Optional cover In-Built cover
2. Permanent Total Disablement of the Insured Person: If
following an Accident which caused permanent
Conditions impairment of the Insured’s mental or physical
• This benefit will be available for those purchased this capabilities, then the Company will pay the benefits as
policy up to the entry age of 50 years. provided in the “Table of Benefits – B1”, depending upon
• No additional premium will be charged in the middle of the degree of disablement provided that:
the tenure in case of claims. At the time of renewal (in a) The disablement occurs within 12 Calendar months
case of a claim), the premium will be charged as per the from the date of the Accident.
current age of the insured at renewal. b) The disablement is confirmed and claimed for, prior to
the expiry of a period of 60 days since occurrence of the
• In case of multi tenure policies, the premium for the entire
disablement.
tenure will be charged as per the entry age.
• Floater Plan: During the renewal of this policy, If the Coverage for Accidental Death and Permanent Total Disablement
insured adds a member to the floater plan, then the Premier Plan Elite Plan & Signature Plan
premium will be charged as per the entry age of the eldest Cover for Accidental Death and Permanent Total
member and will lock the premium at that age, till a claim Disablement
is paid. Self: Covered up to 2 times of health sum insured or
• Individual Plan: During the renewal of this policy, If the maximum of Rs.1,00,00,000/- whichever is less
insured adds a member to an individual plan and convert Dependent Spouse: Covered up to 50% of primary
Not
it into a Floater plan, then the premium will be charged as insured or maximum of Rs.50,00,000/- whichever is
Applicable less
per the entry age of the eldest member and will lock the
premium at that age, till a claim is paid. Dependent Children: Covered up to 25% of primary
insured or maximum of Rs.25,00,000/- whichever is
• If the eldest member is no longer part of the Floater plan, less
then the Floater premium will be calculated as per the If Spouse is a earning member, self PA sum insured
original entry age of the eldest member amongst the can be given.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 20/39
 Table – B2
Condition: Percentage Of
Physical function already impaired
1. If the Accident affects any physical function, which was Sum Insured
prior to accident Deducted
already impaired prior to the accident, a deduction as per
“Table – B2” will be made in respect of this prior Loss of toes All 20
disablement. Loss of Great toe both phalanges 5
2. In the event of Permanent Total Disablement, the Insured 1 Loss of Great toe one phalanx 2
Person will be under obligation: Other than Great, if more
a) To have himself / herself examined by doctors appointed than
by the Company / and the Company will pay the costs One toe lost, for each toe For each toe 1
involved thereof. Loss of hearing both ears Both ears 75
2
b) To authorize doctors to provide treatments or give expert Loss of hearing one ear One ear 30
opinion and any other authority to supply the company Loss of four fingers and
with any information that may be required. If the 3 thumbs of One hand 40
obligations are not met with due to whatsoever reason, Loss of four fingers 35
the Company shall be relieved of its liability to pay. 4
Loss of thumb both Both phalanges 25
3. This optional cover is applicable for the phalanges One phalanx 10
person specifically mentioned in the Schedule. Loss of index finger three 10
phalanges Three phalanges
4. Where a claim has been paid during the policy period the 5
cover under this optional cover ceases until the expiry of Two phalanges Two phalanges 8
the policy for the insured who made a claim under this One phalanx One phalanx 4
optional cover. Upon renewal the cover applies to the Three phalanges 6
person specifically chosen again. However, even if the Loss of middle finger Two phalanges 4
6
sum insured under this optional cover is exhausted by One phalanx 2
way of claim, the coverage under health will continue Three phalanges 5
until expiry of the policy period. 7 Loss of ring finger Two phalanges 4
One phalanx 2
5. Any claim under health portion will not affect the Sum
Three phalanges 4
Insured under this optional cover.
8 Loss of little finger Two phalanges 3
6. Where there is an admissible claim for Accidental Death 2
One phalanx
during the policy period, the health cover will continue for
First or second 3
the remaining insured persons.
9 Loss of metacarpals Additional (third
7. Where there is an admissible claim for Permanent Total fourth or fifth) 2
Disability during the policy period, the health cover would Percentage as
continue until the expiry of the policy for all the insured Any other Permanent
assessed by the
persons covered including the person who has made a 10 Medical Board or
partial disablement by the government
claim for Permanent Total Disability and renewal thereof. doctor
8. Geographical Scope: This optional cover applies Worldwide.
Table of Benefits – B1 9. Claims under this optional cover will not have an impact on
Percentage Premium Promise and Cumulative Bonus / No Claim Discount.
Benefit of the Basic 35. Hospital Cash (Optional Cover Applicable only for Elite and
Sum Insured Signature Plan)
On payment of additional premium, Subject to an admissible
Accidental Death – Benefit 1 100%
Hospitalisation claim, Cash Benefit up to the limits mentioned in
Permanent Total Disablement – Benefit 2 100% the table below for each completed day of Hospitalisation for a
Total and Irrevocable loss of maximum of 10 days per occurrence is payable.
a. Sight of both eyes 100% a) This Benefit is available for a maximum of 120 days during
the entire policy period.
b. Physical separation of two entire hands 100%
b) This benefit is subject to an excess of first 24 hours of
c. Physical separation of two entire feet’s 100% Hospitalisation for every claim.
d. One entire hand and one entire foot 100% c) Claims under this optional cover will not reduce the Sum
e. Sight of one eye and loss of one hand 100% Insured.

f. Sight of one eye and loss of one entire foot 100% Limit Per day (Rs.)

g. Use of two hands 100% Sum Insured Premier Elite Plan Signature Plan
(Rs) Plan
h. Use of two feet’s 100% 3,00,000
Not Applicable Not Applicable
i. Use of one hand and one foot 100% 4,00,000
j. Sight of one eye and use of one hand 100% 5,00,000 1000 1000
7,50,000 1500 1500
k. Sight of one eye and use of one foot 100% Not
10,00,000 1500 1500
Applicable
15,00,000 2000 2000
20,00,000 2000 2000
25,00,000 2500 2500
50,00,000 3000 3000
1,00,00,000 Not Applicable 3000

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 21/39
 Note: Note: This deductible is applied on each claim for every
i) Claims under this optional cover are valid only if the claim is policy year.
admissible either under this policy or any other insurance policy. 38. Room Rent Enhancement (Optional cover applicable only
ii) Claims only under this optional cover, without claims on the for Elite & Signature Plan for sum insured options Rs.5 lakhs to
base cover will not affect the Premium Promise, Cumulative Rs.20 lakhs): Room rent including boarding, nursing charges,
Bonus/ No Claim Bonus. Residential/Duty Medical Officer charges during Hospitalisation
as charged by the Hospital. The Insured Person has option to
36. Pre Existing Diseases (PED) Buy Back (Optional Cover choose Any Room by paying an additional premium at time of
applicable only for Signature Plan) purchasing of the policy or during renewal.
On payment of additional premium, at the time of inception of the 39. Insta Care cover from 31st Day (Optional cover applicable
first policy the Insured Person has the option to opt for reduction only for Signature Plan): If Insured Person has Pre-Existing
of waiting period in respect of Pre-Existing Diseases from 36 Disease (PED) related to the list of Diseases/illnesses/Conditions
months to 12 months or 24 months. This optional cover cannot be mentioned below at the time of issuance of first Policy with the
opted during mid-term of the policy/at the time of renewal/at the Company, then by choosing this Optional cover by paying an
time of portability. additional premium , the applicable Pre-Existing Disease (PED)
37. a. Option to choose Aggregate Deductible (Optional Cover waiting period shall be waived off and coverage will be available
applicable only for Elite and Signature Plan) from 31st Day under In-patient / Day Care Treatment. This
If the insured person chooses any of the following deductible, the optional cover cannot be opted during mid-term of the policy/ at
Company will provide a discount on premium as per the tables the time of renewal / at the time of Portability.
given below: List of diseases/illnesses/conditions covered under this
The insured is allowed to choose either an aggregate deductible optional cover:
(As per Table 1) or Per claim deductible (as per Table 2) option. (i) Asthma - Asthma is a Chronic condition that affects the
Opt in/Opt out of deductible will be subject to underwriting airways (bronchi) of the lungs, causing them to constrict (become
discretion. narrow) when exposed to certain triggers which results in the
Table 1: Aggregate Deductible (for both Elite and Signature Plans) symptoms of wheezing, coughing, tight chest and shortness of
breath.
Sum Insured Deductible Option (ii) Blood pressure (Hypertension) is the term used to describe
Discount offered
(Rs.) a persistent elevated blood pressure, commonly referred to as
Rs.25,000/- 18% high blood pressure, and if this chronic disease is not treated
Up to
Rs. 50,000/- 35% appropriately, is a major risk factor for heart disease, stroke,
20,00,000/-
kidney disease and even eye diseases.
Rs. 1,00,000/- 45%
(iii) Cholesterol (Hyperlipidaemia)- Hyperlipidaemia is a chronic
Rs. 25,000/- 13%
Above disease that refers to an elevated level of lipids (fats), including
20,00,000/- Rs. 50,000/- 25% cholesterol and triglycerides, in the blood and if not treated
Rs. 1,00,000/- 40% appropriately, it is a major risk factor for increased risks of heart
disease, heart attacks, strokes and other incidents of disease.
Note: This deductible is applied on aggregate basis for every
policy year i.e., The combined maximum limit of amount 40. Consumables (Optional cover applicable only for Elite Plan)
deducted on the eligible claims during the policy year, beyond If there is an admissible claim under inpatient / day care under
which claim will be paid. this policy, then Items as per List I will become payable. Further,
(or) the Company also cover Admission /Registration charges,
37.b. Table 2: Per claim Deductible (for both Elite and Record charges and Insurance Processing charges will become
Signature Plans) payable. This can be opted either at the time of first policy or
during renewal by paying an additional premium.
Per Claim Deductible Discount offered 41. Premium Promise (Optional cover applicable only for Elite
Rs. 5,000/- 7.5% Plan): Please refer coverages, terms and conditions as mentioned
under III (33). This can be opted either at the time of first policy or
Rs. 10,000/- 15% during renewal by paying an additional premium.

List of Benefits which are part of sum insured and in addition to Sum Insured
S.No Coverage Premier Plan Elite Plan Signature Plan
1 Room rent including boarding, nursing charges, Forming part of Sum Insured/In addition to Sum Insured
Residential /Duty Medical Officer charges, Surgeon,
Anesthetist, Medical Practitioner, Consultants,
Specialist Fees, Anesthesia, Blood, Oxygen, Operation
Forming part of Forming part of Forming part of
theatre charges, ICU charges, Digital ICU, Surgical
Sum Insured Sum Insured Sum Insured
appliances, Medicines and Drugs, Diagnostic materials
and X-ray, Diagnostic imaging modalities, investigation
test, dialysis, chemotherapy, radiotherapy, cost of
pacemaker, stent and similar expenses with regard to
coronary stenting, medicines, Implants and other similar
items the Company will pay cost of stent as per the
Drug Price Control Order (DPCO) / National
Pharmaceuticals Pricing Authority (NPPA) Capping.

Forming part of Forming part of Forming part of

2 Road Ambulance
Sum Insured Sum Insured Sum Insured

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 22/39
 List of Benefits which are part of sum insured and in addition to Sum Insured

S.No Coverage Premier Plan Elite Plan Signature Plan

3 Air Ambulance Not applicable Forming part of Sum Insured Forming part of Sum Insured
4 Pre & Post Hospitalisation Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
5 Day Care Procedures Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
6 Cataract Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
7 Premium Promise Not Applicable Not Applicable Not Applicable
8 Cumulative Bonus In addition to Sum Insured In addition to Sum Insured In addition to Sum Insured
9 No Claim Discount Not Applicable Not Applicable Not Applicable
10 Automatic Restoration Not Applicable In addition to Sum Insured In addition to Sum Insured
11 Health Check-up In addition to Sum Insured In addition to Sum Insured In addition to Sum Insured
12 Domiciliary Hospitalisation Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
13 Delivery Expenses Not Applicable Not Applicable Forming part of Sum Insured
14 Newborn Baby Cover Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
15 AYUSH Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
16 Organ Transplantation Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
Insured: Forming part of
Sum Insured
17 Organ Donor Expenses Not Applicable Not Applicable
Donor: In addition to
Sum Insured
18 Second Medical Opinion Not Applicable Not Applicable Not Applicable
19 Emergency Domestic
Medical Evacuation Not Applicable Not Applicable In addition to Sum Insured
20 Repatriation of Mortal Remains Not Applicable In addition to Sum Insured In addition to Sum Insured
21 Assisted Reproduction Treatment Not Applicable Not Applicable Forming part of Sum Insured
22 Surrogacy Not Applicable Not Applicable Forming part of Sum Insured
23 Oocyte Donor Not Applicable Not Applicable Forming part of Sum Insured
24 Treatment for sleep disorders:
Not Applicable Not Applicable Forming part of Sum Insured
Sleep study test-Polysomnography
25 Modern Treatments Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
26 Gala Fit-Pro Active Care Not Applicable Not Applicable Not Applicable
27 Home care treatment Not Applicable Not Applicable Forming part of Sum Insured
In Utero Fetal
28 Surgery/Intervention Not Applicable Not Applicable Forming part of Sum Insured
Treatment for Chronic Severe
29 Not Applicable Not Applicable Forming part of Sum Insured
Refractory Asthma
30 Compassionate Travel Not Applicable In addition to Sum Insured In addition to Sum Insured
31 Treatment in Valuable
service provider's network Not Applicable In addition to Sum Insured In addition to Sum Insured
32 Optional Cover:
Consumables Not Applicable
Forming part of Sum Insured Forming part of Sum Insured
33 Bariatric Surgery Forming part of Sum Insured Forming part of Sum Insured Forming part of Sum Insured
34 Rehabilitation and
Not Applicable Forming part of Sum Insured Forming part of Sum Insured
Pain Management
35 Hospice Care Not Applicable Not Applicable Forming part of Sum Insured
36 Personal Accident Optional Cover: Optional Cover:
Not Applicable In addition to Sum Insured In addition to Sum Insured
37 Hospital Cash Optional Cover: Optional Cover:
Not Applicable
In addition to Sum Insured In addition to Sum Insured
38 PED buy back Optional Cover:
Not Applicable Not Applicable
Forming part of Sum Insured
39 Option to choose
Not Applicable Not Applicable Not Applicable
Aggregate Deductible
40 Per Claim Deductible Not Applicable Not Applicable Not Applicable
41 Room rent Enhancement Optional Cover: Optional Cover:
Not Applicable
Forming part of Sum Insured Forming part of Sum Insured
42 Not Applicable Optional Cover:
Insta Care cover from 31st day Not Applicable
Forming part of Sum Insured

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 23/39
 portability stipulated by IRDAI, then waiting period for the
IV. EXCLUSIONS
same would be reduced to the extent of prior coverage.
Standard Exclusions F. List of specific diseases/procedures
1. Pre-Existing Diseases - Code- Excl 01: 1. Treatment of Cataract and diseases of the anterior and
A. Applicable for 3-year policy term: Expenses related to posterior chamber of the Eye, Diseases of ENT, Diseases
the treatment of a pre-existing Disease (PED) and its related to Thyroid, Benign diseases of the breast.
direct complications shall be excluded until the expiry of 2. Subcutaneous Benign Lumps, Sebaceous cyst, Dermoid
the period mentioned in the below given table provided cyst, Mucous cyst lip / cheek, Carpal Tunnel Syndrome,
continuous coverage after the date of inception of the first Trigger Finger, Lipoma, Neurofibroma, Fibroadenoma,
policy with insurer. Ganglion and similar pathology.
Applicable for 1 year and 2-year policy term: Expenses 3. All treatments (Conservative, Operative treatment) and all
related to the treatment of a pre-existing Disease (PED) types of intervention for Diseases related to Tendon,
and its direct complications shall be excluded until the Ligament, Fascia, Bones and Joint Including Arthroscopy
expiry of 36 months of continuous coverage after the date and Arthroplasty / Joint Replacement [other than caused
of inception of the first policy with insurer. by accident].
B. In case of enhancement of sum insured the exclusion shall 4. All types of treatment for Degenerative disc and Vertebral
apply afresh to the extent of sum insured increase. diseases including Replacement of bones and joints and
C. If the Insured Person is continuously covered without any Degenerative diseases of the Musculo-skeletal system,
break as defined under the portability norms of the extant Prolapse of Intervertebral Disc (other than caused by
IRDAI (Health Insurance) Regulations, then waiting period accident),
for the same would be reduced to the extent of prior 5. All treatments (conservative, interventional, laparoscopic
coverage. and open) related to Hepato-pancreato-biliary diseases
including diseases of liver, Gall bladder and Pancreatic
D. Applicable for 3-year policy term: Coverage under the
calculi. All types of management for Kidney calculi and
policy after the expiry of the period as per the table given
Genitourinary tract calculi.
below for any pre-existing disease is subject to the same
being declared at the time of application and accepted by 6. All types of Hernia.
Insurer. 7. Desmoid Tumour, Umbilical Granuloma, Umbilical Sinus,
Applicable for 1 year and 2-year policy term: Coverage under Umbilical Fistula,
the policy after the expiry of 36 months for any pre-existing 8. All treatments (conservative, interventional, laparoscopic
disease is subject to the same being declared at the time of and open) related to all Diseases of Cervix, Uterus,
application and accepted by Insurer. Fallopian tubes, Ovaries, Uterine Bleeding, Pelvic
Inflammatory Diseases.
Waiting Period for Pre-Existing Diseases - Code- Excl 01
9. All Diseases of Prostate, Stricture Urethra, all Obstructive
Policy Term Signature Uropathies,
Premier Plan Elite Plan
/ Plan Plan 10. Benign Tumours of Epididymis, Spermatocele, Varicocele,
One year 36 Months 36 Months 36 Months Hydrocele,
Two years 36 Months 36 Months 36 Months 11. Fistula, Fissure in Ano, Haemorrhoids, Pilonidal Sinus and
Three years 36 Months 36 Months 25 Months Fistula, Rectal Prolapse, Stress Incontinence.
12. Varicose veins and Varicose ulcers.
2. Specified disease/procedure waiting period – Code Excl 02 13. All types of transplants and related surgeries.
A. Expenses related to the treatment of the listed 14. Congenital Internal disease / defect - [except for Unborn
conditions: surgeries/treatments shall be excluded until Coverage (16) and Newborn Coverage (18)].
the expiry of the period mentioned in the below given
Note: Waiting period for the following benefits are as follows
table provided continuous coverage after the date of
inception of the first policy with us. This exclusion shall a. Delivery Expenses Cover(Applicable only for Signature
not be applicable for claims arising due to an accident. Plan): Both self and spouse are covered under this policy
for a period of 2 years continuously without break either
Waiting Period for Specified disease/procedure – Code Excl 02 under Individual or floater sum insured (or) if insured
Policy Term Signature women alone covered under this policy for 4 years
Premier Plan Elite Plan continuously without break.
/ Plan Plan
One year 24 Months 24 Months 24 Months b. Assisted Reproduction Treatment(Applicable only for
Two years 24 Months 24 Months 24 Months Signature Plan): A waiting period of 24 months from the
date of first inception of this policy with the Company for
Three years 24 Months 24 Months 18 Months the insured person
B. In case of enhancement of sum insured the exclusion shall c. Newborn Baby Cover(Applicable for Premier, Elite and
apply afresh to the extent of sum insured increase. Signature Plan): This cover is available only if delivery
expenses claim is paid under this policy or if insured
C. If any of the specified disease/procedure falls under the women is covered under this policy for a continuous period
waiting period specified for pre-Existing diseases, then of 12 months without break or if the insured women
the longer of the two waiting periods shall apply. submits 12th and 20th week of ante natal scan at the time
D. The waiting period for listed conditions shall apply even if of pregnancy.
contracted after the policy inception or declared and d. Organ Transplantation (Applicable for Premier, Elite and
accepted without a specific exclusion. Signature Plan): A waiting period of 24 months from the
E. If the Insured Person is continuously covered without any date of first inception of this policy with the Company for
break as defined under the applicable norms on the insured person

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 24/39
 7. Change-of-Gender treatments – Code Excl 07: Expenses
e. Organ Donor Expenses (Applicable only for Signature
related to any treatment, including surgical management,
Plan): A waiting period of 24 months from the date of
to change characteristics of the body to those of the
first inception of this policy with the Company for the
opposite sex.
insured person
8. Cosmetic or plastic Surgery – Code Excl 08: Expenses for
f. Treatment for Sleep disorders (Applicable only for
cosmetic or plastic surgery or any treatment to change
Signature Plan): A waiting period of 24 months from the
appearance unless for reconstruction following an
date of first inception of this policy with the Company
Accident, Burn(s) or Cancer or as part of medically
g. Bariatric Surgery (Applicable for Premier, Elite and necessary treatment to remove a direct and immediate
Signature Plan): A waiting period of 24 months from the health risk to the insured. For this to be considered a
date of first inception of this policy with the Company. medical necessity, it must be certified by the attending
Medical Practitioner.
h. Hospice care (Applicable only for Signature Plan): A
waiting period of 24 months from the date of first 9. Hazardous or Adventure sports – Code Excl 09:
inception of this policy with the Company. Expenses related to any treatment necessitated due to
participation as a professional in hazardous or adventure
i. Hospital Cash: If optional is cover opted, the above sports, including but not limited to, para jumping, rock
mentioned specified disease/procedure waiting period – climbing, mountaineering, rafting, motor racing, horse
Code Excl 02 is applicable. racing or scuba diving, hand gliding, sky diving, deep-sea
3. 30-day waiting period – Code Excl 03 (Not Applicable for diving.
Accidents) 10. Breach of law – Code Excl 10: Expenses for treatment
a. Expenses related to the treatment of any illness within 30 directly arising from or consequent upon any Insured
days from the first policy commencement date shall be Person committing or attempting to commit a breach of
excluded except claims arising due to an accident, law with criminal intent.
provided the same are covered. 11. Excluded Providers–Code Excl 11: Expenses incurred
b. This exclusion shall not, however, apply if the Insured towards treatment in any hospital or by any Medical
Person has Continuous Coverage for more than twelve Practitioner or any other provider specifically excluded by
months the Insurer and disclosed in its website / notified to the
policyholders are not admissible. However, in case of life
c. The within referred waiting period is made applicable to threatening situations or following an accident, expenses
the enhanced sum insured in the event of granting higher up to the stage of stabilization are payable but not the
sum insured subsequently complete claim.
4. Investigation & Evaluation – Code Excl 04 12. Treatment for Alcoholism, drug or substance abuse or any
a. Expenses related to any admission, primarily for addictive condition and consequences thereof – Code Excl
diagnostics and evaluation purposes only are excluded 12
b. Any diagnostic expenses which are not related or not 13. Treatments received in health hydros, nature cure clinics,
incidental to the current diagnosis and treatment are spas or similar establishments or private beds registered
excluded as a nursing home attached to such establishments or
where admission is arranged wholly or partly for domestic
5. Rest Cure, rehabilitation (except to the extent covered reasons – Code Excl 13
under Coverage 31) and respite care – Code Excl 05:
Expenses related to any admission primarily for enforced 14. Dietary supplements and substances that can be
bed rest and not for receiving treatment. This also purchased without prescription, including but not limited
includes: to Vitamins, minerals and organic substances unless
prescribed by a medical practitioner as part of
a. Custodial care either at home or in a nursing facility for hospitalisation claim or day care procedure – Code Excl 14
personal care such as help with activities of daily living
such as bathing, dressing, moving around either by skilled 15. Refractive Error – Code Excl 15 Expenses related to the
nurses or assistant or non skilled persons treatment for correction of eyesight due to refractive error
less than 7.5 diopters.
b. Any services for people who are terminally ill to address
physical, social, emotional and spiritual needs 16. Unproven Treatments – Code Excl 16: Expenses related
to any unproven treatment, services and supplies for or in
6. Obesity/ Weight Control (except to the extent covered connection with any treatment. Unproven treatments are
under Coverage 30)– Code Excl 06: Expenses related to treatments, procedures or supplies that lack significant
the surgical treatment of obesity that does not fulfil all medical documentation to support their effectiveness.
the below conditions
17. Sterility and Infertility (Except to the extent covered
i. Surgery to be conducted is upon the advice of the Doctor
under Coverage 16) – Code Excl 17: Expenses related to
ii. The surgery/Procedure conducted should be supported sterility and infertility. This includes;
by clinical protocols
a. Any type of contraception, sterilization
iii. The member must be 18 years of age or older and b. Assisted Reproduction services including artificial
iv. Body Mass Index (BMI) insemination and advanced reproductive technologies
1. greater than or equal to 40 or such as IVF, ZIFT, GIFT,ICSI
2. greater than or equal to 35 in conjunction with any of the c. Gestational Surrogacy
following severe co-morbidities following failure of less d. Reversal of sterilization
invasive methods of weight loss: 18. Maternity – Code Excl 18 (Except to the extent covered
a. Obesity-related cardiomyopathy under Coverage 18)
b. Coronary heart disease Medical treatment expenses traceable to childbirth
i.
c. Severe Sleep Apnea (including complicated deliveries and caesarean
d. Uncontrolled Type2 Diabetes sections incurred during hospitalisation) except

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 25/39
 ectopic pregnancy. 3. Any claim arising out of Accidents that the Insured
ii. Expenses towards miscarriage (unless due to an Person has caused.
accident) and lawful medical termination of i. intentionally or
pregnancy during the policy period ii. by committing a crime / involved in it or
A. Specific Exclusions iii. as a result of / in a state of drunkenness or addiction
(drugs, alcohol)
19. Circumcision (unless necessary for treatment of a
disease not excluded under this policy or necessitated 4. Insured Person engaging in Air Travel unless he/she
due to an accident), Preputioplasty, Frenuloplasty, flies as a fare-paying passenger on an aircraft
Preputial Dilatation and Removal of SMEGMA -Code- properly licensed to carry passengers. For the
Excl 19 purpose of this exclusion Air Travel means being in or
on or boarding an aircraft for the purpose of flying
20. Congenital External Condition / Defects / Anomalies
therein or alighting there from.
-Code- Excl 20
21. Convalescence, general debility, run-down condition, 5. Accidents that are results of war and warlike
Nutritional deficiency states -Code- Excl 21 occurrence or invasion, acts of foreign enemies,
hostilities, civil war, rebellion, insurrection, civil
22. Intentional self -injury-Code- Excl 22
commotion assuming the proportions of or amounting
23. Injury/disease caused by or arising from or to an uprising, military or usurped power, seizure
attributable to war, invasion, act of foreign enemy, capture arrest restraints detainments of all kings
warlike operations (whether war be declared or not) princes and people of whatever nation, condition or
-Code- Excl 24 quality whatsoever.
24. Injury or disease caused by or contributed to by 6. Participation in riots, confiscation or nationalization or
nuclear weapons/ materials -Code- Excl 25 requisition of or destruction of or damage to property
25. Expenses incurred on Enhanced External Counter by or under the order of any government or local
Pulsation Therapy and related therapies, Chelation authority.
therapy, Hyperbaric Oxygen Therapy, Rotational Field
7. Any claim resulting or arising from or any
Quantum Magnetic Resonance Therapy, VAX-D, Low
consequential loss directly or indirectly caused by or
level laser therapy, Photodynamic therapy and such
contributed to or arising from.
other therapies similar to those mentioned herein
under this exclusion -Code- Excl 26. a. Ionizing radiation or contamination by radioactivity
26. Unconventional, Untested, Experimental therapies from any nuclear fuel or from any nuclear waste from
-Code- Excl 27 the combustion of nuclear fuel or from any nuclear
waste from combustion (including any self sustaining
27. Autologous derived Stromal vascular fraction,
process of nuclear fission) of nuclear fuel
Chondrocyte Implantation, Procedures using Platelet
Rich plasma and Intra articular injection therapy -Code- b. Nuclear weapons material
Excl 28 c. The radioactive, toxic, explosive or other hazardous
28. Biologicals, except when administered as an properties of any explosive nuclear assembly or
in-patient, when clinically indicated and nuclear component thereof
hospitalisation warranted. - Code- Excl 29
d. Nuclear, chemical and biological terrorism
29. Inoculation or Vaccination (except for post–bite
treatment and for medical treatment for therapeutic 8. Any claim arising out of sporting activities in so far as
reasons) -Code- Excl 31 they involve the training or participation in
competitions of professional or semi-professional
30. Cost of spectacles and contact lens, hearing aids,
sports persons.
Cochlear implants and procedures, walkers and
crutches, wheel chairs, CPAP, BIPAP, Continuous 9. Participation in Hazardous Sport / Hazardous
Ambulatory Peritoneal Dialysis, infusion pump and Activities.
such other similar aids. -Code- Excl 35 10. Persons who are physically challenge unless
31. Any hospitalisation which are not medically necessary specifically agreed and endorsed in the policy.
/ does not warrant hospitalisation-Code-Excl 36
11. Any loss arising out of the Insured Person's actual or
32. Other Excluded Expenses as detailed in the website attempted commission of or wilful participation in an
www.galaxyhealth.com (Except to the extent illegal act or any violation or attempted violation of
covered under Coverage 29 and 40) - Code Excl 37. the law.
33. Existing disease/s, disclosed by the insured and
12. Any payment in case of more than one claim under the
mentioned in the policy schedule under permanent
policy during the period of insurance by which the
exclusion (based on insured's consent), for specified
maximum liability of the Company in that period
ICD codes -Code- Excl 38
would exceed the amount specified in the Schedule.
B. Specific Exclusions – Accidental Death and
13. Any other claim after a claim has been admitted by
Permanent Total Disablement (Optional cover
the Company and becomes payable for Death or
applicable only for Elite and Signature Plan)
Permanent Total Disablement, as mentioned In Table.
1. Any claim relating to events occurring before the
commencement of the cover or otherwise outside the 14. Any claim arising out of an accident related to
Period of Insurance. pregnancy or childbirth, infirmity, whether directly or
indirectly.
2. Any injuries/conditions which are Pre-existing
conditions. 15. Any claim for Death or Permanent Total Disablement
of the Insured Person from self-endangerment unless
in self-defence or to save human life.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 26/39
 V. CONDITIONS
D. Notification of Claim: Upon the happening of the event,
Standard Conditions notice with full particulars shall be sent to the Company within
1. Disclosure of Information: The policy shall be void and 24 hours from the date of occurrence of the event irrespective of
all premium paid thereon shall be forfeited to the whether the event is likely to give rise to a claim under the policy
Company in the event of misrepresentation, or not.
misdescription or non-disclosure of any material fact by Note: Conditions C and D are precedent to admission of liability
the policy holder. under the policy. The Company will examine and relax the time
limit mentioned in these conditions depending upon the merits of
2. Claim Settlement the case.
A. Condition Precedent to Admission of Liability: The terms
and conditions of the policy must be fulfilled by the E. Documents to be submitted for Reimbursement: The
insured person for the Company to make any payment for reimbursement claim is to be supported with the following
claim(s) arising under the policy documents and submitted within the prescribed time limit.
B. For Cashless Treatment: i. Duly filled in claim forms with treating doctor signature.
ii. Pre/Post Hospitalisation investigations and treatment papers.
a. Call the 24 hour help-line for assistance – 18002030007.
Senior Citizens may call at 18002030007. iii. All investigations reports including Radiological films (Xray,
CT scan, MRI and USG) and Biopsy during hospitalisation.
b. Inform the ID number for easy reference.
iv. Discharge Summary from the hospital
c. On admission in the hospital, produce the ID Card issued
by the Company at the Hospital Helpdesk. v. Cash receipts from hospital, chemists
vi. Cash receipts and reports for tests done
d. Obtain the Pre-authorisation Form from the Hospital
Help Desk, complete the Patient Information and vii. Receipts from doctors, surgeons, anaesthetist
resubmit to the Hospital Help Desk. (Insurers shall also viii. Certificate from the attending doctor regarding the diagnosis.
provide pre-authorization to the policyholder through ix. KYC (Identity proof with Address) of the proposer, as per
Digital mode).
AML Guidelines
e. The Treating Doctor will complete the hospitalisation/ x. Copy of PAN Card
treatment information, and the hospital will fill up
expected cost of treatment. This form is submitted to the xi. NEFT documents viz., Customer name, Bank Account No.,
Company. Name of the Bank, IFSC code
f. The Company will process the request and call for xii. CKYC No. of the proposer (if available)
additional documents / clarifications if the information xiii. Legal heir/succession certificate, wherever applicable
furnished is inadequate.
F. For Accidental Death Claims:
g. Once all the details are furnished, the Company will i. Claim Intimation
process the request as per the terms and conditions as
well as the exclusions therein and either approve or reject ii. Claim Form duly filled and signed
the request based on the merits.
iii. Death Certificate
h. In case of emergency hospitalisation information to be
given within 24 hours after hospitalisation iv. Death Summary

i. Cashless facility can be availed only in networked v. Post-mortem Certificate, if conducted

Hospitals. For details of Networked Hospitals, the insured vi. First Information Report (FIR) / Spot Panchanama /
may visit www.galaxyhealth.com or contact the nearest Inquest Panchanama (wherever applicable)
branch or refer to the list of Networked Hospitals vii. Police Investigation report (wherever applicable)
provided with the policy document. KYC (Identity proof
with Address) of the proposer as per AML Guidelines. viii. Viscera Sample Report (wherever applicable)

In non-network hospitals payment must be made up-front and ix. Forensic Science Laboratory report (wherever applicable)
then reimbursement will be effected on submission of x. Legal Heir Certificate (in case nomination has not been
filled by deceased)
documents.
xi. Succession Certificate (wherever applicable)
Note: The Company reserves the right to call for additional
documents wherever required. G. For Permanent Total Disablement Claims:
Denial of a Pre-authorization request is in no way to be i. Claim Intimation
construed as denial of treatment or denial of coverage. The ii. Claim Form duly filled and signed
Insured Person can go ahead with the treatment, settle the iii. Police Investigation report (wherever applicable)
hospital bills and submit the claim for a possible reimbursement.
iv. Photograph of the Insured with reflecting disablement
C. For Reimbursement claims: Time limit for submission of
v. Medical Certificate from treating doctor
necessary claim documents for
vi. Investigation reports
S.No. Type of Claim Prescribed time limit vii. First Information Report (FIR)/Spot Panchanama/Inquest
Panchanama (wherever applicable)
Reimbursement of Claim must be filed within
1. hospitalisation, day care and 15 days from the date of viii. Certificate from Government doctor confirming the disability
and its percentage.
pre-hospitalisation expenses discharge from the Hospital.
ix. Leave certificate from the employer
within 15 days after
completion of 60 days for x. Treatment Papers.
Reimbursement of Post Premier Plan, 90 days for Note:
2.
hospitalisation Elite Plan and 180 days for i. Call the 24 hour help-line for assistance - 18002030007.
Signature plan from the Senior Citizens may call at 18002030007.
date of discharge from ii. The Company authorized doctor may examine the insured
hospital if required.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 27/39
 iii. The Company reserves the right to call for additional c) any other act fitted to deceive and
documents wherever required.
d) any such act or omission as the law specially declares to
3. Provision for Penal Interest be fraudulent.
i) The Company shall settle or reject a claim, as the case may The Company shall not repudiate the claim and / or forfeit the
be, within 15 days from the date of receipt of last policy benefits on the ground of Fraud, if the insured person /
necessary document. beneficiary can prove that the misstatement was true to the
ii) ln the case of delay in the payment of a claim, the best of his knowledge and there was no deliberate intention
Company shall be liable to pay interest to the policyholder to suppress the fact or that such misstatement of or
from the date of receipt of last necessary document to the suppression of material fact are within the knowledge of the
date of payment of claim at a rate 2% above the bank rate. insurer.
iii) However, where the circumstances of a claim warrant an
investigation in the opinion of the Company, it shall initiate 7. Cancellation
and complete such investigation at the earliest, in any case i. The policyholder may cancel his/her policy at any time
not later than 30 days from the date of receipt of last during the term, by giving 7 days notice in writing. The
necessary document. ln such cases, the Company shall Insurer shall.
settle or reject the claim within 45 days from the date of a. refund proportionate premium for unexpired policy
receipt of last necessary document. period, if the term of policy up to one year and there
iv) ln case of delay beyond stipulated 45 days, the Company is no claim (s) made during the policy period.
shall be liable to pay interest to the policyholder at a rate b. refund premium for the unexpired policy period, in
2% above the bank rate from the date of receipt of last respect of policies with term more than 1 year and
necessary document to the date of payment of claim risk coverage for such policy years has not
v) "Bank rate" shall mean the rate fixed by the Reserve Bank commenced.
of lndia (RBI) at the beginning of the financial year in Note: Not with standing anything contained herein or otherwise,
which claim has fallen due. no refunds of premium shall be made in respect of Cancellation
4. Complete Discharge: Any payment to the policyholder, where, any claim has been admitted or has been lodged or any
benefit has been availed by the insured person under the policy.
insured person or his/ her nominees or his/ her legal
representative or assignee or to the Hospital, as the case may ii. The Company may cancel the policy at any time on
be, for any benefit under the policy shall be a valid discharge grounds of misrepresentation, non-disclosure of material
towards payment of claim by the Company to the extent of that facts, fraud by the insured person by giving 15 days'
amount for the particular claim. written notice. There would be no refund of premium on
cancellation on grounds of misrepresentation,
5. Claims in respect of multiple Policies held by non-disclosure of material facts or fraud.
policyholders: iii. Incase of long term policies the refund will be given after
a) Indemnity Policies: adjusting the long term discount/instalment loading
availed by the insured/ policyholder.
A policyholder can file for claim settlement as per his/her
choice under any policy. The Insurer of that chosen policy shall 8. Migration in case of Indemnity policies:
be treated as the primary Insurer. In case the available In case of migration of one policy to another with the same
coverage under the said policy is less than the admissible claim Insurer, the policyholder (including all members under family
amount, the primary Insurer shall seek the details of other cover and group insurance policies) can transfer the credits
available policies of the policyholder and shall coordinate with gained to the extent of the Sum Insured, No Claim Bonus,
other Insurers to ensure settlement of the balance amount as Specific Waiting periods, waiting period for pre-existing
per the policy conditions, without causing any hassles to the diseases, Moratorium period etc. in the previous policy to the
policyholder. migrated policy.
b) Benefit based Policies: 9. Portability in case of Indemnity Policies:
On occurrence of the insured event, the policyholders can claim a. A policyholder desirous of porting his/her policy to
from all Insurers under all policies. another insurer shall apply to such insurer to port
the entire policy along with all the members of the
6. Fraud: lf any claim made by the insured person, is in any
family, if any, at least 30 days before, but not earlier
respect fraudulent, or if any false statement, or declaration is than 60 days from the due date for renewal.
made or used in support thereof, or if any fraudulent means or Insurers are free to consider proposal for portability,
devices are used by the insured person or anyone acting on but in all such cases acquiring insurer shall ensure
his/her behalf to obtain any benefit under this policy, all that there is no break in policy.
benefits under this policy and the premium paid shall be b. The policyholder is entitled to transfer the credits
forfeited. gained to the extent of the Sum Insured, No Claim
Any amount already paid against claims made under this policy Bonus, specific waiting periods, waiting period for
but which are found fraudulent later shall be repaid by all pre-existing disease, Moratorium period etc from
the Existing Insurer to the Acquiring Insurer in the
recipient(s)/policyholder(s), who has made that particular
previous policy.
claim, who shall be jointly and severally liable for such
repayment to the insurer. 10. Renewal of Health Insurance policy:
a. A health insurance policy shall be renewable
For the purpose of this clause, the expression "fraud" means
provided the product is not withdrawn, except in
any of the following acts committed by the insured person or by case of established fraud or non-disclosure or
his agent or the hospital/doctor/any other party acting on misrepresentation by the Insured. If the product is
behalf of the insured person, with intent to deceive the insurer withdrawn, the policyholder shall be provided with
or to induce the insurer to issue an insurance policy: suitable options to migrate.
a) the suggestion, as a fact of that which is not true and b. An Insurer shall not deny the renewal on the ground
which the insured person does not believe to be true. that the policyholder had made a claim (s) in the
b) the active concealment of a fact by the insured person preceding policy years.
having knowledge or belief of the fact.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 28/39
 c. An Insurer shall not resort to fresh underwriting the Premium Rates: The Company may revise or modify the
unless there is an increase in sum insured. In case terms of the policy including the premium rates with the extant
increase in sum insured is requested by the guidelines. The insured person shall be notified three months
policyholder, the Insurer may underwrite only to the before the changes are effected.
extent of increased sum insured.
15. Free Look Period : The Free Look Period shall be
d. Request for renewal along with requisite premium applicable on new individual health insurance policies and not
shall be received by the Company before the end of
on renewals or at the time of porting/migrating the policy.
the policy period.
e. At the end of the policy period, the policy shall The insured person shall be allowed free look period of thirty
terminate and can be renewed within the Grace days from date of receipt of the policy document whether
Period of 30 days to maintain continuity of benefits electronically or otherwise to review the terms and conditions
without break in policy. of the policy, and to return the same if not acceptable.
f. Coverage is not available during the grace period. lf the insured has not incurred any claim during the Free Look
g. No loading shall apply on renewals based on Period, the insured shall be entitled to,
individual claims experience. i. a refund of the premium paid less any expenses incurred
by the Company on medical examination of the insured
11. Withdrawal of policy person and the stamp duty charges or
i. In the likelihood of this product being withdrawn in future, ii. where the risk has already commenced and the option of
the Company will intimate the insured person about the return of the policy is exercised by the insured person, a
same 90 days prior to expiry of the policy. deduction towards the proportionate risk premium for
ii. Insured Person will have the option to migrate to similar period of cover or
health insurance product available with the Company at iii. where only a part of the insurance coverage has
the time of renewal with all the accrued continuity benefits commenced, such proportionate premium commensurate
such as cumulative bonus, waiver of waiting period as per with the insurance coverage during such period.
IRDAI guidelines, provided the policy has been maintained
without a break. 16. Redressal of Grievance: In case of any grievance the
insured person may contact the Company through,
12. Moratorium Period: After completion of sixty continuous
months of coverage (including portability and migration) in Website : www.galaxyhealth.com
health insurance policy, no policy and claim shall be contestable Toll free : 18002030007
by the insurer on grounds of non-disclosure, misrepresentation, Senior Citizens may call at 18002030007
except on grounds of established fraud. This period of sixty E-mail : gro@galaxyhealth.com
continuous months is called as moratorium period. The
moratorium would be applicable for the sums insured of the first Phone No. : 044 - 4001 7238
policy. Wherever, the sum insured is enhanced, completion of "Prestige Polygon – 12th Top Floor (P), No. 471,
Courier :
sixty continuous months would be applicable from the date of Anna Salai, Nandanam, Chennai – 600035.
enhancement of sums insured only on the enhanced limits. lnsured person may also approach the Grievance officer at any
After the expiry of Moratorium Period no health insurance claim of the company's branches with the details of grievance.
shall be contestable except for proven fraud, nondisclosure,
misrepresentation and exclusions specified in the policy contract. lf lnsured person is not satisfied with the redressal of grievance
The policies would however be subject to all limits, sub limits, through one of the above methods, insured person may contact
co-payments and deductibles as per the policy contract. the Grievance redressal officer (GRO) at corporate office - 044
13. Premium Payment in Instalments: lf the insured person - 4001 7238.
has opted for Payment of Premium on an instalment basis i.e. For updated details of grievance officer, kindly refer the link
Annually or Half Yearly or Quarterly or Monthly or two or four https://www.galaxyhealth.com/grievance-redressal
or twelve instalments as mentioned in the policy
Schedule/Certificate of Insurance, the following Conditions lf lnsured person is not satisfied with the redressal of grievance
shall apply (notwithstanding any terms contrary elsewhere in through above methods, the insured person may also approach
the policy). the office of Insurance Ombudsman of the respective area/region
for redressal of grievance as per insurance Ombudsman Rules
i. The grace period of 15 days (where premium is paid on a 2017. For the details of Insurance Ombudsman, please visit:
monthly instalments) and 30 days (where premium is paid https://cioins.co.in/Complaint/Online
in quarterly/half yearly/annual/2/4/12 instalments) is
available on the premium due date, to pay the premium. If Grievance may also be lodged at IRDAI integrated Grievance
the premium is paid in instalments during the policy Management System - https://bimabharosa.irdai.gov.in/
period, coverage will be available for the grace period also. 17. Nomination:
ii. If the policy is renewed during grace period, all the credits a. The policyholder shall give his nomination for the purpose
(sum insured, No Claim Bonus, Specific Waiting periods, of payment of claims. In the event of death of the
waiting periods for pre-existing diseases, Moratorium policyholder, the claim proceeds will be paid to the
period etc.) accrued under the policy shall be protected. nominee.
The same is applicable for both Indemnity and Benefit
products. b. Nomination can be changed any time during the term of the
policy.
iii. No interest will be charged if the instalment premium is
not paid on due date.
iv. ln case of instalment premium due not received within the
grace period, the policy will get cancelled.
v. ln the event of a claim, all subsequent premium
instalments shall immediately become due and payable.
vi. The company has the right to recover and deduct all the
pending instalments from the claim amount due under the
policy.
14. Possibility of Revision of Terms of the Policy including

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 29/39
 Specific Conditions 28. Important Note
a) Where the policy is issued for more than 1st year, the Sum
18. The Insured Person/s shall obtain and furnish the Company
Insured including sublimits, automatic restoration benefit
with all original bills, receipts and other documents upon which
(if applicable) is for each of the year, without any carry over
a claim is based and shall also give the Company such
benefit thereof. The said benefits / covers available for the
additional information and assistance as the Company may
2nd year or 3rd years cannot be utilized in the 1st year
require in dealing with the claim.
itself. The terms conditions and exceptions that appear in
19. All claims under this policy shall be payable in Indian the Policy or in any Endorsement are part of the contract,
currency. must be complied with and applies to each policy year
20. The premium under this policy shall be payable in advance. b) Where the policy is issued on floater basis, The Sum
No receipt of premium shall be valid except on the official form Insured, cumulative bonus and other related benefits floats
of the company signed by a duly authorized official of the amongst the insured members.
company. The due payment of premium and the observance of c) The Policy Schedule and any Endorsement are to be read
fulfilment of the terms, provision, conditions and endorsements of together and any word or such meaning wherever it
this policy by the Insured Person/s, in so far as they relate to appears shall have the meaning as stated in the Act /
anything to be done or complied with by the Insured Person/s, Indian Laws.
shall be a conditions precedent to any liability of the Company to d) The terms conditions and exceptions that appear in the
make any payment under this policy. No waiver of any terms, Policy or in any Endorsement are part of the contract, must
provisions, conditions, and endorsements of this policy shall be be complied with and applies to each relevant insured
valid unless made in writing and signed by an authorized official person. Failure to comply with may result in the claim
of the Company. being denied.
21. Any medical practitioner authorized by the Company shall e) The attention of the policy holder is drawn to the company
be allowed to examine the Insured Person in case of any website www.galaxyhealth.com for anti-fraud policy of the
alleged injury or diseases requiring Hospitalisation when and as company for necessary compliance by all stake holders.
often as the same may reasonably be required on behalf of the
Company at Company’s cost. 29. Customer Service: If at any time the Insured Person
requires any clarification or assistance, the insured may contact
22. Notice and Communication: Any notice, direction or Galaxy Health Insurance Company Limited, "Prestige Polygon –
instruction given under this Policy by the policy holder / claimant 12th Top Floor (P), No. 471, Anna Salai, Nandanam, Chennai –
shall be in writing and delivered by hand, post or / email to Galaxy 600035. during business hours of normal working days.
Health Insurance Company Limited, "Prestige Polygon – 12th Top
Floor (P), No. 471, Anna Salai, Nandanam, Chennai – 600035. Toll 30. Midterm Inclusion : Midterm inclusion of Newly Married
Free No.18002030007, E-Mail: support@galaxyhealth.com Spouse, legally adopted child and New Born baby is
Permissible on payment of proportionate premium subject to the
Notice and instructions will be deemed served 7 days after following:
posting or immediately upon receipt in the case of hand
delivery or e-mail. i. The cover for newborn commences from 16th day of its
birth.
23. Territorial Limit: All investigations/treatments under this ii. Waiting periods as stated in the policy will be applicable
policy shall have to be taken in India. from the date of inclusion of such newly married spouse,
24. Automatic Expiry: The insurance under this policy with new born baby, legally adopted child.
respect to each relevant Insured Person policy shall expire iii. Such midterm inclusion will be subject to underwriter’s
immediately on the earlier of the following events approval.
 Upon the death of the Insured Person This means that, the
cover for the surviving members of the family will
continue, subject to other terms of the policy.
 Upon exhaustion of the Sum Insured, Limit of Coverage
and plus *Automatic restoration Sum Insured.
Note: Applicable for Elite plan.
25. Policy disputes: Any dispute concerning the interpretation
of the terms, conditions, limitations and/or exclusions
contained herein is understood and agreed to by both the
Insured and the Company to be subject to Indian Law.
26. Revision of Sum Insured: Reduction or enhancement of
Sum Insured is permissible only at the time of renewal. The
acceptance for enhancement and the amount of enhancement
will be at the discretion of the Company and subject to
Exclusion Code Excl 01, Exclusion Code Excl 02 and
Exclusion Code Excl 03.
27. Relief under Section 80-D: Insured Person is eligible for
relief under Section 80-D of the IT Act in respect of the
premium paid by any mode other than cash.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 30/39
 List of Insurance Ombudsman
Jurisdiction of Office Union
Office Details
Territory, District
AHMEDABAD:
Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Gujarat, Dadra & Nagar Haveli,
Tilak Marg, Relief Road, Ahmedabad – 380 001. Daman and Diu.
Tel.: 079 - 25501201/02/05/06  Email: bimalokpal.ahmedabad@cioins.co.in

BENGALURU:
Office of the Insurance Ombudsman, Jeevan Soudha Building,
PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road,
Karnataka.
JP Nagar, Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049  Email: bimalokpal.bengaluru@cioins.co.in

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

BHUBANESHWAR:
Office of the Insurance Ombudsman, 62, Forest park, Bhubaneshwar – 751 009.
Odisha.
Tel.: 0674 - 2596461 /2596455/2596003  Fax: 0674 – 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in

CHANDIGARH: Punjab, Haryana(excluding Gurugram,

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

CHENNAI:
Office of the Insurance Ombudsman, Fatima Akhtar Court, Tamil Nadu, Tamil Nadu
4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018. Puducherry Town and Karaikal (which
Tel.: 044 - 24333668 / 24333678  Fax: 044 - 24333664 are part of Puducherry).
Email: bimalokpal.chennai@cioins.co.in

DELHI :
Delhi & Following Districts of Haryana -
Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building,
Gurugram, Faridabad, Sonepat &
Asaf Ali Road, New Delhi – 110 002.
Tel.: 011 - 23232481/23213504/46013992  Email: bimalokpal.delhi@cioins.co.in Bahadurgarh.

GUWAHATI:
Assam, Meghalaya, Manipur, Mizoram,
Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor,
Arunachal Pradesh, Nagaland and
Nr. Panbazar over bridge, S.S. Road, Guwahati – 781001(ASSAM).
Tripura.
Tel.: 0361 - 2632204 / 2602205 / 2631307  Email: bimalokpal.guwahati@cioins.co.in

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

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

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

KOLKATA:
Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, West Bengal, Sikkim,
4, C.R. Avenue, Kolkata - 700 072. Andaman & Nicobar Islands.
Tel.: 033 - 22124339 / 22124341  Email: bimalokpal.kolkata@cioins.co.in

LUCKNOW: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba,

Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur,
Office of the Insurance Ombudsman, 6th Floor, JeevanBhawan, Phase-II, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,
Nawal Kishore Road, Hazratganj, Lucknow - 226 001. Varanasi, Gazipur, Jalaun, Kanpur, Lucknow,Unnao,
Tel.: 0522 - 4002082 / 3500613 Fax: 0522 - 2231310 Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli,
Email: bimalokpal.lucknow@cioins.co.in Sravasti, Gonda, Faizabad, Amethi, Kaushambi,
Balrampur, Basti, Ambedkarnagar, Sultanpur,
Maharajgang, Santkabirnagar, Azamgarh,
Kushinagar, Gor khpur, Deoria, Mau, Ghazipur,
Chandauli, Ballia, Sidharathnagar.

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 31/39
 Jurisdiction of Office Union
Office Details
Territory, District
MUMBAI: List of wards under Mumbai
Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, Metropolitan Region excluding wards
S. V. Road, Santacruz (W), Mumbai - 400 054. in Mumbai – i.e M/E, M/W, N , S and T
Tel.: 022 - 69038800/27/29/31/32/33  Email: bimalokpal.mumbai@cioins.co.in covered under Office of Insurance
Ombudsman Thane and areas of Navi
Mumbai.
NOIDA : State of Uttaranchal and the following
Office of the Insurance Ombudsman, Bhagwan Sahai Palace, 4th Floor, Main Road, Districts of Uttar Pradesh: Agra, Aligarh,
Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301. Bagpat, Bareilly, Bijnor, Budaun,
Tel.: 0120-2514252 / 2514253  Email: bimalokpal.noida@cioins.co.in Bulandshehar, Etah, Kanooj, Mainpuri,
Mathura, Meerut, Moradabad,
Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Farrukhabad, Firozbad, Gautambodhanagar,
Ghaziabad, Hardoi, Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj, Sambhal,
Amroha, Hathras, Kanshiramnagar,
Saharanpur.
PATNA:
Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001. Bihar, Jharkhand
Tel.: 0612-2547068  Email: bimalokpal.patna@cioins.co.in

PUNE: State of Goa and State of Maharashtra

Office of the Insurance Ombudsman, JeevanDarshan Bldg., 3rd Floor,C.T.S. excluding areas of Navi Mumbai, Thane
No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030. district, Palghar District, Raigad district &
Tel.: 020-24471175  Email: bimalokpal.pune@cioins.co.in Mumbai Metropolitan Region
THANE : Area of Navi Mumbai, Thane District,
Office of the Insurance Ombudsman, 2nd Floor,Jeevan Chintamani Building, Vasantrao Naik Raigad District, Palghar District and wards of
Mahamarg, Thane (West), Thane - 400604.  Email: bimalokpal.thane@cioins.co.in Mumbai, M/East, M/West, N, S and T.

For the details of Insurance Ombudsman, please visit: https://cioins.co.in/Complaint/Online

List I — Items
This cover is available only in Signature plan as inbuilt. However, as optional cover under Elite plan.)
S.No. ITEM S.No. ITEM
1 BABY FOOD 26 BIRTH CERTIFICATE
2 BABY UTILITIES CHARGES 27 CERTIFICATE CHARGES
3 BEAUTY SERVICES 28 COURIER CHARGES
4 BELTS/ BRACES 29 CONVEYANCE CHARGES
5 BUDS 30 MEDICAL CERTIFICATE
6 COLD PACK/HOT PACK 31 MEDICAL RECORDS
7 CARRY BAGS 32 PHOTOCOPIES CHARGES
8 EMAIL / INTERNET CHARGES 33 MORTUARY CHARGES
9 FOOD CHARGES 34 WALKING AIDS CHARGES
(OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL) 35 OXYGEN CYLINDER
10 LEGGINGS (FOR USAGE OUTSIDE THE HOSPITAL)
11 LAUNDRY CHARGES 36 SPACER
12 MINERAL WATER 37 SPIROMETRE
13 SANITARY PAD 38 NEBULIZER KIT
14 TELEPHONE CHARGES 39 STEAM INHALER
15 GUEST SERVICES 40 ARMSLING
16 CREPE BANDAGE 41 THERMOMETER
17 DIAPER OF ANY TYPE 42 CERVICAL COLLAR
18 EYELET COLLAR 43 SPLINT
19 SLINGS 44 DIABETIC FOOT WEAR
20 BLOOD GROUPING AND CROSS 45 KNEE BRACES (LONG/ SHORT/ HINGED)
MATCHING OF DONORS SAMPLES 46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
21 SERVICE CHARGES WHERE NURSING 47 LUMBO SACRAL BELT
CHARGE ALSO CHARGED
48 NIMBUS BED OR WATER OR AIR BED CHARGES
22 TELEVISION CHARGES 49 AMBULANCE COLLAR
23 SURCHARGES 50 AMBULANCE EQUIPMENT
24 ATTENDANT CHARGES 51 ABDOMINAL BINDER
25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH 52 PRIVATE NURSES CHARGES -
FORMS PART OF BED CHARGE) SPECIAL NURSING CHARGES

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 32/39
 List I — Items
This cover is available only in Signature plan as inbuilt. However, as optional cover under Elite plan.)
S.No. ITEM S.No. ITEM
53 SUGAR FREE TABLETS 60 MASK
54 CREAMS POWDERS LOTIONS 61 OUNCE GLASS
(Toiletries are not payable, only prescribed medical)
62 OXYGEN MASK
pharmaceuticals
55 ECG ELECTRODES 63 PELVIC TRACTION BELT
56 GLOVES 64 PAN CAN
57 NEBULISATION KIT 65 TROLLY COVER
58 ANY KIT WITH NO DETAILS MENTIONED 66 UROMETER, URINE JUG
[DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC] 67 AMBULANCE
59 KIDNEY TRAY 68 VASOFIX SAFETY

List II — Items that are to be subsumed into Room Charges

S.No. ITEM S.No. ITEM
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED) 20 LUXURY TAX
2 HAND WASH 21 HVAC
3 SHOE COVER 22 HOUSE KEEPING CHARGES
4 CAPS 23 AIR CONDITIONER CHARGES
5 CRADLE CHARGES 24 IM IV INJECTION CHARGES
6 COMB 25 CLEAN SHEET
7 EAU-DE-COLOGNE / ROOM FRESHNERS 26 BLANKET/WARMER BLANKET
8 FOOT COVER 27 ADMISSION KIT
9 GOWN 28 DIABETIC CHART CHARGES
10 SLIPPERS 29 DOCUMENTATION CHARGES /
11 TISSUE PAPER ADMINISTRATIVE EXPENSES

12 TOOTHPASTE 30 DISCHARGE PROCEDURE CHARGES

13 TOOTHBRUSH 31 DAILY CHART CHARGES

14 BED PAN 32 ENTRANCE PASS / VISITORS PASS CHARGES

15 FACE MASK 33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE

16 FLEXI MASK 34 FILE OPENING CHARGES

17 HAND HOLDER 35 INCIDENTAL EXPENSES /

MISC. CHARGES (NOT EXPLAINED)
18 SPUTUM CUP
36 PATIENT IDENTIFICATION BAND / NAME TAG
19 DISINFECTANT LOTIONS
37 PULSEOXYMETER CHARGES

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

S.No. ITEM S.No. ITEM
1 HAIR REMOVAL CREAM 12 SURGICAL BLADES, HARMONIC SCALPEL, SHAVER

2 DISPOSABLES RAZORS CHARGES 13 SURGICAL DRILL

(for site preparations) 14 EYE KIT
3 EYE PAD 15 EYE DRAPE
4 EYE SHEILD 16 X-RAY FILM
5 CAMERA COVER 17 BOYLES APPARATUS CHARGES
6 DVD, CD CHARGES 18 COTTON
7 GAUSE SOFT 19 COTTON BANDAGE
8 GAUZE 20 SURGICAL TAPE
9 WARD AND THEATRE BOOKING CHARGES 21 APRON
10 ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS 22 TORNIQUET
11 MICROSCOPE COVER 23 ORTHOBUNDLE, GYNAEC BUNDLE

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 33/39
 List IV — Items that are to be subsumed into costs of treatment
S.No. ITEM S.No. ITEM
1 ADMISSION/REGISTRATION CHARGES 10 HIV KIT
2 HOSPITALISATION FOR EVALUATION/
11 ANTISEPTIC MOUTHWASH
DIAGNOSTIC PURPOSE
3 URINE CONTAINER 12 LOZENGES
4 BLOOD RESERVATION CHARGES AND 13 MOUTH PAINT
ANTE NATAL BOOKING CHARGES
14 VACCINATION CHARGES
5 BIPAP MACHINE
6 CPAP/ CAPD EQUIPMENTS 15 ALCOHOL SWABES
7 INFUSION PUMP— COST 16 SCRUB SOLUTION/STERILLIUM
8 HYDROGEN PEROXIDE\SPIRIT/ DISINFECTANTS ETC 17 GLUCOMETER & STRIPS
9 NUTRITION PLANNING CHARGES - DIETICIAN
CHARGES- DIET CHARGES 18 URINE BAG

Schedule of Benefits – Premier Plan

Sum Insured
S. (Rs.) 3 4 5 7.5 10 15 20 25
No. (in Lakhs)
Room, Boarding,
1 Nursing
Expenses 1% of Sum 1% of Sum 1% of Sum
all-inclusive as 1% of Sum 1% of Sum Insured Insured Insured Maximum Maximum Maximum
provided by the Insured Insured maximum up to maximum up to maximum up to up to up to up to
Hospital / Rs.10,000 Rs.10,000 Rs.10,000
Rs.7,500 Rs.7,500 Rs.7,500
Nursing Home
as per the limits
Pre & Post 30 days & 30 days & 30 days & 30 days & 30 days & 30 days & 30 days & 30 days &
2 Hospitalisation 60 days 60 days 60 days 60 days 60 days 60 days 60 days 60 days
Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to
Road Rs.2,500/- per Rs.2,500/- per Rs.2,500/- per Rs.2,500/- per Rs.2,500/- per Rs.2,500/- per Rs.2,500/- per Rs.2,500/- per
3 Ambulance hospitalisation, hospitalisation, hospitalisation, hospitalisation, hospitalisation, hospitalisation, hospitalisation, hospitalisation,
Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per
policy year policy year policy year policy year policy year policy year policy year policy year

Day Care All day care All day care All day care All day care All day care All day care All day care All day care
4 Procedures procedures are procedures are procedures are procedures are procedures are procedures are procedures are procedures are
covered. covered. covered. covered. covered. covered. covered. covered.
5 Cataract 25,000 25,000 35,000 50,000 50,000 50,000 50,000 50,000
25% of sum 25% of sum 25% of sum 25% of sum 25% of sum 25% of sum 25% of sum 25% of sum
insured after insured after insured after insured after insured after insured after insured after insured after
completion of completion of completion of completion of completion of completion of completion of completion of
Cumulative first claim free first claim free first claim free first claim free first claim free first claim free first claim free first claim free
6.A year,10% of sum year,10% of sum year,10% of sum year,10% of sum year,10% of sum year,10% of sum year,10% of sum year,10% of sum
Bonus
insured for every insured for every insured for every insured for every insured for every insured for every insured for every insured for every
claim free claim free claim free claim free claim free claim free claim free claim free
year subject to year subject to year subject to year subject to year subject to year subject to year subject to year subject to
maximum of maximum of maximum of maximum of maximum of maximum of maximum of maximum of
100% 100% 100% 100% 100% 100% 100% 100%
or

6.B No Claim 4% 4% 2% 2% 1% 1% 1% 1%
Discount
Gala Fit - Pro Premium discount Premium discount Premium discount Premium discount Premium discount Premium discount Premium discount Premium discount
7 Active Care available up to available up to available up to available up to available up to available up to available up to available up to
(Wellness 20% 20% 20% 20% 20% 20% 20% 20%
Discount)
Individual: Individual: Individual: Individual: Individual: Individual: Individual: Individual:
8 Health Rs. 750/- Floater: Rs. 750/- Rs. 750/- Rs. 1,500/- Rs. 1,500/- Rs. 1,500/- Rs. 1,500/- Rs. 1,500/-
Check-Up Rs. 1,500/- Floater: Rs.1,500/- Floater: Rs.1,500/- Floater: Rs.2,500/- Floater:Rs.2,500/- Floater:Rs.2,500/- Floater:Rs.2,500/- Floater:Rs.2,500/-
Second
9 Medical Opinion Covered Covered Covered Covered Covered Covered Covered Covered
10 AYUSH Actuals Actuals Actuals Actuals Actuals Actuals Actuals Actuals
Domiciliary Covered up to the Covered up to the Covered up to the Covered up to the Covered up to the Covered up to the Covered up to the Covered up to the
11 Hospitalisation Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
Modern Sub-limits Sub-limits Sub-limits Sub-limits Sub-limits Sub-limits Sub-limits Sub-limits
12 applicable applicable applicable applicable applicable applicable
Treatments applicable applicable
13 Bariatric Surgery Rs.2 Lakhs Rs.2 Lakhs Rs.2 Lakhs Rs.2 Lakhs Rs.2 Lakhs Rs.2 Lakhs Rs.3 Lakhs Rs.3 Lakhs
For Insured: For Insured: For Insured: For Insured: For Insured: For Insured: For Insured: For Insured:
Organ Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals)
14 if insured is
Transplantation if insured is if insured is if insured is if insured is if insured is if insured is if insured is
recipient recipient recipient recipient recipient recipient recipient recipient
10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum
15 Newborn Baby Insured or max up Insured or max up Insured or max up Insured or max up Insured or max up Insured or max up Insured or max up Insured or max up
Cover to Rs.50,000/- to Rs.50,000/- to Rs.50,000/- to Rs.50,000/- to Rs.50,000/- to Rs.50,000/- to Rs.50,000/- to Rs.50,000/-
whichever is lower whichever is lower whichever is lower whichever is lower whichever is lower whichever is lower whichever is lower whichever is lower

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 34/39
 Schedule of Benefits – Elite Plan
S. Sum Insured
No. (Rs.) 5 7.5 10 15 20 25 50
(in Lakhs)
Room, Boarding,
1 Nursing Expenses
all-inclusive as Up to Up to Up to Up to Up to Any Any
provided by the Deluxe room Deluxe room Deluxe room Deluxe room Deluxe room room room
Hospital / Nursing
Home as per the limits
Pre & Post 60 days & 60 days & 60 days & 60 days & 60 days & 60 days & 60 days &
2 Hospitalisation 90 days 90 days 90 days 90 days 90 days 90 days 90 days
Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to
Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per
3 Road hospitalisation. hospitalisation. hospitalisation. hospitalisation. hospitalisation. hospitalisation. hospitalisation.
Ambulance: Maximum Maximum Maximum Maximum Maximum Maximum Maximum
Rs.10,000/- per Rs.10,000/- per Rs.10,000/- per Rs.10,000/- per Rs.10,000/- per Rs.10,000/- per Rs.10,000/- per
policy year policy year policy year policy year policy year policy year policy year
10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum
Insured during the Insured during the Insured during the Insured during the Insured during the Insured during the Insured during the
4 Air entire policy entire policy entire policy entire policy entire policy entire policy entire policy
Ambulance year maximum year maximum year maximum year maximum year maximum year maximum year maximum
Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.2.5 Lakhs
Day Care All day care All day care All day care All day care All day care All day care All day care
5 procedures are procedures are procedures are procedures are procedures are procedures are procedures are
Procedures
covered covered covered covered covered covered covered
6 Cataract Up to 60,000/- Up to 75,000/- Up to 75,000/- Up to 75,000/- Up to 75,000/- Up to 75,000/- Up to 75,000/-
50% of SI after 50% of SI after 50% of SI after 50% of SI after 50% of SI after 50% of SI after 50% of SI after
completion of first completion of first completion of first completion of first completion of first completion of first completion of first
claim free year,25% claim free year,25% claim free year,25% claim free year,25% claim free year,25% claim free year,25% claim free year,25%
Cumulative of Sum insured for of Sum insured for of Sum insured for of Sum insured for of Sum insured for of Sum insured for of Sum insured for
7.A Bonus every claim every claim every claim every claim every claim every claim every claim
free year subject free year subject free year subject free year subject free year subject free year subject free year subject
to a maximum to a maximum to a maximum to a maximum to a maximum to a maximum to a maximum
of 150% of 150% of 150% of 150% of 150% of 150% of 150%
or

7.B No Claim Discount 3% 3% 1% 1% 1% 1% 1%

Gala Fit - Pro Premium Premium Premium Premium Premium Premium Premium
8 Active Care discount available discount available discount available discount available discount available discount available discount available
(Wellness Discount) up to 20% up to 20% up to 20% up to 20% up to 20% up to 20% up to 20%
100% of 100% of 100% of 100% of 100% of 100% of 100% of
Sum Insured. Sum Insured. Sum Insured. Sum Insured. Sum Insured. Sum Insured. Sum Insured.
Automatic Applicable for Applicable for Applicable for Applicable for Applicable for Applicable for Applicable for
9 Restoration of different illness different illness different illness different illness different illness different illness different illness
Sum Insured once in a once in a once in a once in a once in a once in a once in a
policy year policy year policy year policy year policy year policy year policy year
Individual: Individual: Individual:
Individual: Individual: Individual: Individual:
Health Rs.5,000/- Rs.5,000/- Rs.5,000/-
10 Rs.1,500/- Rs.2,000/- Rs.2,000/- Rs.4,000/-
check-up Floater: Floater: Floater:
Floater: Rs.2,500/- Floater: Rs.5,000/- Floater: Rs.5,000/- Floater: Rs.8,000/-
Rs.10,000/- Rs.10,000/- Rs.10,000/-
Second Covered Covered Covered Covered Covered Covered Covered
11 Medical Opinion
12 AYUSH Actuals Actuals Actuals Actuals Actuals Actuals Actuals
Domiciliary Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to
13
Hospitalisation Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
Modern Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to
14 Treatments Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
15 Bariatric Surgery Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.2.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs
For Insured: For Insured: For Insured: For Insured: For Insured: For Insured: For Insured:
16 Organ Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals) Covered (Actuals)
Transplantation if insured is if insured is if insured is if insured is if insured is if insured is if insured is
recipient recipient recipient recipient recipient recipient recipient
10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum
Insured or max up Insured or max up Insured or max up Insured or max up Insured or max up Insured or max up Insured or max up
17 Newborn to Rs.1 Lakh, to Rs.1 Lakh, to Rs.1 Lakh, to Rs.1 Lakh, to Rs.1 Lakh, to Rs.1 Lakh,
to Rs.1 Lakh,
Baby Cover whichever is whichever is whichever is whichever is whichever is whichever is whichever is
lower lower lower lower lower lower lower
18 Compassionate Travel Up to Rs. 10,000/- Up to Rs. 10,000/- Up to Rs. 10,000/- Up to Rs. 10,000/- Up to Rs. 10,000/- Up to Rs. 10,000/- Up to Rs. 10,000/-
Rehabilitation Covered up to Rs. Covered up to Rs. Covered up to Rs. Covered up to Rs. Covered up to Rs. Covered up to Rs. Covered up to Rs.
19 and Pain 25,000/- per 25,000/- per 25,000/- per 25,000/- per 25,000/- per 25,000/- per 25,000/- per
Management policy year policy year policy year policy year policy year policy year policy year
Repatriation of Up to Rs.15,000/- Up to Rs.15,000/- Up to Rs.15,000/- Up to Rs.15,000/- Up to Rs.15,000/- Up to Rs.15,000/- Up to Rs.15,000/-
20
Mortal Remains Per Policy Year Per Policy Year Per Policy Year Per Policy Year Per Policy Year Per Policy Year Per Policy Year
1% of Sum 1% of Sum 1% of Sum 1% of Sum 1% of Sum 1% of Sum 1% of Sum
Treatment in Insured max of Insured max of Insured max of Insured max of Insured max of Insured max of Insured max of
21 Valuable service Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per Rs.5,000/- per
provider's network policy Period policy Period policy Period policy Period policy Period policy Period policy Period

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 35/39
 Schedule of Benefits – Optional Covers Applicable for Elite Plan
S. Sum Insured
No. (Rs.) 5 7.5 10 15 20 25 50
(in Lakhs)
Insured has an Insured has an Insured has an Insured has an Insured has an Insured has an Insured has an
1 option to modify option to modify option to modify option to modify option to modify option to modify option to modify
Room Rent the room rent the room rent the room rent the room rent the room rent the room rent
the room rent
Enhancement eligibility to eligibility to eligibility to eligibility to eligibility to eligibility to
eligibility to
any room any room any room any room any room any room any room

2 Consumables Applicable Applicable Applicable Applicable Applicable Applicable Applicable

3 Hospital Cash Rs. 1000/- Rs. 1500/- Rs. 1500/- Rs. 2000/- Rs. 2000/- Rs. 3000/-
(Per Day) Rs. 2500/-
Deductible Deductible Deductible Deductible Deductible Deductible Deductible
Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/-
Option to Discount 18%, Discount 18%, Discount 18%, Discount 18%, Discount 18%, Discount 13%, Discount 13%,
Choose Deductible Deductible Deductible Deductible Deductible Deductible Deductible
4.A Rs.50,000/- Rs.50,000/- Rs.50,000/- Rs.50,000/- Rs.50,000/- Rs.50,000/-
Aggregate Rs.50,000/-
Deductible Discount 35%, Discount 35%, Discount 35%, Discount 35%, Discount 35%, Discount 25%, Discount 25%,
Deductible Deductible Deductible Deductible Deductible Deductible Rs. 1 Deductible Rs. 1
(or) Rs. 1 Lakh - 45% Rs. 1 Lakh - 45% Rs. 1 Lakh - 45% Rs. 1 Lakh - 45% Rs. 1 Lakh - 45% Lakh - 40% Lakh - 40%
Discount Discount Discount Discount Discount Discount Discount
Rs. 5,000 : 7.5% Rs. 5,000 : 7.5% Rs. 5,000 : 7.5% Rs. 5,000 : 7.5% Rs. 5,000 : 7.5% Rs. 5,000 : 7.5% Rs. 5,000 : 7.5%
Per Claim Discount Discount Discount Discount Discount Discount Discount
4.B Rs.10,000 : Rs.10,000 : Rs.10,000 : Rs.10,000 : Rs.10,000 : Rs.10,000 : Rs.10,000 :
Deductible
15% Discount 15% Discount 15% Discount 15% Discount 15% Discount 15% Discount 15% Discount
Premium remains Premium remains Premium remains Premium remains Premium remains Premium remains Premium remains
same until claims same until claims same until claims same until claims same until claims same until claims same until claims
Premium made or made or made or made or made or made or made or
5 Promise Up to 55 years Up to 55 years Up to 55 years Up to 55 years Up to 55 years Up to 55 years Up to 55 years
whichever is whichever is whichever is whichever is whichever is whichever is whichever is
earlier earlier earlier earlier earlier earlier earlier
Cover for Cover for Cover for Cover for Cover for Cover for Cover for
Personal Accidental Death Accidental Death Accidental Death Accidental Death Accidental Death Accidental Death Accidental Death
6 and Permanent and Permanent and Permanent and Permanent and Permanent and Permanent and Permanent
Accident
Total Total Total Total Total Total Total
Disablement Disablement Disablement Disablement Disablement Disablement Disablement

Schedule of Benefits - Signature Plan

S. Sum Insured
5 7.5 10 15 20 25 50 100
No. (Rs.) (in Lakhs)

1 Room, Boarding, Up to Up to Up to Up to Up to
Nursing deluxe room deluxe room deluxe room deluxe room deluxe room Any room Any room Any room
Expenses
all-inclusive as
provided by the
Hospital /
Nursing Home
as per the limits
Pre & Post 90 days & 180 90 days & 180 90 days & 180 90 days & 180 90 days & 180 90 days & 180 90 days & 180 90 days & 180
2 days
Hospitalisation days days days days days days days
3 Road Actuals Actuals Actuals Actuals Actuals Actuals Actuals Actuals
Ambulance
10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum 10% of the Sum
4
Air Insured during Insured during Insured during Insured during Insured during Insured during Insured during Insured during
Ambulance the en�re the en�re the en�re the en�re the en�re the en�re the en�re the en�re
policy year policy year policy year policy year policy year policy year policy year policy year

Day Care All day care All day care All day care All day care All day care All day care All day care All day care
5 Procedures procedures are procedures are procedures are procedures are procedures are procedures are procedures are procedures are
covered covered covered covered covered covered covered covered
6 Cataract Actuals Actuals Actuals Actuals Actuals Actuals Actuals Actuals
100% of SI a�er 100% of SI a�er 100% of SI a�er 100% of SI a�er 100% of SI a�er 100% of SI a�er 100% of SI a�er 100% of SI a�er
comple�on of comple�on of comple�on of comple�on of comple�on of comple�on of comple�on of comple�on of
first claim free first claim free first claim free first claim free first claim free first claim free first claim free first claim free
7.A year, 25% of Sum year, 25% of Sum year, 25% of Sum year, 25% of Sum year, 25% of Sum year, 25% of Sum year, 25% of Sum year, 25% of Sum
Cumulative
insured for next insured for next insured for next insured for next insured for next insured for next insured for next insured for next
Bonus
every claim free every claim free every claim free every claim free every claim free every claim free every claim free every claim free
(or) year subject to year subject to year subject to year subject to year subject to year subject to year subject to year subject to
maximum maximum maximum maximum maximum maximum maximum maximum
of 500%. of 500%. of 500%. of 500%. of 500%. of 500%. of 500%. of 500%.
7.B No Claim
Discount 4% 4% 2% 2% 2% 2% 2% 2%

Gala Fit - Pro Premium Premium Premium Premium Premium Premium Premium Premium
8 Active Care discount discount discount discount discount discount discount discount
(Wellness available available available available available available available available
Discount) up to 20% up to 20% up to 20% up to 20% up to 20% up to 20% up to 20% up to 20%

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 36/39
 Schedule of Benefits - Signature Plan
S. Sum Insured
5 7.5 10 15 20 25 50 100
No. (Rs.) (in Lakhs)
Unlimited Sum Unlimited Sum Unlimited Sum Unlimited Sum Unlimited Sum Unlimited Sum Unlimited Sum Unlimited Sum
Insured, can be Insured, can be Insured, can be Insured, can be Insured, can be Insured, can be Insured, can be Insured, can be
used for all used for all used for all used for all used for all used for all used for all used for all
Automatic subsequent subsequent
subsequent subsequent subsequent subsequent subsequent subsequent
9 Restoration of claims claims
claims claims claims claims claims claims
Sum Insured: (Applicable for (Applicable for
(Applicable for (Applicable for (Applicable for (Applicable for (Applicable for (Applicable for
same same same same same same same same
disease/different disease/different disease/different disease/different disease/different disease/different disease/different disease/different
disease also) disease also) disease also) disease also) disease also) disease also) disease also) disease also)
Individual: Individual: Individual: Individual: Individual: Individual: Individual: Individual:
10 Health Rs.1500 Rs.2000 Rs.2000 Rs.4000 Rs.5000 Rs.5000 Rs.5000 Rs.8000
Check-up Floater:Rs.2500 Floater:Rs.5000 Floater:Rs.5000 Floater:Rs.8000 Floater: Rs.10000 Floater: Rs.10000 Floater: Rs.10000 Floater: Rs.15000
Second Covered Covered Covered Covered Covered Covered Covered Covered
11 Medical Opinion
12 AYUSH Actuals Actuals Actuals Actuals Actuals Actuals Actuals Actuals
Domiciliary Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to
13 Hospitalisation
Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
Modern Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to
14 Treatments Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
15 Bariatric Surgery Rs.3 Lakhs Rs.3 Lakhs Rs.3 Lakhs Rs.3 Lakhs Rs.6 Lakhs Rs.6 Lakhs Rs.6 Lakhs Rs.6 Lakhs
For Insured: For Insured: For Insured: For Insured: For Insured: For Insured: For Insured: For Insured:
Organ Covered Covered Covered Covered Covered Covered Covered Covered
16 Transplantation (Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if
insured is insured is insured is insured is insured is insured is insured is insured is
recipient recipient recipient recipient recipient recipient recipient recipient
For Insured: For Insured: For Insured: For Insured: For Insured: For Insured: For Insured: For Insured:
Covered Covered Covered Covered Covered Covered Covered Covered
(Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if (Actuals) if
insured insured insured insured insured insured insured insured
donates organ donates organ donates organ donates organ donates organ donates organ donates organ donates organ
Organ For Donor: For Donor: For Donor: For Donor: For Donor: For Donor: For Donor: For Donor:
17 Additional SI up Additional SI up Additional SI up
Donor Expenses Additional SI up Additional SI up Additional SI up Additional SI up Additional SI up
to Basic SI for to Basic SI for to Basic SI for to Basic SI for to Basic SI for to Basic SI for to Basic SI for to Basic SI for
the Complica- the Complica- the Complica- the Complica- the Complica- the Complica- the Complica- the Complica-
tions (if any) tions (if any) tions (if any) tions (if any) tions (if any) tions (if any) tions (if any) tions (if any)
that necessitate that necessitate that necessitate that necessitate that necessitate that necessitate that necessitate that necessitate
a Redo Surgery/ a Redo Surgery/ a Redo Surgery/ a Redo Surgery/ a Redo Surgery/ a Redo Surgery/ a Redo Surgery/ a Redo Surgery/
ICU admission ICU admission ICU admission ICU admission ICU admission ICU admission ICU admission ICU admission
Treatment for
sleep disorders:
18 Sleep study test - Rs.10,000/- Rs.10,000/- Rs.15,000/- Rs.15,000/- Rs.15,000/- Rs.15,000/- Rs.25,000/- Rs.25,000/-
Polysomnography
Assisted
19 Reproduction Max up to Max up to Max up to Max up to Max up to Max up to Max up to Max up to
Treatment: Rs.1 Lakh Rs.2 Lakhs Rs.2 Lakhs Rs.2 Lakhs Rs.2 Lakhs Rs.2 Lakhs Rs.5 Lakhs Rs.5 Lakhs
In-patient In-patient In-patient In-patient In-patient In-patient In-patient In-patient
hospitalisation hospitalisation hospitalisation hospitalisation hospitalisation hospitalisation hospitalisation hospitalisation
expenses for expenses for expenses for expenses for expenses for expenses for expenses for expenses for
post-partum post-partum post-partum post-partum post-partum post-partum post-partum post-partum
delivery delivery delivery delivery delivery delivery delivery delivery
20 Surrogacy complications complications complications complications complications complications complications complications
for a period for for a period for for a period for for a period for for a period for for a period for for a period for for a period for
36 months up to 36 months up to 36 months up to 36 months up to 36 months up to 36 months up to 36 months up to 36 months up to
Assisted Assisted Assisted Assisted Assisted Assisted Assisted Assisted
Reproduction Reproduction Reproduction Reproduction Reproduction Reproduction Reproduction Reproduction
Treatment limits Treatment limits Treatment limits Treatment limits Treatment limits Treatment limits Treatment limits Treatment limits
Company will Company will Company will Company will Company will Company will Company will Company will
indemnify the indemnify the indemnify the indemnify the indemnify the indemnify the indemnify the indemnify the
complications complications complications complications complications complications complications complications
arising out of arising out of arising out of arising out of arising out of arising out of arising out of arising out of
21 Oocyte Donor
Assisted Assisted Assisted Assisted Assisted Assisted Assisted Assisted
Reproductive Reproductive Reproductive Reproductive Reproductive Reproductive Reproductive Reproductive
procedure for procedure for procedure for procedure for procedure for procedure for procedure for procedure for
12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months
In Utero Fetal
22 Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to Covered up to
Surgery /
Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
Intervention
10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum
Insured or up to Insured or up to Insured or up to Insured or up to Insured or up to Insured or up to Insured or up to Insured or up to
Maximum of Maximum of Maximum of Maximum of Maximum of Maximum of Maximum of Maximum of
Delivery Rs.2 Lakh, Rs.2 Lakh, Rs.2 Lakh, Rs.2 Lakh, Rs.2 Lakh, Rs.2 Lakh, Rs.2 Lakh, Rs.2 Lakh,
23
Expenses whichever is whichever is whichever is whichever is whichever is whichever is whichever is whichever is
lower (including lower (including lower (including lower (including lower (including lower (including lower (including lower (including
C-sec & Normal C-sec & Normal C-sec & Normal C-sec & Normal C-sec & Normal C-sec & Normal C-sec & Normal C-sec & Normal
delivery) delivery) delivery) delivery) delivery) delivery) delivery) delivery)

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 37/39
 Schedule of Benefits - Signature Plan
S. Sum Insured
5 7.5 10 15 20 25 50 100
No. (Rs.) (in Lakhs)
Insured women Insured women Insured women Insured women Insured women Insured women Insured women Insured women
must be in this must be in this must be in this must be in this must be in this must be in this must be in this must be in this
policy for 1 year: policy for 1 year: policy for 1 year: policy for 1 year: policy for 1 year: policy for 1 year: policy for 1 year: policy for 1 year:
New Born 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum 10% of Sum
24 Baby Cover Insured or Max Insured or Max Insured or Max Insured or Max Insured or Max Insured or Max Insured or Max Insured or Max
up to up to up to up to up to up to up to up to
Rs.2.5 Lakhs, Rs.2.5 Lakhs, Rs.2.5 Lakhs, Rs.2.5 Lakhs, Rs.2.5 Lakhs, Rs.2.5 Lakhs, Rs.5 Lakhs, Rs.5 Lakhs,
whichever is whichever is whichever is whichever is whichever is whichever is whichever is whichever is
lower. lower. lower. lower. lower. lower. lower. lower.
Upto 10% of Upto 10% of Upto 10% of Upto 10% of Upto 10% of Upto 10% of Upto 10% of Upto 10% of
Sum Insured, Sum Insured, Sum Insured, Sum Insured, Sum Insured, Sum Insured, Sum Insured, Sum Insured,
maximum of maximum of maximum of maximum of maximum of maximum of maximum of maximum of
Home care Rs.5 Lakhs in a Rs.5 Lakhs in a Rs.5 Lakhs in a Rs.5 Lakhs in a Rs.5 Lakhs in a Rs.5 Lakhs in a Rs.5 Lakhs in a Rs.5 Lakhs in a
25 policy year policy year policy year policy year policy year policy year policy year policy year
treatment
including including including including including including including including
Multi-drug Multi-drug Multi-drug Multi-drug Multi-drug Multi-drug Multi-drug Multi-drug
resistance TB resistance TB resistance TB resistance TB resistance TB resistance TB resistance TB resistance TB
treatment treatment treatment treatment treatment treatment treatment treatment

10% of sum 10% of sum 10% of sum 10% of sum 10% of sum 10% of sum 10% of sum 10% of sum
Treatment for insured insured insured insured insured insured insured insured
26 Chronic Severe maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to
Refractory Rs.5 Lakhs per Rs.5 Lakhs per Rs.5 Lakhs per Rs.5 Lakhs per Rs.5 Lakhs per Rs.5 Lakhs per Rs.5 Lakhs per Rs.5 Lakhs per
Asthma policy period policy period policy period policy period policy period policy period policy period policy period

Emergency
27 Domestic
Rs. 7,500/- Rs. 7,500/- Rs. 7,500/- Rs. 7,500/- Rs. 10,000/- Rs. 10,000/- Rs. 10,000/- Rs. 10,000/-
Medical
Evacuation

Compassionate Up to Rs. Up to Rs. Up to Rs. Up to Rs. Up to Rs. Up to Rs. Up to Rs. Up to Rs.

28 25,000/- 25,000/- 25,000/- 25,000/- 25,000/- 25,000/- 25,000/- 25,000/-
Travel

Sub-limit (or) Sub-limit (or) Sub-limit (or) Sub-limit (or) Sub-limit (or) Sub-limit (or) Sub-limit (or) Sub-limit (or)
maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to
Rehabilitation 20% of the 20% of the 20% of the 20% of the 20% of the 20% of the 20% of the 20% of the
29 and Pain sum insured sum insured sum insured sum insured sum insured sum insured sum insured sum insured
Management whichever is whichever is whichever is whichever is whichever is whichever is whichever is whichever is
less, per less, per less, per less, per less, per less, per less, per less, per
policy year policy year policy year policy year policy year policy year policy year policy year

10% of the sum 10% of the sum 10% of the sum 10% of the sum 10% of the sum 10% of the sum 10% of the sum 10% of the sum
Hospice insured insured insured insured insured insured insured insured
30 maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to maximum up to
Care
Rs.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs Rs.5 Lakhs

Repatriation Up to Up to Up to Up to Up to Up to Up to Up to
31 of Mortal Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/-
Remains Per Policy Year Per Policy Year Per Policy Year Per Policy Year Per Policy Year Per Policy Year Per Policy Year Per Policy Year

Treatment in 1% of Sum 1% of Sum 1% of Sum 1% of Sum 1% of Sum 1% of Sum 1% of Sum 1% of Sum

32 Valuable service Insured max of Insured max of Insured max of Insured max of Insured max of Insured max of Insured max of Insured max of
provider's Rs.5000/- per Rs.5000/- per Rs.5000/- per Rs.5000/- per Rs.5000/- per Rs.5000/- per Rs.5000/- per Rs.5000/- per
network policy Period policy Period policy Period policy Period policy Period policy Period policy Period policy Period

33 Consumables Covered Covered Covered Covered Covered Covered Covered Covered

Premium Premium Premium Premium Premium Premium Premium Premium

remains same remains same remains same remains same remains same remains same remains same remains same
until claims until claims until claims until claims until claims until claims until claims until claims
Premium made or made or made or made or made or made or made or made or
34
Promise Up to 55 years Up to 55 years Up to 55 years Up to 55 years Up to 55 years Up to 55 years Up to 55 years Up to 55 years
whichever is whichever is whichever is whichever is whichever is whichever is whichever is whichever is
earlier earlier earlier earlier earlier earlier earlier earlier

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 38/39
 Schedule of Benefits – Optional Covers Applicable for Signature Plan
S. Sum Insured
5 7.5 10 15 20 25 50 100
No. (Rs.) (in Lakhs)
Asthma, Blood Asthma, Blood Asthma, Blood Asthma, Blood Asthma, Blood Asthma, Blood Asthma, Blood Asthma, Blood
Pressure & Pressure & Pressure & Pressure & Pressure & Pressure & Pressure & Pressure &
1 Insta Care Cholesterol Cholesterol Cholesterol Cholesterol Cholesterol Cholesterol Cholesterol Cholesterol
Cover covered from covered from covered from covered from covered from covered from covered from covered from
31st day 31st day 31st day 31st day 31st day 31st day 31st day 31st day
Reduce PED Reduce PED Reduce PED Reduce PED Reduce PED Reduce PED Reduce PED Reduce PED
waiting period waiting period waiting period waiting period waiting period waiting period waiting period waiting period
from from from from from from from from
36 months to 36 months to 36 months to 36 months to 36 months to 36 months to 36 months to 36 months to
2 PED
Buy Back 12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months
(or) Reduce (or) Reduce (or) Reduce (or) Reduce (or) Reduce (or) Reduce (or) Reduce (or) Reduce
PED waiting PED waiting PED waiting PED waiting PED waiting PED waiting PED waiting PED waiting
period from 36 period from 36 period from 36 period from 36 period from 36 period from 36 period from 36 period from 36
months to 24 months to 24 months to 24 months to 24 months to 24 months to 24 months to 24 months to 24

Insured has an Insured has an Insured has an Insured has an Insured has an Insured has an Insured has an Insured has an
option to option to option to option to option to option to option to option to
Room Rent modify the modify the modify the modify the modify the modify the modify the modify the
3 room rent room rent room rent room rent room rent room rent room rent room rent
Enhancement
eligibility to eligibility to eligibility to eligibility to eligibility to eligibility to eligibility to eligibility to
any room any room any room any room any room any room any room any room

4 Hospital Cash
Rs.1,000/- Rs.1,500/- Rs.1,500/- Rs.2,000/- Rs.2,000/- Rs.2,500/- Rs.3,000/- Rs.3,000/-
(Per Day)
Deductible Deductible Deductible Deductible Deductible Deductible Deductible Deductible
Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/- Rs.25,000/-
Discount 18%, Discount 18%, Discount 18%, Discount 18%, Discount 18%, Discount 13%, Discount 13%, Discount 13%,
Option to
Deductible Deductible Deductible Deductible Deductible
5A Choose Deductible Deductible Deductible
Rs.50,000/- Rs.50,000/- Rs.50,000/- Rs.50,000/- Rs.50,000/-
Aggregate Rs.50,000/- Rs.50,000/- Rs.50,000/-
Discount 35%, Discount 35%, Discount 35%, Discount 35%, Discount 35%, Discount 25%, Discount 25%, Discount 25%,
Deductible
Deductible Deductible Deductible Deductible Deductible Deductible Rs. 1 Deductible Rs. 1 Deductible Rs. 1
Rs. 1 Lakh - Rs. 1 Lakh - Rs. 1 Lakh - Rs. 1 Lakh - Rs. 1 Lakh - Lakh -40% Lakh -40% Lakh -40%
45% Discount 45% Discount 45% Discount 45% Discount 45% Discount Discount Discount Discount

or

Rs.5,000: 7.5% Rs.5,000: 7.5% Rs.5,000: 7.5% Rs.5,000: 7.5% Rs.5,000: 7.5% Rs.5,000: 7.5% Rs.5,000: 7.5% Rs.5,000: 7.5%
Per Claim Discount Discount Discount Discount Discount Discount Discount Discount
5B Rs.10,000: Rs.10,000: Rs.10,000: Rs.10,000: Rs.10,000: Rs.10,000: Rs.10,000: Rs.10,000:
Deductible
15% Discount 15% Discount 15% Discount 15% Discount 15% Discount 15% Discount 15% Discount 15% Discount

Cover for Cover for Cover for Cover for Cover for Cover for Cover for Cover for
Accidental Accidental Accidental Accidental Accidental Accidental Accidental Accidental
6 Personal Death and Death and Death and Death and Death and Death and Death and Death and
Accident Permanent Permanent Permanent Permanent Permanent Permanent Permanent Permanent
Total Total Total Total Total Total Total Total
Disablement Disablement Disablement Disablement Disablement Disablement Disablement Disablement

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording 39/39
 GALAXY HEALTH INSURANCE COMPANY LIMITED
( Formerly known as Galaxy Health and Allied Insurance Company Limited)
Registered Office: “Prestige Polygon”, 12th Top Floor (P), #471, Anna Salai,
Nandanam, Chennai - 600 035  T: 044 - 4001 7227  Website: www.galaxyhealth.com
IRDAI Registration No.167  CIN: U65120TN2023PLC165765

GALAXY PROMISE  UIN: GHIHLIP25035V012425  V1-2024 GALAXY HEALTH INSURANCE  Policy Wording