NAVI SPECIAL CARE – POLICY WORDING

1. PREAMBLE

This Policy is a contract of insurance issued by Navi General Insurance Ltd (hereinafter called the “Company”) and
the proposer mentioned in the schedule (hereinafter called the “Insured”) to cover the person(s)named in the
schedule (hereinafter called the "Insured Persons). The Policy is based on the statements and declaration provided
in the Proposal Form and any further information shared by the proposer, and is subject to receipt of the due
premium in full.

This Policy is specially designed for:

A) Covering Persons with Disability as per The Rights of Persons with Disabilities Act, 2016. The cover under
this policy is available for persons with the following disability/disabilities as defined under the Act and any
subsequent additions / modifications to the list in the Act.

1. Blindness 2. Muscular Dystrophy

3. Low vision 4. Chronic Neurological conditions
5. Leprosy Cured persons 6. Specific Learning Disabilities
7. Hearing Impairment (deaf and hard of hearing) 8. Multiple Sclerosis

9. Locomotor Disability 10. Speech and Language disability

11. Dwarfism 12. Thalassemia
13. Intellectual Disability 14. Haemophilia
15. Mental Illness 16. Sickle Cell disease
17. Autism spectrum disorder 18. Multiple Disabilities including deaf/ blindness

19. Cerebral Palsy 20. Acid Attack victim

21. Parkinson's disease

a) It is Condition Precedent that this cover can be availed only on mandatory submission of Disability
certificate issued by the Certifying Authority.
b) Disability for the purpose of this policy means a person with not less than forty percent of a specified
disability as per the Act, where, specified disability has not been defined in measurable terms and includes
an Insured Person with disability where specified disability has been defined in measurable terms, as
Certified by the Certifying authority.

Or / and

B) Individuals with HIV/AIDS as defined under the Human Immunodeficiency Virus and Acquired Immune
Deficiency Syndrome (Prevention and Control) Act, 2017. Individuals diagnosed as HIV/AIDs by a duly
qualified Medical Practitioner with CD4 count above 500 will only be eligible for cover under this policy.

2. OPERATIVE CLAUSE

If during the Policy Period an Insured Person is required to be hospitalized for treatment of an Illness
or Injury at a Hospital/ Day Care Centre, following Medical Advice of a duly qualified Medical
 Practitioner, the Company shall indemnify the Medical Expenses
that are medically necessary as confirmed by the Medical Practitioner towards the Coverage mentioned in the
Policy Schedule.

Provided further that, any amount payable under the Policy shall be subject to the terms of Coverage
(including, co-pay, sub limits), exclusions, conditions and definitions contained herein. Maximum liability of the
Company under all such Claims paid under indemnity and/or benefit basis, during each Policy Year shall be
the Sum Insured opted and specified in the Policy Schedule.

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

3.1 Standard Definitions

1. Accident: means sudden, unforeseen and involuntary event caused by external, visible and violent
means.

2. Any One Illness: means continuous period of Illness and includes relapse within 45 days from the date of
last consultation with the Hospital/Nursing Home where treatment was taken.

3. AYUSH Treatment refers to hospitalisation treatments given under Ayurveda, Yoga and Naturopathy,
Unani, Siddha and Homeopathy systems.

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

5. AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health
Centre (PHC), Dispensary, Clinic, Polyclinic or any such health centre which is registered with the
local authorities, wherever applicable and having facilities for carrying out treatment procedures
and medical or surgical / para-surgical interventions or both under the supervision of registered
AYUSH Medical Practitioner(s) on day care basis without in-patient services and must comply with
all the following criterion:
● Having qualified registered AYUSH Medical Practitioner in charge round the clock.
 ● Having dedicated AYUSH therapy sections as
required and/or has equipped operation theatre where surgical procedures are to be
carried out.
● Maintaining daily records of the patients and making them accessible to the insurance
company’s authorized representative.
6. Break in Policy means the period of gap that occurs at the end of the existing policy term, when the
premium due for renewal on a given policy is not paid on or before the premium renewal date or within 30
days thereof.

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

8. Condition Precedent means a policy term or condition upon which the Insurer’s liability under the policy is
conditional upon.

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

10. Co-Payment means a cost sharing requirement under a health insurance policy that provides that the
policy holder/insured will bear a specified percentage of the admissible claims amount. A co-payment does
not reduce the sum insured.

11. Day Care Centre means any institution established for day care treatment of illness and/or injuries ora
medical setup with a hospital and which has been registered with the local authorities, wherever
applicable, and is under supervision of a registered and qualified medical practitioner and must comply
with all minimum criterion as under:

i. has qualified nursing staff under its employment.

ii. has qualified medical practitioner/s in charge.
iii. has fully equipped operation theatre of its own where surgical procedures are carried out
iv. maintains daily records of patients and will make these accessible to the insurance
company’s authorized personnel.

12. Day Care Treatment means medical treatment, and/or surgical procedure which is
i. Undertaken under General or Local Anesthesia in a hospital/day care center in less than
24 hours because of technological advancement, and
ii. which would have otherwise required hospitalization of more than 24 hours.

Treatment normally taken on an out-patient basis is not included in the scope of this definition.

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

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

15. Emergency Care means management for an Illness which results in symptoms which occur
suddenly and unexpectedly and requires immediate care by a medical practitioner to prevent death
or serious long-term impairment of the insured person’s health.

16. Grace Period means the specified period of time immediately following the premium due date
during which a payment can be made to renew or continue a policy in force without loss of
 continuity benefits such as waiting periods and coverage of
pre-existing diseases. Coverage is not available for the period for which no premium is received.

17. Domiciliary Hospitalisation: means medical treatment for an Illness/disease/Injury which in the normal
course would require care and treatment at a Hospital but is actually taken while confined at home under
any of the following circumstances:
(a) the condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or
(b) the patient takes treatment at home on account of non-availability of room in a Hospital.

18. Hospital means any institution established for In-patient Care and Day Care Treatment of diseases,
injuries and which has been registered as a Hospital with the local authorities under the clinical
Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under the
Schedule of Section 56(1) of the said Act or complies with all minimum criteria as under:
i. has qualified nursing staff under its employment round the clock,
ii. has at least 10 in-patient beds, in towns having a population of less than 10,00,000 and
15 in- patient beds in all other places,
iii. has qualified Medical Practitioner(s) in charge round the clock,
iv. has a fully equipped operation theatre of its own where surgical procedures are carried
out,
v. maintains daily records of patients and will make these accessible to the insurance
company’s authorized personnel.
19. Hospitalization - means admission in a Hospital for a minimum of 24 consecutive “In patient Care” hours
except for specified procedures / treatments, where such admission could be for a period of less than 24
consecutive hours.

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

21. Illness means a sickness or a disease or pathological condition leading to the impairment of normal
physiological function and requires medical treatment.
i. Acute condition - Acute condition is a disease, Illness that is likely to respond quickly to
treatment which aims to return the person to his or her state of health immediately before suffering the
disease/ Illness which leads to full recovery
ii. Chronic condition - A chronic condition is defined as a disease, Illness that has one or more
of the following characteristics:
a. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and
/or tests
b. it needs ongoing or long-term control or relief of symptoms
c. it requires your rehabilitation for the patient or for the patient to be specially trained to cope
with it
d. It continues indefinitely.
e. it recurs or is likely to recur.

22. In-patient Care means treatment for which the Insured Person has to stay in a Hospital for more than 24
hours for a covered event.

23. Insured Person means person(s) named in the schedule of the Policy.

24. Intensive Care Unit means an identified section, ward or wing of a Hospital which is under the constant
supervision of a dedicated Medical Practitioner(s), and which is specially equipped for the continuous
monitoring and treatment of patients who are in a critical condition or require life support facilities and
where the level of care and supervision is considerably more sophisticated and intensive than in the
ordinary and other wards.
25. ICU Charges means the amount charged by a Hospital towards
ICU expenses which shall include the expenses for ICU bed, general medical support services provided to
any ICU patient including monitoring devices, critical care nursing and intensivist charges.

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

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

28. Medically Necessary Treatment: means any treatment, tests, medication, or stay in Hospital or part of a
stay in Hospital which:
(a) is required for the medical management of the Illness or Injury suffered by the Insured.
(b) must not exceed the level of care necessary to provide safe, adequate and appropriate
medical care in scope, duration or intensity.
(c) must have been prescribed by a Medical Practitioner.
(d) must conform to the professional standards widely accepted in international medical practice
or by the medical community in India.

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

30. Migration means the right accorded to health insurance policyholders (including all members under Family
cover and members of group Health insurance policy), to transfer the credit gained for pre- existing
conditions and time bound exclusions, with the same insurer.

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

32. Non-Network Provider means any Hospital, Day Care Centre or other provider that is not part of the
Network.

33. New born Baby means baby born during the Policy Period and is aged up to 90 days.

34. Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the
recognized modes of communication.

35. OPD Treatment means the one in which the Insured visits a clinic / hospital or associated facility like a
consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The Insured
is not admitted as a day care or in-patient.

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

37. Post-Hospitalization Medical Expenses means medical expenses incurred during pre- defined number
of days immediately after the insured person is discharged from the hospital provided that:
i. Such Medical Expenses are for the same condition for which the insured person’s
hospitalization was required, and
ii. The inpatient hospitalization claim for such hospitalization is admissible by the insurance
company.
 38. Pre-Existing Disease (PED): Pre-existing disease means any condition, ailment, injury, or disease.
i. That is/are diagnosed by a physician within 48 months prior to the effective date of the
policy issued by the insurer or its reinstatement or
ii. For which medical advice or treatment was recommended by, or received from, a
physician within 48 months prior to the effective date of the policy issued by the insurer or
its reinstatement.

39. Portability: means the right accorded to an individual health insurance Policy Holder (including all
members under Family cover), to transfer the credit gained for pre-existing conditions and time bound
exclusions, from one Insurer to another Insurer.

40. Qualified Nurse is a person who holds a valid registration from the nursing council of India or the nursing
council of any state in India.

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

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

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

44. Surgery or Surgical Procedures means manual and / or operative procedure (s) required for treatment of
an illness or injury, correction of deformities and defects, diagnosis and cure of diseases, relief from
suffering and prolongation of life, performed in a hospital or day care centre by a Medical Practitioner.

45. Unproven/Experimental Treatment is a treatment including drug experimental therapy, which is based on
established medical practice in India, is a treatment experimental or unproven.

3.2 Specific Definitions

1. Adventurous/Hazardous Sports means any sport or activity involving physical exertion and
skill in which an Insured Person participates or competes for entertainment or as part of his
profession whether he / she is trained or not.

2. Age means completed years on last birthday as on Commencement Date.

3. Ambulance means a motor vehicle operated by a licensed/authorized service provider and

equipped for the transport and paramedical treatment of the person requiring medical attention.

4. Antiretroviral therapy (ART) is treatment of people infected with human immunodeficiency

virus (HIV) using anti-HIV drugs.

5. Associated Medical Expenses means those expenses that an Insured Person has
necessarily and actually incurred for medical treatment on account of Illness or Accident on
 the advice of a Medical Practitioner. In case of copayment
associated with room rent higher than the entitled room rent limit, Associated Medical Expenses
will not include:

i. Cost of pharmacy and consumables.

ii. Cost of implants and medical devices
iii. Cost of diagnostics

6. Alternative /AYUSH Treatment refers to hospitalization treatments given under Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homeopathy systems.

7. Biological Attack or Weapons means the emission, discharge, dispersal, release or escape of any
pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including
genetically modified organisms and chemically synthesized toxins) which are capable of causing any
Illness, incapacitating disablement or death.

8. Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any
solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing
any Illness, incapacitating disablement or death.

9. Claims means a demand made by the Policyholder/Insured Person or on his behalf, for payment of
Medical Expenses under any other Benefit, as covered under the Policy.

10. Commencement Date means the date of inception of first policy with Us as specified in the Policy
Schedule.
11. CD4 cells are a type of white blood cells, also called CD4 T lymphocytes or ‘helper T cells’ which
serve as primary receptors for HIV.

12. Dependent Child: means biological or legally adopted son or daughter of the Insured, whose Age is
less than or equal to 30 years, is financially dependent on the Insured with no source of income and
has not established his/her own independent household.

13. Diagnosis: means conclusion drawn by a Medical Practitioner, supported by acceptable clinical,
radiological, histological, histo-pathological, and laboratory evidence wherever applicable.

14. Family: means the persons named in the Policy Schedule who are the Policy Holder’s legal spouse,
Dependent Children.

15. Family Floater: means a Policy described as such in the Policy Schedule where the Insured and the
Insured’s Family named in the Policy Schedule are covered under the Policy as at the Policy
Commencement Date. The Sum Insured for a Family Floater is the amount specified in the Policy
Schedule which represents the Insurer’s maximum liability for all claims made by the Insured and/or
Insured’s Family during each Policy Year.

16. Harvesting: means a Surgical Procedure to remove organs or tissues from a donor (live), for the
purpose of organ transplantation.

17. Insured Person (Insured)/Policy Holder/You/Your: means the person(s) named in the Policy
Schedule who is covered under this Policy, for whom the insurance is proposed and in respect of
whom the applicable premium has been received. (policy holder separate definition is there).

18.IRDAI means the Insurance Regulatory and Development Authority of India

19. Diagnostic Centre means a place where diagnostic tests and exploratory or therapeutic procedures
required for the detection, identification and treatment of a medical condition are done.
20. Person with Disability/Disability/Disabled means a
person with long term physical, mental, intellectual or sensory impairment which, in interaction with
barriers, hinders his full and effective participation in society equally with others.

21.HIV means Human Immunodeficiency Virus

22. Insured Person/You/Your means the person named in the Policy Schedule who is insured under the
Policy and is citizen of India, in respect of whom the applicable premium has been received by the
Company.

23. Life-threatening Medical Condition shall mean a serious medical condition or symptom resulting
from Injury or Illness which is not Pre-Existing Disease, which arises suddenly and unexpectedly, and
requires immediate care and treatment by a Medical Practitioner, generally received within 24 hours of
onset to avoid jeopardy to life or serious long-term impairment of the Insured Person’s health, until
stabilization at which time this medical condition or symptom is not considered an Emergency
anymore.

24. Material Facts means all relevant information sought by the Company in the Proposal Form and other
connected documents to enable it to take informed decision in the context of underwriting the risk.

25. Mental Illness means a substantial disorder of thinking, mood, perception, orientation or memory that
grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary
demands of life, mental conditions associated with the abuse of alcohol and drugs but does not
include mental retardation which is a condition of arrested or incomplete development of mind of a
person, specially characterised by sub normality of intelligence.

26. Medical practitioner for treatment of mental illnesses means a medical practitioner possessing a
postgraduate degree or diploma in psychiatry awarded by an university recognized by the University
Grants Commission established under the University Grants Commission Act, 1956, or awarded or
recognized by the National Board of Examinations and included in the First Schedule to the Indian
Medical Council Act, 1956, or recognized by the Medical Council of India, constituted under the Indian
Medical Council Act, 1956, and includes, in relation to any State, any medical officer who having
regard to his knowledge and experience in psychiatry, has been declared by the Government of that
State to be a psychiatrist for the purposes of this Act.

27. Mental Health Establishment means any health establishment, including Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homoeopathy establishment, by whatever name called, either wholly
or partly, meant for the care of persons with mental Illness, established, owned, controlled or
maintained by the appropriate Government, local authority, trust, whether private or public,
corporation, co-operative society, organisation or any other entity or person, where persons with
mental Illness are admitted and reside at, or kept in, for care, treatment, convalescence and
rehabilitation, either temporarily or otherwise; and includes any general Hospital or general nursing
home established or maintained by the appropriate Government, local authority, trust, whether private
or public, corporation, co-operative society, organisation or any other entity or person; but does not
include a family residential place where a person with mental Illness resides with his relatives or
friends.

28. Material Fact: means all relevant information sought by the Company in the Proposal Form and other
connected documents to enable it to take informed decision in the context of underwriting the risk.

29. Medical Diagnostic Laboratory: means a clinical establishment, registered as per applicable law
where pathological, bacteriological, genetic, radiological, chemical, biological investigations or other
diagnostic or investigative services, are usually carried on with the aid of laboratory or other medical
equipment.
30. Nominee: means the person named in the Policy Schedule, Policy certificate and/or endorsement (if
any) who is nominated by the Policy Holder/Insured Person, to receive the benefits under this Policy in
accordance with the terms of the Policy, if the Insured Person is deceased.

31. Organ Donor: any person whose organ has been made available in accordance and in compliance
with The Transplantation of Human Organs (Amendment) Act , 1994 and relevant rules and
amendments thereof. The organ donated is for the use of the Insured Person.

32. Organ Donor Expenses: incurred necessarily towards living donor’s Hospitalization for Harvesting
the organ donated, where the Insured Person is recipient.

33. Policy: means the Proposal Form, the Policy Schedule, annexures, insuring clauses that are
appearing in each applicable coverage, definitions, exclusions, conditions and other terms contained
herein and any endorsement attaching to or forming part hereof, either at inception or during the Policy
Period.

34.Policyholder means the entity or person named as such in thePolicy Schedule.

35. Policy Commencement Date means the date from which cover under the Policy shall be available for
the Insured Person and the date from which the Company’s liability commences under the Policy. The
Policy Commencement Date is as specified in the Policy Schedule.

36. Policy Period: means the period commencing from the Policy Commencement Date and time as
specified in the Policy Schedule and terminating either at midnight on the Policy End Date as specified
in the Policy Schedule or the date of cancellation of the Policy, whichever is earlier.

37. Policy Schedule: means schedule attached to and forming part of this Policy mentioning the details of
the Insured Person(s), the Sum Insured, the Policy Period and the limits, and conditions to which the
benefits under the Policy are subject to, including any annexures and/or endorsements, as amended
from time to time.

38. Policy Year: means a period of twelve consecutive months commencing from the Policy
Commencement Date and such twelve consecutive months thereafter but not beyond the Policy
Period.
Or Policy Year means a period of twelve months beginning from the Commencement Date and
ending on the last day of such twelve-month period. For the purpose of subsequent years, Policy
Year shall mean a period of twelve months commencing from the end of the previous Policy Year
and lapsing on the last day of such twelve-month period, till the Expiry Date, as specified in the
Policy Schedule.

39. Proposal Form means a form to be filled in by the prospect in written or electronic or any other format
as approved by the IRDAI, for furnishing all material information as required by the Insurer, in order to
enable the Insurer to take an informed decision in the context of underwriting the risk and in the event
of acceptance of the risk, to determine the rates, benefits, terms and conditions of the cover to be
granted.

40. Single Private A/C Room: means a single occupancy air-conditioned room with attached rest room
and a couch for the attendant. Such room must be the most economical of all accommodations
available in that Hospital as a single occupancy. This does not include Deluxe room or a Suite.

41. Sum Insured means sum of Base Insured and total and cumulative liability for any and all claims
during the policy year in respect of all insured person(s) as mentioned in the Policy Schedule.
42. Sub-limit means a cost sharing requirement under a health
insurance policy in which an insurer would not be liable to pay any amount in excess of the pre-defined
limit. The Sub- limit as applicable under the Policy is specified in the Policy Schedule against the
relevant Cover in force under the Policy.

43. TPA: means any entity who is registered under the IRDAI (Third Party Administrators - Health
Services) Regulations, 2016 notified by the IRDAI, and is engaged, for a fee or remuneration by an
insurance Company, for the purposes of providing health services.

44. Telemedicine means Medical consultation service availed via telecommunications and digital
communication technologies by the Insured Person from a Medical Practitioner while taking treatment
for the health condition that has resulted in an admissible Claim under a cover in this Policy. Such
Telemedicine services shall be delivered in compliance with the Medical Council of India’s
‘Telemedicine Practice Guidelines’ dated March 2020 or its subsequent amendments, if any.

45. Waiting Period: means a period from the inception of this Policy during which specified
diseases/treatments are not covered. On completion of the period, diseases/treatments shall be
covered provided the Policy has been continuously renewed without any break.

46.We/ Our/ Us / Insurer/ Company: means Navi General Insurance Limited.

4. SCOPE OF COVER
HOSPITALIZATION COVER

4.1 Inpatient Care:

The Company shall indemnify medical expenses incurred for Hospitalization of the Insured Person
during the Policy Year, up to the Base Sum Insured as specified in the Policy Schedule

i. Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home up to
1% of the Sum Insured per day.

ii. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to maximum of
2% of Sum Insured per day.

iii. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly
to the treating doctor/ surgeon or to the hospital

iv. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and
drugs, costs towards diagnostics, diagnostic imaging modalities and such similar other expenses.

Other expenses

i. Expenses incurred on treatment of cataract subject to the sub limits.

ii. Dental treatment necessitated due to disease or injury.

iii. Plastic surgery necessitated due to disease or injury.

iv. All day care

treatments Note:

1. Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be

admissible. However, the time limit shall not apply in respect of Day Care Treatment.

2. The above-mentioned Medical Expenses shall be payable only after the first commencement
of thePolicy with the Company.
 3. If the Insured Person is admitted in a room where

the Room Rent expenses incurred are higher than the above specified limit, then the Insured Person

shall bear a rateable proportion of the total Associated Medical Expenses (including surcharge or

taxes thereon), except pharmacy charges, diagnostic costs, costs of implants & medical devices and

consumables expenses, in the proportion of the difference between the Incurred Room Rent and

Eligible Room Rent to the Incurred Room Rent.

Expenses to be borne by Insured Person = {( Associated Medical Expenses) X (Incurred Room Rent–

Eligible Room Rent )} / Incurred Room Rent

Proportionate Expenses is applied in respect of the Hospital which follow differential billing or for

those expenses in respect of which differential billing is adopted based on the Room Category.

4.2 AYUSH Treatment

The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga
and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to 50% of
sum insured as specified in the policy schedule in any AYUSH Hospital.

4.3 Pre-Hospitalization Medical Expenses:

The Company shall indemnify Pre-Hospitalization Medical Expenses incurred, related to an admissible
Hospitalization requiring Inpatient care, for a fixed period of 30 days prior to the date of admissible
Hospitalization covered under the Policy.

Conditions:
i. The claim is accepted under Section 4.1 (Inpatient Care) or Section 4.2(AYUSH Treatment) or Section
4.7 (Modern Treatments) in respect of that Insured Person.
ii. Pre-hospitalization Medical Expenses can be claimed under this Section on a Reimbursement basis
only.

4.4 Post-Hospitalization Medical Expenses:

The Company shall indemnify Post Hospitalization Medical Expenses incurred, related to an admissible
Hospitalization requiring Inpatient Care, for a fixed period of 60 days from the date of discharge from
the Hospital, following an admissible hospitalization covered under the Policy.

Conditions:
i. The claim is accepted under Section 4.1 (Inpatient Care) or Section 4.2(AYUSH Treatment) or
Section
4.7 (Modern Treatments) in respect of that Insured Person.
ii. Post-hospitalization Medical Expenses can be claimed under this Section on a
Reimbursement basis only.

4.5 Emergency Ground Ambulance

The Company will reimburse Reasonable and Customary Charges for expenses incurred towards
ambulance charges for transportation of an Insured person, per hospitalization as per the limit
mentioned in Policy Schedule.
 Specific Conditions:
The Company will reimburse payments under this Benefit provided that.

i. The medical condition of the Insured Person requires immediate ambulance services from the
place where the Insured Person is Injured or is suffering from an Illness to a Hospital where appropriate
medical treatment can be obtained or from the existing Hospital to another Hospital as advised by the
treating Medical Practitioner in writing for management of the current Hospitalization.

ii. Expenses incurred on road Ambulance subject to a maximum of Rs.2000/- per hospitalisation.

iii. The ambulance service is offered by a healthcare or Registered Ambulance Service Provider.

iv. The original Ambulance bills and payment receipt is submitted to the Company.

v. The Company has accepted a claim under Section 4.1 (Inpatient Care) above in respect of the
same period of Hospitalization or Section 4.2(AYUSH Treatment) or Section 4.7 (Modern Treatments).

vi. Any payment under this Benefit will be excluded if the Insured Person is transferred to any
Hospital or diagnostic center for evaluation purposes only.

4.6 Cataract Treatment

The company shall indemnify medical expenses incurred for treatment of Cataract, subject to a limit of
Rs.40,000/-, whichever is lower, per each eye in one policy year.

4.7 Modern Treatment: means the following procedures:

The following procedures will be covered (wherever medically indicated) either as In- patient
or as part of Day Care Treatment in a Hospital up to 50% of Sum Insured, specified in the Policy
Schedule, during the Policy Period.

a. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)

b. Balloon Sinuplasty
c. Deep Brain Stimulation
d. Oral Chemotherapy
e. Immunotherapy - Monoclonal Antibody to be given as injection.
f. Intra-vitreal injections
g. Robotic Surgeries
h. Stereotactic radio Surgeries
i. Bronchial Thermoplasty
j. Vaporisation of the prostrate (Green Laser Treatment or Holmium Laser Treatment
k. IONM - (Intra Operative Neuro Monitoring)
l. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological
conditions to be covered.

5. WAITING PERIOD

The Company is not liable to make any payment under the Policy in connection with or in respect
of the following expenses till the expiry of the waiting period and any claim in respect of any
Insured Person directly or indirectly for, caused by, arising from or any way attributable to any of
the following unless expressly stated to the contrary in this Policy.
A. Waiting Periods

1. Pre-Existing Diseases (Code- Excl01)

a) Expenses related to the treatment of a pre-existing Disease (PED) and its direct
complications shall be excluded until the expiry of 24 months for pre-existing disability / 48 months
for all pre-existing conditions other than HIV/AIDS and Disability (as mentioned in Policy
Schedule) of continuous coverage after the date of inception of the first policy with insurer.

b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of
sum insured increase.

c) If the Insured Person is continuously covered without any break as defined under the
portability norms of the extant IRDAI (Health Insurance) Regulations, then waiting period for the
same would be reduced to the extent of prior coverage.

d) Coverage under the policy after the expiry of number of months (as mentioned in Policy
Schedule) for any pre-existing disease is subject to the same being declared at the time of
application and accepted by Us.

2. First 30 days waiting period- Code- Excl03

a) Expenses related to the treatment of any illness within 30 days from the first policy
commencement date shall be excluded except claims arising due to an accident, provided the
same are covered.

b) This exclusion shall not, however, apply if the Insured Person has Continuous Coverage
for more than twelve months.

c) The within referred waiting period is made applicable to the enhanced sum insured in the
event of granting higher sum insured subsequently.

3. Specified disease/procedure waiting period- Code- Excl02

a) Expenses related to the treatment of the listed Conditions; surgeries/treatments shall be

excluded until the expiry of 24 months as (mentioned in Policy Schedule) of continuous coverage
after the date of inception of the first policy with us. This exclusion shall not be applicable for
claims arising due to an accident.

b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of
sum insured increase.

c) If any of the specified disease/procedure falls under the waiting period specified for pre-
existing diseases, then the longer of the two waiting periods shall apply.

d) The waiting period for listed conditions shall apply even if contracted after the policy or
declared and accepted without a specific exclusion.

e) If the Insured Person is continuously covered without any break as defined under the
applicable norms on portability stipulated by IRDAI, then waiting period for the same would be
reduced to the extent of prior coverage.

24 Months waiting period.

1. Benign ENT disorders

2. Tonsillectomy

3. Adenoidectomy
 4. Mastoidectomy

5. Tympanoplasty

6. Hysterectomy

7. All internal and external benign tumors, cysts, polyps of any kind, including benign breast
lumps.

8. Benign prostate hypertrophy

9. Cataract and age-related eye ailments

10. Gastric/ Duodenal Ulcer

11. Gout and Rheumatism

12. Hernia of all types

13. Hydrocele

14. Non-Infective Arthritis

15. Piles, Fissures and Fistula in anus

16. Pilonidal sinus, Sinusitis and related disorders

17. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident.

18. Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.

19. Varicose Veins and Varicose Ulcers

6. . SPECIFIC CONDITIONS APPLICABLE FOR PERSONS WITH DISABILITY

The Company will indemnify reasonable and customary charges for Life-threatening Emergency Care
only, that are incurred by the Insured Person towards Inpatient Hospitalisation arising due to the
pre-existing disability covered, or condition as listed under The Rights of Persons With Disabilities Act,
2016 subject to the terms and limits mentioned below.

i. Any treatment for the pre-existing disability covered, will have a waiting period of 24 months
from the first policy inception date.

ii. Any reconstructive / Cosmetic / prosthesis / external or internal device implanted/ used at
home for the purpose of treatment of existing disability or used for activities of daily living are/is
excluded from the policy.

7. SPECIFIC CONDITIONS APPLICABLE FOR PERSONS WITH HIV -AIDS

The Company will indemnify the Reasonable and Customary Charges for any Medical Condition which
requires Inpatient Hospitalization of the Insured Person, up to the sum insured opted as mentioned in
the Policy Schedule, provided,

Conditions: This cover will exclude cost for any Anti-Retroviral Treatment.

8. EXCLUSIONS

8.1 Standard Exclusions

1. Investigation & Evaluation- Code- Excl04
a) Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment
are excluded.

2. Rest Cure, rehabilitation, and respite care- Code- Excl05

a) Expenses related to any admission primarily for enforced bed rest and not for receiving treatment.
This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of
daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled
persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.

3. Obesity/ Weight Control: Code- Excl06

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1) Surgery to be conducted is upon the advice of the Doctor.
2) The surgery/Procedure conducted should be supported by clinical protocols.
3) The member must be 18 years of age or older and
4) Body Mass Index (BMI).
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co- morbidities following
failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. coronary heart disease
iii. Severe Sleep Apnoea
iii. Uncontrolled Type2 Diabetes

4. Change-of-Gender treatments: Code- Excl07

Expenses related to any treatment, including surgical management, to change characteristics of the body to
those of the opposite sex.

5. Cosmetic or plastic Surgery: Code- Excl08

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

6. Hazardous or Adventure sports: Code- Excl09

Expenses related to any treatment necessitated due to participation as a professional in hazardous or
adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor
racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.

7. Breach of law: Code- Excl10

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

8. Excluded Providers: Code- Excl11

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

9. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences
thereof. Code- Excl12
10. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private
beds registered as a nursing home attached to such establishments or where admission is arranged wholly or
partly for domestic reasons. Code- Excl13

11. Dietary supplements and substances that can be purchased without prescription, including but not
limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of
hospitalization claim or day care procedure. Code- Excl14

12. Refractive Error: Code- Excl15

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

13. Unproven Treatments: Code- Excl16

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

14. Sterility and Infertility: Code- Excl17

Expenses related to sterility and infertility. This includes:
(i) Any type of contraception, sterilization
(ii) Assisted Reproduction services including artificial insemination and advanced reproductive
technologies such as IVF, ZIFT, GIFT, ICSI
(iii) Gestational
Surrogacy (iv)Reversal of
sterilization

15. Maternity: Code Excl18

i. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean
sections incurred during hospitalization) except ectopic pregnancy.
ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of
pregnancy during the policy period.

8.2 Specific Exclusions

1. Any medical treatment taken outside India.

2. Hospitalization for donation of any body organs by an Insured including complications arising from the
donation of organs.

3. Nuclear damage caused by, contributed to, by or arising from ionising radiation or contamination by
radioactivity from:
a. any nuclear fuel or from any nuclear waste; or
b. from the combustion of nuclear fuel (including any self-sustaining process of nuclear fission);
c. nuclear weapons material.
d. nuclear equipment or any part of that equipment.

4. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war,
commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or
nationalisation or requisition of or damage by or under the order of any government or public local authority.

5. Injury or Disease caused by or contributed to by nuclear weapons/materials.

6. Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder, or
as may be necessitated due to an accident.
 7. Treatment with alternative medicines or Treatment, experimental or any other treatment such as
acupuncture, acupressure, magnetic, osteopath, naturopathy, chiropractic, reflexology and aromatherapy.

8. Suicide, Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs
or alcohol) and any violation of law or participation in an event/activity that is against law with a criminal intent.

9. Vaccination or inoculation except as post bite treatment for animal bite.

10. Convalescence, general debility, “Run-down” condition, rest cure, Congenital external
illness/disease/defect.

11. Outpatient diagnostic, medical and surgical procedures or treatments, non-prescribed drugs and
medical supplies, hormone replacement therapy and expenses related to Domiciliary hospitalization shall not
be covered.

12. Dental treatment or Surgery of any kind unless requiring Hospitalisation as a result of accidental
Bodily Injury.

13. Venereal/ Sexually Transmitted disease other than HIV/AIDS.

14. Stem cell storage.

15. Any kind of service charge, surcharge levied by the hospital.

16. Personal comfort and convenience items or services such as television, telephone, barber or guest
service and similar incidental services and supplies.

17. Non-Payable items: The expenses that are not covered in this Policy are placed under List-I of
Annexure-II

18. 21. Any medical procedure or treatment, which is not medically necessary or not performed by a Doctor.

9. GENERAL TERMS & CLAUSES

9.1 Standard General Terms & Clauses

I. Condition Precedent to the contract

i. Disclosure of Information
The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of
misrepresentation, mis-description or non-disclosure of any Material Fact by the Policy Holder.

ii. Condition Precedent to Admission of Liability

The terms and conditions of the Policy must be fulfilled by the Insured Person for the Company to make
any payment for claim(s) arising under the Policy.

iii. Complete Discharge

Any payment to the Policy Holder, Insured Person or his/ her Nominees or his/ her legal representative or
to the Hospital/Nursing Home or Assignee, as the case may be, for any benefit under the Policy shall in all
cases be a valid discharge towards payment of claim by the Company to the extent of that amount for the
particular claim.
iv. Multiple Policies
a) In case of multiple policies taken by an Insured during a period from one or more Insurers to indemnify
treatment costs, the Insured Person shall have the right to require a settlement of his/her claim in
terms of any of his/her policies. In all such cases the Insurer chosen by the Insured Person shall be
obliged to settle the claim as long as the claim is within the limits of and according to the terms of the
chosen Policy.
b) Insured Person having multiple policies shall also have the right to prefer claims under this Policy for
the amounts disallowed under any other Policy / policies even if the Sum Insured is not exhausted.
Then the Insurer shall independently settle the claim subject to the terms and conditions of this Policy.
c) If the amount to be claimed exceeds the Sum Insured under a single Policy, the Insured Person shall
have the right to choose Insurer from whom he/she wants to claim the balance amount.
d) Where an Insured Person has policies from more than one Insurer to cover the same risk on indemnity
basis, the Insured Person shall only be indemnified the treatment costs in accordance with the terms
and conditions of the chosen Policy.
e) Under this product , no insured can take more than one policy from any or all insurers.

v. Fraud
If any claim made by the Insured Person, is in any respect fraudulent, or if any false statement, or
declaration is made or used in support thereof, or if any fraudulent means or devices are used by the
Insured Person or anyone acting on his/her behalf to obtain any benefit under this Policy, all benefits under
this Policy and the premium paid shall be forfeited.

Any amount already paid against claims made under this Policy but which are found fraudulent later shall
be repaid by all recipient(s)/Policy Holders(s), who has made the particular claim, who shall be jointly and
severally liable for such repayment to the Insurer.

For the purpose of this clause, the expression "fraud" means any of the following acts committed by the
Insured Person or by his agent or the Hospital/doctor/any other party acting on behalf of the Insured
Person, with intent to deceive the Insurer or to induce the Insurer to issue an insurance Policy:
a) the suggestion, as a fact of that which is not true and which the Insured Person does not believe to be
true;
b) the active concealment of a fact by the Insured Person having knowledge or belief of the fact;
c) any other act fitted to deceive; and
d) any such act or omission as the law specially declares to be fraudulent

The Company shall not repudiate the claim and/ or forfeit the Policy benefits on the ground of Fraud, if the
Insured Person / beneficiary can prove that the misstatement was true to the best of his knowledge and
there was no deliberate intention to suppress the fact or that such misstatement of or suppression of
Material Fact is within the knowledge of the Insurer.

vi. Cancellation
a) The Policy Holder may cancel this Policy by giving 15 days’ written notice and in such an event, the
Company shall refund premium for the unexpired Policy Period as per the rates detailed below:

Cancellation grid for Upfront Premium option

Within 1 month (first time health insurance Policy customers) Free look period cancellation

Within 1 month (Renewal Policy) 75%

Exceeding 1 months but less than or equal to 3 months 50%

 Exceeding 3 months but less than or equal to 6 months 25%

Exceeding 6 months but less than or equal to 12 months Nil

Note- For monthly premium payment frequency, no refund shall be applicable for cancellation of the Policy
except for Free Look period cancellation.

Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect
of cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by
the Insured Person under the Policy.

b) The Company may cancel the Policy at any time on grounds of misrepresentation, non-disclosure of
Material Facts, fraud by the Insured Person, by giving 15 days’ written notice. There would be no
refund of premium on cancellation on grounds of misrepresentation, non-disclosure of Material Facts
or Fraud.

vii. Migration:
The Insured Person will have the option to migrate the Policy to other health insurance products/plans
offered by the company as per extant Guidelines related to Migration. If such person is presently covered
and has been continuously covered without any lapses under any health insurance product/plan offered by
the company, as per Guidelines on migration, the proposed Insured Person will get all the accrued
continuity benefits in waiting periods as per below: i. The waiting periods specified in Section 5 shall be
reduced by the number of continuous preceding years of coverage of the Insured Person under the
previous health insurance Policy. ii. Migration benefit will be offered to the extent of sum of previous
insured and accrued bonus/multiplier benefit (as part of the base sum insured), migration benefit shall not
apply to any other additional increased Sum Insured.
kindly refer the link www.navi.com/Insurance

viii. Portability

Portability The Insured Person will have the option to port the Policy to other insurers as per extant
Guidelines related to portability, If such person is presently covered and has been continuously covered
without any lapses under any health insurance plan with an Indian General/Health insurer as per
Guidelines on portability, the proposed Insured Person will get all the accrued continuity benefits in waiting
periods as under:
i. The waiting periods specified in Section 5 shall be reduced by the number of
continuous preceding years of coverage of the Insured Person under the previous
health insurance Policy.
ii. ii. Portability benefit will be offered to the extent of sum of previous sum insured and
accrued bonus(as part of the base sum insured), portability benefit shall not apply to
any other additional increased Sum Insured.
kindly refer the link www.navi.com/Insurance

ix. Refund of Premium in case of Death of Insured

a) No refund shall be made if the policy is taken on Monthly Premium Mode.
b) In the event of death of any insured member during the course of policy period when there is no claim
lodged (and in the process to be paid) or paid during the policy period, the proportionate premium for
the unexpired policy period for the respective insured member will be paid to the nominee/other
existing policyholders.
c) In case claim(s) have been made on a policy, no refund shall be made in the event of death of any
insured member during the course of policy period.
 x. Renewal of Policy
The Policy shall ordinarily be renewable except on grounds of fraud, misrepresentation by the Insured
Person.
a) The Company shall endeavour to give notice for Renewal. However, the Company is not under
obligation to give any notice for Renewal.
b) Renewal shall not be denied on the ground that the Insured had made a claim or claims in the
preceding Policy Years.
c) Request for Renewal along with requisite premium shall be received by the Company before the end
of the Policy Period.
d) At the end of the Policy Period, the Policy shall terminate and can be renewed within the Grace Period
of 30 Days to maintain continuity of benefits without Break in Policy. Coverage is not available during
the Grace Period.
e) No loading shall apply on renewals based on individual claims experience.

xi. Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy including the
premium rates. The Insured Person shall be notified three months before the changes are affected.

xii. Free look period

The Free Look Period shall be applicable on new individual health insurance policies and not on Renewals
or at the time of porting/migrating the Policy. The Insured shall be allowed free look period of 1 month from
date of receipt of the Policy document to review the terms and conditions of the Policy, and to return the
same if not acceptable.
If the Insured has not made any claim during the Free Look Period, the Insured shall be entitled to:
● a refund of the premium paid less any expenses incurred by the Company on medical
examination of the Insured Person and the stamp duty charges or
● where the risk has already commenced and the option of return of the policy is exercised by the
insured person, a deduction towards the proportionate risk premium for period of cover or
● Where only a part of the insurance coverage has commenced, such proportionate premium
commensurate with the insurance coverage during such period

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

xiv. Withdrawal of Policy

(a) In the likelihood of this product being withdrawn in future, the Company will intimate the Insured
Person about the same 90 days prior to expiry of the Policy.
(b) Insured Person will have the option to migrate to similar health insurance product available with the
Company at the time of Renewal with all the accrued continuity benefits such as cumulative bonus,
waiver of waiting period. as per IRDAI guidelines, provided the Policy has been maintained without a
break.
 xv. Moratorium Period-
After completion of eight continuous years under the Policy no look back to be applied. This period of eight
years is called as moratorium period. The moratorium would be applicable for the sums Insured of the first
Policy and subsequently completion of 8 continuous years would be applicable from date of enhancement
of sums Insured only on the enhanced limits. After the expiry of Moratorium Period no health insurance
claim shall be contestable except for proven fraud and permanent exclusions specified in the Policy
contract. The policies would however be subject to all limits, sub limits, co-payments, deductibles as per
the Policy contract.

xvi. Claim Settlement (Provision of Penal Interest)

(a) The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt
of last necessary document.
(b) In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the Policy
Holder from the date of receipt of last necessary document to the date of payment of claim at a rate
2% above the bank rate.
(c) However, where the circumstances of a claim warrant an investigation in the opinion of the Company,
it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from
the date of receipt of last necessary document. In such cases, the Company shall settle or reject the
claim within 45 days from the date of receipt of last necessary document.
(d) In case of delay beyond stipulated 45 days, the Company shall be liable to pay interest to the Policy
Holder at a rate 2% above the bank rate from the date of receipt of last necessary document to the
date of payment of claim.
(e) “Bank rate” shall mean the rate fixed by the Reserve Bank of India (RBI) at the beginning of the
financial year in which claim has fallen due.

xvii. Redressal of Grievance

(a) ln case of any grievance the insured person may contact the company through:
Website: www.navi.com/Insurance
Toll free: +91 8147544555
E-mail: insurance.help@navi.com
Courier: Navi General Insurance Limited, Vaishnavi Tech Square, 7th Floor, Iballur Village, Begur
Hobli, Bengaluru, Karnataka- 560102

insured person may also approach the grievance cell at any of the company's branches with the
details of grievance.

(b) If Insured Person is not satisfied with the redressal of grievance through one of the above methods,
Insured Person may contact the grievance office Manager.CustomeExperience@navi.com
(c) For updated details of grievance officer, kindly refer the link - https://navi.com/insurance/contact-us.
For senior citizens, We have a special cell, and our senior citizen customers can email Us at
seniorcare@navi.com for priority resolution.
(d) If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured
Person may also approach the office of Insurance Ombudsman of the respective area/region for
redressal of grievance as per Insurance Ombudsman Rules 2017.
For all Ombudsman Offices & Addresses: please refer to List V under Annexure 1
(e) Grievance may also be lodged at IRDAI lntegrated Grievance Management System –
http://igms.irda.gov.in
9.2 Specific Terms & Conditions

I. Condition Precedent to the contract

a. Change of Sum Insured

Sum Insured can be changed (increase / decrease) only at the time of Renewal or at any time,
subject to underwriting by the Company. For any increase in Sum Insured, the waiting period shall
start afresh only for the enhance portion of the Sum Insured.

b. Material Change The Insured Person shall notify the Company in writing of any material
change in the risk in relation to the declaration made in the Proposal form or medical examination
report at each Renewal and the Company may, adjust the scope of cover and / or premium, if
necessary, accordingly.

c. Notice and Communication

i. Any notice, direction, instruction, or any other communication related to the Policy should
be made in writing.
ii. Such communication shall be sent to the address of the Company or through any other
electronic modes specified in the Policy Schedule.
iii. The Company shall communicate to the Insured at the address or through any other
electronic mode mentioned in the schedule/certificate of insurance.

d. Records to be Maintained. The Insured Person shall keep an accurate record

containing all relevant medical records and shall allow the Company or its representatives to
inspect such records. The Insured Person shall furnish such information as the Company may
require for settlement of any claim under the Policy, within reasonable time limit and within the
time limit specified in the Policy.
 e. Territorial Jurisdiction All disputes or differences under or in relation to the
interpretation of the terms, conditions, validity, construct, limitations and/or exclusions contained in
the Policy shall be determined by the Indian court and according to Indian law.

f. Eligibility Criteria
i. All Persons with Disability who have at least one of the disabilities as defined under
Specified Disability under The Rights Of Persons With Disabilities Act, 2016 with valid disability
certificate are eligible to enroll this product.
ii. Any person suffering from HIV/AIDS, with diagnostic test report confirming the evidence of
HIV/AIDS with minimum eligibility CD4 count 500 and above, during inception of the policy.

II. Conditions applicable during the contract

i. Alterations in the Policy

The Proposal Form, Policy Schedule constitute the complete contract of insurance. This Policy
constitutes the complete contract of insurance between the Policyholder and the Company. No
change or alteration will be effective or valid unless approved in writing which will be evidenced by
a written endorsement, signed, and stamped by Company. All endorsement requests will be made
by the Insured Person only. This Policy cannot be changed by anyone (including an insurance
agent or broker) except the Company.

ii. Revision and Modification of the Policy Product

i. Any revision or modification will be done with the approval of the Authority. We shall
notify You about revision /modification in the Policy including premium payable thereunder. Such
information shall be given to You at least ninety (90) days prior to the effective date of modification
or revision coming into effect.
ii. Existing Policy will continue to remain in force till its expiry, and revision will be applicable
only from the date of next renewal. Credit of continuity/waiting periods for all the previous policy
years would be extended in the new policy on Renewal with Us.

iii. Terms and conditions of the Policy

The terms and conditions contained herein and in the Policy Schedule be deemed to form part of
the Policy and shall be read together as one document.

Claims Process
(a) Completed claim form and other relevant documents including documents must be furnished to Us / TPA
within the stipulated timelines for reimbursement of all claims under this Policy. Failure to furnish this
documentation within the time required shall not invalidate nor reduce any claim if You can satisfy that it
was not reasonably possible for You to submit / give proof within such time.
(b) Cashless Facility and Reimbursement Claim processing shall be carried out through TPAs empanelled by
Us or in-house by Us, details of the same will be available on the Policy Schedule. For the latest list of
Network Providers, You can log on to Our mobile application/ Our website.

Claim Intimation:
If You meet with any Accident leading to Injury or suffer an Illness that may result in a claim under this
Policy, then as a Condition Precedent to Our liability, You must comply with the following claim procedures:
You must notify Your claim to Us through online channel
including mobile application that is available or at call centre.

Typeof
Notify Us
Hospitalisation

Planned Hospitalisation Immediately and in any event at least 48 hours prior to Your admission.

Emergency Within 24 hours of Your admission to Hospital or before discharge whichever is

Hospitalisation earlier

The following details may be required by Us at the time of intimation of Claim:

● Policy number/ member number
● Name of the Policy Holder
● Name of the Insured Person in whose relation the claim is being lodged
● Nature of Illness / Injury
● Name and address of the attending Medical Practitioner and Hospital
● Date of admission
● Any other information as requested by Us

Failure to intimate a claim within the time required shall not invalidate nor reduce any claim if You can
satisfy that it was not reasonably possible for You to intimate the claim within such time

Cashless Facility Claim Procedure:

Cashless Facility is available for Hospitalisation only at Our Network Provider. The Insured Person can
avail Cashless Facility at Network Provider, by presenting the health card as provided by Us with this
Policy, along with a valid photo identification proof (Voter ID card / Driving License / Passport / PAN Card /
Aadhar Card, any other identity proof as approved by Us)
(a) For Planned Hospitalisation:
i) The Insured Person should at least 48 hrs prior to admission to the Hospital approach the
Network Provider for Hospitalisation for Medical Necessary Treatment.
ii) Insured Person will need to provide health Card / Policy details at Hospital admission counter.
iii) The Network Provider may either consider treating the Insured Person by taking a token deposit
or treating as per their norms.
iv) The Network Provider shall electronically send the pre-authorization form along with all the
relevant details to Us or TPA along with contact details of the treating Medical Practitioner and
the Insured Person.
v) Wherever the information provided in the request is sufficient to ascertain the authorisation, the
authorisation letter will be issued to the Network Provider. Wherever additional information or
documents are required, the same will be called for from the Network Provider and upon
satisfactory receipt of last necessary documents the authorisation will be issued.
vi) If the procedure above is followed, on Our written authorization, You will not be required to
directly pay for the bill amount in the Network Hospital that We are liable under Section 3.1,
Hospitalization of the Policy.
vii) You must leave the original bills and evidence of treatment in respect of the Hospitalization with
the Network Provider and ensure to take photocopies of relevant medical records for future
reference. Pre-authorisation does not guarantee that all costs and expenses will be covered. We
reserve the right to review each claim for Medical Expenses and accordingly coverage will be
determined according to the terms and conditions of this Policy.
viii) At the time of discharge, Network Provider may request You to sign the final authorization letter
that was issued by Us.
 ix) The Network Provider shall refund the deposit amount
to You barring an amount to be charged for non-covered expenses, if any.

(b) In case of Emergency Hospitalisation:

i. The Insured Person may approach the Network Provider for Hospitalisation
ii. The Network Provider/ Insured Person shall follow the same process as explained above in
septs iii to viii above under section Planned Hospitalization.
It is possible that Cashless Facility may be denied for Hospitalisation due to insufficient Sum
Insured or insufficient information to determine admissibility in which case You/Insured Person
may be required to pay for the treatment and submit the claim for reimbursement to Us/ TPA
which will be considered subject to the Policy Terms & Conditions.

We, in Our sole discretion, reserve the right to modify, add or restrict any Network Provider for
Cashless Facility under the Policy. Before availing the Cashless Facility, the Policy Holder /
Insured Person is required to check the applicable/latest list of Network Providers on Our mobile
application/ Our website at www.navi.com/Insurance

Reimbursement Claim Procedure:

Wherever You have opted for a reimbursement of expenses, You may submit the documents for
reimbursement of the claim electronically including by direct upload on Our mobile application not later
than 15 days from the date of discharge from the Hospital. You can obtain a Claim Form from by
downloading a copy from Our website at www.navi.com/Insurance or from Our mobile application. The
necessary copies of claim documents to be submitted for reimbursement may include following: (a) duly
filled claim form; (b) discharge/ death Summary (as applicable); (c) operation theatre notes (if any); (d)
hospital main bill along with break up bill and original receipts; (e) investigation reports- Haematology,
Histo-pathology and Radiology; (f) doctors referral slips or prescription for investigations/pharmacy; (g)
pharmacy bills; (h) MLC/FIR report/post mortem report (if applicable and conducted); (i) details of the
implants including the sticker indicating the type as well as invoice towards the cost of implant; (j) KYC
documents (Photo ID proof, Pan Card, Aadhar Card); (k) Cancelled cheque for NEFT payment

We may call for any additional documents/information as required based on the circumstances of the
claims. To obtain the necessary medical records, You may also require to arrange a meeting between Our
representative and the Medical Practitioner and/or Hospital involved in Your medical care.

i. Physical Examination
You may require undergoing medical examination by a Medical Practitioner authorized by Us to examine
You to establish Our liability in case of a claim under the Policy. The cost towards performing such medical
examinations shall be borne by Us.

ii. Claim Related Information

You may submit a query related to the claim or intimate the claim or submit a claim document to Us
through Our mobile application. Alternatively, You may also contact Us through:
Website: www.navi.com/Insurance
Toll free: +91 8147544555
E-mail: insurance.help@navi.com
Annexure I

● Items which are mentioned under List – I are payable under the policy.
● Items which are to be subsumed into room charges are specified in List – II, procedure charges are
specified in List III, costs of treatment (including costs of diagnostics) specified in List IV.
● Items which are part of room / surgical procedure / treatment (including diagnostics) as referred in
the lists (II-IV) herein may not be eligible for coverage if billed separately by Hospital.

List I - TOILETRIES / COSMETICS / PERSONAL COMFORT OR CONVENIENCE ITEMS / SIMILAR EXPENSES

No. Item

1 BABY FOOD

2 BABY UTILITES CHARGES

3 BEAUTY SERVICES

4 BELTS/ BRACES

5 BUDS

6 COLD PACK/HOT PACK

7 CARRY BAGS

8 EMAIL / INTERNET CHARGES

9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL)

10 LEGGINGS

11 LAUNDRY CHARGES

12 MINERAL WATER

13 SANITARY PAD

14 TELEPHONE CHARGES

15 GUEST SERVICES
16 CREPE BANDAGE

17 DIAPER OF ANY TYPE

18 EYELET COLLAR

19 SLINGS

20 BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES

21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED

22 TELEVISION CHARGES

23 SURCHARGES

24 ATTENDANT CHARGES

25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS PART OF BED CHARGE)

26 BIRTH CERTIFICATE

27 CERTIFICATE CHARGES

28 COURIER CHARGES

29 CONVENYANCE CHARGES

30 MEDICAL CERTIFICATE

31 MEDICAL RECORDS

32 PHOTOCOPIES CHARGES

33 MORTUARY CHARGES

34 WALKING AIDS CHARGES

35 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)

36 SPACER

37 SPIROMETRE

38 NEBULIZER KIT

39 STEAM INHALER

40 ARMSLING

41 THERMOMETER

42 CERVICAL COLLAR

43 SPLINT

44 DIABETIC FOOT WEAR

45 KNEE BRACES ( LONG / SHORT / HINGED)

46 KNEE IMMOBILIZER / SHOULDER IMMOBILIZER

47 LUMBO SACRAL BELT

48 NIMBUS BED OR WATER OR AIR BED CHARGES

49 AMBULANCE COLLAR

50 AMBULANCE EQUIPMENT

51 ABDOMINAL BINDER

52 PRIVATE NURSES CHARGES - SPECIAL NURSING CHARGES

53 SUGAR FREE TABLETS

54 CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical pharmaceuticals
payable)

55 ECG ELECTRODES
56 GLOVES

57 NEBULISATION KIT

58 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC]

59 KIDNEY TRAY

60 MASK

61 OUNCE GLASS

62 OXYGEN MASK

63 PELVIC TRACTION BELT

64 PAN CAN

65 TROLLY COVER

66 UROMETER, URINE JUG

67 AMBULANCE

68 VASOFIX SAFETY

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

No. Item

1 BABY CHARGES (UNLESS SPECIFIED/INDICATED)

2 HAND WASH

3 SHOE COVER

4 CAPS

5 CRADLE CHARGES
6 COMB

7 EAU-DE-COLOGNE / ROOM FRESHNERS

8 FOOT COVER

9 GOWN

10 SLIPPERS

11 TISSUE PAPER

12 TOOTH PASTE

13 TOOTH BRUSH

14 BED PAN

15 FACE MASK

16 FLEXI MASK

17 HAND HOLDER

18 SPUTUM CUP

19 DISINFECTANT LOTIONS

20 LUXURY TAX

21 HVAC

22 HOUSE KEEPING CHARGES

23 AIR CONDITIONER CHARGES

24 IM IV INJECTION CHARGES

25 CLEAN SHEET
26 BLANKET/WARMER BLANKET

27 ADMISSION KIT

28 DIABETIC CHART CHARGES

29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES

30 DISCHARGE PROCEDURE CHARGES

31 DAILY CHART CHARGES

32 ENTRANCE PASS / VISITORS PASS CHARGES

33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE

34 FILE OPENING CHARGES

35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)

36 PATIENT IDENTIFICATION BAND / NAME TAG

37 PULSEOXYMETER CHARGES

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

No. Item

1 HAIR REMOVAL CREAM

2 DISPOSABLES RAZORS CHARGES (for site preparations)

3 EYE PAD

4 EYE SHEILD

5 CAMERA COVER
6 DVD, CD CHARGES

7 GAUSE SOFT

8 GAUZE

9 WARD AND THEATRE BOOKING CHARGES

10 ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS

11 MICROSCOPE COVER

12 SURGICAL BLADES, HARMONICSCALPEL,SHAVER

13 SURGICAL DRILL

14 EYE KIT

15 EYE DRAPE

16 X-RAY FILM

17 BOYLES APPARATUS CHARGES

18 COTTON

19 COTTON BANDAGE

20 SURGICAL TAPE

21 APRON

22 TORNIQUET

23 ORTHOBUNDLE, GYNAEC BUNDLE

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

No. Item

1 ADMISSION/REGISTRATION CHARGES

2 HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE

3 URINE CONTAINER

4 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES

5 BIPAP MACHINE

6 CPAP/ CAPD EQUIPMENTS

7 INFUSION PUMP– COST

8 HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC

9 NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES

10 HIV KIT

11 ANTISEPTIC MOUTHWASH

12 LOZENGES

13 MOUTH PAINT

14 VACCINATION CHARGES

15 ALCOHOL SWABES

16 SCRUB SOLUTION/STERILLIUM

17 Glucometer & Strips

18 URINE BAG

List V : List of Insurance Ombudsman

AHMEDABAD BENGALURU BHOPAL

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Office of the Insurance
Jeevan Prakash Building, 6th floor, Jeevan Soudha Building,PID No. Ombudsman, Janak Vihar Complex,
Tilak Marg, Relief Road, Ahmedabad 57-27-N19 Ground Floor, 19/19, 24th 2nd Floor, 6, Malviya Nagar, Opp.
– 380 001. Tel.: 079 - Main Road, JP Nagar, Ist Phase, Airtel Office, Near New Market,
25501201/02/05/06 Email: Bengaluru – 560 078. Tel.: 080 - Bhopal – 462 003.
bimalokpal.ahmedabad@cioins.co.i 26652048 / 26652049 Email: Tel.: 0755 - 2769201 / 2769202
n bimalokpal.bengaluru@cioins.co.in Fax: 0755 – 2769203 Email:
bimalokpal.bhopal@cioins.co.in

JURISDICTION: Gujarat, Dadra &

Nagar Haveli, Daman and Diu. JURISDICTION: Karnataka. JURISDICTION: Madhya Pradesh
Chattisgarh.

BHUBANESHWAR CHANDIGARH CHENNAI

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Office of the Insurance
62, Forest park, Bhubneshwar – 751 S.C.O. No. 101, 102 & 103, 2nd Ombudsman, Fatima Akhtar Court,
009. Tel.: 0674 Floor, Batra Building, Sector 17 – D, 4th Floor, 453, Anna Salai,
- 2596461 /2596455 Fax: 0674 – Chandigarh – 160 Teynampet, Chennai – 600 018.
2596429 Email: 017. Tel.: 0172 - 2706196 / Tel.: 044 - 24333668 / 24335284
bimalokpal.bhubaneswar@cioins.c 2706468 Fax: 0172 - 2708274 Fax: 044 - 24333664 Email:
o.in Email: bimalokpal.chennai@cioins.co.in
bimalokpal.chandigarh@cioins.co.i
n

JURISDICTION: Orissa JURISDICTION: Tamil Nadu, Tamil

Nadu Puducherry Town and Karaikal
JURISDICTION: Punjab, Haryana (which are part of Puducherry).
(excluding Gurugram, Faridabad,
Sonepat and Bahadurgarh)
Himachal Pradesh, Union Territories
of Jammu & Kashmir, Ladakh &
Chandigarh
DELHI ERNAKULAM GUWAHATI

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Office of the Insurance
2/2 A, Universal Insurance Building, 2nd Floor, Pulinat Bldg., Opp. Ombudsman, Jeevan Nivesh, 5th
Asaf Ali Road, New Delhi – 110 002. Cochin Shipyard, M. G. Road, Floor, Nr. Panbazar over bridge,
Tel.: 011 - 23232481/23213504 Ernakulam - 682 015. Tel.: S.S. Road, Guwahati –
Email: 0484 - 2358759 / 2359338 Fax: 781001(ASSAM). Tel.: 0361 -
bimalokpal.delhi@cioins.co.in 0484 - 2359336 Email: 2632204 / 2602205 Email:
bimalokpal.ernakulam@cioins.co.i bimalokpal.guwahati@cioins.co.in
n

JURISDICTION: Delhi & Following

Districts of Haryana - Gurugram, JURISDICTION: Assam,
Faridabad, Sonepat & Bahadurgarh. JURISDICTION: Kerala, Meghalaya, Manipur, Mizoram,
Lakshadweep, Mahe-a part of Arunachal Pradesh, Nagaland and
Union Territory of Puducherry. Tripura.

HYDERABAD JAIPUR KOLKATA

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Office of the Insurance
6-2-46, 1st floor, "Moin Court", Lane Jeevan Nidhi – II Bldg., Gr. Floor, Ombudsman, Hindustan Bldg.
Opp. Saleem Function Palace, A. C. Bhawani Singh Marg, Jaipur - 302 Annexe, 4th Floor, 4, C.R. Avenue,
Guards, Lakdi-Ka-Pool, Hyderabad - 005.Tel.: 0141 - 2740363 Email: KOLKATA - 700 072. Tel.: 033 -
500 bimalokpal.jaipur@cioins.co.in 22124339 / 22124340 Fax : 033 –
004. Tel.: 040 – 23312122 Fax: 040 22124341 Email:
- 23376599 Email: bimalokpal.kolkata@cioins.co.in
bimalokpal.hyderabad@cioins.co.in

JURISDICTION: Rajasthan.
JURISDICTION: West Bengal,
JURISDICTION: Andhra Pradesh, Sikkim, Andaman & Nicobar Islands.
Telangana, Yanam and part of Union
Territory of Puducherry
LUCKNOW NOIDA MUMBAI

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Office of the Insurance
6th Floor, Jeevan Bhawan, Phase-II, Bhagwan Sahai Palace 4th Floor, Ombudsman, 3rd Floor, Jeevan
Nawal Kishore Road, Hazratganj, Main Road, Naya Bans, Sector 15, Seva Annexe, S. V. Road,
Lucknow - 226 Distt: Gautam Buddh Nagar, Santacruz (W), Mumbai - 400 054.
001. Tel.: 0522 - 2231330 / 2231331 U.P-201301. Tel.: 0120-2514252 / Tel.: 022 - 26106552 / 26106960
Fax: 0522 - 2231310 Email: 2514253 Email: Fax: 022 – 26106052 Email:
bimalokpal.lucknow@cioins.co.in bimalokpal.noida@cioins.co.in bimalokpal.mumbai@cioins.co.in

JURISDICTION: Districts of Uttar JURISDICTION: State of JURISDICTION: Goa, Mumbai

Pradesh Lalitpur, Jhansi, Mahoba, Uttaranchal and the following Metropolitan Region excluding Navi
Hamirpur, Banda, Chitrakoot, Districts of Uttar Pradesh: Agra, Mumbai & Thane.
Allahabad, Mirzapur, Sonbhabdra, Aligarh, Bagpat, Bareilly, Bijnor,
Fatehpur, Pratapgarh, Budaun, Bulandshehar, Etah,
Jaunpur,Varanasi, Gazipur, Jalaun, Kanooj, Mainpuri, Mathura, Meerut,
Kanpur, Lucknow, Unnao, Sitapur, Moradabad, Muzaffarnagar,
Lakhimpur, Bahraich, Barabanki, Oraiyya, Pilibhit, Etawah,
Raebareli, Sravasti, Gonda, Farrukhabad, Firozbad,
Faizabad, Amethi, Kaushambi, Gautambodhanagar, Ghaziabad,
Balrampur, Basti, Ambedkarnagar, Hardoi, Shahjahanpur, Hapur,
Sultanpur, Maharajgang, Shamli, Rampur, Kashganj,
Santkabirnagar, Azamgarh, Sambhal, Amroha, Hathras,
Kushinagar, Gorakhpur, Deoria, Mau, Kanshiramnagar, Saharanpur.
Ghazipur, Chandauli, Ballia,
Sidharathnagar.

PUNE PATNA

Office of the Insurance Ombudsman, Office of the Insurance

Jeevan Darshan Bldg., 3rd Floor, Ombudsman, 1st Floor,Kalpana
C.T.S. No.s. 195 to 198, N.C. Kelkar Arcade Building, Bazar Samiti Road,
Road, Narayan Peth, Pune – 411 Bahadurpur, Patna 800 006.
030. Tel.: 020- Tel.: 0612-2680952 Email:
41312555 Email: bimalokpal.patna@cioins.co.in
bimalokpal.pune@cioins.co.in

JURISDICTION: Bihar, Jharkhand.

JURISDICTION: Maharashtra, Area
of Navi Mumbai and Thane excluding
Mumbai Metropolitan Region.