Prospectus

This is a Micro-insurance product designed for the lower income group of the society. This policy has 3 sections Section –I covers building and contents, Section –II covers hospitalization expenses of the family. Section –III provides Personal Accident cover to the insured and his/her spouse.

SECTION – I
BUILDING AND CONTENTS ( Excluding Jewellery and Valuables )
The Company will indemnify the Insured in respect of loss of or damage to the Contents/Buildings whilst contained in the insured premises by :

a) Fire, Lightning, Explosion of gas in domestic appliances
b) Bursting and overflowing of water tanks, apparatus or pipes
c) Aircraft or articles dropped therefrom
d) Riot, Strike or Malicious Act
e) Earthquake (Fire and/or Shock) subsidence and Landslide (including Rockslide) damage
f) Flood, Inundation, Strom, Tempest, Typhoon, Hurricane, Tornado or Cyclone
g) Impact damage
EXTENSION

The Insurance by this policy applies also to contents in so far as such property is not otherwise insured whilst temporarily removed and during transit as accompanied baggage anywhere in India to other premises used for temporary residence by the Insured or any member of the Insured’s family permanently residing with him or other premises wherein the Insured shall have placed any of such property in safe custody during his temporary absence from the insured premises during any period or periods not exceeding in the aggregate One Hundred and Twenty (120) days in any one period of insurance provided that the liability of the Company in respect of property so removed shall not exceed one-tenth of the total Sum Insured under this section.

SPECIAL EXCEPTIONS

The Company shall not be liable in respect of :

a) Loss or damage by burglary and/or housebreaking or theft where any member of the Insured’s family is concerned as principal or accessory.
b) Loss of or damage to articles of consumable nature.
c) Loss of or damage to money securities stamps stamp collections bullion livestock motor vehicles and pedal cycles.
d) Loss of or damage to deeds bonds bills of exchange promissory notes shares and stock certificates business books manuscripts documents of any kind unset precious stones and Jewellery and Valuable.
e) The first Rs.2500/- or 21/2% of the Sum Insured whichever is less of each and every loss arising under sub-section (1)‘f’ hereof.

SECTION II : Hospitalisation Expenses

1.1 Subject to the terms, conditions, exclusions and definitions contained herein or endorsed or otherwise expressed hereon, the Company undertakes that if during the period stated in the Schedule any Insured Person shall contract any disease or suffer from any illness (herein after called DISEASE) or sustain any bodily injury through accident (hereinafter called INJURY) and if such disease or injury shall require any such insured person upon the advice of a duly qualified Physician/Medical Specialist/Medical Practitioner (hereinafter called MEDICAL PRACTITIONER) or of a duly qualified Surgeon ( hereinafter called SURGEON) to incur Hospitalisation Expenses for Medical/Surgical treatment at any Nursing Home/Hospital in India as herein defined (hereinafter called HOSPITAL) as an inpatient the Company will pay through TPA to the Hospital / Nursing Home or Insured person the amount of such expenses subject to limits as are reasonably and necessarily incurred in respect thereof by or on behalf of such Insured Person but not exceeding the Sum Insured for that person/family (all claims in aggregate) in one period of Insurance stated in the schedule hereto.

1.2 In the event of any claim becoming admissible under this scheme, the company will pay through TPA to the Hospital/ Nursing Home or insured person the amount of such expenses as would fall under different heads as are reasonably and necessarily incurred thereof by or on behalf of such insured person.

Hospitalisation Benefits
A Room, Boarding expenses as provided by the Hospital/Nursing Home
B Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses
C Anesthesia, Blood, Oxygen, OT charges, Surgical appliances, Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs.
1.3 Maternity Expenses Benefit Extension:

The maximum benefit allowable under this clause will be up to Rs.1, 000/- for Normal Delivery and 3500/- for caesarean delivery of the insured/spouse only.

Special conditions applicable to maternity expenses benefit extension.
i) These benefits are applicable only if the expenses are incurred in hospital/nursing home as inpatient in India.
ii) A waiting period of nine months is applicable for payment of and claim relating to normal delivery or caesarean section or abdominal operation for extra uterine pregnancy. This waiting period may be relaxed only in the case of delivery, miscarriage or abortion induced by accident or other medical emergency

iii) Claims in respect of deliveries for only first two children and/or operations associated therewith will be considered in respect of any one Insured person covered under the policy or any renewal thereof. Those insured person who are already having two or more living children will not be eligible for this benefit

iv) Expenses incurred in connection with voluntary medical termination of pregnancy during the first twelve (12) weeks from the date of conception are not covered.

v) Pre-natal and post-natal expenses are not covered unless admitted in hospital/nursing home and treatment is taken there.

2. DEFINITIONS :

2.1 Hospital/Nursing Home‚ means any institution in India established for indoor care and treatment of disease and injuries and which either
(a) Has been registered either as a hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified medical practitioner
OR
(b) Hospital/ Nursing Home run by Government.
OR
(c) Should comply with minimum criteria as under:
i. It should have at least 15 inpatient beds. In Class "C" town having population of less than five lakhs the number of beds be reduced to 10.

ii. Fully equipped Operation Theatre of its own wherever surgical operations are carried out.

iii.Fully qualified nursing staff under its employment round the clock

iv. Fully qualified doctor(s) should be in charge round the clock

2.1.1 The term‚ `Hospital/Nursing Home’‚ shall not include an establishment which is a place of rest, a place for the aged, a place for drug addiction or place of alcoholics, a hotel or a similar place.
2.2 Surgical Operation means manual and/or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life
2.3 Expenses of Hospitalisation for minimum period of 24 hours are admissible. However this time limit is not applied to specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Lithotripsy (Kidney Stone removal), D & C, Tonsillectomy taken in the Hospital/Nursing Home and the Insured is discharged on the same day. The treatment will be considered under Hospitalisation Benefit. This condition will also not apply in case of stay in Hospital of less than 24 hours provided

a) The treatment is such that it necessitates hospitalization and the procedure involves specialized infrastructural facilities available in hospitals.

b) Due to technological advances hospitalization is required for less than 24 hours only.

3.0 Any One Illness will be deemed to mean continuous period of illness and it includes relapse within 60 days from the date of last consultation with the Hospital/Nursing Home where treatment may have been taken. Occurrence of same illness after a lapse of 60 days as stated above will be considered as fresh illness for the purpose of this policy.

3.3 Medical Practitioner means a person who holds a degree/diploma from a recognised institution and is registered by the Medical Council of India or the respective State Councils. The term Medical Practitioner would include Physician, Specialist and Surgeon.

3.4 Qualified Nurse means a person who holds a certificate of a recognised Nursing Council and who is employed on the recommendations of the attending Medical Practitioner.

3.5 TPA means a Third Party Administrator who is licensed by the Insurance Regulatory and Development Authority, and is engaged, for a fee or remuneration, by whatever name called as may be specified in the agreement with the company, for the provision of health services.

3.6 Pre-esixting Disease means any ailment / disease / injury that the person is suffering from (known / not known, treated, un-treated, declared or not declared in the proposal) whilst taking the policy. Any complications arising from pre existing ailment / disease/ injury will be considered as “pre-existing disease”.

3.7 Family means Insured, Spouse & two dependant children up to 21 years

4 Exclusions

The Company shall not be liable to make any payment under this Policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of :
4.1 Injury or disease directly or indirectly caused by or arising from or attributable to War Invasion Act or Foreign Enemy Warlike operations (whether war be declared or not).
4.2 Circumcision unless necessary for treatment or a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to as accident or as part of any illness.
4.3 The cost of spectacles, contact lenses and hearing aids.
4.4 Any Dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from disease or injury and which requires hospitalization for treatment.
4.5 Convalescence general debility `Run Down’ condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol.
4.6 All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotrophic Virus Type III (HTLB-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or variations Deficiency Syndrome or any Syndrome or condition or a similar kind commonly referred to as AIDS.
4.7 Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence of presence of any ailment, sickness or injury for which confinement is required at a Hospital/Nursing Home.
4.8 Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.
4.9 Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
4.10 Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these including caesarean section.
4.11 Naturopathy treatment
4.12 All diseases / injuries which are pre existing when the cover incepts for the first time. However these diseases will be covered after three continuous claim free policy years.
4.13 Any disease other than those stated in clause 4.14 hereinbelow, contracted by the insured during the first 30 days from the commencement date of the policy. This exclusion shall not however apply in case of the insured person having been covered under any health insurance policy of any Indian Insurance Company for a continuous period of preceeding 12 months.
Note: These exclusions 4.12 & 4.13 shall not however apply if (a) in opinion of the panel of medical practitioners constituted by the Company the insured person could not have known the existence of the disease or any symptoms or complaints thereof at the time of making the proposal for insurance to the Company. (b) Insured had not taken any consultation, treatment or medication in respect of disease for which claim has been lodged under the policy prior to taking the insurance.
4.14 During the first year operation of the policy the expenses incurred on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia of Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in Anus, Piles, Sinusitis and related disorders are not payable.

Section-III PERSONAL ACCIDENT
This Section witnesseth that subject to the terms exclusions definitions and conditions contained herein or endorsed or otherwise expressed hereon the Company will indemnify the Insured and spouse and /or assignee as hereinafter mentioned.
If the Insured shall sustain any bodily injury resulting solely and directly from Accident caused by outward violent and visible means, then the Company shall pay to the Insured the sum hereinafter set forth that is to say :-
(a) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the death of the Insured the capital sum insured stated in the Schedule. The amount payable under this clause shall be paid to the Assignee shown in the Schedule.
(b) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of both eyes or total and irrecoverable loss of use of two hands or two feet, or of one hand one foot or of such loss of sight of one eye and such loss of use of one hand or one foot, the capital sum insured stated in the Schedule hereto.
(c) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of one eye or total and irrecoverable loss of use of a hand or foot, fifty percent of the capital sum insured stated in the Schedule hereto.
(d) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of permanently totally and absolutely disabling the Insured from engaging in, being occupied with or giving attention to any employment of occupation of any description whatsoever the capital sum insured stated in the Schedule. PROVISIONS

Provided always that the Company shall not be liable under this Policy for :-
(i) Compensation under more than one of the Sub-clauses (a), (b), (c) or (d) in respect of same injury or disablement.
1. Payment of compensation in respect of injury or disablement directly or indirectly arising out of or contributed to by or traceable to any disability existing on the date of issue of this Policy.
2. Payment of compensation in respect of death, injury or disablement of the Insured from (a) intentional self-injury, suicide or attempted suicide (b) whilst under the influence of intoxicating liquor or drugs (c) directly or indirectly caused by insanity (d) arising or resulting from the Insured committing any breach of the law with criminal intent.
3. Payment or compensation in respect of death, injury or disablement of the Insured due to or arising out of or directly or indirectly connected with or traceable to war, invasion, act of foreign enemy, hostilities (whether war be declared or not) civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, seizure, capture, arrests, restraints and detainments of all kings, princes, and people of what nation, condition or quality soever.
4. Payment of compensation in respect of death of or bodily injury to the Insured directly or indirectly caused by or contributed to by or arising from or traceable to ionizing radiation or contamination by radioactivity from any source whatsoever, or from nuclear weapons material.
Provided also that the due observance and fulfilment of the terms and conditions of this Policy (which conditions and all endorsements hereon are to be read as part of this Policy) shall so far as they relate to anything to be done or not to be done by the Insured be a condition precedent to any liability of the Company under this Policy.


CONDITIONS
1. Upon the happening of any event which may give rise to a claim under this Policy the Insured shall forthwith give notice thereof to the Company.
2. Proof satisfactory to the Company shall be furnished of all matters upon which a claim is based. Any medical or other agent of the Company shall be allowed to examine the person of the Insured on the occasion of any alleged injury or disablement when and so often as the same may reasonably be required on behalf of the Company. Provided that in the case of valid claim arising under sub-clause (a), (b) or (d) all sums payable hereunder shall be payable only on the delivery of this Policy cancelled and discharged.
3. No sum payable under this Policy shall carry interest.
4. The Company shall not be liable to make any payment under this Policy in respect of any claim if such claim be in any manner fraudulent or supported by any fraudulent statement or device, whether by the Insured or by any person on behalf of the Insured.

Conditions applicable to Sections –I & II :

1. Every notice of communication to be given or made under this policy shall be delivered in writing at the address of the TPA office as shown in the Schedule.
2. The premium payable under this policy shall be paid in advance. No receipt for premium shall be valid except on the official form of the Company signed by the duly authorised official of the Company. The due payment of premium and the observance and fulfillment of the terms provisions conditions and endorsement of this policy by the Insured person in so far as they relate to anything to be done or complied with by the Insured Person shall be condition precedent to any liability of the Company to make any payment under this policy. No waiver of any terms provisions conditions and endorsement on this policy shall be valid unless made in writing and signed by an authorised official of the Company.
3. Upon the happening of any event, which may give rise to a claim under this policy notice with full particulars shall be sent to the TPA named in the Schedule immediately and in case of emergency within 24 hours of Hospitalization.
4. All supporting documents relating to the claim must be filed with TPA within 7 days from the date of discharge from the hospital.
NOTE: Waiver of this condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the TPA/Company that under the circumstances which the Insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time limit.
5. The Insured person shall obtain and furnish the TPA with all original bills, receipts and other documents upon which a claim is based and shall also give the TPA such additional information and assistance as the TPA/Company may require in dealing with the Claim.
6. Any Medical Practitioner authorised by the TPA/Company shall be allowed to examine the Insured person/records of the hospital in case of any alleged injury or disease requiring hospitalisation when and so often as the same may reasonably be required on behalf of the TPA/Company.
7. In case of death of earning member of the family due to accident a post-mortem report must be submitted along with other documents of proof of death.
8. The Company shall not be liable to make any payment under this policy in respect of any claim
a. If the Policy has been obtained by misrepresentation of material facts;
b. If such claim be in any manner be fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his behalf.
9. If at the time when any claim arises under this policy there is in existence any other insurance (other than Cancer Insurance policy in collaboration with Indian Cancer Society) whether it be effected by or on behalf of any insured person in respect of whom the claim may have arisen covering the same loss, liability, compensation, costs or expenses the Company shall not be liable to pay or contribute more than its ratable proportion of any loss, liability, compensation, costs or expenses. The benefits under this policy shall be in excess of the benefits available under the Cancer Insurance Policy.
10. The Policy may be renewed be mutual consent. The Company shall not however be bound to give notice that it is due for renewal and the Company may at any time cancel this policy by sending the Insured 30 (thirty) days notice by Registered Letter at Insured's last known address and in such event the Company shall refund to the Insured a prorata premium for unexpired period of Insurance The Company shall however, remain liable for any claim which arise prior to the date of cancellation The Insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Company's Short period rate only (table given here below) provided no claim has occurred up to the date of cancellation.

Period of risk	Rate of premium to be charged
Up to 1month	1/4 of the annual rate
Up to 3 months	1/2 of the annual rate
Up to 6 months	3/4 of the annual rate
Exceeding 6 months	Full annual rate

11. If any dispute or difference shall arise as to the quantum to be paid under the Policy, (liability being otherwise admitted) such difference shall independently of all other questions, be referred to the decision of a sole arbitrator to be appointed in writing by the parties here to or if they can not agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.
It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of this Policy.
It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this Policy that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.
12. If the TPA/Company shall disclaim liability to the Insured for any claim hereunder and if the Insured shall not within 12 calendar months from the date of receipt of the notice of such disclaimer notify the Company in writing that he does not accept such disclaimer and intends to recover his claim from the Company, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.
13. All medical surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency.
14. Claims Minimisation Clause : The Insured will at all times cooperate with a TPA / Company to contain claims ratio by ensuring that the treatment charges and other expenses are reasonable and necessary and will be subject to further sub-limits as may be required.
SUM INSURED: Section-I : Rs.10000 for dwelling house + contents
Section-II : Rs. 10000(on family floater basis)
Section-III : Rs.10000 each for insured & spouse

Age of insured/insured persons: 3 months to 60 years
PREMIUM: Rs.146 + Service Tax, if any