Formerly Known As Max Bupa Health Insurance Co. Ltd.

Date: 25/04/2024
Policy Number: 33758721202400

Customer ID: 2003219154
MR. SUMEET PRAKASH BATHIYA

S-O PRAKASH BATHIYA SAMARTH NAGAR PLOT NO 86,
UTTAM,
AURANGABAD,
MAHARASHTRA - 431001
Mobile: XXXXXX4572
Subject : Niva Bupa Health Insurance Policy No. 33758721202400
Dear MR. SUMEET PRAKASH BATHIYA,
Thank you for choosing Niva Bupa as your preferred health insurance partner. At Niva Bupa, we put your health first and are committed to provide
you access to the very best of healthcare, backed by the highest standards of service.
Please find enclosed your Niva Bupa Policy kit which will help you understand your policy in detail and give you more information on how to access
our services easily. Your Policy kit includes the following:
• Personalized Health Card: To access our wide range of hospitals for cashless hospitalization.
• Insurance Certificate: Confirming your specific policy details like date of commencement, persons covered and specific conditions related to
your plan.
• Premium Receipt: Receipt issued for the premium paid by you.
• Policy Terms and Conditions: For a clear understanding of policy coverages and exclusions.
• Proposal Form: This is a copy of the proposal form as per the information provided by you. Do inform us immediately in case there is any change
in the details mentioned therein.
• Annexure of Policyholder Servicing Turnaround Times as prescribed by Insurance Regulatory and Development Authority (IRDA)
Do visit us online at www.nivabupa.com to view and download our updated list of network hospitals in your city, download claim forms and for other
useful information. You can register with us online using your policy number, date of birth & email id and access your policy details. In case of any
further assistance, call us at 1860-500-8888 (customer helpline number) or raise a request using our self-service platform, Insta Assist by clicking:
https://rules.nivabupa.com/customer-service/.
We request you to read your policy terms and conditions carefully so that you are fully aware of your policy benefits. For benefits related to section
80D, please consult your tax advisor.
Assuring you of our best services and wishing you and your loved ones good health always.
Yours Sincerely,
Director - Operations & Customer Service

For and on behalf of Niva Bupa Health Insurance Co. Ltd.
(Formerly known as Max Bupa Health Insurance Co. Ltd.)
Important - Please read this document and keep in a safe place.
Product Name: Aspire, Product UIN: NBHHLIP24129V012324 | Add-on Name: Fast Forward; Add-on UIN: NBHHLIA24126V012324
POLICY SERVICING Turnaround time*
(Calendar Days)
Processing of Proposal and Communication of decisions – from the date
of receipt of proposal form 15 Days
Providing copy of the proposal – from the date of acceptance of risk 30 Days
Post Policy issue service requests – from the date of receipt of service
10 Days
request
Proposal refund in case of cancellation – from the date of decision of
15 Days
the proposal
Request for policy cancellation with free-look period– from the date of
15 Days
receipt of service request
CLAIM SERVICING Turnaround time*

(Calendar Days)
From the date of receipt of last necessary document (no investigation) 30 Days
From the date of receipt of last necessary document (with investigation) 45 Days
GRIEVANCE HANDLING Turnaround time*

(Calendar Days)
Acknowledge a grievance – from the date of receipt of grievance 3 Days
Resolve a grievance– from the date of receipt of grievance 14 Days
*Turnaround time will start from the date of receipt of complete documents at Niva Bupa Health Insurance Company Ltd.
Product Name: Heartbeat | Product UIN: MAXHLIP20065V051920
Product
ProductName: Health Aspire
Name: Assurance| Product
| Product UIN:
UIN:IRDAI/HLT/MBHI/P-H/V.II/175/2016-17
NBHHLIP24129V012324
Aspire Insurance Certificate
Policyholder Name: MR. SUMEET PRAKASH BATHIYA Policy Number 33758721202400

Policyholder Address: Policy Commencement Date and Time From 06/02/2024 00:00
S-O PRAKASH BATHIYA SAMARTH NAGAR PLOT NO 86, Policy Expiry Date and Time To 05/02/2027 23:59
UTTAM, Base Sum Insured INR 10,00,000
AURANGABAD, Variant Opted Titanium+
MAHARASHTRA - 431001 Plan Opted Family Floater

Policy Period 3 Years
Details of Electronic Insurance Account (eIA) Renewal / Payment Due Date 05/02/2027
eIA Number None Reported claims in the policy since 0

inception
Insurance Repository Name None
Cover Details
Name of the Insured Base Sum Sum Insured Booster+ Sum Insured M-iracle Personal Cash-Bag
Person(s) Insured (INR) Safeguard+ Sum Insured (Base Sum Booster+ Accident opted Amount
(INR) (INR) Insured + Sum Sum Insured
Insured
Safeguard/
Safeguard+
+Booster+ Sum
Insured) (INR)
Mr. Sumeet Prakash 10,00,000 0 0 10,00,000 0 0 0

Bathiya
Mrs. Khushboo 0
Sumeet Bathiya
.
Premium Details
Net Integrated Central State/UT Goods Loading Gross Premium Gross Premium (INR)
Premium/Taxa Goods and Goods and and Service Tax (INR) (in words)
ble Value Service Tax Service Tax (9.00 %)
(INR) (18.00%) (9.00 %)
48,738.00 0.00 4,386.42 4,386.42 0.00 57,511.00 Fifty-Seven Thousand Five Hundred
Eleven Only
Nominee Details
Nominee Name Relationship with the Policyholder
Khushboo Sumeet Bathiya Spouse
Intermediary Details
Intermediary Name Intermediary Code Intermediary Contact No.

Archana Prabhakar AUR01201977 8446465629
Wanaskar - Aur01201977
Claim Administrator Servicing Branch Details
Niva Bupa Health Insurance Company Limited Niva Bupa Health Insurance co. Ltd. 209,Yash Tower, Second floor,
Rokadiya Hanuman Colony, Opp Bsnl Office(Tar Bhavan) - Aurangabad Maharashtra
Contact Details For Registering Borderless Claim: Pin-431001
Europ Assistance
24*7 Emergency Contact For +91 22 6787 2092
Email ID: nivabupa@europ-assistance.in
Niva Bupa Health Insurance

Contact No: 1860-500-8888;
Fax No.: 011- 30902010
Email ID: nivabupa@europ-assistance.in
Optional Benefit/Feature Details
Particulars Details
Hospital Cash INR 2,000/day; for maximum up to 30 days
Safeguard+ Yes
Personal Accident Not Opted
Smart Health+ (Disease Management) (Add-on) Not Opted
Smart Health+ (Acute Care) (Add-on) Not Opted
Pre Existing Disease Waiting Time Modification Not Opted
Co-payment Not Opted
Room Type Modification Not Opted
Annual Aggregate Deductible Not Opted
Tiered Network Not Opted
Future Ready Not Opted
Fast Forward (Add-on) Yes
Borderless Not Opted
Cash-Bag Not Opted
WellConsult (OPD) Not Opted
Product Benefit Table1
Expenses in Reaching Hospital • Road Ambulance: Up to Sum Insured

• Air Ambulance: Up to Sum Insured
Expenses During Hospitalization (Covers AYUSH) Covered up to Sum Insured for 2+ hours of Hospitalization. (24+ hours for Ayush
Treatment)
Modern Treatments Covered up to Sum Insured.
Expenses Before and After a Hospitalization Covered up to Sum Insured.
60 Days and 180 Days Respectively
Home Care/Domiciliary Covered up to Sum Insured

Organ Donor Covered up to Sum Insured
Annual Health Check-up (Only Cashless) Covered for defined list of tests
• ReAssure "Forever": First claim paid triggers ReAssure, forever. It is unlimited.

ReAssure+ Each claim under ReAssure "Forever" will be up to Base Sum Insured.
• Lock the Clock+: Pay premiums as per your entry age, till a claim is paid.
Booster+ Carry forward unutilized sum Insured Maximum up to 10X times of Base Sum
Insured
• Covered up to INR 12,000
M-iracle Waiting Period of 9 Months Applicable.
• Carry forward unutilized M-iracle. Sum Insured, maximum up to 10X times of
M-iracle Sum Insured
Live Healthy Up to 30% Discount on Renewal premium basic steps taken.
Second Medical Opinion Unlimited times in a Policy Year (network only)
e-consultation Unlimited e-consultation within our network
1
The details of the benefits will change depending upon the plan opted. All the benefits are on per Policy Year basis, if otherwise not mentioned.
Insured Person Details
Name of the Insured Person (s) Age (in Years) Insured DOB Gender Relationship Pre-existing Disease# Personal
Waiting Period*
Mr. Sumeet Prakash Bathiya 31 18/03/1992 Male Applicant None None
Mrs. Khushboo Sumeet Bathiya 31 16/09/1992 Female Spouse None None
#
( -Pre existing Disease as disclosed by You / Insured Person or discovered by us during medical underwriting)
(* - Please refer to Policy terms & Conditions for details)
Permanent Exclusion (if any):
None
Pursuant to Notification no 13/2020- Central Tax and Notification no 14/2020- Central Tax both dated 21st March 2020 read with rule 54 (2) of
CGST Rules 2017, the provisions of E Invoicing & QR code are not applicable to an Insurance company, hence E Invoice number and QR code has not
been printed on this document. GST under RCM: NIL
GSTI No.: 27AAFCM7916H1Z8 SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 27 Customer State Code / Customer GSTI No.: 27 /NA
Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
Location: New Delhi Director - Operations & Customer Service

Date: 25/04/2024 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)
Premium Receipt - Aspire
Dear MR. SUMEET PRAKASH BATHIYA
S-O PRAKASH BATHIYA SAMARTH NAGAR PLOT NO 86
UTTAM
AURANGABAD
MAHARASHTRA - 431001
We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policyholder Name Mr. Sumeet Prakash Bathiya Policy Number 33758721202400
Product Name Aspire Plan Opted Family Floater Base Sum Insured 10,00,000
Policy Commencement Date # 06/02/2024 Policy Expiry Date 05/02/2027
Premium Calculation:
Premium (Rs.) - Base Product 42,007.00
Premium (Rs.) - Hospital Cash 2,730.00
Premium (Rs.) - Safeguard+ 5,120.00
Underwriting Loading (Rs.) 0.00
Net Premium / Taxable value (Rs.) 48,738.00
Integrated Goods and Service Tax (18.00 %) 0.00
Central Goods and Service Tax (9.00 %) 4,386.42
State/UT Goods and Service Tax (9.00 %) 4,386.42
Gross Premium (Rs.) 57,511.00

#
Issuance of policy is subject to clearance of premium paid
Details of persons Insured:

Name of Person Insured Age Gender Relationship**
Mr. Sumeet Prakash Bathiya 31 Male Applicant
Mrs. Khushboo Sumeet Bathiya 31 Female Spouse
For the purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax Act,1961 and any amendments made
thereafter. For your eligibility and deductions, please refer to provisions of Income Tax Act 1961 as modified and consult your tax consultant. In the
event of non-realization of premium, tax benefits cannot be obtained against this premium receipt.
Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void.
GSTI No.: 27AAFCM7916H1Z8 SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 27 Customer State Code / Customer GSTI No.: 27 /NA
Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
Location: New Delhi Director - Operations & Customer Service

Date: 25/04/2024 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)
List of Un-recognized Hospitals
Sr. State City Hospital Address
No.
1 Gujarat Surat Aakanksha Hospital 126, Aaradhnanagar Soc., B/H. Bhulkabhavan
School, Aanand-Mahal Rd., Adajan, Surat
2 Gujarat Surat Abhinav Hospital Harsh Apartment, Nr Jamna Nagar Bus Stop,
God Dod Road Surat
3 Gujarat Surat Adhar Ortho Hospital Dawer Chambers, Nr. Sub Jail, Ring Rd., Surat
4 Gujarat Surat Aris Care Hospital A 223-224, Mansarovar Soc, 60 Feet ,
Godadara Road, Surat
5 Gujarat Surat Arzoo Hospital Opp. L.B. Cinema, Bhatar Rd., Surat
6 Gujarat Surat Auc Hospital B-44 Gujarat Housing Board, Nandeshara
7 Gujarat Surat Dharamjivan General Hospital Karmayogi - 1, Plot No. 20/21, Near Piyush Point,
& Trauma Centre Pandesara
8 Gujarat Surat Dr. Santosh Basotia Hospital Bhatar Road, Surat
9 Gujarat Surat Ghevariya Dental Clinic 202, M K Complex, Variya Compound, Hirabag
Circal
10 Gujarat Surat God Father Hospital 344, Nandvan Soc., B/H. Matrushakti Soc.,
Puna Gam, Surat.
11 Gujarat Surat Govind-Prabha Arogya Opp. Ratna-Sagar Vidhyalaya, Kaji Medan,
Sankool Gopipura, Surat
12 Gujarat Surat Hari Milan Hospital L H Road
13 Gujarat Surat Jaldhi Ano-Rectal Hospital
Tadwadi, Surat
14 Gujarat Surat Jeevan Path Gen. Hospital 2nd. Fl., Dwarkesh Nagri, Nr. Laxmi Farsan,
Sayan, Surat.
15 Gujarat Surat Kalrav Children Hospital Yashkamal Complex, Nr. Jivan Jyot, Udhna
16 Gujarat Surat Kanchan General Surgical Plot No. 380, Ishwarnagar Soc, Bhamroli-Bhatar,
Hospital Pandesara Surat
17 Gujarat Surat Krishnavati General Hospital Bamroli Road
18 Gujarat Kutch Mantra Orthopaedic Hospital Dr. Bhavin N. Patel
Gandhidham(Kutch)
19 Gujarat Surat Niramayam Hosptial & Shraddha Raw House, Near Natures Park
Prasutigruah
20 Gujarat Surat Patna Hospital 25, Ashapuri Soc - 2, Bamroli Road, Surat
21 Gujarat Surat Poshia Children Hospital Harekrishan Shoping Complex 1St Floor, Varachha
Road, Surat
22 Gujarat Surat Prayosha Hospital A-102/103, Shagun Residency, Puna Bombay Mar-
ket Road, Puna, Surat, Gujarat
23 Gujarat Surat R.D Janseva Hospital 120 Feet Bamroli Road, Pandesara, Surat
24 Gujarat Surat Radha Hospital & Maternity 239/240 Bhagunagar Society, Opp Hans Society,
Home L H Road, Varachha Road
25 Gujarat Surat Santosh Hospital L H Road
26 Gujarat Surat Shaurya Hospital Udhna, Surat
27 Gujarat Surat Shikha General Hospital 14 – Umiya Nagar – 1, Navagam Dindoli Road,
- Changed Name To Sai Udhna
Hospital
28 Gujarat Surat Shishumangal Children Surat
Hospital
ProductProduct
Name: Health
Name:Companion
Aspire || Product
Product UIN:
UIN:NBHHLIP23007V052223
NBHHLIP24129V012324
No.
29 Gujarat Surat Shree Ramdev General & 248,Shiv Nagar G.I.D.C. Road,Nr:Udhna Citizen
Surgical Hospital Co-Operative Bank,Pandasara
30 Gujarat Surat Shree Sai Hospital & Prasuti 14, Umiya Nagar-1, Navagam Dindoli Road, Udhna
Gruh
31 Gujarat Surat Shreyans Anorectal & Daycare 5Th Floor, Opp. Ayurvedic Collage,
Hospital Station Road, Surat
32 Gujarat Surat Shri Panchratna Hospital & Geetanagar, Near Dindoli Jakat Naka,
Prasutugruah Navagam, Udhna, Surat
33 Gujarat Surat Shubham General Hospital 2nd Floor, Nirmal Complex, Near Maruti Gaushala,
Opp. Bhagwati Rus
34 Gujarat Surat Siddhi Clinic & Nursing Home 33- Nandanvan Apt., Naginawadi, Surat
35 Gujarat Surat Sparsh Multy Specality G.I.D.C Road, Nr Udhana Citizan Co-Op.Bank
Hospital & Trauma Care
Center
36 Gujarat Surat Sree Uday Narayan General 193,Sukhi Nagar, Bamroli Road, Near New Bridge,
Hospital Pandesara, Surat
37 Gujarat Surat Tripathi Chartiable Hospital Geetanagar, Near Dindoli Jakat Naka, Navagam,
Udhna, Surat
38 Gujarat Ahmedabad Umiya Medical & Surgical 2Nd Floor, Centre Plaza, Sattadhar Char Rasta,
Hospital Sola Road
39 Gujarat Surat Varachha General Hospital 17-26, Samarth Park Near Archana School
40 Uttar Kushi Nagar Aastha Multispecialty Hospital Padrauna Road, Kushinagar, Up, Ph :
Pradesh 9598440966/9793196178
41 Maharashtra Thane Ashwini Nursing Home Prashanti, Ground Floor, Agarkar Road,
Dombivli East, Thane
42 Maharashtra Thane Asmita Nursing Home Prashanti, Ground Floor, Agarkar Road,
43 Maharashtra Thane Balaji Nursing Home Prashanti, Ground Floor, Agarkar Road,
44 Haryana Rohtak Channan Devi Memorial Plot No.952, Ward No.23, Lal Chand Colony Chowk,
Hopital Near Durga Mandir, Rohtak
45 Telangana Hyderabad Goodlife Hospitals #1-7-309, Hanuman Nagar, Opp. Jaginis Foodland,
Chaitanyapri X Roads, Dilskhnagar
46 Orissa Dhenkanal Jagannath Clinic & Nursing Durgabazar, Nuahata, Kantabania, Banarpal
Home
47 Uttar Allahabad Jeevan Jyoti Hospital 162, Bai Ka Bagh, Lowther Road, Allahabad, Up
Pradesh
48 Tamilnadu Mayiladuthurai Krishna Hospital No 8 Pattamangala Street Mayiladuthurai
49 Maharashtra Mumbai Mumtaz Nursing Home 3/299/3774, Opp. Choti Masjid, Tagore Nagar,
Near Hariyali Police Chowki, Vikhroli (E),
Mumbai-400083
50 Telangana Kesava Nagar Padmaja Hospital # 17-1- 386/1/18 Kesava Nagar Colony Champapet
Colony Hyderabad
51 Bihar Harnaut Pragya Nurshing Home Harnaut
52 Telangana Jeedimetla Ram Hospitals Shapur Nagar, Ida, Jeedimetla
53 Haryana Gurgaon Ramanarayan Hospital Vill Bass Hariya P.O Bass Lambi Ggn-122503
54 Maharashtra Mumbai Royal Nursing Home Plot No 7, Sector-1, Airoli,, Navi Mumbai-400708
55 Orrissa Cuttak Sabarmati General Hospital Mahanadi Vihar
56 Uttar Meerut Sahara Hospital Ajanta Colony, Garh Road
Pradesh
Product Name:Name:
Product Health Companion | Product UIN:
Aspire | Product UIN: NBHHLIP23007V052223
NBHHLIP24129V012324
No.
57 Maharashtra Mumbai Sb Nursing Home Powai
58 Uttar Meerut Shagun Hospital 24 Tyagi Market Tej Garhi
Pradesh
59 Haryana Gurgaon Shri Balaji Hospital & Trauma Gadoli, Pataudi Road, Gurgaon
Center
60 Telangana Hyderabad Sri Sai Thirumala Hospitals Kishan Kumar Complex, Durga Nagar, Karmanghat
Main Road
61 Madhya Bhopal Venus Hospital And Medical H. No-2,Pipal Square,Karond, Bhopal
Pradesh Research Centre
62 Telangana Vanasthali Vijaya Nursing Home Near Double Road, Vanasthali Puram
Puram
63 Uttar Allahabad Virendra Hospital 7 Stanley Road (Next To Mishra Bhavan)Civil Lines,
Pradesh Allahabad
64 Uttar Meerut Yog Nursing Home Near Tej Garhi, University Road
Pradesh
Note:
1. Claims whether Cashless or reimbursement pertaining to treatments taken at the above mentioned Hospitals shall not
be entertained, processed or paid by Niva Bupa.
2. The above list is only for the purpose of admissibility of claims with respect to any health insurance policies of Niva
Bupa Health Insurance Company Limited.
3. The above list is subject to be updated from time to time. For updated list please visit this site at www.nivabupa.com
or call our customer care at 1860 500 8888
Product Name:Name:
Product Health Companion | Product UIN:
Aspire | Product UIN: NBHHLIP23007V052223
NBHHLIP24129V012324
Aspire Customer Information Sheet
Customer Information Sheet/ Know Your Policy
This document provides key information about your policy. You are advised to go
through your policy document
Policy
Sl.
Title Description Clause
No
Number
1 Name of Aspire
Insurance
Product/ Policy
2 Policy Number 33758721202400
3 Type of Both Indemnity and Benefit
Insurance
Product/ Policy
4 Sum Insured Sum Insured Options are: 3 Lacs, 5 Lacs, 7.5 Lacs,
10 Lacs, 15 Lacs, 20 Lacs, 25 Lacs, 50 Lacs, 100
Lacs
The Sum Insured opted by you is mentioned in the

Policy Schedule.
5 Policy Coverage Expenses in respect of:
Base Coverage:
 Expenses in Reaching the Hospital: Road 4.1.1
ambulance & Air Ambulance covered up to Sum
Insured
 Expenses during Hospitalization: Hospital 4.1.2
admission for 2 hours or more.
 AYUSH Treatments are also covered if admitted 4.1.2
for 24 hours or more in AYUSH Hospital
 Modern treatments Up to Sum Insured. 4.1.2
 All Day Care Treatments covered. 4.1.2
 Pre & Post Hospitalization expenses of 60 days
& 180 Days. 4.1.3
 Home Care/Domiciliary treatment covered up to
Sum Insured. 4.1.4
 Organ donor expenses covered up to Sum
4.1.5
Insured
 Annual Health Check-up can be availed from day
4.1.6
1 of the policy as per plan chosen by You
 ReAssure+ –
· ReAssure “Forever”: The first paid claim
triggers ReAssure “Forever”. Maximum 4.1.7
Page 1 of 13
Product Name: Aspire | Product UIN: NBHHLIP24129V012324

amount this benefit pays for any single

claim is up to Base Sum Insured.
· Lock the Clock: Entry age is locked at the
time of buying the policy, till a claim is paid
· Lock the Clock+: Entry age is locked at
the time of buying the policy, till a claim is
paid. M-iracle benefit also will not impact
Lock.
·
 ReAssureX - The first paid claim triggers 4.1.8
ReAssure “Forever”. Maximum amount this
benefit pays for any for any single claim is up to
Base Sum Insured.
(Consumer can choose between wither ReAssure or

ReAssure X as per the Variant)
 Booster+ - carry forward unutilized sum insured 4.1.9

for maximum 10 times of Base Sum Insured
based on the entry age. 4.1.10
 M-iracle: Up to defined limits. Unutilized M-iracle
Sum Insured carries forward.
4.1.11
 Live Healthy - discount on premium at renewal 4.1.12
 Second Medical opinion - choose to take a
second medical opinion. Unlimited times in a
policy year. 4.1.13
 E-consultation - Unlimited e-consultation with our
partners.
Optional Coverage:
 Annual Aggregate Deductible 4.1.14
4.1.15
 Hospital Cash
4.1.16
 Co-Payment
4.1.17
 Pre-Existing Disease Waiting Time Modification 4.1.18
 Room Type Modification 4.1.19
 Personal Accident 4.1.20
 Safeguard 4.1.21
 Safeguard+ 4.1.22
 Future Ready 4.1.23
 Borderless 4.1.24
 Cash-Bag 4.1.25
 WellConsult (OPD)
6 Exclusions Standard Exclusions 5
Page 2 of 13

 Pre-existing Diseases (Code–Excl01)

 Specified disease/procedure waiting period
(Code- Excl02)
 30-day waiting period (Code- Excl03)
 Investigation & Evaluation (Code-Excl04)
 Rest Cure, rehabilitation and respite care (Code-
Excl05)
 Obesity/ Weight Control (Code-Excl06)
 Cosmetic or plastic Surgery (Code-Excl08)
 Hazardous or Adventure sports (Code-Excl09)
 Breach of law (Code-Excl10)
 Excluded Providers (Code-Excl11)
 Treatment for, alcoholism, drug or substance
abuse or any addictive condition and
consequences thereof. (Code-Excl12)
 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)
 Refractive Error (Code-Excl15)
 Unproven Treatments (Code-Excl16)
Specific Exclusions
 Personal Waiting Period- Conditions specified for
an Insured Person under Personal Waiting Period
will be subject to a Waiting Period of up to 48
months from the inception of the First Policy with
Us
 Conflict & Disaster- Treatment for any Injury or
Illness resulting directly or indirectly from nuclear,
radiological emissions, war or war like situations
(whether war is declared or not), rebellion (act of
armed resistance to an established government or
leader), acts of terrorism.
 External Congenital Anomaly- Screening,
counseling or treatment related to external
Congenital Anomaly.
 Dental treatment- All dental treatments other than
due to accidents and cancers.
 Unrecognized Physician or Hospital-
Page 3 of 13

- Treatment or Medical Advice provided by a

Medical Practitioner not recognized by the
Medical Council of India or by Central Council
of Indian Medicine or by Central council of
Homeopathy.
- Treatment provided by anyone with the same
residence as an Insured Person or who is a
member of the Insured Person’s immediate
family or relatives.
- Treatment provided by Hospital or health
facility that is not recognized by the relevant
authorities in India.
 Costs which are not Reasonable and Customary
and treatments which are not Medically
Necessary. Refer Definition 2.1.37 for
Reasonable and Customary Charges.
 Artificial life maintenance for the Insured Person
who has been declared brain dead or in vegetative
state
7 Waiting period  Initial Waiting Period (Excl03) - 30 days for all 5.1.3
illnesses (not applicable in case of continuous
renewal or accidents)
 Specific Waiting Period (Not applicable for

claims arising due to an accident) (Excl02): 5.1.2
a. 24 Months for Gold+, Gold, Sapphire+,
Sapphire, Diamond+, Diamond, Platinum,
Titanium, Platinum+, Titanium+
b. 24/12 Months for Flexi variant
The above waiting periods will apply for the below

conditions -
o Pancreatitis and stones in biliary and urinary

system
o Cataract, glaucoma and retinal detachment
o Hyperplasia of prostate, hydrocele and
spermatocele
o Prolapse uterus or cervix, endometriosis,
Fibroids, Polycystic ovarian disease (PCOD),
hysterectomy (unless necessitated by
Malignancy)
Page 4 of 13

o Hemorrhoids, fissure, fistula or abscess of

anal and rectal region
o Hernia of any site or type,
o Osteoarthritis, joint replacement,
osteoporosis, systemic connective tissue
disorders, inflammatory polyarthropathies,
Rheumatoid Arthritis, gout, intervertebral disc
disorders, arthroscopic surgeries for ligament
repair
o Varicose veins of lower extremities
o All internal or external benign neoplasms/
tumours, cyst, sinus, polyps, nodules, mass
or lump
o Ulcer, erosion or varices of gastro intestinal
tract
o Surgical treatment for diseases of middle ear
and mastoid (including otitis media,
cholesteatoma, perforation of tympanic
membrane), Tonsils and adenoids, nasal
septum and nasal sinuses
5.1.1
 Pre-existing diseases (Excl01): Pre-existing
Disease (PED) and its direct complications shall
be excluded until the expiry of below waiting
periods of continuous coverage -
c. 48 Months for Gold+, Gold, Sapphire, Diamond,
Platinum, Titanium
d. 36 Months for Sapphire+, Diamond+, Platinum+, 5.2.1
Titanium+
e. 12months/24 months/ 36 months/ 48 months for
Flexi variant
4.1.10
 Personal Waiting Periods: Conditions specified
for an Insured Person under Personal Waiting
Period in the Policy Schedule will be subject to a
Waiting Period of 48 months from the inception of
the First Policy with Us.
 M-iracle Waiting Period:

a. 48 months (Gold+/Gold)
b. 12 months (Sapphire)
c. 24 Months (Diamond+/Diamond)
d. 9 months (Platinum+, Titanium+, Platinum,
Titanium)
Page 5 of 13

e. 48 Months/24 Months/12 Months/9 Months

for Flexi Variant
8 Financial Limits i. Sublimit

of Coverage
 Room Type Capping: Up to Single Private 4.1.2
i. Sub-limit (It is Room for Gold variant and Up to Sum Insured
a pre-defined for all other variants
limit and the  M-iracle: The benefit Sum Insured limits is 4.1.10
insurance as below –
company will
not pay any
Base Sum Insured M-iracle Sum
amount in
(INR) Insured
excess of this
limit) 3L INR 4,000
5L INR 5,000
ii. Co-Payment (It 7.5L INR 10,000
is a specified 10L INR 12,000
amount/ 15L INR 15,000
percentage of 20L & 25L INR 20,000
the admissible 50L & 1Cr INR 25,000
claim amount  Hospital Cash:
to be paid by a. Up to INR 5 Lakh Base Sum Insured: INR 4.1.15
policyholder/ 1,000/day
insured)
b. Between INR 7.5 Lakh to INR 15 Lakh Base
iii. Deductible (It Sum Insured: INR 2,000/day
is a specified c. Above 15 Lakh Base Sum Insured: INR
amount up to 4,000/day
which an d. Maximum coverage offered under this
insurance benefit is for 30 days / policy year / insured
company will person.
not pay any
claim, and  Personal Accident: up to 5 times of Base 4.1.19
which will be Sum Insured. Maximum up to INR 1 Crore.
deducted from  WellConsult (OPD)
total claim a. Physical Consultations: INR 10,000 on
amount (if our network. Flat 20% co-payment in 4.1.25
claim amount case of re-imbursement.
is more than
specified
amount)
Page 6 of 13

b. Prescribed Diagnostics: INR 10,000 on

iv. Any other limit our network. Flat 20% co-payment in
(as applicable) case of re-imbursement.
c. Prescribed Pharmacy: INR 2,500 on our
network. Flat 20% co-payment in case of
re-imbursement.
d. 10 Online sessions on Emotional
Wellness. Can be availed only through
our network.
e. Gym memberships for 2 days a week
4.1.18
per adult
f. 10 sessions for Emotional Wellness
 Room Type Modification – Optional benefit
to opt for room category Standard Single
Room or a Shared Room
4.1.16
ii. Co-payment –
 Optional benefit with following options – 0%,
10%, 20%, 30%, 40% and 50%.
 Borderless: Option to choose co-payment as
per customer - 0%, 20%, 30%, 40% and 50%.
iii. Annual Aggregate Deductible - Optional 4.1.14

benefit with following options - INR 10,000;
INR 20,000; INR 30,000; INR 50,000; INR
1,00,000; INR 2,00,000; INR 3,00,000; INR
4,00,000; INR 5,00,000
9 Claims/ Claims Details of procedure to be followed for cashless 6.2.4
Procedure service as well as for reimbursement of claim
including pre and post hospitalization.
Turn Around Time (TAT) for claims settlement

- TAT for pre-authorization of cashless facility-
2 Hours
- TAT for cashless final bill authorization - 4
Hours
Network Hospital Details-

https://rules.nivabupa.com/hospital-network/
Helpline No- 1860-500-8888
Page 7 of 13

Downloading/ getting claim form-

https://transactions.nivabupa.com/pages/downloads.
aspx
Hospitals which are blacklisted or from where no 5.2.5

claim will be accepted by insurer-
https://rules.nivabupa.com/doc/Exclude_List.pdf
10 Policy Servicing  Call center no of Insurer- Contact No: 1860-500- 6.1.8
8888
 Details of Company Officials-
Website: www.nivabupa.com
Customer Services Department
Niva Bupa Health Insurance Company
Limited
D-5, 2nd Floor, Logix Infotech Park
opp. Metro Station, Sector 59, Noida, Uttar
Pradesh, 201301
Self-service platform, Insta Assist
https://rules.nivabupa.com/customer-service/
11 Grievances/Com Details of 6.1.8
plaints
 Grievance Redressal Officer of the insurer
Grievance Redressal Officer
Limited
Pradesh, 201301
For details of grievance officer, kindly refer the
link https://www.nivabupa.com/customer-
care/health-services/grievance-redressal.aspx
 Insurance company grievance portal/

Department
Website: www.nivabupa.com
Customer Services Department
Limited
Pradesh, 201301
Contact No: 1860-500-8888
Page 8 of 13

Fax No.: 011-41743397

Self-service platform, Insta Assist
https://rules.nivabupa.com/customer-service/
Senior citizens may write to us at at:
seniorcitizensupport@nivabupa.com
lnsured person may also approach the
grievance cell at any of the company's
branches with the details of grievance
 IRDAI/(IGMS/Call Centre): Email ID:

www.igms.irdai.gov.in Ombudsman (Refer
Annexure II of policy document for List of
Insurance Ombudsmen)
12 Things to  Free Look cancellation: You may cancel the 6.1.1
Remember insurance policy if you do not want it, within 15
days (30 days for policies with a term of 3 years,
if sold through distance marketing) days from the
beginning of the policy.
You have 15 days from receipt of the policy

document to re visit your policy terms & conditions
and if you have any disagreement to it, you may
apply for Free look cancellation through
submission of Free look Cancellation form.
Please note that free look cancellation is
applicable only when no claims have been paid
under any benefits. Also, there could be few
deductions that may be applicable as per policy
document.
lf the insured has not made any claim during the
Free Look Period, the insured shall be entitled to:
i. refund of the premium paid, less any expenses
incurred by the Company on medical
examination of the insured person.
 Policy renewal: Except on grounds of fraud,

moral hazard or misrepresentation or non-
6.1.3
cooperation, renewal of your policy shall not be
denied, provided the policy is not withdrawn.
 Migration and Portability: When your policy is 6.1.12 &

due for renewal, you may migrate to another 6.1.13
policy with us or port your policy to another
Page 9 of 13

insurer.
You can contact Customer Service Department
(details provided above) for migration and
portability.
 Change in Sum Insured: Sum Insured can be 6.2.3

changed (increased/decreased) only at the time
of renewal or at any time, subject to underwriting
by the company. For increase in Sl, the waiting
period if any shall start afresh only for the
enhanced portion of the sum insured.
6.1.10
 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 eight 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 policy shall be contestable except for
proven Fraud and permanent exclusions
specified in the policy contract.
13 Your Obligations Please disclose all pre-existing disease/s or 6.1.14
condition/s before buying a policy. Non-disclosure
may affect the claim settlement.
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 policyholder.
(Explanation: “Material facts” for the purpose of this
policy shall mean 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)
Page 10 of 13

Benefit Illustration
Benefit Illustration (5 Lac Sum Insured, Policy Term 1 year)

Age Coverage Coverage opted on Coverage opted on family
of opted on individual basis covering floater basis with overall
the individual multiple members of the Sum Insured (Only one Sum
me basis family under a single policy Insured is available for the
mb covering (Sum Insured is available entire family)
ers each for each member of the
ins member of family)
ure the family
d separately
(at a single
point in
time)
Prem Sum Prem Disco Prem Sum Premi Float Prem Sum
ium Insur ium unt, if ium Insur um or er ium Insur
(Rs.) ed (Rs.) any after ed Cons disco after ed
(Rs.) disco (Rs.) olidat unt, disco (Rs.)
unt ed if any unt
(Rs.) premi (Rs.)
um
for all
mem
bers
of
famil
y
(Rs.)
Illustration 1
18
7,316 5,00, 7,316 731.6 6,584 5,00, 7,316. 13,70 21,32 5,00,
.00 000 .00 0 .40 000 00 0.00 7.00 000
21
7,316 5,00, 7,316 731.6 6,584 5,00, 7,316.
.00 000 .00 0 .40 000 00
39
9,484 5,00, 9,484 948.4 8,535 5,00, 9,484.
.00 000 .00 0 .60 000 00
Page 11 of 13

45
10,91 5,00, 10,91 1,091 9,819 5,00, 10,91
1.00 000 1.00 .10 .90 000 1.00
Total premium for all Total premium for all Total premium when the policy
members of the members of the family is is opted on floater basis is
family is Rs.35,027, Rs.31,524, when they are Rs.21,327.
when each member covered under a single policy.
is covered Sum Insured of Rs.500,000 is
separately. Sum Insured available for available for the entire family.
each family member is
Sum Insured Rs.500,000.
available for each
individual is
Rs.500,000.
Illustration 2
55
18,16 5,00, 18,16 1,816 16,35 5,00, 18,16 8,678 41,03 5,00,
8.00 000 8.00 .80 1.20 000 8.00 .00 0.00 000
63
31,54 5,00, 31,54 3,154 28,38 5,00, 31,54
0.00 000 0.00 .00 6.00 000 0.00
members of the members of the family is is opted on floater basis is
family is Rs. 49,708, Rs.44,737, when they are Rs.41,030.
available for each
individual is
Rs.500,000.
Illustration 3
65
31,54 5,00, 31,54 3,154 28,38 5,00, 31,54 19,51 51,99 5,00,
0.00 000 0.00 .00 6.00 000 0.00 3.00 4.00 000
70
39,96 5,00, 39,96 3,996 35,97 5,00, 39,96
7.00 000 7.00 .70 0.30 000 7.00
Page 12 of 13

members of the members of the family is is opted on floater basis is Rs.
family is Rs.71,507, Rs.64,356, when they are 51,994.
available for each
individual is
Rs.500,000.
Note: Premium rates specified in the above illustration are standard premium
rates without considering any loading. Also, the premium rates are exclusive of
taxes applicable.
Premium is considered for Gold+ Variant and Zone 1
Page 13 of 13

Aspire
Policy Wordings
1. Preamble
You are a global citizen and the world is your playground. This Policy covers Allopathic treatments anywhere in the world.
AYUSH treatments are covered in India only. After all, the world comes to us for the best of AYUSH.
2. Definitions
It is IMPORTANT You should go through the definition of some words used in the policy. Definition of these may vary from the common understanding and
colloquial meaning. If a word is not specifically defined in the following section, it’s common meaning will apply.
2.1. Standard Definitions:
2.1.1. Accident or Accidental means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
2.1.2. 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:
a. Central or state government AYUSH Hospital; or
b. Teaching Hospital attached to AYUSH college recognized by the Central Government / Central Council of Indian Medicine / Central Council of
Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine, registered with the local
authorities, wherever applicable and is under the supervision of a qualified registered AYUSH Medical Practitioner and must comply with all the
following criterion:
i. Having at least five in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures are to be carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized representative.
AYUSH Hospitals referred above shall also obtain either pre-entry level certificate (or higher level of certificate) issued by National Accreditation
Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or higher level of certificate) under National Quality Assurance
Standards (NQAS), issued by National Health Systems Resources Centre (NHSRC).
2.1.3. AYUSH Treatment refers to the medical and / or hospitalization treatments given under Ayurveda, Yoga and Naturopathy, Unani, Sidha and
Homeopathy systems.
2.1.4. 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.
2.1.5. Congenital Anomaly means a condition which is present since birth, and which is abnormal with reference to form, structure or position.
a. Internal Congenital Anomaly: Congenital Anomaly which is not in the visible and accessible parts of the body.
b. External Congenital Anomaly: Congenital Anomaly which is in the visible and accessible parts of the body.
2.1.6. Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified
percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured.
2.1.7. Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer without an associated increase in premium.
2.1.8. Day Care Centre means any institution established for Day Care Treatment of Illness and/or Injuries or a medical set-up with a Hospital and which has
been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified Medical Practitioner AND must
comply with all minimum criterion as under:
a. has Qualified Nursing staff under its employment;
b. has qualified Medical Practitioner(s) in charge;
c. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
d. maintains daily records of patients and will make these accessible to the insurance company’s authorized personnel.
2.1.9. Day Care Treatment refers to medical treatment, and/or Surgical Procedure which is:
a. undertaken under General or Local Anaesthesia in a Hospital/Day Care Centre in less than 24 hrs because of technological advancement, and
b. which would have otherwise required a Hospitalization of more than 24 hours.
Treatment normally taken on an out patient basis is not included in the scope of this definition.
Product Name: Aspire | UIN: NBHHLIP24129V012324

2.1.10. Deductible means a cost sharing requirement under a health insurance policy that provides that the insurer will not be liable for a specified rupee
amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies which will apply before any benefits are
payable by the insurer. A deductible does not reduce the Sum Insured.
2.1.11. Dental Treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings (where appropriate), crowns,
extractions and Surgery.
2.1.12. Domiciliary Hospitalization means medical treatment for an Illness/disease/Injury which in the normal course would require care and treatment at a
Hospital but is actually taken while confined at home under any of the following circumstances:
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.
2.1.13. Emergency care means management for an Illness or Injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate
care by a Medical Practitioner to prevent death or serious long term impairment of the Insured Person’s health.
2.1.14. 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.
2.1.15. Hospital means any institution established for Inpatient Care and Day Care Treatment of Illness and / or Injuries and which has been registered as a
Hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under
the Schedule of Section 56(1) of the said Act OR complies with all minimum criteria as under:
a. has Qualified Nursing staff under its employment round the clock;
b. has at least 10 Inpatient beds in towns having a population of less than 10,00,000 and at least 15 Inpatient beds in all other places;
c. has qualified Medical Practitioner(s) in charge round the clock;
d. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
e. maintains daily records of patients and makes these accessible to the Insurance company’s authorized personnel.
2.1.16. Hospitalization means admission in a Hospital for a minimum period of 24 consecutive ‘In-patient Care’ hours except for specified procedures/
treatments, where such admission could be for a period of less than 24 consecutive hours.
2.1.17. Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function and requires medical
treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his
or her state of health immediately before suffering the disease/ illness/ injury which leads to full recovery
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury 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 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
2.1.18. Injury means Accidental physical bodily harm excluding Illness or disease solely and directly caused by external, violent and visible and evident means
which is verified and certified by a Medical Practitioner.
2.1.19. 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.
2.1.20. 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 considerable more sophisticated and intensive than in the ordinary and other wards.
2.1.21. ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses on a per day basis 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.
2.1.22. Maternity Expenses shall include:
a. Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization)
b. Expenses towards lawful medical termination of pregnancy during Policy Period.
2.1.23. Medical Advice means any consultation or advice from a Medical Practitioner including the issuance of any prescription or follow-up prescription.

2.1.24. 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.
2.1.25. 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 his licence.
2.1.26. 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.
2.1.27. 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.
2.1.28. Network Provider means Hospital enlisted by an insurer, TPA or jointly by an insurer and TPA to provide medical services to an insured by a Cashless
Facility.
2.1.29. New Born Baby means baby born during the policy period and is aged up to 90 days.
2.1.30. Non-Network Provider means any Hospital, Day Care Centre or other provider that is not part of the network.
2.1.31. Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes of communication
2.1.32. 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.
2.1.33. Pre-existing Disease means any condition, ailment, injury or disease
a. 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
b. 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.
2.1.34. Pre-hospitalization Medical Expenses means medical expenses incurred during pre-defined number of days preceding the hospitalization of the
Insured Person, provided that:
a. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
2.1.35. 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:
a. Such Medical Expenses are for the same condition for which the Insured Person’s Hospitalization was required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
2.1.36. Portability means the right accorded to an individual health insurance policyholders (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.
2.1.37. 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.
2.1.38. 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.
2.1.39. Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the associated medical expenses.
2.1.40. Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an Illness or Injury, correction of deformities
and defects, diagnosis and cure of diseases, relief from suffering or prolongation of life, performed in a Hospital or Day Care Centre by a Medical
Practitioner.
2.1.41. Unproven/Experimental treatment means the treatment including drug experimental therapy which is not based on established medical practice in
India, is treatment experimental or unproven

2.2. Specific Definitions
2.2.1. Base Sum Insured means the coverage amount for which the premium is computed and charged for this policy.
2.2.2. Biological mother means a woman whose ovum was fertilized and became a foetus.
2.2.3. Partner Network means Hospital, Diagnostic Centers, Clinics, Doctors, Health Care Workers, empanelled by the Insurer and/or by a consolidated
organization to provide health related medical services.
2.2.4. Insured Person is the one for whom the company has received full premium (including additional premium if any), completed the risk assessment
and issued the policy. The names of the Insured persons covered in the policy are specified in the policy document, who are also referred as You/Your/
Policyholder in this policy.
2.2.5. Policy Year means the period of one year from the date of commencement of the policy.
3. Sum Insured(s)
The product offers you so much more! More benefits, More options and More Sum Insured. Sum Insured will be utilized as per following sequence in event of any
claim:
1. Base Sum Insured
2. Booster+ Sum Insured
3. Safeguard/Safeguard+ Sum Insured
4. ReAssure+/ReAssureX
4. Benefits available under the policy.
Different benefits have different limits or Sum Insured. A limit or Sum Insured is our maximum liability (basically this is the maximum claim we will pay)
under the benefit. These limits & Sum Insured will be mentioned in your Policy Schedule.
4.1.1. Expenses in reaching a Hospital
a. Road Ambulance: We will pay you up to Base Sum Insured
b. Air Ambulance: Only in case of Emergency. We will pay up to Base Sum Insured.
Note: This will be paid only if claim for hospitalization is paid by us. You must always use a registered ambulance / air ambu-
lance provider.
4.1.2. Expenses during Hospitalization
a. We will pay the expenses incurred by you on treatment (Naturally this excludes expenses not linked to treatment like food, beverage, toiletries and
cosmetics). We don’t limit your choice. Choose the room you like, but choose judiciously to protect your Sum Insured.
• Hospitalized for 2 hours or more (minimum 24 hours for AYUSH treatment in a AYUSH Hospital). This means that all Day Care Treatments will
also be covered.
Note:
• We will NOT pay, even if you were Hospitalized, if there was no treatment and only investigations were done. Examples: MRI, CT Scan,
Endoscopy, Colonoscopy etc.
• We will NOT pay for Automation machine for peritoneal dialysis
b. We pay for Modern treatments, up to Base Sum Insured for the list as specified below:
1. Uterine Artery 2. Immunotherapy- 3. Vaporisation of the prostrate 4. Stem cell therapy: Hematopoietic stem
Embolization and Monoclonal Antibody to be (Green laser treatment or cells for bone marrow transplant for
HIFU (High intensity given as injection holmium laser treatment) haematological conditions
focused ultrasound)
5. Balloon Sinuplasty 6. Oral Chemotherapy 7. Robotic surgeries 8. Stereotactic radio Surgeries
9. Deep Brain stimulation 10. Intra vitreal injections 11. Bronchical Thermoplasty 12. IONM - (Intra Operative Neuro
Monitoring)
4.1.3. Expenses before and after hospitalization (Pre & Post hospitalization)
We will pay expenses incurred on consultations, medicines, physiotherapy, diagnostic tests for 60 days before the date of admission and 180 days after
date of discharge IF these are related to the condition for which hospitalization claim is paid.
4.1.4. Home Care / Domiciliary Treatment
Home Care Treatment means treatment availed by the insured person at home which in normal course would require care and treatment at a hospital but
is actually taken at home provided that:

a. The medical practitioner advices the insured person to undergo treatment at home
b. There is continuous active line of treatment with monitoring of health status by a medical practitioner for each day through the duration of the home
care treatment
c. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained
Note:
• We will pay for Pre & Post hospitalization benefit as per section 4.1.3 for Home Care / Domiciliary Treatment.
• We pay for peritoneal dialysis, Chemotherapy taken at home.
• We do NOT pay for any Medical & ambulatory devices used at home (like Pulse Oxymeter, BP monitors, Sugar monitors, automation device for
peritoneal dialysis, CPAP, BiPAP, Crutches, wheel chair etc.)
4.1.5. Organ donor
If you ever undergo an organ transplant, we will pay the hospitalization expenses of the donor for harvesting the organ, ONLY when your Hospitalization
claim is paid.
If you donate any of your organs, we will pay for the expenses for harvesting the organ from you. We respect this noble deed. Remember, organ donation
saves many lives.
4.1.6. Annual Health Checkup
Available once every Policy Year, from day 1 of the policy. You can choose any test(s) from the list specified below. The tests MUST be booked through
digital assets (e.g. Mobile App). This benefit is available ONLY on cashless basis and no reimbursement is allowed.
List of tests covered:

Complete blood count (CBC) Complete Physical Examination by Physician Serum Electrolytes
Urine Routine & Microscopic Post prandial/lunch blood sugar (PPBS / PLBS) HbA1C
Erythrocyte Sedimentation Rate (ESR) Uric Acid Thyroid function test
Fasting Blood sugar (FBS) Lipid Profile Liver Function Test (LFT)
Electrocardiogram (ECG) Kidney function test Treadmill test (TMT) OR 2 D ECHO
X Ray chest Serum Vitamin D Ultrasound test (USG)
Mammogram Colonoscopy (for >50 year olds) Serum calcium
PAP smear
Note:
If you undergo multiple tests, make sure that all these are done within 7 days.
4.1.7. ReAssure+
4.1.7.1. ReAssure “Forever”: Enjoy unlimited Sum Insured. The first paid claim in the life of the policy triggers ReAssure “Forever”. Once Triggered it
stays for life, provided that the policy is renewed without break.
Note:
a. Maximum amount ReAssure+ pays for any single claim is up to Base Sum Insured.
b. We will consider a claim, if it is paid under the following: Expenses in reaching a Hospital, Expenses during Hospitalization, Expenses
before and after hospitalization, Home Care / Domiciliary Treatment, Organ Donor, Borderless.
c. Expenses in reaching a Hospital and Expenses before and after hospitalization for the 1st ever hospitalization will be treated as the
1st claim itself.

Illustration:
Year 1: Once the Policy is bought.
Base Sum 1st paid ReAssure+ Balance 2nd payable Claim amount Balance 3rd Payable Claim amount
Insured Claim is triggered Base Sum claim paid Base Sum claim paid
(Equal to Base Insured Insured
10 Lakh 7 Lakh Sum Insured) 3 Lakh 12 Lakh 12 Lakh (3 Lakh Nil 11 Lakh 10 Lakh from
from Base Sum ReAssure+
Insured and
9 Lakh from
ReAssure+
Year 2: Once the policy is renewed:
ReAssure+ Balance Balance

Base Sum 2nd payable Claim amount 3rd Payable Claim amount
is already 1st Claim Paid Base Sum Base Sum
Insured claim paid claim paid
triggered Insured Insured
10 Lakh 10 Lakh 15 Lakh Nil 12 Lakh 10 Lakh Nil 10 Lakh 10 Lakh from
ReAssure+
10 Lakhs from
Base Sum (this 10 Lakh
Insured and ReAssure+ ReAssure+ will trigger
5 Lakhs from unlimited
ReAssure+ times)
4.1.7.2. Lock the Clock: Your age is locked at entry when you buy the policy, till a claim is paid.
E.g. if you buy the policy at 25 years, you will keep paying the premium applicable for 25-year-old at each renewal, till a claim is paid in the policy.
Post the claim is paid, the premium charged will be as per your current age and will continue to change as per the age slabs at each renewal.
4.1.7.3. Lock the Clock+: Your age is locked at entry when you buy the policy, till a claim is paid. Even if a claim is paid for the M-iracle benefit, the age
lock will not break.
E.g. if you buy the policy at 25 years, you will keep paying the premium applicable for a 25 year old at each renewal, till a claim is paid in the
policy. Even if a claim is paid under the M-iracle benefit (provided that no other claim is paid) you will keep paying the premium applicable for 25
year old at each renewal.
If any other claim is paid, then the premium charged will be as per your current age and will continue to change as per the age slabs at each
renewal.
Note (Lock the Clock & Lock the Clock+)

a. In case of multi tenure policies, the premium for the entire tenure will be charged as per the entry age. No additional premium will be charged
In the middle of the tenure in case of claims.
At the time of renewal (in case of a claim), the premium will be charged as per the current age of the consumer at renewal.
b. If you add a member to the floater plan, then the premiums will be charged as per the entry age of the eldest member and will lock the
premium at that age, till a claim is paid.
c. If you add a member to an individual plan and convert it into a Floater plan, then the premiums will be charged as per the entry age of the
eldest member and will lock the premium at that age, till a claim is paid.
d. If the eldest member is no longer part of the Floater plan, then the Floater premium will be calculated as per the original entry age of the
eldest member in the policy amongst the remaining members and lock at that age, till a claim is paid.
e. If a floater plan, splits into multiple policies, then we will carry forward the locked age at which the floater policies were taken by individuals
(as per the claim history) in the policies carried forward, till a claim is paid.
f. In a multi individual policy, the age will unlock only for the individuals who claim.
g. In a floater policy, if a claim is paid for anyone in the plan then we will unlock the age for the entire policy.
h. We will consider a claim, if a claim is paid under the following: Expenses in reaching a Hospital, Expenses during Hospitalization, Expenses
before and after hospitalization, Home Care / Domiciliary Treatment, Organ Donor, Borderless, M-iracle.
i. Claim paid under the M-iracle benefit will not impact Lock the Clock +

4.1.8. ReAssureX
Enjoy unlimited Sum Insured. The first paid claim in the life of the policy triggers ReAssure “Forever”. Once Triggered it stays for life, provided that the
Policy is renewed without break.
Note:
a. Maximum amount ReAssureX pays for any single claim is up to Base Sum Insured.
b. We will consider a claim, if it is paid under the following: Expenses in reaching a Hospital, Expenses during Hospitalization, Expenses before and
after hospitalization, Home Care / Domiciliary Treatment, Organ Donor, Borderless.
c. Expenses in reaching a Hospital and Expenses before and after hospitalization for the 1st ever hospitalization will be treated as the 1st claim itself.
Illustration:
Year 1: Once the Policy is bought.
Base Sum 1st paid ReAssureX is Balance 2nd payable Claim amount Balance 3rd Payable Claim amount
Insured Claim triggered (Equal Base Sum claim paid Base Sum claim paid
to Base Sum Insured Insured
10 Lakh 7 Lakh Insured) 3 Lakh 12 Lakh 12 Lakh Nil 11 Lakh 10 Lakh from
ReAssureX
(3 Lakh from
Base Sum
Insured and
9 Lakh from
ReAssureX
Year 2: Once the policy is renewed:
Balance Balance
Base Sum ReAssureX 2nd payable Claim amount 3rd Payable Claim amount
1st Claim Paid Base Sum Base Sum
Insured Sum Insured claim paid claim paid
Insured Insured
10 Lakh 10 Lakh 15 Lakh Nil 12 Lakh 10 Lakh Nil 10 Lakh 10 Lakh from
ReAssureX
10 Lakhs from
Base Sum (this 10 Lakh
Insured and ReAssureX ReAssureX will trigger
5 Lakhs from unlimited
ReAssureX times)
Either ReAssure+ or ReAssureX can be offered in a single policy.
4.1.9. Booster+
Don’t lose what you don’t use.
Unutilized Base Sum Insured carries forward. Maximum it will accumulate up to 10 times of the Base Sum Insured, based on variant chosen and
your entry age into this plan.
Example: If you are 25-year-old at the time of buying the policy and have opted for Titanium+ Variant of 10 Lakh base sum insured, then at the end of 10
years (if no claim is paid in these years) you will have INR 1.10 Crore Sum Insured (that is INR 10 Lakh base + INR 1 Crore Booster+).
Don’t forget that you would have the Safeguard / Safeguard+ (this is a great benefit. You must choose it) and ReAssure “Forever” (in case of claim)
over and above the INR 1.10 Crore.
That’s 11 times more sum insured than what you paid for.
Note:
a. If you convert an Individual Sum Insured policy in any manner, into a floater plan, then the least of the Booster+ Sum Insured of individual insured
members will be carried forward to the floater plan.
b. If a floater plan, splits into multiple policies, then the Booster+ Sum Insured of floater plan will be carried forward to the split policies, provided the
Base Sum Insured is not reduced.
c. If you reduce the Base Sum Insured, Booster+ Sum Insured will be proportionately reduced. Let’s say if you reduce the current INR 10 lakh Sum Insured
to INR 5 lakh, your Booster+ Sum Insured will be halved.

d. You can and should regularly increase Sum Insured of your Health insurance policy. Medical inflation is a reality and current Sum Insured will fall short
in future for advanced treatments. When you enhance your Sum Insured, the accumulated Booster+ Sum Insured will continue and grow even more
(remember Booster+ is up to maximum 10 times (based on the entry age and plan you have chosen) of the Base Sum Insured. Higher the Base Sum
insured higher the Booster+ Sum Insured .
4.1.10. M-iracle
Celebrating Parenthood!
A baby adds new meaning to life, new meaning to family. All that goes in to planning for, welcoming and bringing up the little ones are the most
beautiful times in life.
• Antenatal check-ups. Those Gynecologist consultations, Sonograms, blood and other tests You would need
• Vaccines for the expecting mother
• Delivery. Normal or Caesarian section
• Surrogacy & Delivery by surrogate mother
• Assisted reproduction like In vitro fertilization (IVF), Gamete intrafallopian transfer (GIFT), Zygote intrafallopian transfer (ZIFT), Intracytoplasmic
Sperm Injection (ICSI)
• (Medical) termination of pregnancy
• Treatment for infertility
• Charges for legally adopting a child.
Note: The maximum charges per adoption is fixed by central adoption resource authority (CARA) and we will pay that.
• Up to INR 10,000 will be paid for tests conducted on the child, at the time of adoption. These will be paid post the child is legally adopted.
• The New Born will be covered from Day 1 in the policy. (Excl 5.2.3 will not apply for New Born Babies added)
We know You want to give the baby the best the world can offer. You have made so many plans. We understand that. Your M-iracle Sum Insured too
works like Booster+. Unutilized part of Your M-iracle Sum Insured carries forward. The maximum You can accumulate depends on the age when you first
purchased this Policy and the Plan chosen. Earlier the better.
Example: If you are 25-year-old at the time of buying the policy and have opted for Titanium+ Variant of 20 Lakh base sum insured, then at the end of
10 years (if no claim is paid under the M-iracle benefit in these years) you will have INR 2.2 Lakh sum insured (that is INR 20,000 M-iracle Base Sum
Insured + INR 2 Lakh “M-iracle Booster+).
Don’t forget that this is over and above your Base Sum Insured, Booster+ on Base Sum Insured and ReAssure+/ReAssureX.
Note:
• M-iracle Sum Insured and Waiting Period is as per the Variant you have chosen
• Ectopic pregnancy is covered under the Hospitalization benefit.
• The Biological mother MUST be insured under the policy except when a child is born through Surrogacy or is legally adopted.
• This benefit is applicable only in India.
• All complications related to Maternity will be paid from M-iracle Sum Insured only.
• Vaccines that will be covered are Tdap (Tetanus, Diphtheria, Pertussis), Td (Tetanus, Diphtheria), Flu Shot, Hepatitis A, Hepatitis B.
Note: You can add your spouse in to the running policy if you get married after purchase of this policy. However, if you are already married, you can add
Your spouse ONLY at renewal.
4.1.11. Live Healthy

Simply walk and earn up to 30% discount at renewal, by downloading the recommended mobile App and get your Health points. 1000 steps will help
you earn one health point!
Note: Discount is on the individual’s premium in Individual plan and on Floater Policy Premium in Floater plans. Discount will be considered only for
Insured’s 18 years and above.
Renewal discount is computed based on the health score on 90 days before the due date of renewal. These points are not lost and will be considered for
the next policy year.

Policy Period: 1 year
Policy Start End of 9 months Points at the end of Points Total points Discount on renewal premium (Renewal
Date 9 months (A)This in next 3 considered for policy start date 1st April 2024)
will be considered months (B) discount (A +
NOTE: Discount applicable on the
for discount on the B) from 2nd
member’s premium in Individual sum
first renewal. Policy Period
insured policies and on the Policy premium
onwards
in case of Floater
Individual sum insured Floater
policy and Floater policies policies with
with 1 Adult more than 1
Adult
1 April 2023 31st December 2023 Up to 1500 0% 0%
1501 –2250 5% 2.5%

2251 – 3000 15% 7.5%
3001 – 3750 20% 10%
>=3751 30% 15%
Policy Period: 2 years
Policy Start End of 21 months Points at the end of Points Total points Discount on renewal premium (Renewal
Date 21 months (A)This in next 3 considered policy start date 1st April 2025)
will be considered months (B) for discount
NOTE: Discount applicable on the member’s
for discount on the (A + B) from
premium in Individual sum insured policies
first renewal. 2nd Policy
and on the Policy premium in case of Floater
Period
onwards
Individual sum insured policy Floater policies
and Floater policies with 1 with more than
Adult 1 Adult
3001 – 4500 5% 2.5%
4501 – 6000 15% 7.5%
6001 – 7500 20% 10%
>=7501 30% 15%

Policy Period: 3 years
Policy Start End of 33 months Points at the end of Points Total points Discount on renewal premium
Date 33 months (A) in next 3 considered (Renewal policy start date 1st April 2026)
This will be months (B) for discount
NOTE: Discount applicable on the member’s
considered for (A + B) from
premium in Individual sum insured policies
discount on the first 2nd Policy
and on the Policy premium in case of Floater
renewal. Period
onwards
Individual sum insured Floater policies
policy and Floater policies with more than 1
with 1 Adult Adult
4501 – 6750 5% 2.5%

6751 – 9000 15% 7.5%
9001 – 11250 20% 10%
>=11251 30% 15%
4.1.12. Second Medical Opinion

Unlimited times in a Policy year, you can choose to take a second medical opinion from any Medical Practitioner for which we have paid a claim under
expenses during hospitalization. Through our partners we can help you get a second opinion from some of the most reputed doctors in the country.
4.1.13. e-consultation
You can take unlimited e-consultations from our Partner Network.
Optional Benefit:
4.1.14. Annual Aggregate Deductible
This is an aggregate amount in a year that is incurred by you on Expenses in reaching a Hospital, Expenses during Hospitalization, Expenses before and
after hospitalization, Home Care / Domiciliary Treatment, Organ Donor, which we will NOT pay. Once the total expense exceeds this amount, balance we
will pay.
Note:
a. Deductible amount borne by you should also be payable as per policy terms and conditions.
b. Deductible will NOT apply to M-iracle, Cash-Bag, WellConsult (OPD), Annual Health Check-up, Live Healthy, Second Medical Opinion, e-consultation,
Personal Accident, Hospital Daily Cash, Borderless benefits.
4.1.15. Hospital Cash:

We will pay for an Insured, an additional fixed amount for each day’s hospitalization for maximum up to 30 days. One day is considered as 24 continuous
hours of hospitalization.
4.1.16. Co-Payment:
It is the percentage of admissible claim amount You would have to bear for every claim, Rest we will pay.
Note: Co-payment will NOT apply to M-iracle, Cash-Bag, WellConsult (OPD), Annual Health Check-up, Live Healthy, Second Medical Opinion,
e-consultation, Personal Accident, Hospital Daily Cash, Borderless benefits.
Note: Co-Payment & Annual Aggregate Deductible cannot be opted together.

4.1.17. Pre-Existing Disease Waiting Time Modification
You can choose to reduce or increase the Pre-Existing Disease waiting time.
Note: This can only available at the time of buying the policy and cannot be opted/modified/removed at renewal

4.1.18. Room Type Modification
You can as per your lifestyle, choose to change the room category we are offering, and opt for what suits you best!
You can choose between a Standard Single Room and a Shared Room up to Sum Insured. Irrespective of the Room type you choose, ICU admission will
always be paid up to Sum Insured.
Note: You will have to bear additional co-payment IF treatment is taken in a higher room category than the eligible room category
Category Available in the Base Plan Category Claimed for Co-Payment Percentage
Shared Room Standard Single Room 10%
Shared Room Deluxe/Suite Room 25%
Standard Single Room Deluxe/Suite Room 15%
4.1.19. Personal Accident

4.1.19.1. Accidental Death (AD)
In event of unfortunate demise of the insured within 365 days from the date of the Accident, within the Policy Period, we will pay the Sum
Insured.
The Personal accident benefit will terminate after the Accidental Death benefit is paid for.
4.1.19.2. Permanent Total Disability
If the Insured Person suffers Permanent Total Disability, within 365 days from the date of the Accident, within the Policy Period, we will pay the
benefit as per the below Table
Condition for Permanent Total Disability % of Accidental Death Sum Insured
Complete & Irrecoverable loss of :
• Any 2 Limbs
• Sight of both eyes 125%
• Speech & hearing of both Ears
• Combination of One Limb & Sight of One Eye
Complete & Irrecoverable loss of :
• 1 Limb 50%
• Sight of 1 Eye
a. Complete & Irrecoverable loss of limb means physical separation or complete loss of functionality of the limb, within 365 days from the date of
the Accident. This will include Paralysis including Paraplegia, Quadriplegia with loss of functional use of limb.
The Personal accident benefit will terminate after the Permanent Total Disability benefit is paid for.
4.1.19.3. Permanent Partial Disability
If the Insured Person suffers a Permanent Partial Disability, within 365 days from the date of the Accident, within the Policy Period, we will pay
the benefit as per the below Table.
Condition for Permanent Partial Disability % of Accidental Death Sum Insured
Each arm at the shoulder joint 70%

Each arm to a point above elbow joint 65%
Each arm below elbow joint 50%
Each hand at the wrist 50%
Each Thumb 20%
Each Index Finger 10%
Each other Finger 5%
Each leg above center of the femur 70%
Each leg up to a point below the femur 65%
Each leg to a point below the knee 50%

Each foot at the ankle 40%
Each big toe 5%
Each other toe 2%
Each eye 50%
Hearing in each ear 30%
Sense of smell 10%
Sense of taste 5%
a. If a Permanent Partial Disability loss is not mentioned in the table above, then we will internally assess the degree of disablement and deter-
mine the amount of payment to be made.
b. If there is more than one Permanent Partial Disability loss, then the total claim amount put together for all losses will not exceed the total
Accidental Death Sum Insured opted. Once Total Sum Insured is paid, the policy will lapse.
4.1.20. Safeguard
4.1.20.1.1. Claim Safeguard: We will cover non-payable items mentioned in ‘List I – Expenses not covered’ of Annexure I’. Clause 2.1.37 for Reasonable
and Customary Charges will still apply.
4.1.20.1.2. Booster+ Safeguard: Booster+ will not be impacted if the total claim in a policy year is up to INR 50,000
4.1.20.1.3. Sum Insured Safeguard: Preserves the value of Sum Insured. Safeguards it against inflation. We will increase the Base Sum Insured on
cumulative basis at each renewal by the rate of inflation in the previous year. Inflation rate would be the average consumer price index (CPI) of
the entire calendar year published by the Central Statistical Organization (CSO).
Note: You will lose all accumulated Sum Insured Safeguard if you opt out of this benefit at any point in time.
4.1.21. Safeguard+
4.1.21.1. Claim Safeguard+: We will cover non-payable items mentioned in ‘List I,II,III,IV of Annexure I’. Clause 2.1.37 for Reasonable and Customary
Charges will still apply.
4.1.21.2. Booster+ Safeguard+: Booster+ will not be impacted if the total claim in a policy year is up to INR 1,00,000.
4.1.21.3. Sum Insured Safeguard+: Preserves the value of Sum Insured. Safeguards it against inflation. We will increase the Base Sum Insured on
cumulative basis at each renewal by the rate of inflation in the previous year. Inflation rate would be the average consumer price index (CPI) of
the entire calendar year published by the Central Statistical Organization (CSO).
Note: You will lose all accumulated Sum Insured Safeguard+ if you opt out of this benefit at any point in time.
Note: You can either choose Safeguard or Safeguard+ at a given point in time.
4.1.22. Future Ready

Add your Future Spouse to the plan, and all waiting periods (Initial Waiting Period, Pre-Existing Disease, specified disease/procedure, M-iracle Waiting
Periods) completed by you will be passed on to your Future Spouse, when they are added in the policy.
Note:
• This Optional Benefit can be opted at the time of new policy inception or at any renewal.
• You can ONLY add your newly married spouse to the plan.
• We will NEED the marriage certificate to add the spouse. The spouse can be added anytime during the policy tenure or at Renewal.
• Newly Married spouse MUST be added within 90 days of the marriage.
4.1.23. Borderless
Get emergency or planned treatments anywhere in the world. Choose from a range of co-payments options 0%, 20%, 30%, 40% & 50%
Note:
• The consumer can be diagnosed anywhere in the world and can go for treatments anywhere in the world. This benefit is also available under cashless
and reimbursement.
• The Sum Insured will be same as the Policy Sum Insured.
• The following benefits will be considered for Borderless also: Expenses in reaching a Hospital, Expenses during Hospitalization, Expenses before
and after hospitalization, Organ Donor.
• This optional benefit is not available to Non-Indian citizens & people who are not permanent residents of India.

4.1.24. Cash-Bag:
For each claim free year get an amount equal to 10% of the premium to be paid on 1st Renewal and 5% thereafter on each renewal from 2nd renewal
onwards. Accumulate this amount and use the amount for OPD, pay for deductibles, pay for co-payment, Non-payable items and pay premiums. This
optional benefit can be accessed through our Mobile App.
Note:
• Deductibles, Co-Payments can only be paid for claims under Aspire Product.
• Only Aspire Product premium can be paid for using this Cash-Bag
• Claims under Cash-Bag will not impact Booster+, Lock the Clock/Lock the Clock+
4.1.25. WellConsult (OPD):
Opt for complete wellness and OPD benefits.
4.1.25.1. Tele/Video Consultation on our network.
4.1.25.2. Physical Consultations with Specialists & General Practitioner on our network. Flat 20% co-payment in case of re-imbursement.
4.1.25.3. Prescribed Diagnostics on our Partner network. Flat 20% co-payment in case of re-imbursement.
4.1.25.4. Prescribed Pharmacy on our Partner network. Flat 20% co-payment in case of re-imbursement.
4.1.25.5. Online sessions on Emotional Wellness. Can be availed only through our Partner network.
4.1.25.6. Diet and Nutrition Coaching. Can be availed only through our Partner network.
4.1.25.7. Artificial Intelligence lead Smart Fitness Coaching. Can be availed only through our Partner network.
4.1.25.8. Access to Global online content on wellness through our Partner network
4.1.25.9. Access to Gym memberships on our Partner network.
Note:
• All benefits are as per limits mentioned in your policy schedule.
• Claims under WellConsult (OPD) will not impact Booster+, Lock the Clock/Lock the Clock+
• We will not pay for Dental and ophthalmological consultations, diagnostics and pharmacy under this benefit.
• This benefit is applicable only in India.
5. Exclusions
5.1. Standard Exclusions
5.1.1. 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 12months/24
months/ 36 months/ 48 months (as per Variant selected) of continuous coverage after the date of inception of the first Policy with Us.
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI (Health Insurance)
Regulations, then waiting period for the same would be reduced to the extent of prior coverage.
d. Coverage under the Policy after the expiry of 12months/24 months/ 36 months/ 48 months (as per Variant selected) for any Pre-existing Dis-
ease is subject to the same being declared at the time of application and accepted by Us.
5.1.2. 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/12 months (as
per Variant Selected) 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 (covered from day 1) or Cancer (covered after 30-day waiting period).
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.
f. List of specific diseases/procedures:
i. Pancreatitis and stones in biliary and urinary system

ii. Cataract, glaucoma and retinal detachment
iii. Hyperplasia of prostate, hydrocele and spermatocele
iv. Prolapse uterus or cervix, endometriosis, Fibroids, Polycystic ovarian disease (PCOD), hysterectomy (unless necessitated by Malignancy)
v. Hemorrhoids, fissure, fistula or abscess of anal and rectal region
vi. Hernia of any site or type,
vii. Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies, Rheumatoid Arthritis,
gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair
viii. Varicose veins of lower extremities
ix. All internal or external benign neoplasms/ tumours, cyst, sinus, polyps, nodules, mass or lump
x. Ulcer, erosion or varices of gastro intestinal tract
xi. Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of tympanic membrane), Tonsils
and adenoids, nasal septum and nasal sinuses
5.1.3. 30-day 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.
5.1.4. 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.
5.1.5. Rest Cure, rehabilitation and respite care (Code-Excl05)
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
a. 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, mov-
ing around either by skilled nurses or assistant or non-skilled persons.
b. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
5.1.6. Obesity/ Weight Control (Code-Excl06)
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Doctor.
b. The surgery/Procedure conducted should be supported by clinical protocols.
c. The member has to be 18 years of age or older and;
d. Body Mass Index (BMI);
i. greater than or equal to 40 or
ii. 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:
1. Obesity-related cardiomyopathy
2. Coronary heart disease
3. Severe Sleep Apnea
4. Uncontrolled Type2 Diabetes
5.1.7. 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.
5.1.8. 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.
5.1.9. 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.
5.1.10. Excluded Providers (Code-Excl11)
Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically excluded by Us and disclosed in
Our 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.
The complete list of excluded providers can be referred to on our website.
5.1.11. Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12)
5.1.12. 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)
5.1.13. Refractive Error (Code-Excl15)
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
Note: Less than 7.5 Diopter means a power of eye either >7.5 Dioptre for Hypermetropia or far sightedness (say +7.75 Dioptre) or < 7.5 Dioptre for
Myopia or near sightedness (say -7.75 Dioptre).
5.1.14. 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.
5.2. Specific Exclusions
5.2.1. Personal Waiting Period
Conditions specified for an Insured Person under Personal Waiting Period will be subject to a Waiting Period of up to 48 months from the inception of
the First Policy with Us.
5.2.2. Conflict & Disaster:
Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is
declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
5.2.3. External Congenital Anomaly:
Screening, counseling or treatment related to external Congenital Anomaly.
5.2.4. Dental treatment:
All dental treatments other than due to accidents and cancers.
5.2.5. Unrecognized Physician or Hospital:
a. Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Indian
Medicine or by Central council of Homeopathy.
b. Treatment provided by anyone with the same residence as an Insured Person or who is a member of the Insured Person’s immediate family
or relatives.
c. Treatment provided by Hospital or health facility that is not recognized by the relevant authorities in India.
5.2.6. Costs which are not Reasonable and Customary and treatments which are not Medically Necessary. Refer Definition 2.1.37 for Reasonable and
Customary Charges.
5.2.7. Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state

6. General Terms and Clauses
6.1. Standard General Terms and Clauses

6.1.1. Free Look Period Simplified for you
The Free Look Period shall be applicable on new individual health insurance policies and not on renewals Free look is a 15 / 30 days period during
or at the time of porting/migrating the policy. which you can return back your policy, if
you don’t like what you have purchased.
The insured person shall be allowed free look period of fifteen days (thirty days for policies with a term
of 3 years, if sold through distance marketing) 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.
lf the insured has not made any claim during the Free Look Period, the insured shall be entitled to:
i. refund of the premium paid, less any expenses incurred by the Company on medical examination of
the insured person.
Simplified for you
6.1.2. Cancellation
You can cancel your policy whenever you
i. The policyholder may cancel this policy by giving 15 days’ written notice and in such an event, the wish.
Company shall refund premium for the unexpired policy period as detailed below.
Note: We will NOT refund any premium if
Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in we have paid a claim.
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.
The below grid shall be applicable for ‘Yearly / Annual/One Time’ premium payment frequency. We will refund part of the premium
depending on how many days your policy
1 year Tenure 2 years Tenure 3 years Tenure has been running for, if there is no claim.
Policy in-force Refund Policy in-force Refund Policy in-force Refund
up to Premium up to Premium up to Premium (%)
(%) (%)
Up to 30 days 75% Up to 30 days 87.5% Up to 30 days 90%
31 to 90 days 50% 31 to 90 days 75% 31 to 90 days 87.5%
91 to 180 days 25% 91 to 180 days 62.5% 91 to 180 days 75%
exceeding 180 0% 181 to 365 days 50% 181 to 365 days 60%
days 366 to 455 days 25% 366 to 455 days 50%
456 to 545 days 12% 456 to 545 days 25%
Exceeding 545 0% 545 to 720 days 12%
days Exceeding 720 0%
days
No refund is applicable for Half Yearly, Quarterly & Monthly premium frequencies.
In case of death of an Insured, pro-rate refund of the premium for the deceased insured will be
refunded, provided there is no history of claim.
ii. The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure
Simplified for you
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 If we ever cancel your policy, it will be for
or fraud. Fraud or Non disclosure only. Insurance
contract is a legal contract too and it’s
based on trust.

6.1.3. Renewal of Policy Fraud is an action by you or anyone
The policy shall ordinarily be renewable except on grounds of fraud, misrepresentation by the insured acting on your behalf where you receive
benefits, financial or otherwise, for which
person.
you are either not eligible at all or not to
i. The Company shall endeavor to give notice for renewal. However, the Company is not under obligation the extent under the policy.
to give any notice for renewal. Pay your renewal premium before end
ii. Renewal shall not be denied on the ground that the insured person had made a claim or claims in the of policy period to maintain continuity of
preceding policy years. benefits. A grace period is also available
iii. Request for renewal along with requisite premium shall be received by the Company before the end of to pay the premium after policy expiry.
the policy period. Note: You are NOT insured during the
iv. At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of grace period.
30 days (15 days in case of other than single premium policies) to maintain continuity of benefits without
break in policy. Coverage is not available during the grace period.
v. No loading shall apply on renewals based on individual claims experience
6.1.4. Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy including the
premium rates. The Insured Person shall be notified three months before the changes are effected. Simplified for you
6.1.5. Nomination We will cancel your policy, will not pay

any claim, will not refund any premium
The policyholder is required at the inception of the policy to make a nomination for the purpose of payment
paid and have right to take all possible
of claims under the policy in the event of death of the policyholder. Any change of nomination shall be
legal action against you including for
communicated to the company in writing and such change shall be effective only when an endorsement on
recovery of benefits paid earlier, if
the policy is made. ln the event of death of the policyholder, the Company will pay the nominee {as named
in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting nominee, • You withheld any information from us,
to the legal heirs or legal representatives of the policyholder whose discharge shall be treated as full and whole or part that would have invited
final discharge of its liability under the policy. any decision other than a ‘standard
acceptance’ of your application for
6.1.6. Fraud insurance.
lf any claim made by the insured person, is in any respect fraudulent, or if any false statement, or declaration
Note: Non standard decisions are:
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 ° Loading – We ask for additional
premium paid shall be forfeited. premium
Any amount already paid against claims made under this policy but which are found fraudulent later shall ° Exclusions – We apply a additional
be repaid by all recipient(s)/policyholder(s), who has made that particular claim, who shall be jointly and waiting period for health conditions
or treatments
severally liable for such repayment to the insurer.
° Rejection – We hate to do this. But
For the purpose of this clause, the expression “fraud” means any of the following acts committed by the sometimes are compelled to say no
insured person or by his agent or the hospital/doctor/any other party acting on behalf of the insured person, to a customer
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 IMPORTANT: We understand you
deceive; and d) any such act or omission as the law specially declares to be fraudulent may not know how important is the
information on your health and it’s
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of Fraud, if impact on your policy. Hence it’s very
the insured person / beneficiary can prove that the misstatement was true to the best of his knowledge important that you disclose all health
and there was no deliberate intention to suppress the fact or that such misstatement of or suppression of information and we would decide how
material fact are within the knowledge of the insurer. important (we call it ‘material’) it is.
• Cause fraud of any kind

6.1.7. Withdrawal of Policy
i. ln the likelihood of this product being withdrawn in future, the Company will intimate the insured person
about the same 90 days prior to expiry of the policy.
ii. lnsured 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.
6.1.8. Redressal of Grievance:
ln case of any grievance the Insured Person may contact the company through: Website:
www.nivabupa.com
Toll free: 1860-500-8888
E-mail: Email us through our service platform https://rules.nivabupa.com/customer-service/ (Senior
citizens may write to us at: seniorcitizensupport@nivabupa.com)
Fax: 011-4174-3397
Courier: Customer Services Department
D-5, 2nd Floor, Logix Infotech Park, opp. Metro Station, Sector 59, Noida,
Uttar Pradesh, 201301
lnsured person may also approach the grievance cell at any of the company's branches with the details
of grievance. If lnsured person is not satisfied with the redressal of grievance through one of the above
methods, Insured Person may contact the grievance officer at:
Head – Customer Services
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301
Contact No: 1860-500-8888
Fax No: 011-4174-3397
Email ID: Email our Grievance officer through our Grievance Redressal platform https://
transactions.nivabupa.com/pages/grievance-redressal.aspx
For updated details of grievance officer, kindly refer the link https://www.nivabupa.com/customer-
care/health-services/grievance-redressal.aspx
If the Insured Person is not satisfied with the above, they can escalate to our Grievance Redressal
officer through our platform https://transactions.nivabupa.com/pages/grievance-redressal.aspx.
Simplified for you
lf lnsured person is not satisfied with the redressal of grievance through above methods, the Insured We will provide our decision on claim
Person may also approach the office of lnsurance Ombudsman of the respective area/region for within 30 days (45 days for investigated
redressal of grievance as per lnsurance Ombudsman Rules 2017 (Refer below Annexure). cases) from submission of all necessary
Grievance may also be lodged at IRDAI lntegrated Grievance Management System – claim documents. For any delay in
bimabharosa.irdai.gov.in payment of claim, we will pay interest
on the claim amount at a rate 2% above
6.1.9. Claim settlement (Provision for Penal interest) bank rate.
i. 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.
ii. ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the
policyholder from the date of receipt of last necessary document to the date of payment of claim at a rate
2% above the bank rate.
iii. 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- ln such cases, the Company shall settle or reject the claim
within 45 days from the date of receipt of last necessary document.

iv. ln case of delay beyond stipulated 45 days, the Company shall be liable to pay interest to the policyholder
at a rate 2% above the bank rate from the date of receipt of last necessary document to the date of
payment of claim.
(Explanation: “Bank rate” shall mean the rate fixed by the Reserve Bank of lndia (RBl) at the beginning of
the financial year in which claim has fallen due)
6.1.10. Moratorium Period Simplified for you
After completion of eight continuous years under the Policy no look back to be applied. This period of eight After 8 years, no health insurance claim
years is called as moratorium period. The moratorium would be applicable for the sums insured of the first shall be contestable except for proven
Policy and subsequently completion of 8 continuous years would be applicable from date of enhancement fraud and permanent exclusions
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.
6.1.11. Multiple Policies Simplified for you
i. ln case of multiple policies taken by an insured person during a period from one or more insurers to In case you have multiple policies, you
indemnify treatment costs, the insured person shall have the right to require a settlement of his/her can choose the policy from which you
claim in terms of any of his/her policies. ln all such cases the insurer chosen by the insured person shall want to claim first.
be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the If claim amount exceeds the Sum Insured
chosen policy. of first policy you claim from; then you
ii. lnsured person having multiple policies shall also have the right to prefer claims under this policy for the can claim the balance amount from the
amounts disallowed under any other policy / policies even if the sum insured is not exhausted. Then the second policy.
insurer shall independently settle the claim subject to the terms and conditions of this policy.
iii. lf the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have
the right to choose insurer from whom he/she wants to claim the balance amount.
iv. Where an insured person has policies from more than one insurer to cover the same risk on indemnity
basis, the insured person shall only be indemnified the treatment costs in accordance with the terms and
conditions of the chosen policy.
6.1.12. Migration Simplified for you

The Insured Person will have the option to migrate the Policy to other health insurance products / plans You can shift your policy to any other
offered by the Company policy by applying for migration of the policy at least 30 days before the policy health insurance product / plan offered
renewal date as per IRDAI guidelines on Migration. If such person is presently covered and has been by us as per migration guidelines.
continuously covered without any lapses under any health insurance product / plan offered by the Company,
the insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on
migration.
For Detailed Guidelines on migration, kindly refer the link https://www.irdai.gov.in/ADMINCMS/cms/

whatsNew_Layout.aspx?page=PageNo3987&flag=1
6.1.13. Portability Simplified for you

The Insured Person will have the option to port the Policy to other insurers by applying to such insurer to You can also shift your policy to any other
port the entire Policy along with all the members of the family, if any, at least 45 days before, but not earlier insurer as per portability guidelines.
than 60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is
presently covered and has been continuously covered without any lapses under any health insurance policy
with an Indian General / Health insurer, the proposed insured person will get the accrued continuity benefits
in waiting periods as per IRDAI guidelines on portability.
For Detailed Guidelines on portability, kindly refer the link

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1

6.1.14. 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 policyholder.
(Explanation: “Material facts” for the purpose of this policy shall mean 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)
6.1.15. 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
6.1.16. Complete Discharge
Any payment to the policyholder, insured person or his/ her nominees or his/ her legal representative or
assignee or to the Hospital, as the case may be, for any benefit under the policy shall be a valid discharge
towards payment of claim by the Company to the extent of that amount for the particular claim.
6.1.17. Premium Payment in Instalments
lf the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or
Monthly, as mentioned in the policy Schedule/Certificate of insurance, the following Conditions shall apply
(notwithstanding any terms contrary elsewhere in the policy)
i. Grace Period of 30 days in case of single premium policies, and a period of 15 days in case of other than
single premium policies, would be given to pay the instalment premium due for the policy.
ii. During such grace period, coverage will not be available from the due date of instalment premium till the
date of receipt of premium by Company.
iii. The insured person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific
Waiting Periods” in the event of payment of premium within the stipulated grace Period.
iv. No interest will be charged lf the instalment premium is not paid on due date
v. ln case of instalment premium due not received within the grace period, the policy will get canceled.
vi. ln the event of a claim, all subsequent premium instalments shall immediately become due and payable.
6.2. Specific Terms and Clauses

6.2.1. Automatic Cancellation:
The Policy shall automatically terminate in the event of death of the all Insured Person(s). A refund in
accordance with the table in Section 6.1.2 shall be payable provided that no claim has been admitted or
lodged or not benefit has been availed by the insured person under the policy.
6.2.2. Additional premium (Risk Loading)
i. We may ask for additional premium after due risk evaluation (it’s what referred to as Underwriting)
based on all information provided by you. We will issue policy to you only after you pay us the additional
premium and provide us consent.
ii. We will never ask for more than 100% for any particular health condition and never more than 150% for
any individual.
iii. Once applied, Risk loading continues even for all renewals. However, we offer discounts up to 30% under
LiveHealthy+ for maintenance and improvement in health

6.2.3. Other Renewal Conditions:
a. Renewal Premium:
Renewal premium will alter based on Age. For Floater plan, the age of eldest insured person will be
considered for calculating the premium.
b. Addition of Insured Persons on Renewal:

If a new member is added in the Policy, either by way of endorsement or at the time of Renewal, the
Pre-existing Disease clause, exclusions, loading (if any) and Waiting Periods will be applicable afresh for
that member.
c. Changes to Sum Insured on Renewal:

You may opt for enhancement of Sum Insured at the time of Renewal, subject to underwriting.
All Waiting Periods as defined in the Policy shall apply afresh for this enhanced limit from the effective
date of such enhancement.
6.2.4. Claims
a. Cashless claim facility is available at our network hospitals ONLY. As list of network hospitals is dynamic,
for the latest list, refer to our website www.nivabupa.com.
b. Documents required with claim form:
Hospital / Medical records:
• Original Discharge summary with first and subsequent consultation papers.
• Original Final Hospital bill with detailed break-up and payment receipt (including pharmacy bills).
• Laboratory investigation reports with supporting prescriptions.
• MLC/First Information Report (FIR) (in accident cases).
Policyholder documents (Nominee in case of death of Policyholder):
• KYC documents
• Cancelled cheque
IMPORTANT:
• All documents MUST be submitted within 30 days from discharge.
• For any delay in submission, You MUST provide the reasons in writing. We will condone such
delay on merits (i.e. reasons beyond your control).
• You MUST submit all claim related documents for expenses within the Deductible amount (if
applicable).
• We reserve the right to check and investigate the hospital / medical records from any doctor,
Hospital, clinic, individual or institution.
c. The expenses that are not covered or subsumed into room charges / procedure charges / costs of
treatment are placed as Annexure I.
d. If you opt for a Hospital room which is higher than the eligible room category as specified in your
Policy Schedule, then We will pay only a pro-rated portion of the total Associated Medical Expenses
(including surcharge or taxes thereon) as per the following formula:
(Eligible Room Rent limit / Room Rent actually incurred) * total Associated Medical Expenses
Associated Medical Expenses shall include Room Rent, nursing charges, Medical Practitioners’ fees and
operation theatre charges.
e. For any hospitalization, we will pay for items included in the bill by the Hospital during the duration of
hospitalization. Items not included in the bill will not be paid.

f. For any claim that is presented to us in any currency other than INR, we will use the Exchange rate as
on the date of Admission/Event of that claim.
g. All claims will be paid in INR only.
6.2.5. Policy Disputes
Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions contained
herein shall be governed by Indian law and shall be subject to the jurisdiction of the Indian Courts.
6.2.6. Territorial Jurisdiction
All claims shall be payable in India in Indian Rupees only.
6.2.7. Alteration to the Policy
This Policy constitutes the complete contract of insurance. Any change in the Policy will only be evidenced
by a written endorsement signed and stamped by Us. No one except Us can within the permission of the
IRDAI change or vary this Policy.
6.2.8. Zonal pricing
i. For the purpose of calculating premium, the country has been divided into the following 4 zones:
ii. Zone 1: Delhi NCR (Delhi NCR Includes Delhi, Baghpat, Bulandshahr, Gautam Buddh Nagar, Ghaziabad,
Hapur, Meerut, Muzaffarnagar, Shamli, Charkhi Dadri, Faridabad, Gurugram, Jhajjar, Jind, Karnal,
Mahendragarh, Nuh, Palwal, Panipat, Rewari, Rohtak, Sonipat, Aligarh, Alwar, Hissar, Kaithal, Kurukshetra,
Mathura, Saharanpur, Sirsa), Nasik, Surat, Vadodara
iii. Zone 2: Rest Of Gujarat, Kolkata, Mumbai, Palghar, Raigarh (MH), Thane
iv. Zone 3: Amritsar, Chennai, Hooghly, Hyderabad, Jaipur, K.V.Rangareddy, Kolkata Ext, Madhya Pradesh,
Rest Of Maharashtra, Rest Of Uttar Pradesh, Rest Of Haryana
v. Zone 4: Rest of India (Including Bengaluru and Pune)
vi. Your premium depends upon your residential city. Please inform us immediately in case of change in
your city.
6.2.9. Assignment
The Policy can be assigned subject to applicable laws.

Annexure I - The expenses that are not covered or subsumed into room charges / procedure charges / costs of treatment
List I – Expenses not covered
Sl. No. Item Sl. No. Item Sl. No. Item

1 BABY FOOD 24 ATTENDANT CHARGES 47 LUMBO SACRAL BELT
2 BABY UTILITIES CHARGES 25 EXTRA DIET OF PATIENT (OTHER THAN THAT 48 NIMBUS BED OR WATER OR AIR BED
WHICH FORMS PART OF BED CHARGE) CHARGES
3 BEAUTY SERVICES 26 BIRTH CERTIFICATE 49 AMBULANCE COLLAR
4 BELTS/ BRACES 27 CERTIFICATE CHARGES 50 AMBULANCE EQUIPMENT
5 BUDS 28 COURIER CHARGES 51 ABDOMINAL BINDER
6 COLD PACK/HOT PACK 29 CONVEYANCE CHARGES 52 PRIVATE NURSES CHARGES- SPECIAL
NURSING CHARGES
7 CARRY BAGS 30 MEDICAL CERTIFICATE 53 SUGAR FREE Tablets
8 EMAIL / INTERNET CHARGES 31 MEDICAL RECORDS 54 CREAMS POWDERS LOTIONS (Toiletries
are not payable, only prescribed medical
pharmaceuticals payable)
9 FOOD CHARGES (OTHER THAN 32 PHOTOCOPIES CHARGES 55 ECG ELECTRODES
PATIENT’s DIET PROVIDED BY
HOSPITAL)
10 LEGGINGS 33 MORTUARY CHARGES 56 GLOVES
11 LAUNDRY CHARGES 34 WALKING AIDS CHARGES 57 NEBULISATION KIT
12 MINERAL WATER 35 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE 58 ANY KIT WITH NO DETAILS MENTIONED
HOSPITAL) [DELIVERY KIT, ORTHOKIT, RECOVERY KIT,
ETC]
13 SANITARY PAD 36 SPACER 59 KIDNEY TRAY
14 TELEPHONE CHARGES 37 SPIROMETRE 60 MASK
15 GUEST SERVICES 38 NEBULIZER KIT 61 OUNCE GLASS
16 CREPE BANDAGE 39 STEAM INHALER 62 OXYGEN MASK
17 DIAPER OF ANY TYPE 40 ARMSLING 63 PELVIC TRACTION BELT
18 EYELET COLLAR 41 THERMOMETER 64 PAN CAN
19 SLINGS 42 CERVICAL COLLAR 65 TROLLY COVER
20 BLOOD GROUPING AND CROSS 43 SPLINT 66 UROMETER, URINE JUG
MATCHING OF DONORS SAMPLES
21 SERVICE CHARGES WHERE 44 DIABETIC FOOT WEAR 67 AMBULANCE
NURSING CHARGE ALSO
CHARGED
22 TELEVISION CHARGES 45 KNEE BRACES (LONG/ SHORT/ HINGED) 68 VASOFIX SAFETY
23 SURCHARGES 46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER

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

1 BABY CHARGES (UNLESS SPECIFIED/ 14 BED PAN 27 ADMISSION KIT
INDICATED)
2 HAND WASH 15 FACE MASK 28 DIABETIC CHART CHARGES
3 SHOE COVER 16 FLEXI MASK 29 DOCUMENTATION CHARGES /
ADMINISTRATIVE EXPENSES
4 CAPS 17 HAND HOLDER 30 DISCHARGE PROCEDURE CHARGES
5 CRADLE CHARGES 18 SPUTUM CUP 31 DAILY CHART CHARGES
6 COMB 19 DISINFECTANT LOTIONS 32 ENTRANCE PASS / VISITORS PASS
CHARGES
7 EAU-DE-COLOGNE / ROOM FRESHNERS 20 LUXURY TAX 33 EXPENSES RELATED TO PRESCRIPTION ON
DISCHARGE
8 FOOT COVER 21 HVAC 34 FILE OPENING CHARGES
9 GOWN 22 HOUSE KEEPING CHARGES 35 INCIDENTAL EXPENSES / MISC. CHARGES
(NOT EXPLAINED)
10 SLIPPERS 23 AIR CONDITIONER CHARGES 36 PATIENT IDENTIFICATION BAND / NAME
TAG
11 TISSUE PAPER 24 IM IV INJECTION CHARGES 37 PULSEOXYMETER CHARGES
12 TOOTH PASTE 25 CLEAN SHEET
13 TOOTH BRUSH 26 BLANKET/WARMER BLANKET
List III – Items that are to be subsumed into Procedure Charges

1 HAIR REMOVAL CREAM 9 WARD AND THEATRE BOOKING CHARGES 17 BOYLES APPARATUS CHARGES
2 DISPOSABLES RAZORS CHARGES (for 10 ARTHROSCOPY AND ENDOSCOPY 18 COTTON
site preparations) INSTRUMENTS
3 EYE PAD 11 MICROSCOPE COVER 19 COTTON BANDAGE
4 EYE SHEILD 12 SURGICAL BLADES, 20 SURGICAL TAPE
HARMONICSCALPEL,SHAVER
5 CAMERA COVER 13 SURGICAL DRILL 21 APRON
6 DVD, CD CHARGES 14 EYE KIT 22 TORNIQUET
7 GAUSE SOFT 15 EYE DRAPE 23 ORTHOBUNDLE, GYNAEC BUNDLE
8 GAUZE 16 X-RAY FILM

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

1 ADMISSION/REGISTRATION CHARGES 7 INFUSION PUMP– COST 13 MOUTH PAINT
2 HOSPITALISATION FOR EVALUATION/ 8 HYDROGEN PEROXIDE\SPIRIT\ 14 VACCINATION CHARGES
DIAGNOSTIC PURPOSE DISINFECTANTS ETC
3 URINE CONTAINER 9 NUTRITION PLANNING CHARGES - 15 ALCOHOL SWABES
DIETICIAN CHARGES- DIET CHARGES
4 BLOOD RESERVATION CHARGES AND ANTE 10 HIV KIT 16 SCRUB SOLUTION/STERILLIUM
NATAL BOOKING CHARGES
5 BIPAP MACHINE 11 ANTISEPTIC MOUTHWASH 17 GLUCOMETER & STRIPS
6 CPAP/ CAPD EQUIPMENTS 12 LOZENGES 18 URINE BAG
Annexure II - List of Insurance Ombudsmen
Jurisdiction of Office
Office Details
Union Territory, District)
AHMEDABAD - Shri Kuldip Singh
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor, Gujarat,
Tilak Marg, Relief Road, UT of Dadra & Nagar Haveli,
Ahmedabad – 380 001. Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU - Smt. Neerja Shah
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
Karnataka.
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL - Shri Guru Saran Shrivastava
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Madhya Pradesh
Near New Market,
Chhattisgarh.
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR - Shri Suresh Chandra Panda
62, Forest park,
Bhubneshwar – 751 009. Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in

CHANDIGARH - Dr. Dinesh Kumar Verma
Punjab,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadur-
Batra Building, Sector 17 – D,
garh),
Chandigarh – 160 017.
Himachal Pradesh,
Tel.: 0172 - 2706196 / 2706468
UT of Jammu & Kashmir, Ladakh and Chandigarh.
Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI - Shri M. Vasantha Krishna
Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet, Tamil Nadu, UT-Pondicherry Town and
CHENNAI – 600 018. Karaikal (which are part of UT of Pondicherry).
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in
DELHI - Shri Sudhir Krishna
2/2 A, Universal Insurance Building, Delhi &
Asaf Ali Road, Following Districts of Haryana - Gurugram, Faridabad, Sonepat &
New Delhi – 110 002. Bahadurgarh.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in
GUWAHATI - Shri Kiriti .B. Saha
Assam,
Meghalaya,
Jeevan Nivesh, 5th Floor,
Manipur,
Nr. Panbazar over bridge, S.S. Road,
Mizoram,
Guwahati – 781001(ASSAM).
Arunachal Pradesh,
Tel.: 0361 - 2632204 / 2602205
Nagaland and Tripura.
Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD - Shri I. Suresh Babu
6-2-46, 1st floor, “Moin Court”,
Andhra Pradesh,
Lane Opp. Saleem Function Palace,
Telangana, UT of
A. C. Guards, Lakdi-Ka-Pool,
Yanam and
Hyderabad - 500 004.
part of UT of Pondicherry.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR - Smt. Sandhya Baliga
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg, Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM - Ms. Poonam Bodra
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Kerala, UT of Lakshadweep, Mahe-a part of UT of Pondicherry.
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in

KOLKATA - Shri P. K. Rath
Hindustan Bldg. Annexe, 4th Floor,
West Bengal,
4, C.R. Avenue,
Sikkim, UT of
KOLKATA - 700 072.
Andaman & Nicobar Islands.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in
LUCKNOW -Shri Justice Anil Kumar
Districts of Uttar Pradesh :
Srivastava
Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad,
Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi,
6th Floor, Jeevan Bhawan, Phase-II,
Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur,
Nawal Kishore Road, Hazratganj,
Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi,
Lucknow - 226 001.
Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Mahara-
Tel.: 0522 - 2231330 / 2231331
jgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria,
Fax: 0522 - 2231310
Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
Email: bimalokpal.lucknow@cioins.co.in
MUMBAI - Shri Milind A. Kharat
3rd Floor, Jeevan Seva Annexe,
Goa,
S. V. Road, Santacruz (W),
Mumbai Metropolitan Region
Mumbai - 400 054.
excluding Navi Mumbai & Thane.
Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in
NOIDA - Shri Chandra Shekhar Prasad
Office of the Insurance Ombudsman, State of Uttaranchal and the following Districts of Uttar Pradesh:
Bhagwan Sahai Palace Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah,
4th Floor, Main Road, Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Orai-
Naya Bans, Sector 15, yya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautambodhanagar,
Distt: Gautam Buddh Nagar, U.P-201301. Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
Tel.: 0120-2514252 / 2514253 Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
Email: bimalokpal.noida@cioins.co.in
PATNA - Shri N. K. Singh
1st Floor,Kalpana Arcade Building,,
Bihar,
Bazar Samiti Road,
Jharkhand.
Bahadurpur, Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@cioins.co.in
PUNE - Shri Vinay Sah
Jeevan Darshan Bldg., 3rd Floor, Maharashtra,
C.T.S. No.s. 195 to 198, Area of Navi Mumbai and Thane
N.C. Kelkar Road, Narayan Peth, Pune – 411 030. excluding Mumbai Metropolitan Region.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in
EXECUTIVE COUNCIL OF INSURERS Shri B. C. Patnaik, Secretary General

3rd Floor, Jeevan Seva Annexe, Smt Poornima Gaitonde, Secretary
S. V. Road, Santacruz (W),
Mumbai - 400 054. Ombudsmen details are subject to change. Please refer this link for the updated
Tel.: 022 - 69038801/03/04/05/06/07/08/09 details: CIO (cioins.co.in)”
Email: inscoun@cioins.co.in

Fast Forward (Add-on):
Endorsement Document
Fast Forward is an Add-on which can be endorsed along with the Base Plan only and cannot be bought in isolation or as a separate product. The Add-on can only
be purchased with the Base Plan at the time of either buying a New Policy or at Renewal of a Base Plan.
The Add on can be opted for policies with more than 1 year of tenure only. The Add-on shall be available only if it is specifically mentioned in Your Base Plan’s Policy
Schedule.
How it works:
Even when you purchase a policy of longer than 1 year tenure, your plan Sum Insured operates on Annual Basis. Which means if you have an INR 10 Lakh policy, you
can use INR 10 Lakh each policy year even when the policy tenure may be 2 or 3 years.
With Fast Forward, your Annual Base Sum Insured & M-iracle Sum Insured of the policy is combined for the entire tenure opted by you. This combined Base Sum
Insured and the M-iracle Sum Insured will be available for the entire policy tenure.
For Re-instatement benefits to be triggered under base plans, only one claim is to be made during complete tenure of the policy.
Example:
Base Plan opted for INR 10 Lakh Base Sum Insured. This has M-iracle Sum Insured of INR 12,000.
Base plan of multiple years tenure opted is combined and is available for the entire policy tenure. The policy tenure thus is the entire duration of the policy which
could be 2 or 3 years as opted. Without Fast Forward Add-on, the Sum Insured (both the Base Sum Insured and “M-iracle” Sum Insured) is always Annual i.e
available on policy year basis despite the policy tenure being 2 or 3 years.
Base Sum Insured:
Policy Policy tenure 2 years Without Policy tenure 3 years Without Policy tenure 2 years Policy tenure 3 years
Policy tenure 1 year
year Fast forward. fast forward With fast forward With fast forward
1 INR 10 Lakh INR 10 Lakh INR 10 Lakh

INR 20 Lakh
2 INR 10 Lakh INR 10 Lakh INR 10 Lakh INR 30 Lakh
INR 20 Lakh
5 INR 10 Lakh INR 10 Lakh INR 10 Lakh INR 30 Lakh
INR 20 Lakh
Mi-iracle Sum Insured:
Policy Policy tenure 2 years Without Policy tenure 3 years Without Policy tenure 2 years Policy tenure 3 years
Policy tenure 1 year
year fast forward. fast forward With fast forward With fast forward
1 INR 12,000 INR 12,000 INR 12,000

INR 24,000
2 INR 12,000 INR 12,000 INR 12,000 INR 36,000
3 INR 12,000 INR 12,000 INR 12,000
INR 24,000
4 INR 12,000 INR 12,000 INR 12,000
5 INR 12,000 INR 12,000 INR 12,000 INR 36,000
INR 24,000
6 INR 12,000 INR 12,000 INR 12,000
Note:
• The Add on is available on your Base Sum Insured & M-iracle Sum Insured.
• All waiting periods, co-payments, deductibles, permanent exclusions, definitions, claims procedure and general terms & conditions applicable to the
Base Plan will apply to this Add-on as well.
Product Name: Fast Forward | Product UIN: NBHHLIA24126V012324

Aspire
Proposal Form
URN: 024
Insurance contract is a legal contract too and it's based on TRUST and We TRUST You.
We understand you may not know how relevant is the information on your health and its impact on your policy. Hence, it is very important that you
disclose all health information and we would decide how relevant it is (we call it 'material fact').
We would cancel your policy, will not pay any claim, will not refund any premium paid and have right to take all possible legal action against you
including for recovery of benefits paid earlier, if correct and complete information is not provided about all members proposed to be insured.
Regulations mandate that the coverage can start only after we have received the full premium and have explicitly accepted the risk.
1. Proposer Details:
Title Mr. Name SUMEET PRAKASH BATHIYA

DOB 18/03/1992 Gender Male Nationality Indian
Current Address S-O PRAKASH BATHIYA SAMARTH NAGAR PLOT NO 86

UTTAM
Landmark City Aurangabad
District Aurangabad State Maharashtra Pin Code 431001
Landline Number Mobile No. 9545454572
Alternate Number Email ID sumeetbathiya@ymail.com
PAN Number AWXPB4856G (Mandatory for premium above Rupees 50,000 in cash and Rupees 1 lac through other modes)
Annual income (Rs) CKYC Number 40049802102737
Occupation: Self Employed Other, please specify

Premium paid by SELF Relationship with Proposer SELF
I would like to protect the environment and help save paper by authorizing the Company to send all your Policy and service related communication to
YES the email ID as mentioned here in the application form?
I have read, understood and accepted all Terms and Condition & hereby authorize Niva Bupa Health Insurance or any of its Agents and/or third
Yes party(ies)/ affiliates to contact me via SMS/Email/Phone/WhatsApp/Facebook or any other modes on my registered phone number over-riding my
'DND' registration to make welcome calls/SMS, Service calls/SMS or any other commercial Communication
Are you or any of the proposed applicants a PEP#? No

#
Politically Exposed Persons (PEP) are individuals who are or have been entrusted with prominent public functions i.e. Heads/ministers of central or state
government, senior politicians, senior government, judicial or military officials, senior executives of government companies, important party officials. (If you
have ticked against PEP, kindly fill the separate PEP questionnaire)
Rural and Social Sector Category (if applicable): No
Bank Details:
Bank Name Account Type
Branch City
Account Number IFSC Code
Details of Electronic Insurance Account (eIA)

Do you wish to have this Policy credited to an e-Insurance account ? (Please select any one)
No I do not have an e-insurance account and do not wish to open one
If Yes, Please share existing e-Insurance Account No.
Please select Insurance Repository Name (you have opened your account with)
Or
I do not have existing e-Insurance account and I am interested in creating a new e-Insurance account
(Please submit electronic insurance account opening form (eIA form) along with relevant documents).
Renewal payment sign-up:
Payment of renewal premium of your health insurance Policy can be made every year through continuing your existing Automated clearing House (ACH) /
Standing instructions (SI) with the Company. Under this option, your Policy can be renewed promptly, but subject to you completing all additional requirements
of information and documentation as may be required by the Company.
If you have opted for the ACH/SI renewal option and policy is renewed using the same, a discount of 2.5% will be applicable on the renewal premium.
2. Details of applicants for insurance:
Name SUMEET PRAKASH BATHIYA

Gender Male Height 5 (ft) 11 (inch) Weight 95 (kg)
Mobile number 9545454572 Date of Birth 18/03/1992 Please tick if not Indian Indian
Applicant 1
Relationship to Proposer Self
If a registered Medical Practitioner*, please provide: i. Medical Registration Number
ii. Council Name
iii. Address of workplace
Name KHUSHBOO SUMEET BATHIYA
Gender Female Height 5 (ft) 2 (inch) Weight 50 (kg)
Mobile number 9545454527 Date of Birth 16/09/1992 Please tick if not Indian Indian
Applicant 2
Relationship to Proposer Spouse
If a registered Medical Practitioner*, please provide: i. Medical Registration Number
ii. Council Name
iii. Address of workplace
*Avail a discount of 5% on the premium. 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 State Government and is thereby entitled to practice
medicine within its jurisdiction; and is acting within the scope and jurisdiction of his licence.
3. Coverage selection:
Base Coverage
Policy type#: Family floater
Number of lives to be covered: 2 Adults 0 Children
Variant: titanium+
Base Sum Insured: 10,00,000
Policy term: 3 Years
Optional Coverage:
1. Hospital Cash Yes
2. Safeguard+$ Yes
Applicant Number
1 2 3 4 5 6
3. Please tick if opting for 'Personal Accident cover' (This option is available
only to Applicants of age 18 years or above) No No
4. Annual Aggregate Deductible Options: No
5. Co-Payment No
6. Pre-Existing Disease Waiting Time Modification No
7. Room Type Modification No
8. Tiered Network No
9. Borderless (with Co-payment) No
10. Future Ready No
11. Cash-Bag No
12. WellConsult (OPD) No
Add-ons:
No
1 2 3 4 5 6
1. Smart Health+ (Disease management) *All affected members to choose
one variant gold or platinum. No No
No
2. Smart Health+ (Acute Care) *any one of the two can be opted
Best Care Sum Insured Options: 0
3. Fast Forward Yes

#
Family Floater sum insured is common for all insured members. Floater means individually or collectively all insureds can claim to this limit
4. Portability
Policy No Insurance company Risk start date Risk end date Reasons for porting
Name of First policy No of years of Claims in past Current No Sum insured - Sum insured - Sum insured - Sum insured -
proposed start date continuous policies claim Bonus Year 1 (Oldest) Year 2 Year 3 Year 4
insured for coverage for (Expiring
whom which policy)
portability is portability is
requested requested
5. Nomination
In the event of the death of the Proposer, any payment due under the Policy shall become payable to the Nominee named below. The receipt of the such
payment by the Nominee would constitute discharge of the Company's liability under the Policy.
Nominee Name Date of Birth Relationship Address and contact details of Appointee Name (if nominee is less than
with the Proposer Nominee 18 year of age)
KHUSHBOO SUMEET 16/09/1992 Spouse S-O PRAKASH BATHIYA SAMARTH

BATHIYA NAGAR PLOT NO 86; UTTAM;
Aurangabad; Maharashtra;431001
9545454572
6. ABHA ID
Member Name Do you have ABHA ID? ABHA ID

SUMEET PRAKASH BATHIYA No
KHUSHBOO SUMEET BATHIYA No
Medical Declarations
Application No - 821102759238
Member No - 9907802641
Member Name - SUMEET PRAKASH BATHIYA
Question: First Name
Options:
Answer: SUMEET PRAKASH BATHIYA
Question: Are you suffering from any of the following diseases? 1) Cancer/Leukemia/Malignant Tumour, 2)
Cardiac Ailments (Heart Attack, By-Pass Surgery etc), 3) Major organ failure (Kidney, Liver, Heart, Lungs, etc.),
4) Neurological disorder/Stroke/Paralysis, 5) Chronic Obstructive Pulmonary Disease (COPD) / Progressive
Lungs Disease, 6) Hepatitis B or C, Chronic liver disease, Crohn's disease, Ulcerative colitis, 7) Any anaemia
other than iron deficiency anaemia, 8) Type 1 Diabetes
Options:Yes, No
Answer: no
Question: Select condition most relevant to you
Options:Have Diabetes,Have Hypertension,Diagnosed with a disease that needed treatment for more than a
week,Underwent a surgery Or advised one,Under any follow up or awaiting any treatment,None of the above is
applicable to me
Answer: none of the above is applicable to me
Question: Form has documents ?
Options:Yes, No
Answer: no
Member No - 9907802642
Member Name - KHUSHBOO SUMEET BATHIYA
Question: First Name
Options:
Answer: KHUSHBOO SUMEET BATHIYA
Question: Are you suffering from any of the following diseases? 1) Cancer/Leukemia/Malignant Tumour, 2)
Cardiac Ailments (Heart Attack, By-Pass Surgery etc), 3) Major organ failure (Kidney, Liver, Heart, Lungs, etc.),
4) Neurological disorder/Stroke/Paralysis, 5) Chronic Obstructive Pulmonary Disease (COPD) / Progressive
Lungs Disease, 6) Hepatitis B or C, Chronic liver disease, Crohn's disease, Ulcerative colitis, 7) Any anaemia
other than iron deficiency anaemia, 8) Type 1 Diabetes
Options:Yes, No
Answer: no
Question: Select condition most relevant to you
Options:Have Diabetes,Have Hypertension,Diagnosed with a disease that needed treatment for more than a
week,Underwent a surgery Or advised one,Under any follow up or awaiting any treatment,None of the above is
applicable to me
Answer: none of the above is applicable to me
Question: Form has documents ?
Options:Yes, No
Answer: no
Customer ID: 2003219154
Member No. Name Age Valid From
18161586 Sumeet Prakash Bathiya 31 06/02/2024
18161587 Khushboo Sumeet Bathiya 31 06/02/2024

Formerly Known As Max Bupa Health Insurance Co. Ltd.

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Date: 25/04/2024

Policy Number: 33758721202400

MR. SUMEET PRAKASH BATHIYA

Subject : Niva Bupa Health Insurance Policy No. 33758721202400

Dear MR. SUMEET PRAKASH BATHIYA,

Director - Operations & Customer Service

Important - Please read this document and keep in a safe place.

CLAIM SERVICING Turnaround time*

GRIEVANCE HANDLING Turnaround time*

Acknowledge a grievance – from the date of receipt of grievance 3 Days

Resolve a grievance– from the date of receipt of grievance 14 Days

Product Name: Heartbeat | Product UIN: MAXHLIP20065V051920

Policyholder Name: MR. SUMEET PRAKASH BATHIYA Policy Number 33758721202400

UTTAM, Base Sum Insured INR 10,00,000

AURANGABAD, Variant Opted Titanium+

MAHARASHTRA - 431001 Plan Opted Family Floater

eIA Number None Reported claims in the policy since 0

Mr. Sumeet Prakash 10,00,000 0 0 10,00,000 0 0 0

Nominee Name Relationship with the Policyholder

Khushboo Sumeet Bathiya Spouse

Intermediary Name Intermediary Code Intermediary Contact No.

Niva Bupa Health Insurance

Optional Benefit/Feature Details

Hospital Cash INR 2,000/day; for maximum up to 30 days

Personal Accident Not Opted

Smart Health+ (Disease Management) (Add-on) Not Opted

Smart Health+ (Acute Care) (Add-on) Not Opted

Pre Existing Disease Waiting Time Modification Not Opted

Co-payment Not Opted

Room Type Modification Not Opted

Annual Aggregate Deductible Not Opted

Tiered Network Not Opted

Future Ready Not Opted

Fast Forward (Add-on) Yes

Borderless Not Opted

Cash-Bag Not Opted

WellConsult (OPD) Not Opted

Product Benefit Table1

Expenses in Reaching Hospital • Road Ambulance: Up to Sum Insured

Home Care/Domiciliary Covered up to Sum Insured

• ReAssure "Forever": First claim paid triggers ReAssure, forever. It is unlimited.

Insured Person Details

Permanent Exclusion (if any):

Location: New Delhi Director - Operations & Customer Service

Policyholder Name Mr. Sumeet Prakash Bathiya Policy Number 33758721202400

Policy Commencement Date # 06/02/2024 Policy Expiry Date 05/02/2027

Premium (Rs.) - Base Product 42,007.00

Premium (Rs.) - Hospital Cash 2,730.00

Premium (Rs.) - Safeguard+ 5,120.00

Underwriting Loading (Rs.) 0.00

Net Premium / Taxable value (Rs.) 48,738.00

Integrated Goods and Service Tax (18.00 %) 0.00

Central Goods and Service Tax (9.00 %) 4,386.42

State/UT Goods and Service Tax (9.00 %) 4,386.42

Gross Premium (Rs.) 57,511.00

Details of persons Insured:

Mr. Sumeet Prakash Bathiya 31 Male Applicant

Mrs. Khushboo Sumeet Bathiya 31 Female Spouse

Location: New Delhi Director - Operations & Customer Service