UNITED INDIA INSURANCE COMPANY LIMITED REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014

HEALTH INSURANCE POLICY GROUP 1 WHEREAS the insured designated in the Schedule hereto has by a proposal and declaration dated as stated in the Schedule which shall be the basis of this Contract and is deemed to be incorporated herein has applied to UN !E" N" A NSURANCE C#$%AN& '!"( )hereinafter called the C#$%AN&* for the insurance hereinafter set forth in respect of Employees+$embers )including their eligible family members* named in the Schedule hereto )hereinafter called the NSURE" %ERS#N* and has paid premium as consideration for such insurance( N#W !H S %#' C& W !NESSES that sub,ect to the terms- conditions- e.clusions and definitions contained herein or endorsed- or otherwise e.pressed hereon the Company underta/es that if during the period stated in the Schedule or during the continuance of this policy by renewal any insured person shall contract any disease or suffer from any illness )hereinafter called " SEASE* or sustain any bodily in,ury through accident )hereinafter called N0UR&* and if such disease or in,ury shall re1uire any such insured %erson- upon the ad2ice of a duly 1ualified %hysician+$edical Specialist+$edical practitioner )hereinafter called $E" CA' %RAC! ! #NER* or of a duly 1ualified Surgeon )hereinafter called SUR3E#N* to incur hospitalisation+domiciliary hospitalisation e.penses for medical+surgical treatment at any Nursing Home+Hospital in ndia as herein defined )hereinafter called H#S% !A'* as an inpatient- the Company will pay through !%A to the Hospital + Nursing Home or nsured the amount of such e.penses as are reasonably and necessarily incurred in respect thereof by or on behalf of such nsured %erson but not e.ceeding the Sum nsured in aggregate in any one period of insurance stated in the schedule hereto( n the e2ent of any claim becoming admissible under this scheme- the company will pay through !%A to the Hospital + Nursing Home or insured person the amount of such e.penses as would fall under different heads mentioned below and as are reasonably and necessarily incurred thereof by or on behalf of such insured person but not e.ceeding the Sum nsured in aggregate mentioned in the schedule hereto( A( Room- 5oarding and Nursing e.penses as pro2ided by the Hospital+Nursing Home not e.ceeding 16 of the sum insured per day or the actual amount whiche2er is less( !his also includes nursing care- R$# charges- 7 8luids+5lood transfusion+in,ection administration charges and similar e.penses( 5( ntensi2e Care Unit ) CU* e.penses not e.ceeding 46 of the sum insured per day or actual amount whiche2er is less( C( Surgeon- Anaesthetist- $edical %ractitioner- Consultants- Specialists 8ees( "( Anaesthetic- 5lood- #.ygen- #peration !heatre Charges- surgical appliances$edicines 9 "rugs- "ialysis- Chemotherapy- Radiotherapy- Cost of Artificial 'imbs- cost of prosthetic de2ices implanted during surgical procedure li/e pacema/er- orthopaedic implants- infra cardiac 2al2e replacements- 2ascular stents- rele2ant laboratory+diagnostic tests- :;ray and other medical e.penses related to the treatment( E( Hospitalisation e.penses )e.cluding cost of organ* incurred on donor in respect of organ transplant to the insured( Note < 1( !he amount payable under 1(4 C 9 " abo2e shall be at the rate applicable to the entitled room category( n case the nsured person opts for a room with rent higher than the entitled category as in 1(4 A abo2e- the charges payable under 1(4 C 9 " shall be limited to the charges applicable to the entitled category( !his will not be applicable in respect of medicines 9 drugs and implants( 4( No payment shall be made under 1(4 C other than as part of the hospitalisation bill(

1(1

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1(4(1

E.penses in respect of the following specified illnesses will be restricted as detailed below< ' $ !S per surgery RES!R C!E" !# a( insured b( nsured Actual e.penses incurred or 4>6 of the sum whiche2er is less Actual e.penses incurred or ?@6 of the Sum whiche2er is less

Hospitalisation Benefits

a( b(

Cataract- Hernia- Hysterectomy $a,or surgeries=

= $a,or surgeries include Cardiac surgeries- 5rain !umor surgeries- %acema/er implantation for sic/ sinus syndrome- Cancer surgeries- Hip- Anee- ,oint replacement surgery- #rgan !ransplant( = !he abo2e limits specified are applicable per hospitaliBation+surgery( 1(C %re and %ost Hospitalisation e.penses payable in respect of each hospitalisation shall be the actual e.penses incurred sub,ect to a ma.imum of 1@6 of the Sum nsured( 1(D n addition to the abo2e- the following would apply to claims arising out of persons aged more than E@ years E:%ENSES #N $A0#R ''NESSES CHAR3E" AS A !#!A' %ACAA3E !# 5E SE!!'E" W !H A C#;%A& #N F@<4@ 5AS S( !he co;pay of 4@6 will be applicable on the admissible claim amount(

)N(5< CompanyGs 'iability in respect of all claims admitted during the period of insurance shall not e.ceed the Sum nsured per person as mentioned in the schedule* 4( "E8 N ! #NS< 2.1 H#S% !A' + NURS N3 H#$E means any institution in ndia established for indoor care and treatment of sic/ness and in,uries and which Either )a* has been registered as a Hospital or Nursing Home with the local authorities and is under the super2ision of a registered and 1ualified $edical %ractitioner( #r )b* Should comply with minimum criteria as under<; i* t should ha2e at least 1> inpatient beds( ii* 8ully e1uipped operation theatre of its own where2er surgical operations are carried out( iii* 8ully 1ualified Nursing Staff under its employment round the cloc/( i2* 8ully 1ualified "octor )s* should be in;charge round the cloc/( 2* $aintains a daily record for each of its patients(

N(5< 1( n class GCG towns condition 4(1 b)i* in respect of number of beds be reduced to 1@( 4( 8or Ayur2edic+Homeopathic+Unani !reatment( HospitaliBation e.penses are admissible only when the treatment is ta/en as in patient in a 3o2ernment Hospital+$edical College Hospital( 4(1(1 !he term G Hospital + Nursing Home G shall not include an establishment which is a place of rest- a place for the aged- a place for drug;addicts or place for alcoholics a hotel or a similar place( GSurgical #perationG means manual and + or operati2e procedures for correction of deformities and defects- repair of in,uries- diagnosis and cure of diseases- relief of suffering and prolongation of life( Hospitalisation means admission in a Hospital+Nursing Home in ndia upon the written ad2ice of a $edical %ractitioner for a minimum period of 4D consecuti2e hours( Howe2er- this time limit is not applied to specific treatments- such as

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1( 4( C( D( >( E(

Adenoidectomy Appendectomy Ascitic+%leural tapping Auroplasty Coronary angiography Coronary angioplasty

1H( 4@( 41( 44( 4C(

8ESS Haemo dialysis 8issurectomy+8istulectomy $astoidectomy Hydrocele

4D( Hysterectomy ?( "ental surgery F( H( 1@( 11( 14( 1C( 1D( 1>( 1E( 1?( 1F( "9C Endoscopies E.cision of Cyst+3ranuloma+lump Eye surgery 8racture+dislocation e.cluding hairline fracture Radiotherapy 'ithotripsy ncision and drainage of abcess Colonoscopy 7aricocelectomy Wound suturing 4>( nguinal+2entral+umbilical+ 8emoral hernia 4E( %arenteral chemotherapy 4?( %olypectomy 4F( Septoplasty 4H( %iles+fistula C@( %rostate C1( Sinusitis C4( !onsilectomy CC( 'i2er aspiration CD( Sclerotherapy C>( 7aricose 7ein 'igation

#r any other surgeries + procedures agreed by the !%A+ Company which re1uire less than 4D hours hospitalisation and for which prior appro2al from !%A is mandatory( 4(C(1 8urther if the treatment+procedure+surgeries of abo2e diseases are carried out- in "ay care centres which is fully e1uipped with ad2anced technology and specialiBed infrastructure where the insured is discharged on the same day- the re1uirement of minimum beds will be o2erloo/ed pro2ided following conditions are met( i( !he operation theatre is fully e1uipped for the surgical operation re1uired in respect of sic/ness+ailment+in,ured co2ered under the policy( ii( "ay Care nursing staff is fully 1ualified( iii( !he doctor performing the surgery or procedure as well as post operati2e attending doctors are also fully 1ualified for the specific surgery+procedure( Note< %rocedures+treatments usually done in out patient department are not payable under the policy e2en if con2erted as an in;patient in the hospital for more than 4D hours 4(D "#$ C ' AR& H#S% !A' SA! #N 5ENE8 !< means $edical treatment for a period e.ceeding three days for such illness + disease + in,ury which in the normal course would re1uire care and treatment at a hospital + nursing home but actually ta/en whilst confined at home in ndia under any of the following circumstances namely<; i* !he condition of the patient is such that he + she cannot be remo2ed to the hospital + nursing home or ii* !he patient cannot be remo2ed to Hospital + Nursing home for lac/ of accommodation therein Sub,ect howe2er that domiciliary hospitalisation benefits shall not co2er< * * 1* 4* C* D* E.penses incurred for pre and post hospital treatment and E.penses incurred for treatment for any of the following diseases<; Asthma 5ronchitis Chronic Nephritis and Nephritic Syndrome "iarrhoea and all type of "ysenteries including 3astroenteritis

>* E* ?* F* H* 1@* 11* 14*

"iabetes $ellitus and nsipidus Epilepsy Hypertension nfluenBa- Cough and Cold All %sychiatric or %sychosomatic "isorders %yre.ia of un/nown #rigin for less than 1@ days !onsillitis and Upper Respiratory !ract infection including 'aryngitis and pharangitis Arthritis- 3out and Rheumatism

Note< When treatment such as dialysis- Chemotherapy- Radiotherapy(- etc is ta/en in the hospital + nursing home and the insured is discharged on the same day the treatment will be considered to be ta/en under hospitalisation benefit section( 'iability of the company under this clause is restricted as stated in the Schedule attached hereto( C(@ AN& #NE ''NESS< Any one illness means continuous period of illness and it includes relapse within D> days from the date of discharge from the Hospital + Nursing Home from where treatment has been ta/en( #ccurrence of same illness after a lapse of D> days as stated abo2e will be considered as fresh illness for the purpose of this policy( C(1 %RE ; H#S% !A' SA! #N< Rele2ant medical e.penses incurred during period up to C@ days prior to Hospitalisation on disease + illness + in,ury sustained will be considered as part of claim as mentioned under item 1(4 abo2e(

3.2 %#S! H#S% !A' SA! #N<

Rele2ant medical e.penses incurred during period up to E@ days after Hospitalisation on disease + illness + in,ury sustained will be considered as part of claim mentioned under item 1(4 abo2e( C(C $E" CA' %RAC! #NER means a person who holds a degree + diploma of a recognised institution and is registered by $edical Council of respecti2e State of ndia( !he term $edical %ractitioner would include %hysician- Specialist and Surgeon( C(D IUA' 8 E" NURSE means a person who holds a certificate of recognised Nursing Council and who is employed on recommendation of the attending $edical %ractitioner( C(> $A!ERN !& E:%ENSES 5ENE8 ! means treatment ta/en in Hospital+Nursing Home arising from or traceable to pregnancy- childbirth including normal Caesarean Section( !his is an optional benefit a2ailable on payment of additional premium( When $aternity E.penses 5enefit is opted for in the policy- E.clusion D(14 of the policy stands deleted( !he hospitalisation e.penses in respect of the new born child can be co2ered within the $otherJs $aternity e.penses sub,ect to an o2erall limit of Rs(>@-@@@+;( C(E !%A means a !hird %arty Administrator who holds a 2alid 'icense from nsurance Regulatory and "e2elopment Authority to act as a !H R" %AR!& A"$ N S!RA!#R and is engaged by the Company for the pro2ision of health ser2ices as specified in the agreement between the Company and !%A ( C(? Networ/ Hospital means the Hospital+Nursing Home or such other medical aid pro2ider that has agreed with the !%A to pro2ide cashless access ser2ices to %olicy holders( !he list of networ/ hospitals is maintained by and a2ailable with the !%A and the same is sub,ect to amendment from time to time(

C(F Cashless facility K means facility whereby the !%A agrees on the insuredJs re1uest to settle the admissible claim directly to the networ/ hospital( C(H " card < means the identify card issued to the insured person by the !%A to a2ail cashless facility in networ/ hospitals( C(1@ "ay;care procedure means the course of medical treatment+surgical procedure in specialiBed day care centres which enables the insured to be discharged on the same day( C(11 %re;E.isting condition+"isease L Any condition- ailment or in,ury or related condition)s* for which insured person had signs or symptoms- and+or were diagnosed- and+or recei2ed medical ad2ice+treatment- within DF months prior to his+her first policy with the company( C(14 REAS#NA5'E AN" NECESSAR& E:%ENSES < 8or a networ/ed hospital- it shall mean the rate agreed between Networ/ed Hospital and the !%A for surgical+medical treatment( 8or any other hospital- it shall mean the cost of surgical+medical treatment that is necessary- customary and reasonable for treating the condition for which insured person was hospitaliBed to the e.tent relatable to such condition( 4. E:C'US #NS<

!he company shall not be liable to ma/e any payment under this policy in respect of any e.penses whatsoe2er incurred by any nsured %erson in connection with or in respect of< D(1 Any %re;e.isting condition)s* as defined in the policy- until DF months of continuous co2erage of such insured person ha2e elapsed since inception of his+her first policy with the Company( D(4 Any disease other than those stated in clause D(C below- contracted by the nsured person during the first C@ days from the commencement date of the policy( !his e.clusion shall not howe2er- apply in case of the nsured person ha2ing been co2ered under an nsurance scheme with our Company for a continuous period of preceding 14 months without any brea/( D(C "uring the first two years of the operation of the policy- the e.penses on treatment of diseases such as Cataract- 5enign %rostatic Hyperthrophy- Hysterectomy for $enorrhagia- or 8ibromyoma- Hernia- Hydrocele- Congenital internal disease- 8istula in anus- piles- Sinusitis and related disorders- 3all 5ladder Stone remo2al- 3out 9 Rheumatism- Calculus "iseases are not payable( D(D "uring the first four years of the operation of the policy- the e.penses related to treatment of 0oint Replacement due to "egenerati2e Condition and age;related #steoarthritis 9 #steoporosis are not payable( f these diseases mentioned in E.clusion no(D(C and D(D )other than Congenital nternal "iseases* are pre;e.isting at the time of proposal they will not be co2ered e2en during subse1uent period of renewal sub,ect to the pre;e.isting disease e.clusion clause( f the nsured is aware of the e.istence of congenital internal disease before inception of the policy- the same will be treated as pre;e.isting( D(> n,ury + disease directly or indirectly caused by or arising from or attributable to War- in2asionAct of 8oreign enemy- War li/e operations )whether war be declared or not*( D(E a( Circumcision unless necessary for treatment of a disease not e.cluded hereunder or as may be necessitated due to an accident( b( 7accination or inoculation( c( Change of life or cosmetic or aesthetic treatment of any description such as correction of eyesight(- etc-

d( %lastic surgery other than as may be necessitated due to an accident or as part of any illness( D(? Cost of spectacles and contact lenses- hearing aids( D(F "ental treatment or surgery of any /ind unless necessitated by accident and re1uiring hospitalisation( D(H Con2alescence- general debilityK run;down condition or rest cure- #besity treatment and its complications including morbid obesity- Congenital e.ternal disease+defects or anomaliestreatment relating to all psychiatric and psychosomatic disorders- infertility- Sterility7enereal disease- intentional self in,ury and use of into.ication drugs + alcohol( All e.penses arising out of any condition directly or indirectly caused to or associated with Human !;Cell 'ymphotropic 7irus !ype )H!'5 ; * or lymphadinopathy Associated 7irus )'A7* or the $utants "eri2ati2e or 7ariation "eficiency Syndrome or any syndrome or condition of a similar /ind commonly referred to as A "S( Charges incurred at Hospital or Nursing Home primarily for diagnosis .;ray or 'aboratory e.aminations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positi2e e.istence of presence of any ailment- sic/ness or in,ury- for which confinement is re1uired at a Hospital + Nursing Home( E.penses on 2itamins and tonics unless forming part of treatment for in,ury or diseases as certified by the attending physician

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D(14 D(1C

n,ury or "isease directly or indirectly caused by or contributed to by nuclear weapon + materials( D(1D !reatment arising from or traceable to pregnancy- childbirth- miscarriage- abortion or complications of any of these including caesarean section- e.cept abdominal operation for e.tra uterine pregnancy )Ectopic pregnancy*- which is pro2ed by submission of Ultra Sonographic report and Certification by 3ynaecologist that it is life threatening one if left untreated( D(1>Naturopathy !reatment- acupressure- acupuncture- magnetic therapies- e.perimental and unpro2en treatments+ therapies(

4.16

E.ternal and or durable $edical + Non;medical e1uipment of any /ind used for diagnosis and or treatment including C%A%- CA%"- nfusion pump etc( Ambulatory de2ices i(e(- wal/er- crutches- 5elts- Collars- Caps- Splints- Slings- 5races- Stoc/ings- elastocrepe bandages- e.ternal orthopaedic pads- sub cutaneous insulin pump"iabetic foot wear3lucometer + !hermometer- alpha + water bed and similar related items etc(- and also any medical e1uipment- which is subse1uently used at home etc( D(1?3enetic disorders and Stem Cell implantation+surgery( D(1FChange of treatment from one system of medicine to another unless recommended by the consultant+hospital under whom the treatment is ta/en( D(1H!reatment for Age related $acular "egeneration )AR$"*- treatment such as Rotational 8ield Iuantum magnetic Resonance )R8I$R*- Enhanced E.ternal Counter %ulsation )EEC%*- etc( D(4@All non;medical e.penses including con2enience items for personal comfort such as charges for telephone- tele2ision- ayah- pri2ate nursing+barber or beauty ser2ices- died charges- baby foodcosmetics- tissue paper- diapers- sanitary pads- toiletry items and similar incidental e.penses( D(41 Any /ind of Ser2ice charges- Surcharges- Admission 8ees+Registration Charges- 'u.ury !a. and similar charges le2ied by the hospital >( >(1 C#N" ! #NS< Contract < the proposal form- declaration pre;acceptance health chec/;up and the policy issued shall constitute the complete contract of insurance(

>(4

E2ery notice or communication regarding hospitaliBation or claim to be gi2en or made under this %olicy shall be deli2ered in writing at the address of the !%A office as shown in the Schedule( #ther matters relating to the policy may be communicated to the policy issuing office( !he premium payable under this %olicy shall be paid in ad2ance( No receipt for %remium shall be 2alid e.cept on the official form of the company signed by a duly authorised official of the company( !he due payment of premium and the obser2ance and fulfilment of the terms- pro2isions- conditions and endorsements of this %olicy by the nsured %erson in so far as they relate to anything to be done or complied with by the nsured %erson shall be a condition precedent to any liability of the Company to ma/e any payment under this %olicy( No wai2er of any terms- pro2isions- conditions and endorsements of this policy shall be 2alid unless made in writing and signed by an authorised official of the Company( Notice of Communication < Upon the happening of any e2ent which may gi2e rise to a claim under this %olicy notice with full particulars shall be sent to the !%A named in the schedule immediately and in case of emergency hospitaliBation within 4D hours from the time of Hospitalisation+"omiciliary Hospitalisation All supporting documents relating to the claim must be filed with !%A within 1> days from the date of discharge from the hospital( n case of post;hospitalisation- treatment )limited to E@ days*- all claim documents should be submitted within ? days after completion of such treatment(

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Note< Wai2er of this Condition may be considered in e.treme cases of hardship where it is pro2ed to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to gi2e such notice or file claim within the prescribed time;limit( >(> !he nsured %erson shall obtain and furnish the !%A with all original bills- receipts and other documents upon which a claim is based and shall also gi2e the !%A+ Company such additional information and assistance as the !%A+Company may re1uire in dealing with the claim( Any medical practitioner authorised by the !%A + Company shall be allowed to e.amine the nsured %erson in case of any alleged in,ury or disease leading to Hospitalisation if so re1uired( !he Company shall not be liable to ma/e any payment under this policy in respect of any claim if such claim be in any manner fraudulent or supported by any fraudulent means or de2ice whether by the nsured %erson or by any other person acting on his behalf( f at the time when any claim arises under this %olicy- there is in e.istence any other insurance )other than Cancer nsurance %olicy in collaboration with ndian Cancer Society*whether it be effected by or on behalf of any nsured %erson in respect of whom the claim may ha2e arisen co2ering the same loss- liability- compensation- costs or e.penses- the Company shall not be liable to pay or contribute more than its rateable proportion of any loss- liability- compensation costs or e.penses( !he benefits under this %olicy shall be in e.cess of the benefits a2ailable under Cancer nsurance %olicy( !he %olicy may be renewed by mutual consent and in such e2ent the renewal premium shall be paid to the Company on or before the date of e.piry of the %olicy or of the subse1uent renewal thereof(!he Company shall not be bound to gi2e notice that such renewal premium is due- pro2ided howe2er that if the insured shall apply for renewal and remit the re1uisite premium before the e.piry of this policy- renewal shall not normally be refused- unless the Company has reasonable ,ustification to do so(

>(E

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>(H

Cancellation Clause <

!he Company may at any time cancel this %olicy by sending the nsured 1> days notice by registered letter at the insuredJs last /nown address and in such e2ent the Company shall refund to the nsured a pro;rata premium for une.pired %eriod of nsurance( !he Company shall- howe2er- remain liable for any claim- which arose prior to the date of cancellation( !he nsured may at any time cancel this %olicy and in such e2ent the Company shall allow refund of premium at CompanyGs short period rate only )!able gi2en here below* pro2ided no claim has occurred up to the date of cancellation( %ER #" #N R SA Upto one month Upto three months Upto si. months E.ceeding si. months >(1@ RA!E #8 %RE$ U$ !# 5E CHAR3E" 1+D th of the annual rate 1+4 of the annual rate C+Dth of the annual rate 8ull annual rate(

f any dispute or difference shall arise as to the 1uantum to be paid under the policy )liability being otherwise admitted* such difference shall independently of all other 1uestions be referred to the decision of a sole arbitrator to be appointed in writing by the parties or if they cannot agree upon a single arbitrator within C@ days of any party in2o/ing arbitrationthe same shall be referred to a panel of three arbitrators- comprising of two arbitratorsone to be appointed by each of the parties to the dispute+difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the pro2isions of the Arbitration and Conciliation Act- 1HHE( t is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before pro2ided- if the Company has disputed or not accepted liability under or in respect of this %olicy( t is hereby e.pressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy that award by such arbitrator+arbitrators of the amount of the loss or damage shall be first obtained(

>(11

f the !%A- as per terms and conditions of the policy or the Company shall disclaim liability to the nsured for any claim hereunder and if the nsured shall not within 14 calendar months from the date or receipt of the notice of such disclaimer notify the !%A+ Company in writing that he does not accept such disclaimer and intends to reco2er his claim from the !%A+Company then the claim shall for all purposes be deemed to ha2e been abandoned and shall not thereafter be reco2erable hereunder(

>(14 All medical+surgical treatments under this policy shall ha2e to be ta/en in ndia and admissible claims thereof shall be payable in ndian currency( %ayment of claim shall be made through !%A to the Hospital+Nursing Home or the nsured %erson as the case may be( >(1C 'ow Claim Ratio "iscount )5onus* 'ow Claim Ratio "iscount at the following scale will be allowed on the total premium at renewal only depending upon the incurred claim ratio for the entire group insured under the 3roup $ediclaim nsurance %olicy for the preceding C completed years e.cluding the year immediately preceding the date of renewal where the 3roup $ediclaim nsurance %olicy has not been in force for C completed years- such shorter period of completed years e.cluding the year immediately preceding the date of renewal will be ta/en in to account ncurred Claim ratio under the group policy Not e.ceeding E@6 Not e.ceeding >@6 Not e.ceeding D@6 Not e.ceeding C@6 Not e.ceeding 4>6 "iscount 6 > 1> 4> C> D@

>(1D High Claims Ratio 'oading )$A'US* The total premi m pa!a"le at re#e$al o% the Gro p Poli&! $ill "e loa'e' at the %ollo$i#( )&ale 'epe#'i#( po# the i#& rre' &laim) ratio %or the e#tire (ro p i#) re' #'er the Gro p *e'i&laim I#) ra#&e Poli&! %or the pre&e'i#( !ear +imme'iatel! pre&e'i#( the 'ate o% re#e$al,. ncurred claims ratio under this group policy 5etween ?@6 and 1@@6 5etween 1@16 and 14> 6 5etween 14E 6 and 1>@ 6 5etween 1>1 6 and 1?> 6 5etween 1?E and 4@@ #2er 4@@ 6 Note< 1( 'ow Claim Ratio "iscount )5onus* or High Claim Ratio loading )$alus* will be applicable to the %remium at renewal of the %olicy depending on the incurred claims Ratio for the entire 3roup nsured( 4( ncurred claim would mean claims paid plus claims outstanding in respect of the entire group insured under the policy during the rele2ant period( !he insured shall throughout the period of insurance /eep and maintain a proper record of register containing the names of all the insured persons and other rele2ant details as are normally /ept in any institution+ #rganisation( !he insured shall declare to the company any additions in the number of insured persons as and when arising during the period of insurance and shall pay the additional premium as agreed( t is hereby agreed and understood that- that this insurance being a 3roup %olicy a2ailed by the nsured co2ering $embers- the benefit thereof would not be a2ailable to $embers who cease to be part of the group for any reason whatsoe2er( Such members may obtain further indi2idual insurance directly from the Company and any claims shall be go2erned by the terms thereof( >(1> $A!ERN !& E:%ENSES 5ENE8 ! E:!ENS #N< )Where2er applicable* !his is an optional co2er- which can be obtained on payment of 1@6 of total basic premium for all the nsured %ersons under the %olicy( #ption for $aternity 5enefits has to be e.ercised at the inception of the %olicy period and no refund is allowable in case of nsuredGs cancellation of this option during currency of the policy( >(1E !he hospitalisation e.penses in respect of the new born child can be co2ered within the $otherJs $aternity e.penses( !he ma.imum benefit allowable under this clause will be up to Rs( >@-@@@+; or the sum insured opted by the group whiche2er is lower( Special conditions applicable to $aternity e.penses 5enefit E.tension< 1( !hese 5enefits are admissible only if the e.penses are incurred in Hospital + Nursing Home as in;patients in ndia 4( A waiting period of H months is applicable for payment of any claim relating to normal deli2ery or caesarean section or abdominal operation for e.tra uterine pregnancy( !he waiting period may be rela.ed only in case of deli2ery- miscarriage or abortion induced by accident or other medical emergency( C( Claim in respect of deli2ery for only first two children and + or operations associated therewith will be considered in respect of any one nsured %erson co2ered under the policy or any renewal thereof( !hose nsured %ersons who are already ha2ing two or more li2ing children will not be eligible for this benefit( 'oading 4> 6 >> 6 H@ 6 14@ 6 1>@6 Co2er to be re2iewed

D( >(

E.penses incurred in connection with 2oluntary medical termination of pregnancy during the first 14 wee/s from the date of conception are not co2ered( %re;natal and postnatal e.penses are not co2ered unless admitted in Hospital + Nursing Home and treatment is ta/en there(

Note< When group policy is e.tended to include $aternity E.penses 5enefit- the e.clusion No(D(1D of the policy stands deleted( E REAS#NA5'E AN" NECESSAR& E:%ENSES 1( 8or a networ/ed hospital- it shall mean the rate pre;agreed between Networ/ed Hospital and the !%A for surgical + medical treatment that is necessary- customary and reasonable for treating the condition for which the insured person was hospitalised 4( 8or any other hospital- it shall mean the cost of surgical + medical treatment that is necessary- customary and reasonable for treating the condition for which insured person was hospitalised to the e.tent relatable to such condition( =====