1. Beneficiary means the insured Member or the person nominated by the Member as the recipient of the Benefits under the Rules of the Scheme.
2. Certificate of Insurance means the certificate issued by the Company to Member to confirm the Member
s insurance cover under the Master Policy.
3. Coverage Term means the period for which insurance cover is provided to the individual Member under the Master Policy.
4. Date of Commencement of Cover means the date of commencement of Cover for the individual Members under the Master Policy: (i) at the time of issuance of the Master Policy, it will be the date of acceptance of risk subject to receipt of Member data and premium towards these Members. (ii) for new Members joining during the term of the Master Policy, it will be the date of acceptance of risk subject to receipt of Member data and premium towards these Members. Member Data means the necessary details of the Members required to provide risk Cover.
5. Financial Year is the period from 1st April of a calendar year to 31st of March of the subsequent calendar year.
6. Group means a group of Members accepted by the Company as constituting a Group for the purposes of the Master Policy.
7. Hospital: A hospital means any institution established for in-patient care and day care treatment of illness and/or injuries and which has been registered as a hospital with the local authorities under Clinical Establishments (Registration and Regulation) Act 2010 or under enactments specified under the Schedule of Section 56(1) and the said act Or complies with all minimum criteria as under:
- has qualified nursing staff under its employment round the clock;
- has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient beds in all other places;
- has qualified medical practitioner(s) in charge round the clock;
- has a fully equipped operation theatre of its own where surgical procedures are carried out;
- maintains daily records of patients and makes these accessible to the insurance company
s authorized personnel;
8. Hospitalisation :
Hospitalisation 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.
9. Master Policy shall mean this document, any supplementary contracts or endorsements therein, whenever executed, any amendments thereto agreed to and signed by Us, the application form provided by You, the Schemes Rules, the quotation of the Company for the Scheme and the individual enrolment forms, if any, of the insured Members, which together constitute the entire contract between the parties.
10. Medical Practitioner: A Medical Practitioner is a person who holds a valid registration from the Medical Council of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of license. The Medical Practitioner should neither be the insured person(s) himself nor related to the insured person(s) by blood or marriage.
1. Choice of coverage options:
- Level cover or Reducing cover
- Single Life cover or Joint life cover
2. Choice of Benefit options: Enhance the insurance cover with the following benefits
Accelerated Terminal Illness Benefit ,Accidental Death Benefit ,Enhanced Accidental Death Benefit , Accelerated Accidental Total and Permanent Disability Benefit , Accelerated Critical Illness Benefit ,Additional Critical Illness Benefit ,Cancer Protect Benefit ,Waiver of EMI on Hospitalization Benefit
3. A moratorium of 1 to 7 years
I. Death Benefit
II. Accelerated Terminal Illness (TI) Benefit
III. Accidental Death (AD) Benefit
IV. Accelerated Accidental Total and Permanent Disability (ATPD) Benefit
V. Cancer Protect (CP) Benefit
VI. Hospitalisation Benefit
VII. Accelerated Critical Illness (ACI) Benefit
VIII. Additional Critical Illness (CI) Benefit
IX. Waiver of Premium on Critical Illness or Accidental Total Permanent Disability (WoP)
X. Critical Illnesses covered under the Essential, Classic and Comprehensive Critical Illness coverage packages
XI. Payout Options
Minimum Maturity Age: years. Maximum Maturity Age depends on the Premium Payment Term(PPT)
a) Death Benefit will be payable on death of the Member during the Coverage Term.
b) Upon payment of Death Benefit, the Member s cover will terminate and all rights, benefits and interests of the Member under the Master Policy will stand extinguished.
You / the Member have an option to review the Policy following receipt of the Policy Document / Certificate of Insurance respectively. If you are not satisfied with the terms and conditions of this Policy, please return the Policy Document / Certificate of Insurance to Us with reason for cancellation within
i. 15 days from the date You/ Member received it, if the policy/ member cover is purchased through solicitation in person.
ii. 30 days from the date of receipt of Certificate of Insurance by the Member , in case member is enrolled through electronic mode or voice mode, which includes telephone-calling, Short Messaging Service (SMS), Physical mode which includes direct postal mail and newspaper & magazine inserts and solicitation through any means of communication other than in person
On cancellation of the Policy / Member cover during the free look period, We will return the premium paid subject to the following deductions:
i. Stamp duty charges
ii. Expenses incurred by the Company on medical examination, if any
iii. Proportionate risk premium for the period of cover The Policy / Member s cover shall terminate on payment of this amount and all rights, benefits and interests will stand extinguished.
a) For Regular Pay option - application for member revival can be made through the Master Policyholder within 5 years from the due date of the first unpaid premium and before the end of coverage term.
b) Revival will be based on the prevailing Board approved underwriting policy and guidelines framed thereunder
c) The Member furnishes, at his / her own expense, satisfactory evidence of health as required by the prevailing Board approved underwriting policy.
d) The arrears of Premiums together with interest at such rate as We may charge for late payment of premiums are paid. Revival interest rates will be set monthly and is equal to 150 basis points in addition to the prevailing yield on 10 year Government Securities. The yield on 10 year Government Securities will be sourced from www.bloomberg.com. The revival interest rate applicable for December 2019 is 7.97% p.a. compounded half yearly.
e) The revival of the Member cover may be on terms different from those applicable to the Member before premiums were discontinued; for example, extra mortality premiums or charges may be applicable.
f) We reserve the right to refuse to revive the Member cover.
g) The revival will take effect only if it is specifically communicated by Us to You / Member.
h) Any change in revival conditions will be subject to prior approval from IRDAI and will be disclosed to members.
| Claim Ratio | Solvency Ratio |
|---|---|
| 99% (2023-24) | 2% (March 2024) |