INSURER : ICICI LOMBARD INSURANCE COMPANY LIMITED

Group Health Insurance. Covering the Members only. This policy covers expenses arising out of Illness or accidental bodily Injury or Maternity.

Policy Coverage Hospitalisation Expenses Pre-Hospitalisation Expenses - upto 30 days. Post Hospitalisation Expenses - upto 60 days

Add-on covers available under this Policy 30 days waiting period waived. 1/2/4 Years waiting period waived. Pre Existing Diseases covered. 9 months waiting Period for Maternity waived.

Compensation Platform Room, Boarding Expenses as provided by the Hospitalisation/Nursing Home- 1% of Sum Insured subject to maximum Rs.5000/- (Normal) and 2% of Sum Insured subject to maximum Rs.8000/-(ICU). In the event of Insured getting admitted in the category higher than above, the insured will bear difference of all medical expenses in the final hospital bills in the same proportions. Fees paid to Medical Practitioner, Surgeon, Anaesthetics, consultants and Specialist. Nursing Expenses. Surgical fees,operation theatre, Anaesthetist, Anaesthesia, Blood, Oxygen and Surgical Appliances, Drugs and medicines, X-ray, Lab

Compensation Platform…cont. 20% Co-Payment is applicable on each and every claim. 50% co- Payment shall be applicable for Cyberknife treatment and Stem cell transplantation. Cochlear Implant treatment shall be restricted to 50% of Sum Insured. Psychiatrist ailments is restricted to Rs.50,000/- only.

Compensation Platform…cont. Sub Limits for the following disease subject to maximum of Sum Insured Diseases sub limits Appendicetomy 25,000 Cataract/Glaucoma 20,000 Gall Bladder 31,250 Hernia 25,000 Hydrocele 15,000 Hysterectomy 31,000 Joint Replacement 150,000 including Vertebral joints Kidney Stone 40,000 Piles 18,750 Heart Related 225,000

Maternity Benefit : Expenses incurred towards treatment taken in Hospital/Nursing home arising from or traceable to pregnancy, child birth including normal caesarean section. Claim in respect of delivery for only first 2 children. Normal Delivery - Limited to Rs. 15,000. Caesarian - Limited to Rs. 25,000.

Major Exclusions : Treatment on trial/experimental basis. Treatment on account of Holter Monitoring /Prosthesis/ external medical devices/Lasik Surgery/ Septoplasty etc. Infertility & Related ailments including male sterility. Administration, Services Charges and Miscellaneous Charges are not Covered Domiciliary hospitalization expenses

Important Definitions..  Injury : Caused by External, Violent & Visible cause. Disease : As Certified by a Medical Practitioner or Surgeon.  Hospital/Nursing Home: Registered with the Local Authorities Should have minimum 15 in-patient Beds

Contd…  Hospitalisation : Treatment as in-patient in a hospital/ Nursing Home for min 24 Hrs. The Condition is waived under:  Specific Treatments like Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy, D&C, undertaken by Insured Person in the Hospital/Nursing Home  Due to technological advances, the period of Hospitalisation is less than 24 hours as per our daycare list.  Day care expenses means the medical treatment costs necessary and reasonable in scope for a Day Care Procedure preauthorized by the Administrator and done in a network Hospital to the extent that such Cost does not exceed the reasonable and customary charges in the locality for the same Day Care Procedure.

Important Definitions.. Any One illness: Continuous period of illness including relapse within 45 days from the last consultation date. Pre Hospitalisation: Relevant Expenses for 30 days. Post Hospitalisation: Relevant Expenses for 60 days. Medical Practitioner: It means a person holding a degree/diploma of a recognized institution and registered by Medical Council of respective State of India. The term Medical Practitioner would include Physician, Surgeon and Specialist.

Exclusions Attributable to War, Invasion, Act of Foreign Enemy, War like operation. Cost of Spectacles and contact lens, hearing aids. Dental treatment or Surgery of any Kind unless requiring hospitalization. Convalescence, General Debility, Run down condition or rest cure, congenital External Disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of Intoxicating drugs/alcohols. HIV/AIDS related.

Claim Submission incase of reimbursement : - Incase the member undergoes treatment in a hospital that is not covered under the network of ICICI Lombard, the member can claim reimbursement of the expenses based on their eligibility. All original documents along with a set of photocopy. Bills & receipts. Reports. Duly filled in Claim Form (is available on HR Mantra) Print out of the E – Card. Please note that all the above mentioned documents should be submitted within days of discharge from the hospital. Any delay in the same might result in rejection of the claim by the insurance company. The claim for Post Hospitalization expenses (upto 60 days) can be claimed seperately.

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