# migrations

dir: embeddings_queue
filename: 00001-embeddings.sqlite.sql
hash: d3755dfd232be8e8301f4d7fcfb3a486
sql:
CREATE TABLE embeddings_queue (
    seq_id INTEGER PRIMARY KEY,
    created_at TIMESTAMP NOT NULL DEFAULT CURRENT_TIMESTAMP,
    operation INTEGER NOT NULL,
    topic TEXT NOT NULL,
    id TEXT NOT NULL,
    vector BLOB,
    encoding TEXT,
    metadata TEXT
);


dir: sysdb
filename: 00001-collections.sqlite.sql
hash: 38352d725ad1c16074fac420b22b4633
sql:
CREATE TABLE collections (
    id TEXT PRIMARY KEY,
    name TEXT NOT NULL,
    topic TEXT NOT NULL,
    UNIQUE (name)
);

CREATE TABLE collection_metadata (
    collection_id TEXT REFERENCES collections(id) ON DELETE CASCADE,
    key TEXT NOT NULL,
    str_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (collection_id, key)
);


dir: sysdb
filename: 00002-segments.sqlite.sql
hash: 2913cb6a503055a95f625448037e8912
sql:
CREATE TABLE segments (
    id TEXT PRIMARY KEY,
    type TEXT NOT NULL,
    scope TEXT NOT NULL,
    topic TEXT,
    collection TEXT REFERENCES collection(id)
);

CREATE TABLE segment_metadata (
    segment_id TEXT  REFERENCES segments(id) ON DELETE CASCADE,
    key TEXT NOT NULL,
    str_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (segment_id, key)
);


dir: sysdb
filename: 00004-tenants-databases.sqlite.sql
hash: 048867ce8fcdefe4023c7110e4433591
sql:
CREATE TABLE IF NOT EXISTS tenants (
    id TEXT PRIMARY KEY,
    UNIQUE (id)
);

CREATE TABLE IF NOT EXISTS databases (
    id TEXT PRIMARY KEY, -- unique globally
    name TEXT NOT NULL, -- unique per tenant
    tenant_id TEXT NOT NULL REFERENCES tenants(id) ON DELETE CASCADE,
    UNIQUE (tenant_id, name) -- Ensure that a tenant has only one database with a given name
);

CREATE TABLE IF NOT EXISTS collections_tmp (
    id TEXT PRIMARY KEY, -- unique globally
    name TEXT NOT NULL, -- unique per database
    topic TEXT NOT NULL,
    dimension INTEGER,
    database_id TEXT NOT NULL REFERENCES databases(id) ON DELETE CASCADE,
    UNIQUE (name, database_id)
);

-- Create default tenant and database
INSERT OR REPLACE INTO tenants (id) VALUES ('default_tenant'); -- The default tenant id is 'default_tenant' others are UUIDs
INSERT OR REPLACE INTO databases (id, name, tenant_id) VALUES ('00000000-0000-0000-0000-000000000000', 'default_database', 'default_tenant');

INSERT OR REPLACE INTO collections_tmp (id, name, topic, dimension, database_id)
    SELECT id, name, topic, dimension, '00000000-0000-0000-0000-000000000000' FROM collections;
DROP TABLE collections;
ALTER TABLE collections_tmp RENAME TO collections;


dir: sysdb
filename: 00005-remove-topic.sqlite.sql
hash: b1367c826b8fba5f96f27befdc1d42d2
sql:
-- Remove the topic column from the Collections and Segments tables

ALTER TABLE collections DROP COLUMN topic;
ALTER TABLE segments DROP COLUMN topic;


dir: sysdb
filename: 00006-collection-segment-metadata.sqlite.sql
hash: 4eea7468935bf25d4604a0fed2366116
sql:
-- SQLite does not support adding check with alter table, as a result, adding a check
-- involve creating a new table and copying the data over. It is over kill with adding
-- a boolean type column. The application write to the table needs to ensure the data
-- integrity.
ALTER TABLE collection_metadata ADD COLUMN bool_value INTEGER;
ALTER TABLE segment_metadata ADD COLUMN bool_value INTEGER;


dir: metadb
filename: 00001-embedding-metadata.sqlite.sql
hash: 2b4cf52c4bb2676e21d6860a4409f856
sql:
CREATE TABLE embeddings (
    id INTEGER PRIMARY KEY,
    segment_id TEXT NOT NULL,
    embedding_id TEXT NOT NULL,
    seq_id BLOB NOT NULL,
    created_at TIMESTAMP NOT NULL DEFAULT CURRENT_TIMESTAMP,
    UNIQUE (segment_id, embedding_id)
);

CREATE TABLE embedding_metadata (
    id INTEGER REFERENCES embeddings(id),
    key TEXT NOT NULL,
    string_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (id, key)
);

CREATE TABLE max_seq_id (
    segment_id TEXT PRIMARY KEY,
    seq_id BLOB NOT NULL
);

CREATE VIRTUAL TABLE embedding_fulltext USING fts5(id, string_value);


dir: metadb
filename: 00002-embedding-metadata.sqlite.sql
hash: 12a570f7121b3a8ce750a2a7c36da20f
sql:
-- SQLite does not support adding check with alter table, as a result, adding a check
-- involve creating a new table and copying the data over. It is over kill with adding
-- a boolean type column. The application write to the table needs to ensure the data
-- integrity.
ALTER TABLE embedding_metadata ADD COLUMN bool_value INTEGER


dir: metadb
filename: 00003-full-text-tokenize.sqlite.sql
hash: f97ad6334aeaa8f419f01110b648b97a
sql:
CREATE VIRTUAL TABLE embedding_fulltext_search USING fts5(string_value, tokenize='trigram');
INSERT INTO embedding_fulltext_search (rowid, string_value) SELECT rowid, string_value FROM embedding_metadata;
DROP TABLE embedding_fulltext;


# embeddings_queue

created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_0
encoding: FLOAT32
metadata:
{"chroma:document": "# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT\n\n# Policy Document \u2013 Part II\n\n# 1. Terms & Conditions\n\nThe insurance cover provided under this Policy to the Insured Person up to the Sum Insured is and shall be subject to (a) the terms and conditions of this Policy and (b) the receipt of premium, and (c) the information You provided to Us (including by way of the Proposal or Information Summary Sheet) on Your behalf and on behalf of all persons to be insured. Please inform Us immediately of any change in the address, nature of job, state of health, or of any other changes affecting You or any Insured Person.\n\n# 2. Benefits\n\nThe Policy covers reasonable expenses incurred towards medical treatment taken during the Policy Period for an Illness, Accident or condition described below if this is contracted or sustained by an Insured Person during the Policy Period and subject always to the Sum Insured, any subsidiary limit specified in the Product Benefits Table, the terms, conditions, limitations and exclusions mentioned in the Policy and eligibility as per the insurance plan opted for in the Product Benefits Table and as shown in the Schedule of Insurance Certificate :\n\n# 2.1. In-patient Treatment\n\n(a) Doctors\u2019 fees\n(b) Diagnostics Tests\n(c) Medicines, drugs and consumables\n(d) Intravenous fluids, blood transfusion, injection administration charges\n(e) Operation peatre charges\n(f) The cost of prospetics and oper devices or equipment if implanted internally during a Surgical Operation.\n(g) Intensive Care Unit charges\n\n# 2.2. Hospital Accommodation\n\nWe will cover Reasonable and Customary charges for Hospital accommodation.\n\n# 2.3. Pre-hospitalization Medical Expenses"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_1
encoding: FLOAT32
metadata:
{"chroma:document": "# 2.3. Pre-hospitalization Medical Expenses\n\nWe will cover Medical Expenses incurred due to Illness up to 30 days immediately before an Insured Person\u2019s admission to a Hospital for the same Illness as long as We have accepted an In-patient Hospitalisation claim under 2.1 above. Pre-hospitalization expenses can be claimed as reimbursement only.\n\nPage 1 of 25# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT\n\n|2.4.|Post-hospitalization Medical Expenses|\n|---|---|\n|We will cover Medical Expenses incurred due to Illness up to 60 days immediately after an Insured Person\u2019s discharge from Hospital for the same Illness as long as We have accepted an In-patient Hospitalisation claim under 2.1 above. Post-hospitalization expenses can be claimed as reimbursement only.|We will cover Medical Expenses incurred due to Illness up to 60 days immediately after an Insured Person\u2019s discharge from Hospital for the same Illness as long as We have accepted an In-patient Hospitalisation claim under 2.1 above. Post-hospitalization expenses can be claimed as reimbursement only.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_2
encoding: FLOAT32
metadata:
{"chroma:document": "|2.5.|Day-Care Procedures|\n|---|---|\n|We will cover Medical Expenses for Day Care Procedures (including Chemotherapy, Radiotherapy, Hemodialysis, any procedure which needs a period of specialized observation or care after completion of the procedure) where such procedures are undertaken by an Insured Person as an In-patient in a Hospital for a continuous period of less than 24 hours. Any procedure undertaken on an out-patient basis in a Hospital will not be covered.|We will cover Medical Expenses for Day Care Procedures (including Chemotherapy, Radiotherapy, Hemodialysis, any procedure which needs a period of specialized observation or care after completion of the procedure) where such procedures are undertaken by an Insured Person as an In-patient in a Hospital for a continuous period of less than 24 hours. Any procedure undertaken on an out-patient basis in a Hospital will not be covered.|\n\n|2.6.|Domiciliary Treatment|\n|---|---|\n|We will cover Medical Expenses for medical treatment taken at home if this continues for an uninterrupted period of 3 days and the condition for which treatment is taken would otherwise have necessitated hospitalization as long as either (i) the attending Doctor confirms that the Insured Person could not be transferred to a Hospital or (ii) the Insured Person satisfies Us that a Hospital bed was unavailable.|We will cover Medical Expenses for medical treatment taken at home if this continues for an uninterrupted period of 3 days and the condition for which treatment is taken would otherwise have necessitated hospitalization as long as either (i) the attending Doctor confirms that the Insured Person could not be transferred to a Hospital or (ii) the Insured Person satisfies Us that a Hospital bed was unavailable.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_3
encoding: FLOAT32
metadata:
{"chroma:document": "|2.7|Organ Donor|\n|---|---|\n|We will cover Medical Expenses for an organ donor\u2019s treatment for the harvesting of the organ donated provided that:|We will cover Medical Expenses for an organ donor\u2019s treatment for the harvesting of the organ donated provided that:|\n|a.|The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person;|\n|b.|The Insured Person has been medically advised to undergo an organ transplant;|\n|We will not cover:|We will not cover:|\n|(a)|Pre-hospitalisation or post-hospitalization Medical Expenses or screening expenses of the donor or any other medical expenses as a result of the harvesting from the donor;|\n|(b)|Costs directly or indirectly associated with the acquisition of the donor\u2019s organ.|\n\n|2.8|Emergency ambulance|\n|---|---|\n|We will cover Reasonable and Customary ambulance expenses incurred to transfer the Insured Person by surface transport following an Emergency to the nearest Hospital with adequate facilities if:|We will cover Reasonable and Customary ambulance expenses incurred to transfer the Insured Person by surface transport following an Emergency to the nearest Hospital with adequate facilities if:|\n|a.|The ambulance service is offered by a healthcare or ambulance service provider;|\n|b.|We have accepted an In-patient Hospitalization claim under the provisions of 2.1 above;|\n|In the case of Out-Of-Network Hospitalization of the Insured Person Our maximum liability for ambulance expenses is limited to Rs.2,000/- per event.|In the case of Out-Of-Network Hospitalization of the Insured Person Our maximum liability for ambulance expenses is limited to Rs.2,000/- per event.|\n\nPage 2 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_4
encoding: FLOAT32
metadata:
{"chroma:document": "POLICY DOCUMENT\n\n2.9 Consultation and Diagnostic Tests (For Platinum Policyholders only)\nWe will cover an Insured Person\u2019s Reasonable & Customary consultation expenses of Medically Necessary consultation wip a Doctor, as an out-patient to assess pe Insured Person\u2019s healp condition for any Illness. We will also pay for any Diagnostic Tests prescribed by pe Doctor upto pe sub-limits shown in pe Product Benefits Table.\nIf pere is an unutilized amount (not used by pe Insured Person) under pe applicable subsidiary limit for pis benefit (as specified in pe Product Benefits Table) in a Policy Year, pen if pe Policy is in force and pe Policy has been renewed wip Us wipout any break, We will carry forward 80% of pis amount to pe immediately succeeding Policy Year, provided pat pe total amount (including pe unutilized amount available under pis benefit) shall at no time exceed 2.5 times pe amount of pe entitlement in respect of pis benefit under pe plan applicable to pe Insured Person per pe Product Benefits Table.\n\n3. Co-pay\n\nIf any Insured Person is 65 years of age or over on the date of commencement of the current Policy Year, then it is agreed that We will only pay 80% of any amount We assess for payment or reimbursement in respect of any claim made by that Insured Person and the balance will be borne by the Insured Person.\n\n4. Exclusions\n\nWe shall not be liable under this Policy for any claim in connection with or in respect of the following:"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_5
encoding: FLOAT32
metadata:
{"chroma:document": "- Pre-Existing Conditions: Benefits will not be available for Pre-existing Conditions until 48 months of continuous coverage have elapsed since the inception of the first Policy with Us.\n- 30 Days Initial Waiting Period: We will not cover any treatment taken during the first 30 days since the date of commencement of the Policy, unless the treatment needed is the result of an Accident. This waiting period does not apply for any subsequent and continuous renewals of Your Policy.\n- Specific Waiting Period: The conditions listed below will be subject to a waiting period of 24 months and will be covered from the commencement of the 3rd Policy Year as long as the Insured Person has been insured continuously under the Policy without any break:\n\nStones in biliary and urinary systems\nLumps / cysts / nodules / polyps / internal tumours\nGastric and Duodenal Ulcers\nSurgery on tonsils / adenoids\nOsteoarthrosis / Arthritis / Gout / Rheumatism / Spondylosis / Spondylitis / Intervertebral Disc Prolapse\n\nPage 3 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_6
encoding: FLOAT32
metadata:
{"chroma:document": "POLICY DOCUMENT\n\n|6.|Cataract|\n|---|---|\n|7.|Fissure / Fistula / Haemorrhoids|\n|8.|Hernia / Hydrocele|\n|9.|Chronic Renal Failure or end stage Renal Failure|\n|10.|Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media|\n|11.|Benign Prostatic Hypertrophy|\n|12.|Knee/Hip Joint replacement|\n|13.|Dilatation and Curettage|\n|14.|Varicose veins|\n|15.|Dysfunctional Uterine Bleeding / Fibroids / Prolapse Uterus / Endometriosis|\n|16.|Diabetes and related complications|\n|17.|Hysterectomy for any benign disorder|\n\nPersonal Waiting Periods\n\nConditions mentioned under Personal Waiting Period in the Schedule of Insurance Certificate will be subject to a waiting period of 24 months and will be covered from the commencement of the third Policy Year as long as the Insured Person has been insured continuously under the Policy without any break.\n\nPermanent Exclusions\n\nWe will not be liable under any circumstances, for any claim in connection with or with regard to any of the following permanent exclusions and any such other exclusions as may be specified in the Schedule of Insurance Certificate :\n\n- i. Addictive conditions and disorders\nTreatment related to addictive conditions and disorders, or from any kind of substance abuse or misuse including alcohol abuse or misuse.\n- ii. Ageing and puberty\nTreatment to relieve symptoms caused by ageing, puberty, or other natural physiological cause, such as menopause and hearing loss caused by maturing or ageing.\n- iii. Artificial life maintenance\nArtificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health\n- iv. Circumcision"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_7
encoding: FLOAT32
metadata:
{"chroma:document": "Page 4 of 25Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT\n\nCircumcision unless necessary for pe treatment of a disease or necessitated by an Accident.\nv. Conflict and disaster\nTreatment for any illness or injury resulting from nuclear or chemical contamination, war, riot, revolution, acts of terrorism or any similar event (oper pan natural disaster or calamity), if one or more of pe following conditions apply:\n1. The Insured Person put himself in danger by entering a known area of conflict where active fighting or insurrections are taking place\n2. The Insured Person was an active participant in pe above mentioned acts or events of a similar nature.\n3. The Insured Person displayed a blatant disregard for personal safety\nvi. Congenital conditions\nTreatment for any Congenital Anomaly.\nvii. Convalescence and Rehabilitation\nHospital accommodation when it is used solely or primarily for any of pe following purposes:\n1. Convalescence, rehabilitation, supervision or any oper purpose oper pan for receiving eligible treatment of a type pat normally requires a stay in Hospital.\n2. receiving general nursing care or any oper services pat do not require pe Insured Person to be in Hospital and could be provided in anoper establishment pat is not a Hospital\n3. receiving services from a perapist or complementary medical practitioner or a practitioner of alternative medicine.\nviii. Cosmetic surgery\nTreatment undergone purely for cosmetic or psychological reasons to improve appearance. However, pis exclusion does not apply where medically required as a part of treatment for cancer, accidents and burns to restore functionality.\nix. Dental/oral treatment\nTreatment for any dental or oral condition, which includes surgical operations for pe treatment of bone disease when related to gum disease or damage, or treatment for, or treatment arising from, disorders of pe tempromandibular joint.\n\nPage 5 of 25# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_8
encoding: FLOAT32
metadata:
{"chroma:document": "|EXCEPTION:|We will pay for a Surgical Operation for which the Insured Person is Hospitalised as a result of an Accident and which is undertaken as an In-patient in a Hospital and carried out by a Doctor.|\n|---|---|\n|x.|Drugs and dressings for Out-patient or take-home use|\n| |Any drugs or surgical dressings that are provided or prescribed in the case of Out-patient Treatment, or for an Insured Person to take home on leaving Hospital, for any condition, except as included in post-hospitalization expenses under clause 2.4 above.|\n|xi.|Eyesight|\n| |Treatment to correct refractive errors of the eye, unless required as the result of an Accident. We will not pay for routine eye examinations, contact lenses, spectacles or laser eye sight correction.|\n|xii.|Experimental treatment|\n| |Treatment, including medication, which in competent Medical Practitioner\u2019s opinion is experimental or has not generally been proved to be effective.|\n|xiii.|Health hydros, nature cure, wellness clinics etc.|\n| |Treatment or services received in health hydros, nature cure clinics or any establishment that is not a Hospital.|\n|xiv.|HIV and AIDS|\n| |Any treatment for, or treatment arising from, Human Immunodeficiency Virus (HIV) or Acquired Immuno Deficiency Syndrome (AIDS), including any condition that is related to HIV or AIDS.|\n|xv.|Hereditary conditions|\n| |Treatment of abnormalities, deformities, Illnesses present only because they have been passed down through the generations of the family.|\n|xvi.|Items of personal comfort and convenience, including but not limited to:|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_9
encoding: FLOAT32
metadata:
{"chroma:document": "| |1. Telephone, television, diet charges, (unless included in room rent) personal attendant or barber or beauty services, baby food, cosmetics, napkins, toiletry items, guest services and similar incidental expenses or services.|\n| |2. Private nursing/attendant\u2019s charges incurred during Pre-Hospitalization or Post-Hospitalization.|\n| |3. Drugs or treatment not supported by prescription.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_10
encoding: FLOAT32
metadata:
{"chroma:document": "Page 6 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT\n\n|4.|Issue of medical certificate and examinations as to suitability for employment or travel or any other such purpose.|\n|---|---|\n|5.|Any charges incurred to procure any treatment/Illness related documents pertaining to any period of hospitalization/Illness.|\n|6.|External and or durable medical/non-medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc.|\n|7.|Ambulatory devices such as walkers, crutches, belts, collars, caps, splints, slings, braces, stockings of any kind, diabetic footwear, glucometer/thermometer and similar items and also any medical equipment which is subsequently used at home.|\n|8.|Nurses hired in addition to the Hospital\u2019s own staff.|\n|xvii.|Non-allopathic treatment|\n| |Any other streams of medicine apart from allopathy. We will not pay for other streams of treatment including ayurvedic, homeopathic or unani medicine.|\n|xviii.|Psychiatric and Psychosomatic Conditions|\n| |Treatment of any mental illness or sickness or disease including a psychiatric condition, disorganization of personality or mind, or emotions or behavior, Parkinson\u2019s or Alzheimer\u2019s disease even if caused or aggravated by or related to an Accident or Illness or general debility or exhaustion (\u201crun-down condition\u201d);|\n|xix.|Obesity|\n| |Treatment for obesity.|\n|xx.|Out-patient Treatment|\n| |Out-patient Treatment is not covered except those out-patient benefits explicitly stated as an eligible benefit for Your chosen plan.|\n|xxi.|Reproductive medicine - Birth control & Assisted reproduction|\n|1.|Any type of contraception, sterilization, termination of pregnancy or Family planning.|\n|2.|Treatment to assist reproduction, including IVF treatment.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_11
encoding: FLOAT32
metadata:
{"chroma:document": "Page 7 of 25# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT\n\n|xxii.|Self-inflicted injuries|\n|---|---|\n| |Treatment for, or arising from, an injury that is intentionally self-inflicted, including attempted suicide.|\n\n|xxiii.|Sexual problems and gender issues|\n|---|---|\n| |Treatment of any sexual problem including impotence (irrespective of the cause) and sex changes or gender reassignments or erectile dysfunction.|\n\n|xxiv.|Sexually transmitted diseases|\n|---|---|\n| |Treatment for any sexually transmitted disease, including Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis.|\n\n|xxv.|Sleep disorders|\n|---|---|\n| |Treatment for sleep apnea, snoring, or any other sleep-related breathing problem.|\n\n|xxvi.|Speech disorders|\n|---|---|\n| |Treatment for speech disorders, including stammering unless the disorder occurs directly due to an Accident.|\n\n|xxvii.|Treatment for developmental problems|\n|---|---|\n| |Treatment for, or related to developmental problems, including but not limited to:|\n| |1. learning difficulties, such as dyslexia;|\n| |2. behavioral problems, including attention deficit hyperactivity disorder (ADHD);|\n| |3. deviated nasal septum (straitening of the nasal tract).|\n\n|xxviii.|Treatment received outside India|\n|---|---|\n| |Any treatment received outside India|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_12
encoding: FLOAT32
metadata:
{"chroma:document": "|xxix.|Unrecognised physician or Hospital:|\n|---|---|\n| |1. Treatment provided by a medical practitioner who is not recognized by the Medical Council of India.|\n| |2. Treatment in any hospital or by any medical practitioner or any other provider of services that We have blacklisted as listed on Our website.|\n| |3. Treatment provided by anyone with the same residence as Insured Person or who is a member of the Insured Person\u2019s immediate family|\n\nPage 8 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_13
encoding: FLOAT32
metadata:
{"chroma:document": "POLICY DOCUMENT\n\n5. Standard Terms and Conditions\na. Reasonable Care\nThe Insured Person shall take all reasonable steps to safeguard against any Accident or illnesses pat may give rise to any claim under pis Policy.\nb. Observance of terms and conditions\nThe due observance and fulfillment of pe terms, conditions and endorsement of pis Policy in so far as pey relate to anyping to be done or complied wip by pe Insured Person, shall be a condition precedent to any liability to make payment under pis Policy.\nc. Subrogation\nThe Insured Person shall do and concur in doing and permit to be done all such acts and pings as may be necessary or required by Us, before or after indemnification, in enforcing or endorsing any rights or remedies, or of obtaining relief or indemnity, to which We are or would become entitled or subrogated. Neiper You nor any Insured Person shall do any acts or pings pat prejudice pese subrogation rights in any manner. Any recovery made by Us pursuant to pis clause shall first be applied to pe amounts paid or payable by Us under pis Policy and pe costs and expenses incurred by Us in effecting pe recovery, whereafter We shall pay pe balance amount to You. This clause shall not apply to Hospital Cash benefit (as applicable under pe Policy).\nd. Contribution\nIf pe Insured Person is covered by any oper policy which covers any claim in whole or in part made under pis Policy (or would cover any claim made under pis Policy, if pis Policy did not exist) pen We shall not be liable to pay or contribute more pan Our rateable proportion of pe claim. This clause shall not apply to Hospital Cash benefit (as applicable under pe Policy).\n\nxxx. Unlawful Activity\n\nAny condition as a result of Insured Person committing or attempting to commit a breach of law with criminal intent."}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_14
encoding: FLOAT32
metadata:
{"chroma:document": "xxxi. Hospitalization undertaken for observation or for investigations only and where no medical treatment is provided.\n\nxxxii. Active participation in adventure or hazardous sports including but not limited to para-jumping, rock climbing, mountaineering, motor racing, horse racing or deep-sea diving.\n\nPage 9 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT\n\ne. Fraudulent claims\n\nIf a claim is in any way found to be fraudulent, or if any false statement, or declaration is made or used in support of such a claim, or if any fraudulent means or devices are used by the Insured Person or anyone acting on behalf of the Insured Person to obtain any benefit under this Policy, then this Policy shall be void and all claims being processed shall be forfeited for all Insured Persons and all sums paid under this Policy shall be repaid to Us by all Insured Persons who shall be jointly liable for such repayment.\n\nf. Free Look Provision\n\nYou have a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy. If You have any objections to any of the terms and conditions, You have the option of canceling the Policy stating the reasons for cancellation and You shall be refunded the premium paid by You after adjusting the amounts spent on any medical check-up, stamp duty charges and proportionate risk premium. You can cancel your Policy only if no claims have been made under the Policy. The Insured Persons and Your rights under this Policy shall immediately stand extinguished on the free look cancellation of the Policy. Free look provision is not applicable and available at the time of renewal of the Policy.\n\ng. Portability Benefit\n\n- i. From another company to Our Policy\n\nPage 10 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT\n\nfirst Policy with Us, unless the treatment is needed as a result of an Accident."}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_15
encoding: FLOAT32
metadata:
{"chroma:document": "# (ii) It is understood and agreed that:\n\n(1) If You wish to exercise pe Portability Benefit, We should have received Your application wip complete documentation at least 21 days before pe expiry of Your present period of insurance;\n(2) If pe proposed Sum Insured is more pan pe insurance cover under pe previous policy, pen pe revised waiting period under General Exclusion 4(a) shall only be applicable to pe extent of pe insurance cover under pe previous policy; and\n(3) We may revise pe premium payable based on pe extent of applicability of pe Portability Benefit.\n(4) This benefit is available only at pe time of renewal of existing healp insurance policy.\n(5) The Portability Benefit shall be applied subject to pe following :\n\n- (a) You shall give Us all additional documentation and/or information We request;\n- (b) You pay Us the applicable premium in full;\n- (c) We may, subject to Our medical underwriting, restrict the terms upon which We may offer cover, the decision as to which shall be in Our sole and absolute discretion;\n- (d) There is no obligation on Us to insure all Insured Persons or to insure all Insured Persons on the proposed terms, even if You have given Us all documentation;\n- (e) We have received the database and claim history from the previous insurance company for the Insured Persons\u2019 previous health insurance policy.\n\n# ii. From Our existing health insurance policies to this Policy\n\n# (i) If the proposed Insured Person was insured continuously and without a break under another health insurance policy with Us, then General Exclusion 4(a) of the\n\nPage 11 of 25# Health Companion \u2013 Health Insurance Plan Policy Document"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_16
encoding: FLOAT32
metadata:
{"chroma:document": "Page 11 of 25# Health Companion \u2013 Health Insurance Plan Policy Document\n\n|Policy stands deleted and shall be replaced entirely with the following and General Exclusion 4(b) shall not be applicable:|\n|---|\n|4(a) Pre-Existing Conditions|Benefits will not be available for Pre-existing Conditions until the completion of the period stated in the Schedule of Insurance Certificate for the Insured Person. It is understood and agreed that the period stated in the Schedule of Insurance Certificate for Pre-existing Conditions shall not exceed the difference between the waiting period for pre-existing conditions served under the previous policy and the 48 months waiting period that would otherwise have been applicable from the inception of the first Policy with Us.|\n|(ii) It is understood and agreed that:|\n|(1) If You wish to exercise the Portability Benefit, We should have received Your application before the expiry of Your present period of insurance;|\n|(2) If the proposed Sum Insured is more than the insurance cover under the previous policy, then the revised waiting period under General Exclusion 4(a) shall only be applicable to the extent of the insurance cover under the previous policy;|\n|(3) We are not bound to continue all terms and conditions of the present cover under the Policy of the Insured Person under the new policy, but for calculation of all waiting periods (including the waiting period provided under General Exclusions in clauses 4(c), 4(d) and the maternity benefit endorsement) under the new policy, the time spent by Insured Person under this Policy may be taken into account, provided new policy is taken without any break from this Policy; and|\n|(4) This benefit is available only at the time of renewal of existing health insurance policy.|\n|(5) The Portability Benefit shall be applied subject to the following :|\n|(a) You shall give Us all additional documentation and/or information We request;|\n|(b) You pay Us the applicable premium in full;|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_17
encoding: FLOAT32
metadata:
{"chroma:document": "Page 12 of 25# Health Companion \u2013 Health Insurance Plan Policy Document\n\n# Cancellation/Termination (other than freelook cancellation)\n\n1. Cancellation by Insured Person:\n\nYou may terminate this Policy during the Policy Period by giving Us at least 30 days prior written notice. We shall cancel the Policy and refund the premium for the balance of the Policy Period in accordance with the table below provided that no claim has been made under the Policy by or on behalf of any Insured Person.\n\n|Length of time Policy in force|Refund of premium|\n|---|---|\n|up to 30 days|75%|\n|up to 90 days|50%|\n|up to 180 days|25%|\n|exceeding 180 days|0%|\n\n2. Automatic Cancellation:\n\na. Individual Policy:\n\nThe Policy shall automatically terminate on death of the Insured Person\n\nb. For Policy issued to Family:\n\nThe Policy shall automatically terminate in the event of the death of all the Insured Persons.\n\nc. Refund:\n\nA refund in accordance with the table in section 5(h)(1) above shall be payable if there is an automatic cancellation of the Policy provided that no claim has been filed under the Policy by or on behalf of any Insured Person.\n\n3. Cancellation by Us:\n\nPage 13 of 25# Health Companion \u2013 Health Insurance Plan Policy Document\n\nWithout prejudice to the above, We may terminate this Policy during the Policy Period by sending 30 days prior written notice to Your address shown in the Schedule of Insurance Certificate without refund of premium if in Our opinion:"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_18
encoding: FLOAT32
metadata:
{"chroma:document": "- You or any Insured Person or any person acting on behalf of either has acted in a dishonest or fraudulent manner under or in relation to this Policy;\n- You or any Insured Person has not disclosed any true, complete and all correct facts in relation to the Policy; and/or\n- Continuance of the Policy poses a moral hazard.\n\nFor avoidance of doubt, it is clarified that no claims shall be admitted and/or paid during the notice period by Us in relation to the Policy.\n\n# i. Territorial Jurisdiction\n\nAll benefits are available in India only, and all claims shall be payable in India in Indian Rupees only.\n\n# j. Policy Disputes\n\nAny 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.\n\n# k. Renewal of Policy\n\nThe renewal premium is payable on or before the due date in the amount shown in the Schedule of Insurance Certificate or at such altered rate as may be reviewed and notified by Us before completion of the Policy Period. We are under no obligation to notify You of the renewal date of Your Policy. We will allow a Grace Period of 30 days from the due date of the renewal premium for payment to Us.\n\nIf the Policy is not renewed within the Grace Period then We may agree to issue a fresh policy subject to Our underwriting criteria and no continuing benefits shall be available from the expired Policy.\n\nRenewal of the Policy will not ordinarily be denied other than on grounds of moral hazard, misrepresentation and fraud.\n\n# l. Notices\n\nAny notice, direction or instruction given under this Policy shall be in writing and delivered by hand, post, or facsimile to\n\nPage 14 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_19
encoding: FLOAT32
metadata:
{"chroma:document": "POLICY DOCUMENT\n\ni. The You/Insured Person at the address specified in the Schedule of Insurance Certificate or at the changed address of which We must receive written notice.\n\nii. Us at the following address.\n\nMax Bupa Health Insurance Company Limited\n\nD-1, 2nd Floor,\n\nSalcon Ras Vilas,\n\nDistrict Centre, Saket,\n\nNew Delhi-110 017\n\nFax No.: 1800-3070-3333\n\nIn addition, we may send You/Insured Person other information through electronic and telecommunications means with respect to Your Policy from time to time.\n\nm. Claims Procedure\n\n(a) Cashless Hospitalization Facility for Network Hospitals:\n\n|i.|The health card We provide will enable an Insured Person to access treatment on a cashless basis only at any Network Hospital on the production of the card to the Hospital prior to admission, provided that:|\n|---|---|\n| |(1) The Insured Person has notified Us in writing at least 72 Hours before a planned Hospitalization. In an Emergency the Insured Person should notify Us in writing within 48 hours of Hospitalization; and|\n| |(2) We have pre-authorized the In-patient Treatment or Day Care Procedure.|\n|ii.|Cashless treatment will not be available if You take treatment in an Out-Of-Network Hospital.|\n|iii.|For cashless Hospitalization We will make the payment of the amounts assessed to be due directly to the Network Hospital. The treatment must take place within 15 days of the pre-authorization date and pre-authorization is only valid if all the details of the authorized treatment, including dates, Hospital and locations, match with the details of the actual treatment received.|\n|iv.|If pre-authorisation is not obtained then the cashless facility will not be available and the claims procedure shall be as per (b)(ii) below.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_20
encoding: FLOAT32
metadata:
{"chroma:document": "(b) Out-Of-Network Hospitals & All Other Claims for Reimbursement including Hospital Cash:\n\nPage 15 of 25# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT\n\ni. We should generally be notified in writing at least 72 hours prior to the planned date of such treatment, consultation or procedure being taken and We must have pre-authorised such treatment, consultation, service or procedure. In an Emergency the Insured Person should notify Us in writing within 15 days of discharge from Hospital\n\nThe following information is mandated in the notification:\n\n1. Policy number.\n2. Name of Policyholder.\n3. Name of Insured Person in respect of whom pe claim has been notified.\n4. Name of Hospital wip address and contact number.\n5. Diagnosis.\n6. Treatment undergone (medical / surgical management wip name of surgical procedure undergone, if applicable) and approximate amount being claimed for\n\nii. For any Illness or Accident or medical condition that requires Hospitalization, the Insured Person shall deliver to Us the documents listed below, at his own expense, within 30 days of the Insured Person's discharge from Hospital (when the claim is only in respect of post-hospitalization, within 30 days of the completion of the post-hospitalization):\n\n1. Duly filled claim form.\n2. Original bills, receipts and discharge certificate/card from the Hospital/Doctor.\n3. Original bills from chemists supported by proper prescription.\n4. Original investigation test reports and payment receipts.\n5. Doctor's referral letter advising hospitalization in non-Accident cases.\n6. Details of any other insurance policy that may respond to the claim.\n7. First Information Report (FIR) for medico-legal cases.\n\niii. For any medical treatment taken from an Out-Of-Network Hospital We will only pay Medical Expenses which are Reasonable and Customary.\n\n(c) For Network and Out-Of-Network Hospitals"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_21
encoding: FLOAT32
metadata:
{"chroma:document": "(c) For Network and Out-Of-Network Hospitals\n\nIn all cases:\n\ni. We reserve the right to call for:\n\n1. Any other documentation or information that We believe may be required; and\n\nPage 16 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT\n\n(2) A medical examination by Our doctor or for an investigation as often as We believe this to be necessary. Any expenses related to such examinations or investigations shall be borne by Us.\n\nii. In the event of the Insured Person's death during Hospitalization, written notice accompanied by a copy of the post mortem report (if any) shall be given to Us within 14 days regardless of whether any other notice has been given to Us. We reserve the right to require an autopsy.\n\niii. For the purposes of benefit 2, it is understood and agreed that if a Hospital room as per the rent limit permitted by the insurance plan opted for, as shown in the Product Benefits Table, is unavailable, then We will only be liable to make payment for a Hospital room that is actually occupied or as per entitlement permitted by the plan opted for, whichever is lower. Further where Medical Expenses are linked with room rates, Medical Expenses as applicable to the room that is actually occupied or as per room rates entitlement under the plan opted, whichever is lower, shall be payable.\n\n(d) It is hereby agreed and understood that in providing pre-authorisation or accepting a claim for reimbursement under this Policy or making a payment under this Policy, We make no representation and/or give no guarantee and/or assume no responsibility for the appropriateness, quality or effectiveness of the treatment sought or provided.\n\nn. Alteration to the Policy\n\nThis 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 change or vary this Policy.\n\no. Change of Policy holder"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_22
encoding: FLOAT32
metadata:
{"chroma:document": "o. Change of Policy holder\n\nIf You do not renew the Policy by the due dates specified in the Schedule of Insurance Certificate, any other adult Insured Person may apply to renew the Policy within 30 days of the end of the Policy Period provided that We receive an application and the premium from such Insured Person and evidence satisfactory to Us of the agreement of all other Insured Persons and You (except in case of death). If We accept such application and the premium for the renewed Policy is paid on time, then the Policy shall be treated as having been renewed without a break in cover. Coverage shall not be available for the period for which no premium is received.\n\np. Nominee\n\nYou can at the inception or at any time before the expiry of the Policy, make a nomination for the purpose of payment of claims, under the Policy in the event of death.\n\nAny change of nomination shall be communicated to Us in writing and such change shall be effective only when an endorsement on the Policy is made by Us.\n\nPage 17 of 25Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT\n\nIn case of any Insured Person other than You under the Policy, for the purpose of payment of claims in the event of death, the default nominee would be You.\n\nq. Obligations in case of a minor\n\nIf an Insured Person is less than 18 years of age, the You/adult Insured Person shall be completely responsible for ensuring compliance with all the terms and conditions of this Policy on behalf of that minor Insured Person.\n\nr. Customer Service and Grievances Redressal:\n\n- In case of any query or complaint/grievance, You / Insured Person may approach Our office at the following address:\n\nCustomer Services Department\n\nMax Bupa Health Insurance Company Limited\n\nD-1, 2nd Floor,\n\nSalcon Ras Vilas,\n\nDistrict Centre, Saket,"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_23
encoding: FLOAT32
metadata:
{"chroma:document": "Salcon Ras Vilas,\n\nDistrict Centre, Saket,\n\nNew Delhi-110 017\n\nContact No: 1800-3010-3333\n\nFax No.: 1800-3070-3333\n\nEmail ID: customercare@maxbupa.com\n- In case You/Insured Person are not satisfied with the decision of the above office, or have not received any response within 10 days, You/Insured Person may contact the following official for resolution:\n\nHead \u2013 Customer Services\n\nMax Bupa Health Insurance Company Limited\n\nD-1, 2nd Floor,\n\nSalcon Ras Vilas,\n\nDistrict Centre, Saket,\n\nNew Delhi-110 017\n\nContact No: 1800-3010-3333\n\nFax No.: 1800-3070-3333\n\nEmail ID: customercare@maxbupa.com\n- In case You/Insured Person are not satisfied with Our decision/resolution, You may approach the Insurance Ombudsman at the addresses given in Annexure I.\n- The complaint should be made in writing duly signed by the complainant or by his/her legal heirs with full details of the complaint and the contact information of the complainant.\n\nPage 18 of 25# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT\n\n|v.|As per provision 13(3) of the Redressal of Public Grievances Rules 1998, the complaint to the Ombudsman can be made|\n|---|---|\n| |1. only if the grievance has been rejected by the Grievance Redressal Machinery of the Insurer;|\n| |2. within a period of one year from the date of rejection by the insurer;|\n| |3. if it is not simultaneously under any litigation.|\n\n# Interpretations & Definitions"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_24
encoding: FLOAT32
metadata:
{"chroma:document": "# Interpretations & Definitions\n\nIn this Policy the following words or phrases shall have the meanings attributed to them wherever they appear in this Policy and for this purpose the singular will be deemed to include the plural, the male gender includes the female where the context permits:\n\nDef. 1. Accident or Accidental means a sudden, unforeseen and involuntary event caused by external and visible means which occurs when the policy is in force.\n\nDef. 2. Congenital Anomaly refers to either:\n\n- i) an external condition(s) which is present since birth, in the visible and accessible parts of the body, and which is abnormal with reference to form, structure or position, OR\n- ii) a condition(s) which is present since birth, but is internal and not visible.\n\nDef. 3. Co-pay is a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. Co-pay does not reduce the sum insured.\n\nDef. 4. Day Care Procedure refers to medical treatment, and/or surgical procedure which is:\n\n- undertaken under General or Local Anaesthesia in a hospital/day care centre in less than 24 hrs because of technological advancement, and\n- 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.\n\nDef. 5. Diagnostic Tests: Investigations, such as X-Ray or blood tests, to find the cause of your symptoms and medical condition\n\nDef. 6. Deductible: The amount which, in accordance with the terms of the policy, is deducted from the claim amount that would otherwise have been payable and will therefore be borne by the policyholder."}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_25
encoding: FLOAT32
metadata:
{"chroma:document": "Def. 7. Domiciliary Treatment: Domiciliary treatment means medical treatment for a period exceeding 3 days, 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:\n\nPage 19 of 25# Health Companion \u2013 Health Insurance Plan Policy Document\n\nDef. 8. Doctor is a medical practitioner who holds a valid registration from the medical council of any state of India and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of his license.\n\nDef. 9. Emergency means a severe illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a Doctor to prevent death or serious long term impairment of the Insured Person\u2019s health.\n\nDef. 10. Family means a unit comprising of up to six members who are related to each other in the following manner:\n\ni) Legally married husband and wife as long as they continue to be married; and\n\nii) Up to four of their children who are more than 90 days old and less than 21 years on the date of commencement of the initial cover under the Policy\n\nDef. 11. 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 conditions. Coverage is not available for the period for which no premium is received.\n\nDef. 12. Hospital means any institution established for in-patient care and day care treatment of sickness and / or injuries and which has been registered as a hospital with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner AND must comply with all minimum criteria as under:"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_26
encoding: FLOAT32
metadata:
{"chroma:document": "- a) has at least 10 inpatient beds, in those towns having a population of less than 10,00,000 and 15 inpatient beds in all other places;\n- b) has qualified nursing staff under its employment round the clock;\n- c) has qualified Doctor (s) in charge round the clock;\n- d) has a fully equipped operation theatre of its own where surgical procedures are carried out\n- e) maintains daily records of patients and will make these accessible to the Insurance company\u2019s authorized personnel.\n\nDef. 13. Hospitalisation or Hospitalised means the admission as an In-patient into a Hospital for necessary medical treatment for a continuous minimum period of 24 hours as a consequence of an Illness or Accident occurring during the Policy Period.\n\nDef. 14. Information Summary Sheet means the record and confirmation of information provided to Us or Our representatives over the telephone for the purposes of applying for this Policy.\n\nPage 20 of 25# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_27
encoding: FLOAT32
metadata:
{"chroma:document": "|Def. 15.|Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated Doctor(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 considerably more sophisticated and intensive than in the ordinary and other wards.|\n|---|---|\n|Def. 16.|Illness means sickness (which is a condition or an ailment that impacts on the general soundness and health of the body of the Insured Person) or a disease (which is an affliction of the Insured Person\u2019s bodily organs that has a distinct and recognised pattern of symptoms) or a pathological condition which results in detriment to normal physiological function and which shows itself during the Policy Period and necessitates medical Treatment. Illness does not mean and this Policy does not cover any mental illness or sickness or disease (including but not limited to a psychiatric condition, disorganisation of personality or mind, or emotions or behaviour) even if caused by or aggravated by or related to an Accident or Illness.|\n|Def. 17.|In-patient: Treatment for which the Insured Person has to stay in a hospital for more than 24 hours for a covered event.|\n|Def. 18.|Insured Person means person named as insured in the Schedule of Insurance Certificate. Any Family member may be added as an Insured Person during the Policy Period if We have accepted his application for insurance and issued an endorsement confirming the addition of such person as an Insured Person.|\n|Def. 19.|Medical Expenses means expenses necessarily and actually incurred for medical treatment during the Policy Period on the advice of a Doctor due to Illness or Accident, by an Insured Person, which are Reasonable and Customary.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_28
encoding: FLOAT32
metadata:
{"chroma:document": "|Def. 20.|Medically Necessary: Medically necessary treatment is defined as 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 Doctor; d) must conform to the professional standards widely accepted in international medical practice or by the medical community in India.|\n|Def. 21.|Network means all such Hospitals, day care centres or other providers that the We have mutually agreed with, to provide services like cashless access to Policyholders. The list is available with Us and subject to amendment from time to time.|\n|Def. 22.|Out-Of-Network means any Hospital, day care centre or other provider that is not part of the Network.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_29
encoding: FLOAT32
metadata:
{"chroma:document": "Page 21 of 25# Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_30
encoding: FLOAT32
metadata:
{"chroma:document": "|Def. 23.|Out-patient Treatment means treatment given at a hospital, doctors' consulting room, office or Out-patient clinic where Insured Person are not admitted for Day-Care Procedures or In-patient treatment.|\n|---|---|\n|Def. 24.|Policy means these terms and conditions, any annexure thereto and the Schedule of Insurance Certificate (as amended from time to time), Your statements in the proposal form and the Information Summary Sheet and the policy wording (including endorsements, if any).|\n|Def. 25.|Policy Period means the period between the date of commencement and the expiry date specified shown in the Schedule of Insurance Certificate.|\n|Def. 26.|Policy Year means the period of one year commencing on the date of commencement specified in the Schedule of Insurance Certificate or any anniversary thereof.|\n|Def. 27.|Pre-existing Condition means any condition, ailment or injury or related condition(s) for which the Insured Person had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first Policy issued by Us.|\n|Def. 28.|Product Benefits Table means the Product Benefits Table issued by Us and accompanying this Policy and annexures thereto.|\n|Def. 29.|Qualified Nurse is a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India.|\n|Def. 30.|Rehabilitation: Treatment aimed at restoring health or mobility, or to allow a person to live an independent life, such as after a stroke.|\n|Def. 31.|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 among comparable providers, taking into account the nature of the illness / injury involved.|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_31
encoding: FLOAT32
metadata:
{"chroma:document": "|Def. 32.|Schedule of Insurance Certificate means the schedule provided in the insurance certificate issued by Us, and, if more than one, then the latest in time.|\n|Def. 33.|Sum Insured means the sum shown in the Schedule of Insurance Certificate which represents Our maximum total and cumulative liability for any and all claims under the Policy during the Policy Period.|\n|Def. 34.|Surgical Operation 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 of suffering or prolongation of life, performed in a Hospital or day care centre by a Doctor.|\n|Def. 35.|We/Our/Us means Max Bupa Health Insurance Company Limited|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_32
encoding: FLOAT32
metadata:
{"chroma:document": "Page 22 of 25Health Companion \u2013 Health Insurance Plan\n\nPOLICY DOCUMENT\n\nDef. 36. You/Your/Policyholder means the person named in the Schedule of Insurance Certificate who has concluded this Policy with Us.\n\nAny reference to any statute shall be deemed to refer to any replacement or amendment to that statute.\n\n'Max', Max Logo, 'Bupa' and HEARTBEAT logo are trademarks of their respective owners and are being used by Max Bupa Health Insurance Company Limited under license.\n\nPage 23 of 25# Health Companion \u2013 Health Insurance Plan\n\n# POLICY DOCUMENT"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_33
encoding: FLOAT32
metadata:
{"chroma:document": "|Office of the Ombudsman|Name of the Ombudsmen|Contact Details|Areas of Jurisdiction|\n|---|---|---|---|\n|AHMEDABAD|Insurance Ombudsman|Office of the Insurance Ombudsman, 2nd Floor, Ambica House, Nr. C.U. Shah College, Ashram Road, AHMEDABAD-380 014. Tel.:- 079-27546840, Fax : 079-27546142 Email ins.omb@rediffmail.com|Gujarat , UT of Dadra & Nagar Haveli, Daman and Diu|\n|BHOPAL|Insurance Ombudsman|Office of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel, Near New Market, BHOPAL(M.P.)-462 023. Tel.:- 0755-2569201, Fax : 0755-2769203 Email bimalokpalbhopal@airtelmail.in|Madhya Pradesh & Chhattisgarh|\n|BHUBANESHWAR|Insurance Ombudsman|Office of the Insurance Ombudsman, 62, Forest Park, BHUBANESHWAR-751 009. Tel.:- 0674-2596455, Fax : 0674-2596429 Email ioobbsr@dataone.in|Orissa|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_34
encoding: FLOAT32
metadata:
{"chroma:document": "|CHANDIGARH|Insurance Ombudsman|Office of the Insurance Ombudsman, S.C.O. No.101-103, 2nd Floor, Batra Building. Sector 17-D, CHANDIGARH-160 017. Tel.:- 0172-2706468, Fax : 0172-2708274 Email ombchd@yahoo.co.in|Punjab , Haryana, Himachal Pradesh, Jammu & Kashmir , UT of Chandigarh|\n|CHENNAI|Shri V. Ramasaamy|Insurance Ombudsman, Office of the Insurance Ombudsman, Fathima Akhtar Court, 4th Floor, 453 (old 312), Anna Salai, Teynampet, CHENNAI-600 018. Tel.:- 044-24333668 /5284, Fax : 044-24333664 Email insombud@md4.vsnl.net.in|Tamil Nadu, UT\u2013Pondicherry Town and Karaikal (which are part of UT of Pondicherry)|\n|NEW DELHI|Shri Surendra Pal Singh|Insurance Ombudsman, Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Bldg., Asaf Ali Road, NEW DELHI-110 002. Tel.:- 011-23239633, Fax : 011-23230858 Email iobdelraj@rediffmail.com|Delhi & Rajashthan|"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_35
encoding: FLOAT32
metadata:
{"chroma:document": "|GUWAHATI|Shri Sarat Chandra Sarma|Insurance Ombudsman, Office of the Insurance Ombudsman, \u201cJeevan Nivesh\u201d, 5th Floor, Near Panbazar Overbridge, S.S. Road, GUWAHATI-781 001 (ASSAM). Tel.:- 0361-2132204/5, Fax : 0361-2732937 Email ombudsmanghy@rediffmail.com|Assam , Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura|\n|HYDERABAD|Shri K. Chandrahas|Insurance Ombudsman, Andhra Pradesh, Karnataka and UT of Yanam \u2013 a part of the UT| |# Health Companion \u2013 Health Insurance Plan"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_36
encoding: FLOAT32
metadata:
{"chroma:document": "POLICY DOCUMENT\n\n|Office of the Insurance Ombudsman| |\n|---|---|\n|6-2-46, 1st Floor, Moin Court,|Pondicherry|\n|A.C. Guards, Lakdi-Ka-Pool,|HYDERABAD-500 004.|\n|Tel : 040-65504123, Fax: 040-23376599| |\n|Email insombudhyd@gmail.com| |\n\n|ERNAKULAM| |\n|---|---|\n|Office of the Insurance Ombudsman| |\n|2nd Floor, CC 27/2603, Pulinat Bldg.,| |\n|Opp. Cochin Shipyard, M.G. Road,| |\n|ERNAKULAM-682 015.| |\n|Tel : 0484-2358759, Fax : 0484-2359336| |\n|Email iokochi@asianetindia.com| |\n\n|KOLKATA| |\n|---|---|\n|Ms. Manika Datta|West Bengal , Bihar , Jharkhand|\n|Insurance Ombudsman|and UT of Andeman & Nicobar|\n|Office of the Insurance Ombudsman|Islands , Sikkim|\n|North British Bldg.,| |\n|29, N.S. Road, 4thFloor,| |\n|KOLKATA-700 001.| |\n|Tel : 033-22134866, Fax : 033-22134868| |\n|Email iombkol@vsnl.net| |"}


created_at: 2024-07-15 05:31:29
topic: persistent://default/default/fe41d3d4-c930-4570-a456-9fef50db9968
id: text_37
encoding: FLOAT32
metadata:
{"chroma:document": "|LUCKNOW| |\n|---|---|\n|Insurance Ombudsman|Uttar Pradesh and Uttaranchal|\n|Office of the Insurance Ombudsman,| |\n|Jeevan Bhawan, Phase-2,| |\n|6th Floor, Nawal Kishore Road,| |\n|Hazaratganj,| |\n|LUCKNOW-226 001.| |\n|Tel : 0522 -2231331, Fax : 0522-2231310| |\n|Email insombudsman@rediffmail.com| |\n\n|MUMBAI| |\n|---|---|\n|Shri S Viswanathan|Maharashtra , Goa|\n|Insurance Ombudsman,| |\n|Office of the Insurance Ombudsman,| |\n|3rd Floor, Jeevan Seva Annexe,| |\n|S.V. Road, Santacruz(W),| |\n|MUMBAI-400 054.| |\n|Tel : 022-26106928, Fax : 022-26106052| |\n|Email ombudsmanmumbai@gmail.com| |\n\n# OFFICE OF THE GOVERNING BODY OF INSURANCE COUNCIL\n\n|Smt. Rita Bhattacharya, Secretary General|Shri D V Dixit, Dy. Secretary|\n|---|---|\n|3rd Floor, Jeevan Seva Annexe,|S.V. Road, Santacruz (W),|\n|MUMBAI \u2013 400 021|MUMBAI \u2013 400 021.|\n|Tel : 022-26106245|Tel : 022-26106980|\n|Fax : 022-26106949|Fax : 022-26106949|\n|Email- inscoun@gmail.com| |\n\nPage 25 of 25"}


# embedding_metadata

key: chroma:document
string_value:
# Health Companion – Health Insurance Plan

# POLICY DOCUMENT

# Policy Document – Part II

# 1. Terms & Conditions

The insurance cover provided under this Policy to the Insured Person up to the Sum Insured is and shall be subject to (a) the terms and conditions of this Policy and (b) the receipt of premium, and (c) the information You provided to Us (including by way of the Proposal or Information Summary Sheet) on Your behalf and on behalf of all persons to be insured. Please inform Us immediately of any change in the address, nature of job, state of health, or of any other changes affecting You or any Insured Person.

# 2. Benefits

The Policy covers reasonable expenses incurred towards medical treatment taken during the Policy Period for an Illness, Accident or condition described below if this is contracted or sustained by an Insured Person during the Policy Period and subject always to the Sum Insured, any subsidiary limit specified in the Product Benefits Table, the terms, conditions, limitations and exclusions mentioned in the Policy and eligibility as per the insurance plan opted for in the Product Benefits Table and as shown in the Schedule of Insurance Certificate :

# 2.1. In-patient Treatment

(a) Doctors’ fees
(b) Diagnostics Tests
(c) Medicines, drugs and consumables
(d) Intravenous fluids, blood transfusion, injection administration charges
(e) Operation peatre charges
(f) The cost of prospetics and oper devices or equipment if implanted internally during a Surgical Operation.
(g) Intensive Care Unit charges

# 2.2. Hospital Accommodation

We will cover Reasonable and Customary charges for Hospital accommodation.

# 2.3. Pre-hospitalization Medical Expenses


key: chroma:document
string_value:
# 2.3. Pre-hospitalization Medical Expenses

We will cover Medical Expenses incurred due to Illness up to 30 days immediately before an Insured Person’s admission to a Hospital for the same Illness as long as We have accepted an In-patient Hospitalisation claim under 2.1 above. Pre-hospitalization expenses can be claimed as reimbursement only.

Page 1 of 25# Health Companion – Health Insurance Plan

# POLICY DOCUMENT

|2.4.|Post-hospitalization Medical Expenses|
|---|---|
|We will cover Medical Expenses incurred due to Illness up to 60 days immediately after an Insured Person’s discharge from Hospital for the same Illness as long as We have accepted an In-patient Hospitalisation claim under 2.1 above. Post-hospitalization expenses can be claimed as reimbursement only.|We will cover Medical Expenses incurred due to Illness up to 60 days immediately after an Insured Person’s discharge from Hospital for the same Illness as long as We have accepted an In-patient Hospitalisation claim under 2.1 above. Post-hospitalization expenses can be claimed as reimbursement only.|


key: chroma:document
string_value:
|2.5.|Day-Care Procedures|
|---|---|
|We will cover Medical Expenses for Day Care Procedures (including Chemotherapy, Radiotherapy, Hemodialysis, any procedure which needs a period of specialized observation or care after completion of the procedure) where such procedures are undertaken by an Insured Person as an In-patient in a Hospital for a continuous period of less than 24 hours. Any procedure undertaken on an out-patient basis in a Hospital will not be covered.|We will cover Medical Expenses for Day Care Procedures (including Chemotherapy, Radiotherapy, Hemodialysis, any procedure which needs a period of specialized observation or care after completion of the procedure) where such procedures are undertaken by an Insured Person as an In-patient in a Hospital for a continuous period of less than 24 hours. Any procedure undertaken on an out-patient basis in a Hospital will not be covered.|

|2.6.|Domiciliary Treatment|
|---|---|
|We will cover Medical Expenses for medical treatment taken at home if this continues for an uninterrupted period of 3 days and the condition for which treatment is taken would otherwise have necessitated hospitalization as long as either (i) the attending Doctor confirms that the Insured Person could not be transferred to a Hospital or (ii) the Insured Person satisfies Us that a Hospital bed was unavailable.|We will cover Medical Expenses for medical treatment taken at home if this continues for an uninterrupted period of 3 days and the condition for which treatment is taken would otherwise have necessitated hospitalization as long as either (i) the attending Doctor confirms that the Insured Person could not be transferred to a Hospital or (ii) the Insured Person satisfies Us that a Hospital bed was unavailable.|


key: chroma:document
string_value:
|2.7|Organ Donor|
|---|---|
|We will cover Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated provided that:|We will cover Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated provided that:|
|a.|The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person;|
|b.|The Insured Person has been medically advised to undergo an organ transplant;|
|We will not cover:|We will not cover:|
|(a)|Pre-hospitalisation or post-hospitalization Medical Expenses or screening expenses of the donor or any other medical expenses as a result of the harvesting from the donor;|
|(b)|Costs directly or indirectly associated with the acquisition of the donor’s organ.|

|2.8|Emergency ambulance|
|---|---|
|We will cover Reasonable and Customary ambulance expenses incurred to transfer the Insured Person by surface transport following an Emergency to the nearest Hospital with adequate facilities if:|We will cover Reasonable and Customary ambulance expenses incurred to transfer the Insured Person by surface transport following an Emergency to the nearest Hospital with adequate facilities if:|
|a.|The ambulance service is offered by a healthcare or ambulance service provider;|
|b.|We have accepted an In-patient Hospitalization claim under the provisions of 2.1 above;|
|In the case of Out-Of-Network Hospitalization of the Insured Person Our maximum liability for ambulance expenses is limited to Rs.2,000/- per event.|In the case of Out-Of-Network Hospitalization of the Insured Person Our maximum liability for ambulance expenses is limited to Rs.2,000/- per event.|

Page 2 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT


key: chroma:document
string_value:
POLICY DOCUMENT

2.9 Consultation and Diagnostic Tests (For Platinum Policyholders only)
We will cover an Insured Person’s Reasonable & Customary consultation expenses of Medically Necessary consultation wip a Doctor, as an out-patient to assess pe Insured Person’s healp condition for any Illness. We will also pay for any Diagnostic Tests prescribed by pe Doctor upto pe sub-limits shown in pe Product Benefits Table.
If pere is an unutilized amount (not used by pe Insured Person) under pe applicable subsidiary limit for pis benefit (as specified in pe Product Benefits Table) in a Policy Year, pen if pe Policy is in force and pe Policy has been renewed wip Us wipout any break, We will carry forward 80% of pis amount to pe immediately succeeding Policy Year, provided pat pe total amount (including pe unutilized amount available under pis benefit) shall at no time exceed 2.5 times pe amount of pe entitlement in respect of pis benefit under pe plan applicable to pe Insured Person per pe Product Benefits Table.

3. Co-pay

If any Insured Person is 65 years of age or over on the date of commencement of the current Policy Year, then it is agreed that We will only pay 80% of any amount We assess for payment or reimbursement in respect of any claim made by that Insured Person and the balance will be borne by the Insured Person.

4. Exclusions

We shall not be liable under this Policy for any claim in connection with or in respect of the following:


key: chroma:document
string_value:
- Pre-Existing Conditions: Benefits will not be available for Pre-existing Conditions until 48 months of continuous coverage have elapsed since the inception of the first Policy with Us.
- 30 Days Initial Waiting Period: We will not cover any treatment taken during the first 30 days since the date of commencement of the Policy, unless the treatment needed is the result of an Accident. This waiting period does not apply for any subsequent and continuous renewals of Your Policy.
- Specific Waiting Period: The conditions listed below will be subject to a waiting period of 24 months and will be covered from the commencement of the 3rd Policy Year as long as the Insured Person has been insured continuously under the Policy without any break:

Stones in biliary and urinary systems
Lumps / cysts / nodules / polyps / internal tumours
Gastric and Duodenal Ulcers
Surgery on tonsils / adenoids
Osteoarthrosis / Arthritis / Gout / Rheumatism / Spondylosis / Spondylitis / Intervertebral Disc Prolapse

Page 3 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT


key: chroma:document
string_value:
POLICY DOCUMENT

|6.|Cataract|
|---|---|
|7.|Fissure / Fistula / Haemorrhoids|
|8.|Hernia / Hydrocele|
|9.|Chronic Renal Failure or end stage Renal Failure|
|10.|Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media|
|11.|Benign Prostatic Hypertrophy|
|12.|Knee/Hip Joint replacement|
|13.|Dilatation and Curettage|
|14.|Varicose veins|
|15.|Dysfunctional Uterine Bleeding / Fibroids / Prolapse Uterus / Endometriosis|
|16.|Diabetes and related complications|
|17.|Hysterectomy for any benign disorder|

Personal Waiting Periods

Conditions mentioned under Personal Waiting Period in the Schedule of Insurance Certificate will be subject to a waiting period of 24 months and will be covered from the commencement of the third Policy Year as long as the Insured Person has been insured continuously under the Policy without any break.

Permanent Exclusions

We will not be liable under any circumstances, for any claim in connection with or with regard to any of the following permanent exclusions and any such other exclusions as may be specified in the Schedule of Insurance Certificate :

- i. Addictive conditions and disorders
Treatment related to addictive conditions and disorders, or from any kind of substance abuse or misuse including alcohol abuse or misuse.
- ii. Ageing and puberty
Treatment to relieve symptoms caused by ageing, puberty, or other natural physiological cause, such as menopause and hearing loss caused by maturing or ageing.
- iii. Artificial life maintenance
Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health
- iv. Circumcision


key: chroma:document
string_value:
Page 4 of 25Health Companion – Health Insurance Plan

POLICY DOCUMENT

Circumcision unless necessary for pe treatment of a disease or necessitated by an Accident.
v. Conflict and disaster
Treatment for any illness or injury resulting from nuclear or chemical contamination, war, riot, revolution, acts of terrorism or any similar event (oper pan natural disaster or calamity), if one or more of pe following conditions apply:
1. The Insured Person put himself in danger by entering a known area of conflict where active fighting or insurrections are taking place
2. The Insured Person was an active participant in pe above mentioned acts or events of a similar nature.
3. The Insured Person displayed a blatant disregard for personal safety
vi. Congenital conditions
Treatment for any Congenital Anomaly.
vii. Convalescence and Rehabilitation
Hospital accommodation when it is used solely or primarily for any of pe following purposes:
1. Convalescence, rehabilitation, supervision or any oper purpose oper pan for receiving eligible treatment of a type pat normally requires a stay in Hospital.
2. receiving general nursing care or any oper services pat do not require pe Insured Person to be in Hospital and could be provided in anoper establishment pat is not a Hospital
3. receiving services from a perapist or complementary medical practitioner or a practitioner of alternative medicine.
viii. Cosmetic surgery
Treatment undergone purely for cosmetic or psychological reasons to improve appearance. However, pis exclusion does not apply where medically required as a part of treatment for cancer, accidents and burns to restore functionality.
ix. Dental/oral treatment
Treatment for any dental or oral condition, which includes surgical operations for pe treatment of bone disease when related to gum disease or damage, or treatment for, or treatment arising from, disorders of pe tempromandibular joint.

Page 5 of 25# Health Companion – Health Insurance Plan

# POLICY DOCUMENT


key: chroma:document
string_value:
|EXCEPTION:|We will pay for a Surgical Operation for which the Insured Person is Hospitalised as a result of an Accident and which is undertaken as an In-patient in a Hospital and carried out by a Doctor.|
|---|---|
|x.|Drugs and dressings for Out-patient or take-home use|
| |Any drugs or surgical dressings that are provided or prescribed in the case of Out-patient Treatment, or for an Insured Person to take home on leaving Hospital, for any condition, except as included in post-hospitalization expenses under clause 2.4 above.|
|xi.|Eyesight|
| |Treatment to correct refractive errors of the eye, unless required as the result of an Accident. We will not pay for routine eye examinations, contact lenses, spectacles or laser eye sight correction.|
|xii.|Experimental treatment|
| |Treatment, including medication, which in competent Medical Practitioner’s opinion is experimental or has not generally been proved to be effective.|
|xiii.|Health hydros, nature cure, wellness clinics etc.|
| |Treatment or services received in health hydros, nature cure clinics or any establishment that is not a Hospital.|
|xiv.|HIV and AIDS|
| |Any treatment for, or treatment arising from, Human Immunodeficiency Virus (HIV) or Acquired Immuno Deficiency Syndrome (AIDS), including any condition that is related to HIV or AIDS.|
|xv.|Hereditary conditions|
| |Treatment of abnormalities, deformities, Illnesses present only because they have been passed down through the generations of the family.|
|xvi.|Items of personal comfort and convenience, including but not limited to:|


key: chroma:document
string_value:
| |1. Telephone, television, diet charges, (unless included in room rent) personal attendant or barber or beauty services, baby food, cosmetics, napkins, toiletry items, guest services and similar incidental expenses or services.|
| |2. Private nursing/attendant’s charges incurred during Pre-Hospitalization or Post-Hospitalization.|
| |3. Drugs or treatment not supported by prescription.|


key: chroma:document
string_value:
Page 6 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT

|4.|Issue of medical certificate and examinations as to suitability for employment or travel or any other such purpose.|
|---|---|
|5.|Any charges incurred to procure any treatment/Illness related documents pertaining to any period of hospitalization/Illness.|
|6.|External and or durable medical/non-medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc.|
|7.|Ambulatory devices such as walkers, crutches, belts, collars, caps, splints, slings, braces, stockings of any kind, diabetic footwear, glucometer/thermometer and similar items and also any medical equipment which is subsequently used at home.|
|8.|Nurses hired in addition to the Hospital’s own staff.|
|xvii.|Non-allopathic treatment|
| |Any other streams of medicine apart from allopathy. We will not pay for other streams of treatment including ayurvedic, homeopathic or unani medicine.|
|xviii.|Psychiatric and Psychosomatic Conditions|
| |Treatment of any mental illness or sickness or disease including a psychiatric condition, disorganization of personality or mind, or emotions or behavior, Parkinson’s or Alzheimer’s disease even if caused or aggravated by or related to an Accident or Illness or general debility or exhaustion (“run-down condition”);|
|xix.|Obesity|
| |Treatment for obesity.|
|xx.|Out-patient Treatment|
| |Out-patient Treatment is not covered except those out-patient benefits explicitly stated as an eligible benefit for Your chosen plan.|
|xxi.|Reproductive medicine - Birth control & Assisted reproduction|
|1.|Any type of contraception, sterilization, termination of pregnancy or Family planning.|
|2.|Treatment to assist reproduction, including IVF treatment.|


key: chroma:document
string_value:
Page 7 of 25# Health Companion – Health Insurance Plan

# POLICY DOCUMENT

|xxii.|Self-inflicted injuries|
|---|---|
| |Treatment for, or arising from, an injury that is intentionally self-inflicted, including attempted suicide.|

|xxiii.|Sexual problems and gender issues|
|---|---|
| |Treatment of any sexual problem including impotence (irrespective of the cause) and sex changes or gender reassignments or erectile dysfunction.|

|xxiv.|Sexually transmitted diseases|
|---|---|
| |Treatment for any sexually transmitted disease, including Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis.|

|xxv.|Sleep disorders|
|---|---|
| |Treatment for sleep apnea, snoring, or any other sleep-related breathing problem.|

|xxvi.|Speech disorders|
|---|---|
| |Treatment for speech disorders, including stammering unless the disorder occurs directly due to an Accident.|

|xxvii.|Treatment for developmental problems|
|---|---|
| |Treatment for, or related to developmental problems, including but not limited to:|
| |1. learning difficulties, such as dyslexia;|
| |2. behavioral problems, including attention deficit hyperactivity disorder (ADHD);|
| |3. deviated nasal septum (straitening of the nasal tract).|

|xxviii.|Treatment received outside India|
|---|---|
| |Any treatment received outside India|


key: chroma:document
string_value:
|xxix.|Unrecognised physician or Hospital:|
|---|---|
| |1. Treatment provided by a medical practitioner who is not recognized by the Medical Council of India.|
| |2. Treatment in any hospital or by any medical practitioner or any other provider of services that We have blacklisted as listed on Our website.|
| |3. Treatment provided by anyone with the same residence as Insured Person or who is a member of the Insured Person’s immediate family|

Page 8 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT


key: chroma:document
string_value:
POLICY DOCUMENT

5. Standard Terms and Conditions
a. Reasonable Care
The Insured Person shall take all reasonable steps to safeguard against any Accident or illnesses pat may give rise to any claim under pis Policy.
b. Observance of terms and conditions
The due observance and fulfillment of pe terms, conditions and endorsement of pis Policy in so far as pey relate to anyping to be done or complied wip by pe Insured Person, shall be a condition precedent to any liability to make payment under pis Policy.
c. Subrogation
The Insured Person shall do and concur in doing and permit to be done all such acts and pings as may be necessary or required by Us, before or after indemnification, in enforcing or endorsing any rights or remedies, or of obtaining relief or indemnity, to which We are or would become entitled or subrogated. Neiper You nor any Insured Person shall do any acts or pings pat prejudice pese subrogation rights in any manner. Any recovery made by Us pursuant to pis clause shall first be applied to pe amounts paid or payable by Us under pis Policy and pe costs and expenses incurred by Us in effecting pe recovery, whereafter We shall pay pe balance amount to You. This clause shall not apply to Hospital Cash benefit (as applicable under pe Policy).
d. Contribution
If pe Insured Person is covered by any oper policy which covers any claim in whole or in part made under pis Policy (or would cover any claim made under pis Policy, if pis Policy did not exist) pen We shall not be liable to pay or contribute more pan Our rateable proportion of pe claim. This clause shall not apply to Hospital Cash benefit (as applicable under pe Policy).

xxx. Unlawful Activity

Any condition as a result of Insured Person committing or attempting to commit a breach of law with criminal intent.


key: chroma:document
string_value:
xxxi. Hospitalization undertaken for observation or for investigations only and where no medical treatment is provided.

xxxii. Active participation in adventure or hazardous sports including but not limited to para-jumping, rock climbing, mountaineering, motor racing, horse racing or deep-sea diving.

Page 9 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT

e. Fraudulent claims

If a claim is in any way found to be fraudulent, or if any false statement, or declaration is made or used in support of such a claim, or if any fraudulent means or devices are used by the Insured Person or anyone acting on behalf of the Insured Person to obtain any benefit under this Policy, then this Policy shall be void and all claims being processed shall be forfeited for all Insured Persons and all sums paid under this Policy shall be repaid to Us by all Insured Persons who shall be jointly liable for such repayment.

f. Free Look Provision

You have a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy. If You have any objections to any of the terms and conditions, You have the option of canceling the Policy stating the reasons for cancellation and You shall be refunded the premium paid by You after adjusting the amounts spent on any medical check-up, stamp duty charges and proportionate risk premium. You can cancel your Policy only if no claims have been made under the Policy. The Insured Persons and Your rights under this Policy shall immediately stand extinguished on the free look cancellation of the Policy. Free look provision is not applicable and available at the time of renewal of the Policy.

g. Portability Benefit

- i. From another company to Our Policy

Page 10 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT

first Policy with Us, unless the treatment is needed as a result of an Accident.


key: chroma:document
string_value:
# (ii) It is understood and agreed that:

(1) If You wish to exercise pe Portability Benefit, We should have received Your application wip complete documentation at least 21 days before pe expiry of Your present period of insurance;
(2) If pe proposed Sum Insured is more pan pe insurance cover under pe previous policy, pen pe revised waiting period under General Exclusion 4(a) shall only be applicable to pe extent of pe insurance cover under pe previous policy; and
(3) We may revise pe premium payable based on pe extent of applicability of pe Portability Benefit.
(4) This benefit is available only at pe time of renewal of existing healp insurance policy.
(5) The Portability Benefit shall be applied subject to pe following :

- (a) You shall give Us all additional documentation and/or information We request;
- (b) You pay Us the applicable premium in full;
- (c) We may, subject to Our medical underwriting, restrict the terms upon which We may offer cover, the decision as to which shall be in Our sole and absolute discretion;
- (d) There is no obligation on Us to insure all Insured Persons or to insure all Insured Persons on the proposed terms, even if You have given Us all documentation;
- (e) We have received the database and claim history from the previous insurance company for the Insured Persons’ previous health insurance policy.

# ii. From Our existing health insurance policies to this Policy

# (i) If the proposed Insured Person was insured continuously and without a break under another health insurance policy with Us, then General Exclusion 4(a) of the

Page 11 of 25# Health Companion – Health Insurance Plan Policy Document


key: chroma:document
string_value:
Page 11 of 25# Health Companion – Health Insurance Plan Policy Document

|Policy stands deleted and shall be replaced entirely with the following and General Exclusion 4(b) shall not be applicable:|
|---|
|4(a) Pre-Existing Conditions|Benefits will not be available for Pre-existing Conditions until the completion of the period stated in the Schedule of Insurance Certificate for the Insured Person. It is understood and agreed that the period stated in the Schedule of Insurance Certificate for Pre-existing Conditions shall not exceed the difference between the waiting period for pre-existing conditions served under the previous policy and the 48 months waiting period that would otherwise have been applicable from the inception of the first Policy with Us.|
|(ii) It is understood and agreed that:|
|(1) If You wish to exercise the Portability Benefit, We should have received Your application before the expiry of Your present period of insurance;|
|(2) If the proposed Sum Insured is more than the insurance cover under the previous policy, then the revised waiting period under General Exclusion 4(a) shall only be applicable to the extent of the insurance cover under the previous policy;|
|(3) We are not bound to continue all terms and conditions of the present cover under the Policy of the Insured Person under the new policy, but for calculation of all waiting periods (including the waiting period provided under General Exclusions in clauses 4(c), 4(d) and the maternity benefit endorsement) under the new policy, the time spent by Insured Person under this Policy may be taken into account, provided new policy is taken without any break from this Policy; and|
|(4) This benefit is available only at the time of renewal of existing health insurance policy.|
|(5) The Portability Benefit shall be applied subject to the following :|
|(a) You shall give Us all additional documentation and/or information We request;|
|(b) You pay Us the applicable premium in full;|


key: chroma:document
string_value:
Page 12 of 25# Health Companion – Health Insurance Plan Policy Document

# Cancellation/Termination (other than freelook cancellation)

1. Cancellation by Insured Person:

You may terminate this Policy during the Policy Period by giving Us at least 30 days prior written notice. We shall cancel the Policy and refund the premium for the balance of the Policy Period in accordance with the table below provided that no claim has been made under the Policy by or on behalf of any Insured Person.

|Length of time Policy in force|Refund of premium|
|---|---|
|up to 30 days|75%|
|up to 90 days|50%|
|up to 180 days|25%|
|exceeding 180 days|0%|

2. Automatic Cancellation:

a. Individual Policy:

The Policy shall automatically terminate on death of the Insured Person

b. For Policy issued to Family:

The Policy shall automatically terminate in the event of the death of all the Insured Persons.

c. Refund:

A refund in accordance with the table in section 5(h)(1) above shall be payable if there is an automatic cancellation of the Policy provided that no claim has been filed under the Policy by or on behalf of any Insured Person.

3. Cancellation by Us:

Page 13 of 25# Health Companion – Health Insurance Plan Policy Document

Without prejudice to the above, We may terminate this Policy during the Policy Period by sending 30 days prior written notice to Your address shown in the Schedule of Insurance Certificate without refund of premium if in Our opinion:


key: chroma:document
string_value:
- You or any Insured Person or any person acting on behalf of either has acted in a dishonest or fraudulent manner under or in relation to this Policy;
- You or any Insured Person has not disclosed any true, complete and all correct facts in relation to the Policy; and/or
- Continuance of the Policy poses a moral hazard.

For avoidance of doubt, it is clarified that no claims shall be admitted and/or paid during the notice period by Us in relation to the Policy.

# i. Territorial Jurisdiction

All benefits are available in India only, and all claims shall be payable in India in Indian Rupees only.

# j. 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.

# k. Renewal of Policy

The renewal premium is payable on or before the due date in the amount shown in the Schedule of Insurance Certificate or at such altered rate as may be reviewed and notified by Us before completion of the Policy Period. We are under no obligation to notify You of the renewal date of Your Policy. We will allow a Grace Period of 30 days from the due date of the renewal premium for payment to Us.

If the Policy is not renewed within the Grace Period then We may agree to issue a fresh policy subject to Our underwriting criteria and no continuing benefits shall be available from the expired Policy.

Renewal of the Policy will not ordinarily be denied other than on grounds of moral hazard, misrepresentation and fraud.

# l. Notices

Any notice, direction or instruction given under this Policy shall be in writing and delivered by hand, post, or facsimile to

Page 14 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT


key: chroma:document
string_value:
POLICY DOCUMENT

i. The You/Insured Person at the address specified in the Schedule of Insurance Certificate or at the changed address of which We must receive written notice.

ii. Us at the following address.

Max Bupa Health Insurance Company Limited

D-1, 2nd Floor,

Salcon Ras Vilas,

District Centre, Saket,

New Delhi-110 017

Fax No.: 1800-3070-3333

In addition, we may send You/Insured Person other information through electronic and telecommunications means with respect to Your Policy from time to time.

m. Claims Procedure

(a) Cashless Hospitalization Facility for Network Hospitals:

|i.|The health card We provide will enable an Insured Person to access treatment on a cashless basis only at any Network Hospital on the production of the card to the Hospital prior to admission, provided that:|
|---|---|
| |(1) The Insured Person has notified Us in writing at least 72 Hours before a planned Hospitalization. In an Emergency the Insured Person should notify Us in writing within 48 hours of Hospitalization; and|
| |(2) We have pre-authorized the In-patient Treatment or Day Care Procedure.|
|ii.|Cashless treatment will not be available if You take treatment in an Out-Of-Network Hospital.|
|iii.|For cashless Hospitalization We will make the payment of the amounts assessed to be due directly to the Network Hospital. The treatment must take place within 15 days of the pre-authorization date and pre-authorization is only valid if all the details of the authorized treatment, including dates, Hospital and locations, match with the details of the actual treatment received.|
|iv.|If pre-authorisation is not obtained then the cashless facility will not be available and the claims procedure shall be as per (b)(ii) below.|


key: chroma:document
string_value:
(b) Out-Of-Network Hospitals & All Other Claims for Reimbursement including Hospital Cash:

Page 15 of 25# Health Companion – Health Insurance Plan

# POLICY DOCUMENT

i. We should generally be notified in writing at least 72 hours prior to the planned date of such treatment, consultation or procedure being taken and We must have pre-authorised such treatment, consultation, service or procedure. In an Emergency the Insured Person should notify Us in writing within 15 days of discharge from Hospital

The following information is mandated in the notification:

1. Policy number.
2. Name of Policyholder.
3. Name of Insured Person in respect of whom pe claim has been notified.
4. Name of Hospital wip address and contact number.
5. Diagnosis.
6. Treatment undergone (medical / surgical management wip name of surgical procedure undergone, if applicable) and approximate amount being claimed for

ii. For any Illness or Accident or medical condition that requires Hospitalization, the Insured Person shall deliver to Us the documents listed below, at his own expense, within 30 days of the Insured Person's discharge from Hospital (when the claim is only in respect of post-hospitalization, within 30 days of the completion of the post-hospitalization):

1. Duly filled claim form.
2. Original bills, receipts and discharge certificate/card from the Hospital/Doctor.
3. Original bills from chemists supported by proper prescription.
4. Original investigation test reports and payment receipts.
5. Doctor's referral letter advising hospitalization in non-Accident cases.
6. Details of any other insurance policy that may respond to the claim.
7. First Information Report (FIR) for medico-legal cases.

iii. For any medical treatment taken from an Out-Of-Network Hospital We will only pay Medical Expenses which are Reasonable and Customary.

(c) For Network and Out-Of-Network Hospitals


key: chroma:document
string_value:
(c) For Network and Out-Of-Network Hospitals

In all cases:

i. We reserve the right to call for:

1. Any other documentation or information that We believe may be required; and

Page 16 of 25# Health Companion – Health Insurance Plan

POLICY DOCUMENT

(2) A medical examination by Our doctor or for an investigation as often as We believe this to be necessary. Any expenses related to such examinations or investigations shall be borne by Us.

ii. In the event of the Insured Person's death during Hospitalization, written notice accompanied by a copy of the post mortem report (if any) shall be given to Us within 14 days regardless of whether any other notice has been given to Us. We reserve the right to require an autopsy.

iii. For the purposes of benefit 2, it is understood and agreed that if a Hospital room as per the rent limit permitted by the insurance plan opted for, as shown in the Product Benefits Table, is unavailable, then We will only be liable to make payment for a Hospital room that is actually occupied or as per entitlement permitted by the plan opted for, whichever is lower. Further where Medical Expenses are linked with room rates, Medical Expenses as applicable to the room that is actually occupied or as per room rates entitlement under the plan opted, whichever is lower, shall be payable.

(d) It is hereby agreed and understood that in providing pre-authorisation or accepting a claim for reimbursement under this Policy or making a payment under this Policy, We make no representation and/or give no guarantee and/or assume no responsibility for the appropriateness, quality or effectiveness of the treatment sought or provided.

n. 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 change or vary this Policy.

o. Change of Policy holder


key: chroma:document
string_value:
o. Change of Policy holder

If You do not renew the Policy by the due dates specified in the Schedule of Insurance Certificate, any other adult Insured Person may apply to renew the Policy within 30 days of the end of the Policy Period provided that We receive an application and the premium from such Insured Person and evidence satisfactory to Us of the agreement of all other Insured Persons and You (except in case of death). If We accept such application and the premium for the renewed Policy is paid on time, then the Policy shall be treated as having been renewed without a break in cover. Coverage shall not be available for the period for which no premium is received.

p. Nominee

You can at the inception or at any time before the expiry of the Policy, make a nomination for the purpose of payment of claims, under the Policy in the event of death.

Any change of nomination shall be communicated to Us in writing and such change shall be effective only when an endorsement on the Policy is made by Us.

Page 17 of 25Health Companion – Health Insurance Plan

POLICY DOCUMENT

In case of any Insured Person other than You under the Policy, for the purpose of payment of claims in the event of death, the default nominee would be You.

q. Obligations in case of a minor

If an Insured Person is less than 18 years of age, the You/adult Insured Person shall be completely responsible for ensuring compliance with all the terms and conditions of this Policy on behalf of that minor Insured Person.

r. Customer Service and Grievances Redressal:

- In case of any query or complaint/grievance, You / Insured Person may approach Our office at the following address:

Customer Services Department

Max Bupa Health Insurance Company Limited

D-1, 2nd Floor,

Salcon Ras Vilas,

District Centre, Saket,


key: chroma:document
string_value:
Salcon Ras Vilas,

District Centre, Saket,

New Delhi-110 017

Contact No: 1800-3010-3333

Fax No.: 1800-3070-3333

Email ID: customercare@maxbupa.com
- In case You/Insured Person are not satisfied with the decision of the above office, or have not received any response within 10 days, You/Insured Person may contact the following official for resolution:

Head – Customer Services

Max Bupa Health Insurance Company Limited

D-1, 2nd Floor,

Salcon Ras Vilas,

District Centre, Saket,

New Delhi-110 017

Contact No: 1800-3010-3333

Fax No.: 1800-3070-3333

Email ID: customercare@maxbupa.com
- In case You/Insured Person are not satisfied with Our decision/resolution, You may approach the Insurance Ombudsman at the addresses given in Annexure I.
- The complaint should be made in writing duly signed by the complainant or by his/her legal heirs with full details of the complaint and the contact information of the complainant.

Page 18 of 25# Health Companion – Health Insurance Plan

# POLICY DOCUMENT

|v.|As per provision 13(3) of the Redressal of Public Grievances Rules 1998, the complaint to the Ombudsman can be made|
|---|---|
| |1. only if the grievance has been rejected by the Grievance Redressal Machinery of the Insurer;|
| |2. within a period of one year from the date of rejection by the insurer;|
| |3. if it is not simultaneously under any litigation.|

# Interpretations & Definitions


key: chroma:document
string_value:
# Interpretations & Definitions

In this Policy the following words or phrases shall have the meanings attributed to them wherever they appear in this Policy and for this purpose the singular will be deemed to include the plural, the male gender includes the female where the context permits:

Def. 1. Accident or Accidental means a sudden, unforeseen and involuntary event caused by external and visible means which occurs when the policy is in force.

Def. 2. Congenital Anomaly refers to either:

- i) an external condition(s) which is present since birth, in the visible and accessible parts of the body, and which is abnormal with reference to form, structure or position, OR
- ii) a condition(s) which is present since birth, but is internal and not visible.

Def. 3. Co-pay is a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. Co-pay does not reduce the sum insured.

Def. 4. Day Care Procedure refers to medical treatment, and/or surgical procedure which is:

- undertaken under General or Local Anaesthesia in a hospital/day care centre in less than 24 hrs because of technological advancement, and
- 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.

Def. 5. Diagnostic Tests: Investigations, such as X-Ray or blood tests, to find the cause of your symptoms and medical condition

Def. 6. Deductible: The amount which, in accordance with the terms of the policy, is deducted from the claim amount that would otherwise have been payable and will therefore be borne by the policyholder.


key: chroma:document
string_value:
Def. 7. Domiciliary Treatment: Domiciliary treatment means medical treatment for a period exceeding 3 days, 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:

Page 19 of 25# Health Companion – Health Insurance Plan Policy Document

Def. 8. Doctor is a medical practitioner who holds a valid registration from the medical council of any state of India and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of his license.

Def. 9. Emergency means a severe illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a Doctor to prevent death or serious long term impairment of the Insured Person’s health.

Def. 10. Family means a unit comprising of up to six members who are related to each other in the following manner:

i) Legally married husband and wife as long as they continue to be married; and

ii) Up to four of their children who are more than 90 days old and less than 21 years on the date of commencement of the initial cover under the Policy

Def. 11. 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 conditions. Coverage is not available for the period for which no premium is received.

Def. 12. Hospital means any institution established for in-patient care and day care treatment of sickness and / or injuries and which has been registered as a hospital with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner AND must comply with all minimum criteria as under:


key: chroma:document
string_value:
- a) has at least 10 inpatient beds, in those towns having a population of less than 10,00,000 and 15 inpatient beds in all other places;
- b) has qualified nursing staff under its employment round the clock;
- c) has qualified Doctor (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 will make these accessible to the Insurance company’s authorized personnel.

Def. 13. Hospitalisation or Hospitalised means the admission as an In-patient into a Hospital for necessary medical treatment for a continuous minimum period of 24 hours as a consequence of an Illness or Accident occurring during the Policy Period.

Def. 14. Information Summary Sheet means the record and confirmation of information provided to Us or Our representatives over the telephone for the purposes of applying for this Policy.

Page 20 of 25# Health Companion – Health Insurance Plan

# POLICY DOCUMENT


key: chroma:document
string_value:
|Def. 15.|Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated Doctor(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 considerably more sophisticated and intensive than in the ordinary and other wards.|
|---|---|
|Def. 16.|Illness means sickness (which is a condition or an ailment that impacts on the general soundness and health of the body of the Insured Person) or a disease (which is an affliction of the Insured Person’s bodily organs that has a distinct and recognised pattern of symptoms) or a pathological condition which results in detriment to normal physiological function and which shows itself during the Policy Period and necessitates medical Treatment. Illness does not mean and this Policy does not cover any mental illness or sickness or disease (including but not limited to a psychiatric condition, disorganisation of personality or mind, or emotions or behaviour) even if caused by or aggravated by or related to an Accident or Illness.|
|Def. 17.|In-patient: Treatment for which the Insured Person has to stay in a hospital for more than 24 hours for a covered event.|
|Def. 18.|Insured Person means person named as insured in the Schedule of Insurance Certificate. Any Family member may be added as an Insured Person during the Policy Period if We have accepted his application for insurance and issued an endorsement confirming the addition of such person as an Insured Person.|
|Def. 19.|Medical Expenses means expenses necessarily and actually incurred for medical treatment during the Policy Period on the advice of a Doctor due to Illness or Accident, by an Insured Person, which are Reasonable and Customary.|


key: chroma:document
string_value:
|Def. 20.|Medically Necessary: Medically necessary treatment is defined as 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 Doctor; d) must conform to the professional standards widely accepted in international medical practice or by the medical community in India.|
|Def. 21.|Network means all such Hospitals, day care centres or other providers that the We have mutually agreed with, to provide services like cashless access to Policyholders. The list is available with Us and subject to amendment from time to time.|
|Def. 22.|Out-Of-Network means any Hospital, day care centre or other provider that is not part of the Network.|


key: chroma:document
string_value:
|Def. 23.|Out-patient Treatment means treatment given at a hospital, doctors' consulting room, office or Out-patient clinic where Insured Person are not admitted for Day-Care Procedures or In-patient treatment.|
|---|---|
|Def. 24.|Policy means these terms and conditions, any annexure thereto and the Schedule of Insurance Certificate (as amended from time to time), Your statements in the proposal form and the Information Summary Sheet and the policy wording (including endorsements, if any).|
|Def. 25.|Policy Period means the period between the date of commencement and the expiry date specified shown in the Schedule of Insurance Certificate.|
|Def. 26.|Policy Year means the period of one year commencing on the date of commencement specified in the Schedule of Insurance Certificate or any anniversary thereof.|
|Def. 27.|Pre-existing Condition means any condition, ailment or injury or related condition(s) for which the Insured Person had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first Policy issued by Us.|
|Def. 28.|Product Benefits Table means the Product Benefits Table issued by Us and accompanying this Policy and annexures thereto.|
|Def. 29.|Qualified Nurse is a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India.|
|Def. 30.|Rehabilitation: Treatment aimed at restoring health or mobility, or to allow a person to live an independent life, such as after a stroke.|
|Def. 31.|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 among comparable providers, taking into account the nature of the illness / injury involved.|


key: chroma:document
string_value:
|Def. 32.|Schedule of Insurance Certificate means the schedule provided in the insurance certificate issued by Us, and, if more than one, then the latest in time.|
|Def. 33.|Sum Insured means the sum shown in the Schedule of Insurance Certificate which represents Our maximum total and cumulative liability for any and all claims under the Policy during the Policy Period.|
|Def. 34.|Surgical Operation 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 of suffering or prolongation of life, performed in a Hospital or day care centre by a Doctor.|
|Def. 35.|We/Our/Us means Max Bupa Health Insurance Company Limited|


key: chroma:document
string_value:
Page 22 of 25Health Companion – Health Insurance Plan

POLICY DOCUMENT

Def. 36. You/Your/Policyholder means the person named in the Schedule of Insurance Certificate who has concluded this Policy with Us.

Any reference to any statute shall be deemed to refer to any replacement or amendment to that statute.

'Max', Max Logo, 'Bupa' and HEARTBEAT logo are trademarks of their respective owners and are being used by Max Bupa Health Insurance Company Limited under license.

Page 23 of 25# Health Companion – Health Insurance Plan

# POLICY DOCUMENT


key: chroma:document
string_value:
|Office of the Ombudsman|Name of the Ombudsmen|Contact Details|Areas of Jurisdiction|
|---|---|---|---|
|AHMEDABAD|Insurance Ombudsman|Office of the Insurance Ombudsman, 2nd Floor, Ambica House, Nr. C.U. Shah College, Ashram Road, AHMEDABAD-380 014. Tel.:- 079-27546840, Fax : 079-27546142 Email ins.omb@rediffmail.com|Gujarat , UT of Dadra & Nagar Haveli, Daman and Diu|
|BHOPAL|Insurance Ombudsman|Office of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel, Near New Market, BHOPAL(M.P.)-462 023. Tel.:- 0755-2569201, Fax : 0755-2769203 Email bimalokpalbhopal@airtelmail.in|Madhya Pradesh & Chhattisgarh|
|BHUBANESHWAR|Insurance Ombudsman|Office of the Insurance Ombudsman, 62, Forest Park, BHUBANESHWAR-751 009. Tel.:- 0674-2596455, Fax : 0674-2596429 Email ioobbsr@dataone.in|Orissa|


key: chroma:document
string_value:
|CHANDIGARH|Insurance Ombudsman|Office of the Insurance Ombudsman, S.C.O. No.101-103, 2nd Floor, Batra Building. Sector 17-D, CHANDIGARH-160 017. Tel.:- 0172-2706468, Fax : 0172-2708274 Email ombchd@yahoo.co.in|Punjab , Haryana, Himachal Pradesh, Jammu & Kashmir , UT of Chandigarh|
|CHENNAI|Shri V. Ramasaamy|Insurance Ombudsman, Office of the Insurance Ombudsman, Fathima Akhtar Court, 4th Floor, 453 (old 312), Anna Salai, Teynampet, CHENNAI-600 018. Tel.:- 044-24333668 /5284, Fax : 044-24333664 Email insombud@md4.vsnl.net.in|Tamil Nadu, UT–Pondicherry Town and Karaikal (which are part of UT of Pondicherry)|
|NEW DELHI|Shri Surendra Pal Singh|Insurance Ombudsman, Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Bldg., Asaf Ali Road, NEW DELHI-110 002. Tel.:- 011-23239633, Fax : 011-23230858 Email iobdelraj@rediffmail.com|Delhi & Rajashthan|


key: chroma:document
string_value:
|GUWAHATI|Shri Sarat Chandra Sarma|Insurance Ombudsman, Office of the Insurance Ombudsman, “Jeevan Nivesh”, 5th Floor, Near Panbazar Overbridge, S.S. Road, GUWAHATI-781 001 (ASSAM). Tel.:- 0361-2132204/5, Fax : 0361-2732937 Email ombudsmanghy@rediffmail.com|Assam , Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura|
|HYDERABAD|Shri K. Chandrahas|Insurance Ombudsman, Andhra Pradesh, Karnataka and UT of Yanam – a part of the UT| |# Health Companion – Health Insurance Plan


key: chroma:document
string_value:
POLICY DOCUMENT

|Office of the Insurance Ombudsman| |
|---|---|
|6-2-46, 1st Floor, Moin Court,|Pondicherry|
|A.C. Guards, Lakdi-Ka-Pool,|HYDERABAD-500 004.|
|Tel : 040-65504123, Fax: 040-23376599| |
|Email insombudhyd@gmail.com| |

|ERNAKULAM| |
|---|---|
|Office of the Insurance Ombudsman| |
|2nd Floor, CC 27/2603, Pulinat Bldg.,| |
|Opp. Cochin Shipyard, M.G. Road,| |
|ERNAKULAM-682 015.| |
|Tel : 0484-2358759, Fax : 0484-2359336| |
|Email iokochi@asianetindia.com| |

|KOLKATA| |
|---|---|
|Ms. Manika Datta|West Bengal , Bihar , Jharkhand|
|Insurance Ombudsman|and UT of Andeman & Nicobar|
|Office of the Insurance Ombudsman|Islands , Sikkim|
|North British Bldg.,| |
|29, N.S. Road, 4thFloor,| |
|KOLKATA-700 001.| |
|Tel : 033-22134866, Fax : 033-22134868| |
|Email iombkol@vsnl.net| |


key: chroma:document
string_value:
|LUCKNOW| |
|---|---|
|Insurance Ombudsman|Uttar Pradesh and Uttaranchal|
|Office of the Insurance Ombudsman,| |
|Jeevan Bhawan, Phase-2,| |
|6th Floor, Nawal Kishore Road,| |
|Hazaratganj,| |
|LUCKNOW-226 001.| |
|Tel : 0522 -2231331, Fax : 0522-2231310| |
|Email insombudsman@rediffmail.com| |

|MUMBAI| |
|---|---|
|Shri S Viswanathan|Maharashtra , Goa|
|Insurance Ombudsman,| |
|Office of the Insurance Ombudsman,| |
|3rd Floor, Jeevan Seva Annexe,| |
|S.V. Road, Santacruz(W),| |
|MUMBAI-400 054.| |
|Tel : 022-26106928, Fax : 022-26106052| |
|Email ombudsmanmumbai@gmail.com| |

# OFFICE OF THE GOVERNING BODY OF INSURANCE COUNCIL

|Smt. Rita Bhattacharya, Secretary General|Shri D V Dixit, Dy. Secretary|
|---|---|
|3rd Floor, Jeevan Seva Annexe,|S.V. Road, Santacruz (W),|
|MUMBAI – 400 021|MUMBAI – 400 021.|
|Tel : 022-26106245|Tel : 022-26106980|
|Fax : 022-26106949|Fax : 022-26106949|
|Email- inscoun@gmail.com| |

Page 25 of 25


