Universal Health Insurance Scheme Contact Address Ouphulia chariali

Universal Health Insurance Scheme Contact Address: Ouphulia chariali, Dibrugarh-786613, Assam, India. PH: - +919854809934

Benefits: Ø Section-I: Hopitalisation Expenses The policy provides reimbursement of hospitalisation expenses upto Rs. 30, 000/- to an Individual/Family. Ø Section-II: Personal Accident Coverage for Death of the Earning Head of the family (as named in the schedule) due to accident: Rs. 25, 000/- Kolkata Division-XXII

SALIENT FEATURES Total expenses incurred for any one illness upto Rs. 15, 000/If the earning head of the family hospitalized due to accident/illness a compensation of Rs. 50/- per day will paid upto 15 days after waiting 3 days. Kolkata Division-XXII

Additional Features: Age Limits: 3 months to 65 years Family means: Earning Head, Spouse and maximum three dependent children. Dependent parents can also be included. Floater means: The total reimbursement of Rs. 30, 000/- can be availed of individual or collectively by Ouphulia Chariali, members of the family. Dibrugarh

Main Exclusions: • • ANY PRE-EXISTING DISEASES. 30 DAYS WAITTING PERIOD • • MATERNITY BENEFIT FOR THE FIRST YEAR INTENTIONAL SELF INJURY, SUICIDE OR ATTEMPTED SUICIDE. CIRCUMCISION, PLASTIC SURGERY, VACCINATION DENTAL TREATMENT (EXCEPT ACCIDENTAL), COST OF CONTACT LENS, HEARING AIDS EXTRNAL CONGENITAL DISEASE, STERILITY, VENERAL DISEASE, INTENTIONAL SELF INJURY, GENERAL DEBILITY CONDITION ARISING DUE TO USE OF INTOXICATING DRUGS/ALCOHOL HIV RELATED TREATMENT/AIDS HOSPITALISATION FOR DIAGNOSITIC PURPOSE INJURY CAUSED DUE TO INVASION, WAR, NUCLEAR WEAPONS NATUROPATHY TREATMENT • • • Kolkata Division-XXII

PREMIUM DETAILS: Kolkata Division-XXII Condition Premium (BPL) Premium (APL) Rs. 100/- Rs. 300/- Rs. 150/- Rs. 450/- Rs. 200/- Rs. 600/- For an Individual (Family Earning Head) For Maximum Five Persons (Parents with Three Depending Children) For Maximum Seven Persons (Parents with Three Depending Children and Depending Parents)

Kolkata Division-XXII AVAILING OF CASHLESS FACILITY UHIS/MICRO policy insured needs hospitalization Submits Photo copy of UHIS /MICRO card Hospital UHIS/MICRO desk Patient gets hassle-free treatment § § § Insurance TPA Hospital Mails the filled-up pre. Auth. Form to TPA authorizes pre-agreed package based amt. & mails the athlete to the hospital

Kolkata Division-XXII Aapke Jeevan ka Suraksha Kawach

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach What are the special features of this policy? Specially designed for lower income group of the society This policy has got 3 Sections: • Sec. I: Protects House (Building) and Household contents (excluding Jewellery & Valuables). • Sec. II: Provides payment towards Hospitalization Exp. of the entire family (Insured, Spouse & 2 dep. children upto 21 yrs. ) • Sec. III: Provides Personal Accident Cover to Insured / Spouse Kolkata Division-XXII

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach Sum Insured: • Building & Contents: Rs. 10, 000/- (Excluding Jewellery & Valuables) • Hospitalization Expenses: Rs. 10, 000/- Family Floater (Overall) for Self, Spouse & 2 dependant children • Personal Accident: Rs. 10, 000/-each for Insured & Spouse in the event of death / total or permanent disability due to accident Kolkata Division-XXII

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach What are the perils covered under Sec. I ? • Fire, Lightning, Explosion of Gas in domestic appliances • Bursting & overflowing of water tanks, apparatus or pipes • Aircraft damage or articles dropped therefrom • Riot, Strike & Malicious Act • Earthquake (Fire &/or Shock), Subsidence & Landslide (incldg. Rockslide) damage • Flood, Innundation, Storm, Tempest, Typhoon, Hurricane, Tornado or Cyclone • Impact Damage

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach Section II- What does this policy cover? - • Hospitalization Exp. (In-patient): • Rs. 10, 000/- Family Floater (Overall Limit) - Room, Boarding Exp. (Hospital/Nursing Home) - I. C. Unit Charges Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing exp. - Anesthesia, Blood, Oxygen, OT Charges, Surgical Appliances, Medicines, Drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach Whether Pre-Existing Diseases Covered: • Covered after 36 months from first policy, (subject to un-interrupted cover).

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach Whether Maternity Benefits covered? • Yes, Normal Delivery: Rs. 1, 000/Caesarean Delivery: Rs. 3, 500/-

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach • Ø Ø Ø For Normal Delivery For Caesarean Delivery of First 2 Living Children of the insured/Spouse Not eligible) Ø Ø Section II-What does this policy cover? Maternity Exp. Benefit Extn. : (Within Overall limit) : Rs. 1, 000/: Rs. 3, 500/- (If already two or more living children- Payable only if admitted in hospital/nursing home as In-Patient in India Ø Waiting Period of 9 months Pre & Post Natal Exp. Payable only if admitted & treatment taken in hospital/nursing home as In. Patient Ø Voluntary Medical Termination of Pregnancy during the first 12 weeks from the date of conception – Not Covered

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach Section II-Hospitalization Expenses Relaxation of 24 Hours Condition Normally, Exp. For hospitalization for a minimum period of 24 hours are admissible. Ø Ø Ø This is not applicable for few specific treatments, viz: Dialysis, Chemotherapy, Radiotherapy, Eye- Surgery, Lithotripsy (Kidney Stone removal), D & C, Tonsillectomy If the treatment is such which necessitates hospitalization and the procedure involves specialized infrastructural facilities available in hospitals. Due to technological advances hospitalization is required for less than 24 hours only.

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Does NOT cover: Pre-Existing Illnesses/diseases (will be covered after 36 months of continuous cover from inception of the first policy with any insurer) Ø First 30 days from commencement date of the policy. (Will not apply if having continuous cover under Health policy from any insurer for a continuous period of preceding 12 months. ) Note: The above two exclusions will not apply if: (a) In the opinion of Company’s panel doctor, the insured person could not have known the existence of the disease or or any symptoms or complaints at the time of making proposal. (b) Insured had not taken any consultation, treatment or medication in respect of disease for which claim has been lodged under the policy prior to taking the insurance. Ø

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Does NOT cover: Ø Ø Ø First Year Exclusions: Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia of Fibromyoma, Hernia, Hydrocele, Congenital Internal disease, Fistula in Anus, Piles, Sinusitis and related disorders. Charges incurred primarily for Diagnostic, X-Ray or laboratory examination or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence of presence of any ailment, sickness or injury. Expenses on vitamins and tonics unless forming part of treatment or injury or disease. Ø Ø Naturopathy treatment. Other Exclusions: Nuclear weapon/materials, War & War like perils, AIDS, etc.

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Does NOT cover: Ø Cost of Spectacles, Contact Lenses and hearing aids Ø Any dental treatment or surgery (Which is corrective or aesthetic procedure, including wear & tear) unless arising from disease or injury & which requires hospitalization. Ø Convalescence general debility ‘Run Down’ condition or rest cure, congenital external disease or defects or anomalies, Sterility, Venereal disease, Intentional Self Injury and use of intoxicating drugs/alcohol.

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach What are the perils covered under Sec. III ? • In the event of : • Accidental Death of the Insured/ Spouse: Compensation: Rs. 10, 000/- to Nominee Irrecoverable loss of sight of both eyes or 2 hands/ 2 feets/ 1 hand & 1 feet: Rs. 10, 000/-to the insured • Irrecoverable loss of sight of 1 Eye or 1 hands/1 foot: Rs. 5, 000/-to the insured • Permanent Total & Absolute Disablement: Rs. 10, 000/- to the insured

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach TPA Services: Serviced by Third Party Administrators Premium: Rs. 146 + Service Tax Age Group: 3 Months to 60 Years

Kolkata Division-XXII GRAMIN SURAKSHA BIMA Micro Insurance Policy Aapke Jeevan ka Suraksha Kawach Exclusions: Normal Exclusions of P. A. Policy. Premium: Rs. 146 + Service Tax Age Group: 3 Months to 60 Years (For Hosp. Cover)

Kolkata Division-XXII

Death Due to Accident : 100% of CSI PTD due to Accident : 100% of CSI Loss of One Eye or One Limb : 50% of CSI Loss of Two Limbs; One Eye and One Limb or Two Eyes : 100% of CSI Kolkata Division-XXII

Age Group: 10~70 years Capital Sum Insured (CSI): Rs. 50, 000/- & Rs. 1, 000/Premium Rs. 30/- Only for CSI Rs. 50, 000/Premium Rs. 60/- Only for CSI Rs. 1, 000/Service Tax Not Required Documents Required: Photo Identity Proof. Kolkata Division-XXII

Any existing disablement. Death, Injury or Disablement due to Intentional Self-Injury, Suicide or Attempted Suicide. Disablement or Death under influence of Liquor or Drug Death or Disablement during Racing, Hunting, Mountaineering, Ice Hockey, Winter Sports. Insanity Breach of Law with Criminal Intent. War Group of Perils. Nuclear Group of Perils. Kolkata Division-XXII

Kolkata Division-XXII

Risks Covered for Two Wheelers The Co. will indemnify the insured against Accidental loss or damage to the vehicle insured hereunder and/or its accessories whilst thereon SECTION-I • By Fire explosion, self ignition or lightning • By Burglary, Housebreaking or Theft • By riot and strike • By Earthquake (Fire & Shock Damage) • By Flood, typhoon, hurricane, storm, tempest inundation cyclone hailstorm frost. • By accidental external means. • By malicious act. • By terrorist activity. • Whilst in transit by road rail inland-waterway lift elevator or air. • By landslide rockslide. SECTION-II • Liability to Third Parties Kolkata Division-XXII

Maximum Liability Under Own Damage Section-I • The Sum Insured i. e. Insured Declared Value (IDV) Exclusion Under Own Damage Section-I • Consequential loss, Depreciation, Wear & Tear, Mechanical or Electrical Breakdown, Failures or Breakages. • Damage to tyres and tubes unless the vehicle is damaged at the same time in which case the liability of the company shall be limited to 50% of the cost of replacement. • Any accidental loss or damage suffered whilst the insured or any person driving the vehicle with the knowledge and consent of the insured is under the influence of intoxicating liquor or drugs. • Compulsory Excess For Each and Every Claim of Rs. 50/- Kolkata Division-XXII

Coverage Under Section-III • Personal Accident Cover For Owner Driver Sum Insured • Maximum Rs. 1, 000/This Cover Subject To • The Owner-Driver is the Registered Owner of the vehicle insured herein. • The Owner-Driver is the insured named in this poliocy. • The Owner Driver holds an effective Driving License. Kolkata Division-XXII

General Exclusions of Motor Insurance Policy • Accidental Loss/damage incurred outside the Geographical area. • Accidental Loss/damage incurred otherwise than in accordance with the “ Limitations as to Use”. • Accidental Loss/damage incurred otherwise than in accordance with the “ Driver’s Clause”. • Consequential Loss. • Loss/Damage due to Nuclear Perils. • Loss/Damage due to War Perils. Kolkata Division-XXII

Underwriting Consideration • Make i. e. Name of the Manufacturer. • Cubic Capacity of the Vehicle. • Year of Manufacture and Date of Registration. • Vehicle Zone. • RTA Address • Colour of the Vehicle. • Price of the Vehicle by which insured bought. • Compulsory Personal Accident Cover to Owner Driver. • No Claim Bonus (not for new vehicle)-(Previous Insurance Documents Should be Submitted) Kolkata Division-XXII

Vehicle Zones for Two Wheeler • Zone-A: Ahmedabad/Bangalore/Chennai/Hydewrabad/Kolkata/Mumbai/New Delhi/Pune • Zone-B: Rest of the Country. Kolkata Division-XXII

Claim Documents • Intimation of Loss/damage should be reach to issuing office as early as possible. • Date of Loss/damage should be mentioned in Intimation • Claim Form duly Filled. • Xerox Copy of R. C. Book • Xerox Copy of Tax Token • Xerox copy of Driving License (At the time of Loss who Drive the Vehicle) • F. I. R. in case of any Injury. • Repairers Estimate • Final Bill should be submitted after Surveyor Inspection & when the Vehicle will ready to ply on the road. • Claim will be Settled by the Policy Issuing Office. Kolkata Division-XXII

Procedure of cashless in case of Grameen Suraksha and Universal Health Insurance Scheme

Cashless Hospitalization Planned Hospitalization Patient visits to network hospital Collects & fills the Pre-Authorization form Query retrieved Hospital faxes the form to TPA Query letter sent to Hospital Emergency Hospitalization Patient gets admitted to network/nonnetwork hospital Collects & fills the form Query retrieved TPA scrutinizes the form Yes In case of Query No Authorization within 1 to 6 hours Hospital faxes the form to TPA Query letter sent to Hospital TPA scrutinizes the form Yes In case of Query No Authorization within 1 to 6 hours Presented by: Dedicated Healthcare Services (India) Pvt. Ltd.

Contact Address: Ouphulia chariali, Dibrugarh-786613, Assam, India. PH: - +919854809934