Health Insurance

The escalating cost of medical treatment today is beyond the reach of common man. In case of a medical emergency, cost of hospital room rent, the doctor's fees, medicines and related health services can work out to be a huge sum. In such times, health insurance provides the much needed financial relief.

Health Insurance can be availed by people aged between five and seventy-five (The upper and lower age limits may vary slightly depending on the policy). Do not wait till you fall sick. An investment in health insurance scheme would be a judicious decision. The health insurance scheme could either be a personal scheme or a group scheme sponsored by your employer.

The health insurance does not cover certain ailments at all times and a few ailments are not covered in the first year of cover. It covers hospitalisation charges for accidents, injuries, various ailments and maternity expenses. The overseas mediclaim policies cover hospitalisation and treatment charges on trips abroad. There are four major insurance companies in India and despite the different names of the policies, the schemes and the covers are the same. The possible variation could only be in the quality of service.

We present below the main health policies offered by the Indian Insurance Companies. These policies have been regulated by the General Insurance Corporation and are marketed by the four big insurance companies. United India Insurance Co Ltd., New India Assurance Co Ltd., Oriental Insurance Co Ltd. and National Insurance Co Ltd.

MEDICLAIM

Salient feature of the policy

In the event of any claim/s becoming admissible under this Scheme the Company will pay to the Insured Person the amount of such expenses as would fall under different heads mentioned below and as are reasonably and necessarily incurred thereof by or on behalf of such Insured Person. But not exceeding the Sum Insured in aggregate mentioned in the schedule hereto:

Room, Boarding Expenses as provided by the hospital/nursing home.
Nursing Expenses
Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and x-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pace Maker, Artificial Limbs and Cost of Organs and similar expenses.

Note: Company liability in respect of all claims admitted during the period of insurance shall not exceed the Sum Insured per person mentioned in the Schedule.

Definitions

"Hospital/Nursing Home" means any institution in India established for indoor care and treatment of sickness and injuries and which

Has been registered either as a hospital or nursing home with the local authorities and is under the supervision of a registered and qualified medical practitioner.
Should comply with minimum criteria as under.
1. it should have at least 15 in patient beds.*
2. fully equipped operation theatre of its own wherever surgical operations are carried out.
3. fully qualified nursing staff under its employment round the clock.
4. fully qualified Doctor(s) should be in charge round the clock.

(N.B.* In Class 'c' towns condition of number of beds be reduced to 10).

The terms "Hospital/Nursing Home" shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place for alcoholics, a hotel or a similar place.
"Surgical Operations" means manual and/or operative procedures for correction of deformities and defects, repairs or injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life.
Expenses on Hospitalisation for minimum period of 24 hours are admissible however this time limit will not apply for specific treatments i.e. Dialysis, Chemotheraphy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy (kidney stone removal), Tonsillectomy, D & C taken in the Hospital/Nursing Home and the insured is discharged on the same day, the treatment will be considered to be taken under Hospitalisation Benefit. This condition will also not apply in case of stay in hospital of less than 24 hours provided.
1. The treatment is such that it necessitates hospitalisation and the procedure involves specialised infrastructural facilities available in hospitals.
2. Due to technological advances hospitalisation is required for less than 24 hours only.
Domiciliary Hospitalisation Benefit means: Medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a Hospital/Nursing Home but actually taken whilst confined at home in India under any of the following circumstances namely
1. The condition of the patient such that he/she cannot be removed to the Hospital/Nursing Home or
2. The patient cannot be removed to Hospital/Nursing Home for lack of accommodation therein

Subject, however that domiciliary hospitalisation benefits shall not cover:

expenses incurred for pre and post hospital treatment .
expenses incurred for treatment for any of the following diseases:
1. Asthma
2. Bronchitis
3. Chronic Nephritis and Nephritic Syndrome
4. Diarrhoea and all type of Dysentries including Gastrroenteritis
5. Diabetes, Mellitus and Insipidus
6. Epilepsy
7. Hypertension
8. Influenza, Cough and Cold
9. All Psychiatric or Psychosomatic disorders
10. Pyrexia of unknown origin for less than 10 days
11. Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharangitis
12. Arthritis, Gout and Rheumatism

Note: When treatment such as Dialysis, Chemotherapy, Radiotherapy etc. is taken in the Hospital/Nursing Home and the Insured is discharged on the same day, the treatment will be considered to be taken under Hospitalisation Benefit section. Liability of the Company under this clause is restricted as stated in the Schedule attached hereto.

Pre Hospitalisation :
Relevant medical expenses incurred during period up to 30 days prior to hospitalisation on disease/illness/injury sustained will be considered as part of claim as mentioned under item 1.0 above.
Post Hospitalisation :
Relevant medical expenses incurred during period upto 60 days prior to hospitalisation on disease/illness/injury sustained will be considered as part of claim as mentioned under item 1.0 above.
Medical Practitioner:
means a person who holds a degree/diploma of a recognised institution and is registered by Medical Council of respective State of India. The term Medical Practitioner would include Physician, Specialist and Surgeon.
Qualified Nurse :
means a person who holds a certificate from a recognised Nursing Council and who is employed on recommendations of the attending Medical Practitioner.

Exclusions

The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by my Insured Person in connection with or in respect of

All diseases/injuries, which are pre-existing when the cover incepts for the first time. For the purpose of applying this condition,the date of inception of the initial mediclaim policy taken from any of the Indian Insurance Companies shall be taken, provided the renewals have been continuous and withour any break.
Any disease other than those stated in clause 4.3 contracted by the insured person during the first 30 days from the commencement date of the policy. This exclusion shall not, however, apply if in the opinion of panel of Medical Practitioners constituted by the Company for the purpose, the Insured Person, could not have known the existence of the Disease or any symptoms of complaints thereof at the time of making the proposal for insurance to the Company. This condition4.2. shall not, however, apply incase of the insured person having been covered under this scheme or group insurance scheme with any of the Indian Insurance Companies for a continuous period of preceding 12 months without any break.
(Note: These excludsions 4.1 and 4.2 shall not however apply if.)
1. In the opinion of a Panel of Medical Practitioners constituted by the Company for the purpose,;the Insured Person could not have known of the existence of the disease or any symptoms or complaints there of at the time of making the proposal for insurance to the Company.
2. The insured had not taken any consultation,treatment or medication, in respect of the hospitalisation for which claim has beenlodged under the policy prior to taking the insurance.
During the first year of the operation of insurance cover the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterrectomy for Menorrhea or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases Fistula in anus, Piles, Sinusitis and the related disorders are not payable, If these diseases (other than congential internal disease) are pre-existing at the time of proposal, they will not be covered even during subsequent period of renewal too. If the insured is aware of the existence of congentital internal discase before inception of policy, the same will be treated as pre-existing.
Injury or Disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not)
Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination, innoculation or change of sex of cosmetic or aesthetic treatment of any description. Plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
Cost of spectacles and contact lenses, hearing aids.
Dental treatment or surgery of any kind, unless requiring hospitalisation.
Convalescence, general debility 'Run-down' condition or Rest cure, congenital external disease or defects or anomalies, sterility, veneral disease, intentional self-injury and use of intoxicating drugs/alcohol.
All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB) or Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative orVariations Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
Charges incurred at Hospital or Nursing Home primarily for diagnostic, x-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence of presence of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home.
Expenses on vitamins and tonics, unless forming part of treatment for injury or disease are certified by the attending Physician.
Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
Treatment arising from or traceable to pregnancy, childbirth including caesarian section.Voluntary medical termination of pregnancy during first 12 weeks from the date of conception.
Naturopathy treatment.

Conditions

The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by my Insured Person in connection with or in respect of

Every notice or communication to be given or made under this policy shall be delivered in writing at the address of the Policy issuing office as shown in the Schedule.
The premium payable under this Policy shall be paid in advance. No receipt for Premium shall be valid except on the official form of the company signed by a duly authorised official of the company. The due payment of premium and the observance and fulfillment of the terms, provisions, conditions and endorsements of this Policy by the Insured Person in so far as they relate to anything to be done or completed with by the Insured Person shall be a condition precedent to any liability of the Company to make any payment under this Policy. No waiver of any terms, provisions, conditions and endorsements of this policy shall be valid unless made in writing and signed by an authorised official of the Company.
Upon the happening of any event which may give rise to a claim under this Policy, notice with full particulars shall be sent to the Company within 7days from the date of Death, Injury, Hospitalisation/Domiciliary Hospitalisation.
All suportting documents relating to the Claim must be filed within 30 days from date of discharge from the Hospital. Note: Waiver of this condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the Company, that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time limit.
The Insured Person shall obtain and furnish to the Company with all original bills, receipts and other documents upon which, a claim is based and shall also give the Company such additional information and assistance as the Company may require in dealing with the claim.
Any medical practitioner authorised by the Company shall be allowed to examine the Insured Person in case of any alleged injury or disease requiring Hospitalisatin when and so often as the same may reasonably be required on behalf of the Company.
The Company shall not be liable to make any payment under this policy in respect of any claim, if such claim be in any manner, fraudulent or supported by any fraudulent means or device whether by the insured person or by any other person acting on his behalf.
If at the time when any claim arises under this Policy, there is in existence any other insurance (other than Cancer Insurance Policy in collaboration with Indian Cancer Society), whether it be effected by or on behalf of any insured person in respect of whom the claim may have arisen covering the same loss, liability, compensation, costs or expenses, the Company shall not be liable to pay or contribute more than its rateable proportion of any loss, liability, compensation, costs or expenses. The benefits under this Policy shall be in excess of the benefits available under Cancer Insurance Policy.
The Policy may be renewed by mutual consent. The Company shall not, however, be bound to give notice that it is due for renewal and the Company, may at any time cancel this Policy by sending the insured 30 days notice by registered letter at the Insured's last known address and in such event the Company shall refund to the insured a pro-rata premium for unexpired Period of Insurance. The Company shall, however, remain liable for any claim which arose prior to the date of cancellation. The Insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Company's short period rate only (table given here below) provided no claim has occurred up to the date of cancellation.
If any dispute or difference shall arise as to the quantum to be paid under this Policy (liability being otherwise admitted) such difference shall be referred to the decision of a sole arbitrator to be appointed in writing by the parties or if they cannot agree upon a single arbitrator within 30 days of any any party invoking arbitration, the same shall be referred to a panel of three arbitrators. Comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Oct,1996.arbitration in accordance with the provisions of the Indian Arbitration Act, 1940 as amended from time to time and for the time being in force.
It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided if the Company had disputed or not accepted liability under or in respect of this Policy.
It is hereby expresly stipultated and declared that it shall be a condition precedent to any right of action or suit upon this ppolicy that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.
If the Company shall disclaim liability to the insured for any claim hereunder and if the insured shall not within 12 calendar months from the date of receipt of the notice of such disclaimer notify the Company in writing that he does not accept such disclaimer and intends to recover his claim from the Company, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.
All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency.

Payment of claim

All claims under this policy shall be payable in Indian currency. All medical treatments for the purpose of this insurance will have to be taken in India only.

Cumulative bonus

In case of a claim under the policy in respect of Insured person, who has earned the cumulative bonus, the increased percentage will be reduced by 10% of Sum Insured at the next renewal, however basic Sum Insured will be maintained and will not be reduced.

For existing policy holders(as date of implementation) the accrued amount of benefit of cumulative bonus, the bonus will be added to the Sum Insured, subject to the maximum 10 claim free years.

Cumulative bonus will be lost if policy is not renewed on the date of expiry.

Waiver: In exceptional circumstances the seven days exception in period of renewal is permissible to be entitled for Cumulative bonus although the policy is renewed only subject to Medical Examination and exclusion of diseases.

Cost of health checkup

In addition to Cumulative Bonus, the insured shall be entitled for reimbursement of the cost of medical check-up once at the end of block of every four underwriting years, provided there are no claims reported during the block. The cost so reimbursable shall not exceed the amount equal to 1% of the amount of average sum insured during the block of four underwriting years. IMPORTANT : For Cumulative Bonus and Health Check-up Provisions as 1provisions as aforesaid.

Both Health Check-up and Cumulative Bonus provisions are applicable only in respect of continuous insurance without break excepting however, where in exceptional circumstances the break for a maximum of seven days is approved as a special case subject to medical examination and exclusion of disease during the break period. Health check-up benefit will be accrued after completion of four years continuous claim free insurance.

Age limit

This insurance is available to persons between the age of 5 years and 80 years. Children between the age of 3 months and 5 years of age can be covered provided one or both parents are covered concurrently.

Family discount

A discount of 10%in the total premium will be allowed comprising the insured and any one or more of the following:

Spouse
Dependent children (i.e. legitimate or legally adopted children)
Dependent parents

JAN BIMA AROGYA POLICY

Definitions

What is insured?
Hospitalisation or domiciliary hospitalisation expenses incurred on medical or surgical treatment for any illness or disease (contracted after 30 days from the commencement of the policy) or injury.
Who can be insured?
Any person in the age group of three months to 70 years.
What risks are insured?
Sudden illnesses like heart attack, jaundice, pneumonia, appendicitis, paralytic attack, food poisoning or accidents that require hospitalisation or domiciliary hospitalisation.
What will the policy pay and how much?
Reimbursement of hospitalisation or domiciliary hospitalisation expenses incurred by an insured person for treatment of illness, disease or injury as an inpatient in a nursing home. The limit of liability under the policy per year per person is Rs.5,000.
When will the policy not pay?
Broadly, the policy will not pay claims under the following circumstances:
1. Any disease contracted within 30 days from commencement of the policy.
2. Injury or a disease caused by war or nuclear perils.
3. Circumcision.
4. Routine eye examination.
5. Dental treatments or surgery of any kind, unless hospitalisation is required.
6. Convalescence, general disability or a run down condition or rest cure etc.
7. Expenses on vitamins and tonics.
8. Treatments arising from or traceable to pregnancy or child birth including the caesarian section.

OVERSEAS MEDICLAIM

Definitions

The following definitions apply throughout this insurance :

INSURED PERSON is that person named in the Overseas Mediclaim Policy Schedule, for whom the appropriate premium has been paid.

HERITAGE: HERITAGE Health Services Privated Limited, who provides assistance to the insured person whilst in India. Their registered and head office address is MC Lead House, 3,Netaji,Subhas Road, Kolkatta - 700 001, Tel:(033)248 2411 Fax:(033)248 0482,E-mail:hftl.calcutta vsnl.com,The frontline office address is unit 28,Ground Floor,T.V.Industrial Estate, Hind Cycle Road(Behind Glaxo), Worli, Mumbai - 400 025. India. Tel:(022)492 6255 Fax:(022)498 0926 E-mail :heritagehealth.vsnl.net.

MERCURY is Mercury International Assistance and Claims Limited who provide emergency assistance and claims administration services. Their address is P.O. Box 673, Brighton, Sussex BNI 4EZ, England.

MEDICAL ADVISORS are Medical Practitioners appointed by 'Mercury'.

PHYSICIAN means a person legally qualified to practice in medicine or surgery including other legally qualified medical practitioner duly licensed by their respective jurisdiction which person is not a member of the Insured Person's family.

MEDICAL RELATED EXPENSES REASONABLY AND NECESSARILY INCURRED means expenses that in the opinion of the treating Physician and Mercury are medically necessary in order to maintain life and/or relieve immediate pain or distress for illness/disease/accident first manifested/occurring during the period of insurance.

PERMANENT TOTAL DISBLEMENT: means a condition wherein the insured person is permanently,totally and absolutely disabled from engaging in any employment or occupation of whatsoever description.

LOSS OF EYE means the total and irrecoverable loss of sight from one or more eyes.

LOSS OF LIMB means the loss of a hand or foot by permanent physical severance at or above the wrist or ankle including total and permanent loss of use of a hand or foot.

CHECKED BAGGAGE means the baggage handed by the Insured Person and accepted by an Airline for an International flight for transportation in the same aircraft as the Insured Person and for which the airline has provided a baggage receipt.

VALUABLES means photographic, audio, video, computer, telecommunications and electrical equipment, telescopes, binoculars, spectacles, sunglasses, antiques, watches, jewellery, furs and articles made of precious stones and metals.

Period if Insurance

This insurance is valid from the First Day of Insurance and expires on the last day of the number of days specified in the Overseas Mediclaim Policy schedule or on return to India whichever is earlier.

Extension of the period of insurance is automatic for the period not exceeding 7 days, and without extra charge, if necessitated by delay of public transport services beyond the control of the Insured person.

When injury/illness/accident covered under this policy is contracted during the policy period and treatment for same commences during the policy period and continues beyond the expiry date of this policy, only emergency expenses would be paid up to 45 days from the date of expiry of the policy provided the insured is medically incapable to travel. 'Mercury' must be notified immediately as soon as it is known that insured is unfit to return to India. If any new illness/injury/accident is contracted beyond the expiry date of the policy, treatment for same would not be covered.

General Conditions Applicable to all Sections

The conditions below apply throughout this insurance. Failure to comply with them maybe prejudicial to a claim.
The policy will be valid only if the insured journey commences within 14 days of the First Day of Insurance as indicated in the policy schedule.
Cancellation of the policy may be done ONLY in cases where a journey is not undertaken and ONLY on production the Insured person's PASSPORT as a proof that the journey has not been undertaken. Any request for cancellation will be entertained not less than 14 days after the First Day of Insurance as indicated in the policy schedule. Such cancellation will be subject to deduction of cancellation charges by the underwriters as applicable.
It is a condition precedent to liability hereunder that in the event of any occurrence likely to give rise to a claim under this insurance, that the insured person, or his representative, must notify 'Mercury' immediately. The insured person or his representative should quote to 'Mercury' as much information concerning the illness, accident or occurrence as is available, including the name of the treating doctor, name and telephone number of the hospital, the OMP policy number and it's date of issue. For non-emergency claims 'Mercury' should be contacted upon return to the Republic of India and a claim form obtained. This document, together with invoices, travel documents and any other relevant details must be sent to 'Mercury', clearly stating under which section of this policy a claim is being made. Please note that if medical treatment has been received, medical certificates showing the nature of the injury or illness together with all bills, and receipts if already paid should be forwarded to 'Mercury'. In no event should a claim be notified to 'Mercury' later than 31 days after the end of an insured trip.
Insurers shall be fully and completely subrogated to the rights of the insured person against parties who may be liable to provide indemnity or make a contribution in respect of any matter which is the subject of a claim under this insurance. The insured person further agrees to co-operate fully with insurers in seeking such indemnity or contribution including where appropriate insurers instituting proceedings at their own expense against such parties in the name of the insured person.
The insurers may require the insured person to furnish at his own expense all certificates, information, proofs or other evidence of claims. The insurers may approach any physician who may have treated the insured person, and the insured person must co-operate in this respect.
No person shall admit liability or make any offer or promise of payment without the express written consent of the insurers.
The insured person shall take all reasonable and proper care to safeguard against accident or illness or loss of or damage to his property, as if this insurance was not in force. Failure to do so will prejudice the insured person's position under this insurance.
The insured person may not transfer his interest in this insurance. However, the legal representatives of the insured person shall have the right to act for the insured person who is incapacitated or deceased.
This insurance does not operate beyond a period of 180 days continuous absence from the Republic of India specifically agreed by insurers.
This policy and the Overseas Mediclaim Policy Schedule shall be read together as one contract and any wording or expression to which a specific meaning has been attached in any part of the Overseas Mediclaim Policy and Schedule shall bear such specific meaning wherever it may appear.
Dispute resolution clause and procedure: This contract of insurance includes the following dispute resolution procedure which is exclusive and a material part of this Contract of Insurance.
Nature of Coverage: This policy is not a general health insurance policy. Coverage under the medical expense section of this insurance is intended for use by the Insured person in the event of a sudden and unexpected sickness or accident arising when the Insured is outside the Republic of India.
Pre-existing Exclusion: This Policy is not designed to provide an indemnity in respect of medical services, the need for which arises out of a pre-existing condition.
Pre-existing Condition: Any sickness for which the insured person has sought medical advice or has taken medical treatment in the preceding 12 months prior to the commencement of travel.
Prior Consultation: Any medical services or series of services with a cost of greater than US$ 100 shall not be covered by this policy unless the Insured person consults with 'Mercury' in the manner set out in the important condition number 1.
Choice of Law: The parties to this insurance policy expressly agree that the laws of the Republic of India shall govern the validity, construction, interpretation and affect of this policy.
Arbitration: Any claim, controversy or dispute of any kind or nature arising out of or relating to this Contract on Insurance or breach thereof, or to the construction, existance, interpretation, meaning or validity thereof or to the operation or performance thereunder, involving any of the parties, or anyone claiming the rights of any party to this contract shall be by arbitration in the Republic of India in accordance with the provisions of the Indian Arbitration Act, 1940 as amended from time to time and for the time being in force, and it is the intent and purpose of the parties hereto, to make the submission to arbitration or any dispute or controversy arising out of this condition precedent to any legal or equitable action or proceeding of any nature.
Any claim under this Policy that is fraudulent, or if fraudulent means are used to secure payment of benefits under this policy, then such action shall render this policy null and void and all claims hereunder shall be forfeited.
No sum payable under this policy shall carry interest.
In the event of the insured person's death, Insurers shall have the right to carry out a post mortem at their expenses.
Any claim which has not been conclusively proven and the amount thereof substantiated shall not be payable.

General Exclusions Applicable to all Sections

No claim will be paid where the Insured Person :
1. is travelling against the advice of a Physician; or
2. is receiving or on a waiting list for specified medical treatment declared in the Physician's report or certificate; or
3. is travelling for the purpose of obtaining treatment; or
4. has received a terminal prognosis for a medical condition.
No claim will be paid arising from suicide, attempted suicide or wilfully self inflicted injury or illness, mental disorder, anxiety, stress of depression, venereal disease, alcoholism, drunkenness or the abuse of drugs, or any loss arising directly or indirectly from any injury, illness, death, loss, expense, or other liability attributable to HIV (Human Immunodeficiency Virus) and/or any HIV related illness including AIDS (Acquired Immune Deficiency Syndrome) and/or any mutant erivative or variation there of however caused.
No claim will be paid arising from the Insured Person taking part in Naval, Military or Air force operations.
No claim will be paid arising from War, invasion, acts of foreign enemy, hostilities (Whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or destruction of or damage to property by or under the order of any government or local authority.
This insurance does not cover any claim arising from the loss or destruction or damage to any property whatsoever or any loss or expenses whatsoever resulting or arising there from or any consequential loss directly or indirectly caused by or contributed to by or arising from
1. ionising radiation or contamination by radioactivity from any nuclear waste from the combustion of nuclear fuel; or
2. the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
No claim will be paid which arises from the Insured Person engaging in Air Travel unless he or she flies as a passenger on an aircraft properly licensed to carry passengers. For the purpose of this exclusion, Air Travel means being in or on, or boarding an aircraft for the purpose of flying therein or alighting there from following a flight.
No claim will be paid arising from the participation of the Insured Person in winter sports, mountaineering (where ropes or guides are customarily used), riding or driving in races or rallies, caving or potholing, hunting or equestrian, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2miles),further no claim will be paide in case Inusured
Person participates in professional sports or any other hazardous sports unless specifically covered as an extension of the policy.
Professional sports or any other hazardous or potentially dangerous sport for which the Insured Person is either untrained, not physically fit or using improper equipment.
No claim will be paid for losses arising from accidents on two wheeled motorised vehicles unless at the time of the accident the driver is duly qualified, is in possession of a current full International driving license and the driver is wearing a safety crash helmet, or losses arising from accidents on two wheeled motorised vehicles over 50cc.
No claims will be paid for losses arising directly or indirectly from manual work or hazardous occupation, self-exposure to needless peril (except in an attempt to save human life), or if engaging in any criminal or illegal act.

SECTION-A Personal Accident

The insurance will pay as hereinafter mentioned:

If at any time during the covered trip, the insured person shall sustain any bodily injury resulting soleley and directly from accident caused by violent and visible means, then the insured person or his legal personal representative(s), as the case may be will be paid, the capital mentioned against Personal Accident in the Schedule of this policy,if such injury shall within twelve calendar months of occurance be the sole and direct cause of:

death of the insured person.
permanent Total Disablement (as defined in the policy)of the insured person.
total and irrecoverable loss of both eye or two limbs or of one eye and one limb.

Provided always that the policy will not pay under more than one of the foregoing sub clauses in respect of the same accident. No claim will be paid for

More than US$ 2,000 in respect of death if the insured person's age is under 16 age to be calculated at the time of effecting this insurance.
Any claim in excess of the amount stated in the Schedule in respect of any one Insured Person.

SECTION-B Medical Expenses and Repartriation

Nature of Coverage:

This policy is not a general health insurance policy. Coverage under the medical expense section of this insurance is intended by the Insured person in the eventof a sudden and unexpected sickness or accident arising when the insured person is outside the Republic of India.This insurance will pay up to the limit of cover shown in the Schedule in total for the Insured Person in respect of covered medical related expenses, reasonably and necessarily incurred outside the Republic of India by the Insured Person suffering bodily injury, sickness, disease or death during the period of Insurance.

Notwithstanding the above, if 'Mercury' recommends that continued treatment in India is appropriate, the policy is extended to cover medical expenses incurred in India as specified in covered expenses described below, provided that expenses will only be paid at the usual and customery level for such services, and further provided that expenses will only be paid for treatment incurred within the 90 day period immediately following the first manifestation of the bodily injury, sickness or disease.

Covered Expenses:

The following are payable only if the expenses relats to covered sickness/injury/disease or death.

Expenses for physician services, hospital and medical services and local emergency medical transportation.
Up to US$ 225 per occurrence for dental services for the immediate relief of dental pain only. However, dental care rendered necessary as a result of a covered accident shall be subject to the limit of cover and deductible stated in the policy schedule.
Expenses for physician ordered emergency medical evacuation, including medically appropriate transportation and necessary medical care en route, to the nearest suitable hospital when the Insured Person is critically ill or injured and no suitable local care is available, subject to the prior approval of the Medical Advisors. In extreme emergencies in remote areas where Mercury cannot be contacted, the medical evacuation must be reported to the first available physician and the nearest Indian Consulate.
Expenses for medical evacuation, including transportation and medical care en route to a hospital in the Republic of India or the Insured Person's normal place of residence in the Republic of India when deemed medically advisable by the Medical Advisors and the attending physician.
If the Insured Person dies outside the Republic of India, the expenses for preparing the air transportation of the remains for repatriation to the Republic of India or up to an equivalent amount for a local burial or cremation in the country where the death occurred. All expenses must be approved by Mercury before the remains are prepared for transportation to the Republic of India or for local burial or cremation.

Specific Conditions:- (Applicable to Section - A Medical expenses and repartriation)

Medical,dental and transportation related claims will not be paid except at the usual customary and reasonable level of charges for such services;
All medical evacuation or transportation of remains must be approved in advance by 'Mercury' and their Medical Advisors.
No claim will be paid in respect of expenses for treatment which could reasonably be delayed until the Insured Person's return to the Republic of India. The question of what can or what cannot be reasonably delayed will be decided jointly by the treating physician and the Medical Advisors.s
No claims will be paid that is less than the deductible stated in the Schedule. The deductible shall apply to each insured event and shall be borne by the Insured Person.
No claim in respect of cosmetic surgery will be paid, unless such cosmetic surgery is rendered necessary as a result of a covered accident.
No claims will be paid in respect of routine physical examination or any other examination where there is no objective indication of impairment of normal health.
No claim will be paid in respect of medical treatment and related services obtained within the Republic of India except as stated under Covered Expenses.
The insurance will not cover pregnancy of the Insured Person including resulting childbirth, miscarriage, abortion or complication of any of these.
Restricted Cover: In the event that the proposer is unable to present himself or herself for medical examination where called for by the Insurance Company, the limit of indemnity under this insurance is reduced to US$ 10000 in respect of and limited to the expenses for physician services, hospital physician and medical services and local emergency transportation. Such limit applies to medical expenses incurred through illness or disease only.

SECTION-C Loss of Checked Baggage

This insurance will pay up to the limit of cover shown in the Schedule in the event of the insured Person suffering a total loss of Baggage that has been checked by an International Airline for an International flight. The insurers reserve the right to replace or pay the intrinsic value of any lost article.

Specific Conditions:

The amount payable in respect of any one article, pair or set is limited to the amount stated in the Schedule.
In the event of loss of property whilst in the custody of an airline, a Property Irregularity Report (PIR) must be obtained from the airline immediately upon discovering the loss which must be submitted to 'Mercury' in the event of a claim hereunder.
No partial loss or damage shall become payable. However, total loss or damage of an individual unit(s) of baggage shall not be construed as falling within this exclusion.
No claim will be paid for items valued in excess of US $ 100 without proof of ownership. Such proof shall be presented to Mercury in the event of a claim hereunder.
No claim will be paid for valuable items as defined. Such items should at all times be carried by the Insured Person and not packed as part of checked baggage.
Any recovery from an airline under the terms of the Warsaw Convention shall become the property of insurers.

SECTION-D Delay of Checked Baggage

This insurance will pay up to the limit of cover shown in the Schedule for the necessary emergency purchase of replacement items in the event that the Insured Person suffers a delay of more than 12 hours from the scheduled arrival time at the destination for delivery of Baggage that has been checked by an International Airline for an International outbound flight from the Republic of India.

A non-delivery certificate must be obtained immediately from the airline which must be submitted to 'Mercury' in the event of a claim hereunder.
Proof of purchase must be provided for all items reimbursed under this section.
Any payment under section D shall be offset against any claim ultim

Two wheeler Insurance

No Documents, Attractive discounts

& Speedy claim settlements.Buy now

Bike Insurance Online

Complete Cover with No Claim Bonus.

Great Discounts.Insure Bike Now!