FUTURE HOSPI - CASH POLICY WORDINGS

FUTURE HOSPI - CASH

POLICY WORDINGS

UIN:IRDA/NL-HLT/FGII/P-H/V.I/75/13-14

FGH/UW/RET/67/02

INTENTIONALY LEFT BLANK

FUTURE HOSPI-CASH

CUSTOMER INFORMATION SHEET

(Description is illustrative and not exhaustive)

S.NO

TITLE DESCRIPTION

REFER TO POLICY

CLAUSE NUMBER

Product Name

Future Hospi-cash

What am I covered

for:

Hospital admission longer than 24 hrs

Section A (4) and Section B (I,

II and III)

Hospital Cash benefit for each continuous and completed period of 24 hours for a

maximum of 30 days / 60 days / 90 days/ 180 days as per the schedule

Section B (I)

2 times benefit payable for ICU within the city.

Section B (II)

3 times benefit payable for ICU outside the city.

Section B (III)

a fixed amount towards convalescence for Hospitalisation beyond 10 consecutive

days which is payable only once per hospitalisation event

Section B (IV)

What are the major

exclusions in the

policy:

Benefits will not be available for Any condition, ailment or injury or related

condition(s) for which You have been diagnosed, received medical treatment, had

signs and / or symptoms, prior to inception of Your first Policy, until 48 consecutive

months have elapsed, after the date of inception of the first Policy with Us.

Section C (1)

Without derogation from the above point no. (1), any Medical Expenses incurred

during the first two consecutive annual Periods

during which You have the benefit of

a Health Insurance Policy with Us in connection with cataracts, benign prostatic

hypertrophy, hernia of all types, hydrocele, all types of sinuses, fistulae,

hemorrhoids, fissure in ano, dysfunctional uterine bleeding,

fibromyoma

endometriosis, hysterectomy, all internal or external tumors/cysts/nodules/polyps of

any kind including breast lumps ( except malignant conditions), surgery for

prolapsed inter vertebral disc unless arising from accident, surgery of varicose veins

and varicose ulcers.

Section C (2)

Without derogation from the above point No. (1), any Medical Expenses incurred

during the first annual period during which You have the benefit of a Health

Insurance Policy with Us in connection with any types of gastric or duodenal ulcers,

stones in the urinary and biliary systems, surgery on ears/tonsils/adenoids.

Section C (3)

Medical Expenses incurred during the first three consecutive annual periods during

which You have the benefit of the Policy with Us in

connection with joint

replacement surgery due to Degenerative condition, Age related osteoarthritis and

Osteoporosis unless such joint replacement surgery is necessitated by accidental

Bodily Injury.

Section C (4)

Medical Expenses incurred for any illness diagnosed or diagnosable within 30 days,

of the commencement of the Policy Period except those incurred as a result of

accidental Bodily Injury.

Section C (5)

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).

Section C (6)

Dental treatment or surgery of any kind unless requiring hospitalisation as a result

of Accidental Bodily injury

Section C (9)

General debility, ‘’Run-down’’ condition or rest cure, sexually transmitted disease,

intentional self-injury.

Section C (12)

(Note: the above is a partial listing of the policy exclusions. Please refer to the policy clauses for the full listing).

Waiting period

Initial waiting period: 30 days for all illnesses (not applicable on renewal or for

accidents)

Section C (5)

Specific waiting periods :

24 months for Cataract, Hernia etc diseases

Section C (2)

36 months for Joint Replacement Surgeries

Section C (4)

Pre-existing diseases: Covered after 48 months

Section C (1)

Renewal Conditions

The policy is renewable lifelong.

In case of renewal, grace period of 30 days is admissible.

Section D (9) (a)

Section D (9) (c)

(LEGAL DISCLAIMER) NOTE: The information must be read in conjunction with the product brochure and policy document. In case of any conflict

between the CIS and the policy document the terms and conditions mentioned in the policy document shall prevail.

UIN:IRDA/NL-HLT/FGII/P-H/V.I/75/13-14

FGH/UW/RET/67/02

FUTURE HOSPI- CASH

This Policy is issued to You based on Your Proposal to Us and Your

payment of the premium. You are eligible to be covered under this

Policy if Your age is between 6 months to 65 years with lifelong

renewability. This Policy records the agreement between Us and sets out

the terms of insurance and the obligations of each party.

A. DEFINITIONS

The following words or terms shall have the meaning ascribed to them

wherever they appear in this Policy, and reference to the singular or to

the masculine shall include references to the plural and to the female

wherever the context so permits:

1. Accident is a sudden, unforeseen and involuntary event caused by

external, visible and violent means.

2. Injury/ Bodily Injury means accidental physical bodily harm

excluding Illness or disease solely and directly caused by external,

violent and visible and evident means which is verified and certified

by a Medical Practitioner.

3. Hospital means any institution established for in-patient care and

Day Care Treatment of Illness and/ or injuries and which has been

registered as a Hospital with the local authorities under Clinical

Establishments (Registration and Regulation)Act,2010 or under

enactments specified under the Schedule of Section 56(1) of the

said Act OR complies with all minimum criteria as under:

í has qualified nursing staff under its employment round the

clock;

í has at least 10 in-patient beds in towns having a population of

less than 10,00,000 and at least 15 inpatient beds in all other

places;

í has qualified medical practitioner(s) in charge round the clock;

í has a fully equipped operation theatre of its own where surgical

procedures are carried out

í maintains daily records of patients and will make these accessible

to the insurance company’s authorized personnel

4. Hospitalisation means admission in a Hospital for a minimum

period of 24 In patient Care consecutive hours except for specified

procedures/ treatments, where such admission could be for a period

of less than 24consecutive hours.

5. Intensive care unit means an identified section, ward or wing of a

Hospital which is under the constant supervision of a dedicated

medical practitioner(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.

6. You, Your, Yourself means the Insured person shown in the

Schedule.

7. We, Our, Us, Insurer means Future Generali India Insurance

Company Limited.

8. Family means and includes You, Your Spouse & Your dependent

child/ children (up to the age of 25 years)

8.1. The maximum number of days of Hospitalisation

mentioned in the Schedule would float over all the members

under the Family Floater Policy.

8.2. In the event of more than one Family member being

hospitalised at the same time, the number of days each

member has been hospitalised would be added, and the

maximum allowable for the whole Family would be restricted

to the number of days as mentioned in the

Schedule

(maximum number of days would float over the

Family)

under the Family Floater Policy.

9. Schedule means that portion of the Policy which sets out Your

personal details, the type of insurance cover in force, the period and

the sum insured. Any Annexure or Endorsement to the Schedule

shall also be a part of the Schedule.

10. Proposal means that portion of the Policy which sets out Your

personal details, the type of insurance cover in force, the period and

the sum insured.

11. Policy means the complete documents consisting of the Proposal,

Policy wording, Schedule and Endorsements and attachments if

any.

12. Policy Period means the period between the commencement date

and the expiry date specified in the Schedule and includes both the

commencement date as well as the expiry date.

13. Medical Practitioner is a person who holds a valid registration from

the Medical Council of any State or Medical Council of India or Council

for Indian Medicine or for Homeopathy set up by the Government of

India or a State Government and is thereby entitled to practice

medicine within its jurisdiction; and is acting within the scope and

jurisdiction of his licence. The registered practitioner should not be

the insured or close Family members.

14. Pre-existing Condition means any condition, ailment or Injury or

related condition(s) for which You had signs or symptoms, and / or

were diagnosed, and / or received Medical Advice / treatment

within 48 months to prior to the first

Policy issued by the Insurer.

15. Illness means a sickness or a disease or pathological condition

leading to the impairment of normal physiological function which

manifests itself during the Policy Period and requires medical

treatment.

16. Home City means the city of residence.

17. Other than Home City means the city which is other than the

residential city of the Insured.

18. Day Care Treatment refers to medical treatment, and/or Surgical

Procedure which is:

18.1. undertaken under General or Local Anesthesia in a

Hospital/Day care centre in less than 24 hrs because of

technological advancement, and

18.2. which would have otherwise required a Hospitalisation of

more than 24 hours.

Treatment normally taken on an out-patient basis is not included in

the scope of this definition.

19. Deductible

is a cost-sharing requirement under a health insurance

Policy that provides that the Insurer will not be liable for a specified

rupee amount in case of indemnity policies and for a specified

number of days/hours in case of Hospital cash policies which will

apply before any benefits are payable by the Insurer . A Deductible

does not reduce the sum insured.

20. Dependent child refers to a child (natural or legally adopted), who

is financially dependent on the primary insured or proposer and does

not have his / her independent sources of income.

21. 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

diseases. Coverage is not available for the period for which no

premium is received.

22. Inpatient care means treatment for which the insured person has to

stay in a Hospital for more than 24 hours for a covered event.

23. Surgery or Surgical Procedure 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

Day care centre by a medical practitioner.

24. Medical Advice: Any consultation or advice from a Medical

Practitioner including the issue of any prescription or repeat

prescription.

25. Maternity expense shall include –

a. medical treatment expenses traceable to childbirth (including

complicated deliveries and caesarean sections incurred during

Hospitalisation)

b. expenses towards lawful medical termination of pregnancy during

the Policy period.

26. Dental Treatment is treatment carried out by a dental practitioner

including examinations, fillings (where appropriate), crowns,

extractions and Surgery excluding any form of cosmetic

surgery/implants.

27. Any one illness means continuous Period of Illness and it includes

relapse within 45 days from the date of last consultation with the

Hospital/Nursing Home where treatment may have been taken.

28. Congenital Anomaly :Congenital Anomaly refers to a condition(s)

which is present since birth, and which is abnormal with reference to

form, structure or position

a. Internal Congenital Anomaly- Congenital Anomaly which

is not in the visible and accessible parts of the body.

b. External Congenital Anomaly- Congenital Anomaly which

is in the visible and accessible parts of the body.

29. Condition Precedent shall mean a Policy term or condition upon

which the Insurer's liability under the Policy is conditional upon.

30. Unproven/Experimental treatment: Treatment including drug

experimental therapy which is not based on established medical

practice in India, is treatment experimental or unproven .

31. Disclosure to information norm: The Policy shall be void and all

premium paid hereon shall be forfeited to the Company, in the event

of misrepresentation, mis-description or non-disclosure of any

material fact.

32. Renewal defines the terms on which the contract of insurance can be

renewed on mutual consent with a provision of Grace Period for

treating the Renewal continuous for the purpose of all waiting

periods.

33. Portability means transfer by an individual health insurance

policyholder (including Family cover ) of the credit gained for Pre-

existing conditions and time-bound exclusions if he/she chooses to

switch from one Insurer to another.

34. Alternative treatments are forms of treatments other than

treatment "Allopathy" or "modem medicine" and includes Ayurveda,

Unani, Sidha and Homeopathy in the Indian context.

35. Day care centre means any institution established for Day Care

Treatment of Illness and / or injuries or a medical set -up within a

Hospital and which has been registered 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:-

í has qualified nursing staff under its employment

í -has qualified medical practitioner/s in charge

í -has a fully equipped operation theatre of its own where surgical

procedures are carried out

í -maintains daily records of patients and will make these

accessible to the Insurance company’s authorized personnel.

B. POLICY BENEFITS:

In the event of Accidental Bodily Injury or Illness first occurring or

manifesting itself during the Policy Period and causing the Insured’s

Hospitalisation for Inpatient care within the Policy Period, the

Company will pay:

I. the Hospital Cash benefit for each continuous and completed

period of 24 hours of Hospitalisation necessitated solely by

reason of the said Accidental Bodily Injury or Sickness, for a

maximum of 30 days / 60 days /90 days/ 180 days as per the

Schedule

II. two times the Hospital Cash benefit for each continuous and

completed period of 24 hours required to be spent by the Insured

in the Intensive care unit of a Hospital situated in the Home

Cityof the Insured, during any period of Hospitalisation

necessitated solely by reason of the said Accidental Bodily

Injury or Sickness for a maximum period of 10 days for each

Hospitalisation and 20 days during the Policy period

III. three times the Hospital Cash benefit for each continuous and

completed period of 24 hours required to be spent by the Insured

in the Intensive care unit of a Hospital situated in a city other

than Home Cityof the Insured, during any period of

Hospitalisation necessitated solely by reason of the said

Accidental Bodily Injury or Sickness for a maximum period of 10

days for each Hospitalisation and 20 days during the Policy

period.

* In case of Section II and III the maximum benefit payable in

case of ICU whether in Home City/ other than Home City , is

limited upto 10 days for each Hospitalisation and maximum of

20 days for all Hospitalisations put together in the Policy

period. In case of the same Hospitalisation involving ICU stay in

both Home City as well as other than Home City, the benefits

under the “other than home city” would have precedence over

benefits under Home City while adjudication of claim.

** In case of Sec I, II and III the maximum benefits would

however be restricted to 30/ 60/ 90 /180 days as per the plan

opted for each Hospitalisation or all Hospitalisations during

the Policy period.

***In case the

Hospitalisation

exceeds the maximum stipulated

under Sec I as per the selected plan while adjudicating any claim

the benefits under ICU would have precedence over non ICU

Hospitalisation.

**** In case the Hospitalisation in ICU exceeds the per

Hospitalisation maximum limit of 10 days or the per Policy

period limit of 20 days, the remaining period of Hospitalisation

in ICU will be paid as per non ICU Hospitalisation benefits

subject to the overall Policy maximum of 30/ 60/ 90 or 180 days.

IV. A fixed amount towards convalescence for Hospitalisation

beyond 10 consecutive days which is payable only once per

Hospitalisation event. This benefit is payable only if there is an

admissible claim under any of the daily benefits.

C. EXCLUSIONS

We will not pay for any expenses incurred by You in respect of claims

arising out of or howsoever related to any of the following:

1 Benefits will not be available for Any condition, ailment or Injury or

related condition(s) for which You have been diagnosed, received

medical treatment, had signs and/or symptoms, prior to inception of

Your first Policy, until 48 consecutive months have elapsed, after

the date of inception of the first Policy with Us.

This Exclusion shall cease to apply if You have maintained the Policy

with Us for a continuous period of a 48 months, without break from

the date of Your first Hospital Cash Policy with Us.

The period of this exclusion would stand reduced if this Policy is a

continuous Renewal of an earlier Hospital cash/Daily allowance

Policy of the same per day benefit amount of another Insurer. The

period of exclusion would stand reduced by the period of continuous

existence of the earlier Policy with another Insurer of which this

Policy is a Renewal.

This Exclusion shall apply only to the extent of the amount by which

the benefit amount has been increased if the Policy is a Renewal of

a Hospital cash Policy without break in cover.

2 Without derogation from the above point no. (1), any

Hospitalisation during the first consecutive 24 months during which

You have the benefit of a Health Insurance Policy with Us in

connection with cataracts, benign prostatic hypertrophy, hernia of all

types, hydrocele, all types of sinuses, fistulae, hemorrhoids, fissure in

ano, dysfunctional uterine bleeding, fibromyoma, endometriosis,

hysterectomy, all internal or external tumors/ cysts/ nodules/ polyps

of any kind including breast lumps (except malignant conditions),

Surgery for prolapsed inter vertebral disc unless arising from

Accident, Surgery of varicose veins and varicose ulcers.

This exclusion Period shall apply for a continuous Period of 48 months

from the date of Your first Hospital Cash Policy with Us if the above

referred Illness were present at the time of commencement of the

Policy and if

You had declared such Illness at the time of proposing

the

Policy for the first time.

The period of this exclusion would stand reduced if this Policy is a

continuous Renewal of a earlier Hospital cash/ Daily allowance

Policy of the same per day benefit amount of another Insurer. The

period of exclusion would stand reduced by the period of continuous

existence of the earlier Policy with another Insurer of which this

Policy is a Renewal.

This Exclusion shall apply only to the extent of the amount by which

the benefit amount has been increased if the Policy is a Renewal of

a Hospital cash Policy without break in cover.

3 Without derogation from the above point No.(1), any

Hospitalisation during the first 12 months during which You have

the benefit of a Health Insurance Policy with Us in connection with

any types of gastric or duodenal ulcers, stones in the urinary and

biliary systems, Surgery on ears/ tonsils/ adenoids.

This exclusion period shall apply for a continuous period of 48 months

from the date of Your first Hospital Cash Policy with Us if the above

referred Illness were present at the time of commencement of the

Policy and if You had declared such Illness at the time of proposing

the Policy for the first time.

The period of this exclusion would stand reduced if this Policy is a

continuous Renewal of a earlier Hospital cash / Daily allowance

Policy of the same per day benefit amount of another Insurer. The

period of exclusion would stand reduced by the period of continuous

existence of the earlier Policy with another Insurer of which this

Policy is a Renewal.

This Exclusion shall apply only to the extent of the amount by which

the benefit amount has been increased if the Policy is a Renewal of

a Hospital cash Policy without break in cover.

4 Hospitalisation during the first consecutive 36 months during which

You have the benefit of the Policy with Us in connection with joint

replacement Surgery due to degenerative condition, Age related

osteoarthritis and Osteoporosis unless such joint replacement

Surgery is necessitated by accidental Bodily Injury.

This exclusion period shall apply for a continuous period of 48 months

from the date of Your first Hospital Cash Policy with Us if the above

referred Illness were present at the time of commencement of the

Policy and if You had declared such Illness at the time of proposing

the

Policy for the first time.

The period of this exclusion would stand reduced if this Policy

is a

continuous Renewal of a earlier Hospital cash/Daily allowance Policy

of the same per day benefit amount of another Insurer. The period

of exclusion would stand reduced by the period of continuous

existence of the earlier Policy with another Insurer of which this

Policy is a Renewal.

This Exclusion shall apply only to the extent of the amount by which

the benefit amount has been increased if the Policy is a Renewal of

a Hospital cash Policy without break in cover.

5 Hospitalisation for any Illness diagnosed or diagnosable within 30

days (1month), of the commencement of the Policy Period except

those incurred as a result of accidental Bodily Injury.

6 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).

7 Circumcision unless necessary for treatment of a disease not

excluded hereunder or as may be necessitated due to an Accident.

8 Vaccination (unless post bite) inoculation, cosmetic treatments (for

change of life or 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, refractive error corrective

procedures, Unproven/ Experimental treatment, investigational

or unproven procedures or treatments, devices and pharmacological

regimens of any description.

9 Dental Treatment or Surgery of any kind unless requiring

Hospitalisation as a result of Accidental Bodily Injury.

10 The treatment of obesity (including morbid obesity) and other weight

control programs, services and supplies.

11 Hospitalisation towards treatment of Illness/disease/condition

arising out of abuse of alcohol, substance or drugs.

Hospitalisation for General debility, “Run-down’’ condition or rest

cure, sexually transmitted disease, intentional self-Injury.

13 Hospitalisation for Invitro fertilization (IVF), Gamete intrafallopian

transfer (GIFT) procedures, and zygote intrafallopian transfer (ZIFT)

procedures, and any related prescription medication treatment;

embryo transport; donor ovum and semen, voluntary medical

termination of pregnancy; any treatment related to infertility and

sterilization.

14 Maternity expense for Hospitalisation or treatment arising from or

traceable to pregnancy, childbirth, miscarriage, abortion or

complications of any of this, including caesarian section. However,

this exclusion will not apply to abdominal operation for extra uterine

pregnancy (Ectopic Pregnancy).

15 Hospitalisation arising out of any condition directly or indirectly

caused to or associated with Human T-Cell Lymphtropic Virus type III

(HTLB-III) or Lymphadenopathy Associated Virus (LAV) or Human 5

Immunodeficiency Virus or the Mutants Derivative or Variations

Deficiency Syndrome or any Syndrome or condition of a similar kind

commonly referred to as AIDS.

16 Congenital Internal and /or external Illness/disease/defect anomaly.

17 Hospitalisation primarily for diagnostic, X-ray or laboratory

examinations not consistent with or incidental to the diagnosis and

treatment of the positive existence or presence of any ailment,

sickness or Injury, for which confinement is required at a Hospital/

Nursing Home.

18 Injury or Disease directly or indirectly caused by or contributed to by

nuclear weapons/materials.

19 Costs incurred on all methods of treatment including Alternative

treatments other than Allopathy.

20 Genetic disorders and stem cell implantation/surgery/storage.

21 Any Hospitalisation arising from Insured’s participation in any

hazardous activity including but not limited to scuba diving, motor

racing, parachuting, hang gliding, and rock or mountain climbing.

22 Any treatment received in convalescent home, health hydro, nature

care clinic or similar establishments.

23 Hormone replacement therapy, Sex change or treatment which

results from or is in any way related to sex change.

24 Any treatment including Surgery to remove organs from the donor in

case of a transplant surgery.

25 Hospitalisation for any mental Illness or psychiatric Illness.

26 Any

Hospitalisation received out of India.

D. CONDITIONS

1Due Care

Where this Policy requires You to do or not to do something, then

the complete satisfaction of that requirement by You or someone

claiming on Your behalf is a precondition to any obligation under this

Policy. If You or someone claiming on Your behalf fails to

completely satisfy that requirement, then We may refuse to consider

Your claim. You will cooperate with Us at all times.

2 Insured

Only those persons named, as the Insured in the Schedule shall be

covered under this Policy. The details of the Insured are as provided

by You. A person may be added as an insured during the Policy

Period after his application has been accepted by Us, an additional

premium has been paid and Our agreement to extend cover has been

indicated by it, issuing an endorsement confirming the addition of

such person as an Insured. Cover under this Policy shall be

withdrawn from any Insured upon that Insured giving 14 days written

notice to be received by Us.

3 Cost of pre-insurance medical examination

We will reimburse 50% of the cost of any pre-insurance medical

examination once the Proposal is accepted and the Policy issued for

that insured. We shall maintain a list of and the fees chargeable by,

institutions where such Pre-insurance medical examination may be

conducted, the reports from which will be accepted by Us. Such list

shall be furnished to the prospective policyholder at the time of pre-

insurance medical examination.

4 Communications

a) Any communication meant for Us must be in writing and be

delivered to Our address shown in the Schedule. Any

communication meant for You will be sent by Us to Your address

shown in the

Schedule.

b) All notifications and declarations for Us must be in writing and sent

to the address specified in the Schedule. Agents are not authorized

to receive notices and declarations on Our behalf.

c) You must notify Us

of any change in address.

5Claims Procedure

If You meet with any accidental Bodily Injury or suffer an Illness/

sickness that may result in a claim, then as a Condition Precedent to

Our liability, You must comply with the following:

a) You or someone claiming on Your behalf must inform Us in writing

immediately, and in any event within 48 hours of the aforesaid

Illness or Bodily Injury. You must immediately consult a Medical

Practitioner and follow the Medical Advice and treatment that he

recommends.

b) You must take reasonable steps or measures to minimise the

quantum of any claim that may be made under this Policy.

c) You shall expeditiously provide the Company with any and all

information and documentation in respect of the Hospitalisation.

The claim and/ Our liability hereunder that may be requested, and

You shall submit Yourself for examination by the Company’s

medical advisors as often as may be considered necessary by Us.

The cost of such medical examination will be borne by Us.

d) You or someone claiming on Your behalf must promptly and in any

event within 30 days of discharge from a Hospital give Us the

documentation (written details of the quantum of any claim along

with certified copies of discharge card, Hospital bill and receipt.)

and other information if We ask for, to investigate the claim or Our

obligation to make payment for it.

e) In the event of the death of the insured person, nominee claiming

on his/ her behalf must inform Us in writing immediately and send

Us a copy of the post mortem report (if any) within 14 days.

f) Mandatory necessary documents required to process claim are

i. Completely filled Future Hospi-Cash Claim form ( original )

ii.

Discharge certificate/ card from Hospital (photocopy)

iii. Final Hospital bill with receipt (photocopy)

g) The periods for intimation or submission of any documents as

stipulated under (d) and (e) will be waived in case of any hardships

being faced by the insured or his representative which is supported

by some documentation.

6 Settlement of Claims

i. Our

doctors will scrutinize the claims and flag the claim as

settled/ Rejected/ Pending within the period of 30 days of the

receipt of the last ‘necessary’ documents.

ii. Pending claims will be asked for submission of incomplete

documents.

iii. Rejected claims will be informed to the Insured Person in

writing with reason for rejection.

iv. Upon acceptance of an offer of settlement as stated in sub-

regulation (5) of the (Protection of Policyholders’ Interest)

Regulations, 2000 by You, We will make payment of the

amount due within 7 days from the date of acceptance of the

offer by the insured. In the cases of delay in the payment,

We shall be liable to pay interest at a rate which is 2% above

the bank rate prevalent at the beginning of the financial year.

7 Basis of claims payment

a) If You suffer a relapse within 45 days of the date when You last

obtained medical treatment or consulted a Medical Practitioner

and for which a claim has been made, then such relapse shall be

deemed to be part of the same claim.

b) If the claim event falls within two Policy periods, the claims shall be

paid taking into consideration the available sum insured in the two

Policy periods, including the Deductibles for each Policy period.

Such eligible claim amount to be payable to the insured shall be

reduced to the extent of premium to be received for the

Renewal/due date of premium of health insurance Policy, if not

received earlier.

c) We shall make payment in India in Indian Rupees only.

d) The Company shall only make payment under this Policy to the

Insured or in the event of death or total incapacitation of the

Insured to the Proposer/ Nominee. Any payment made in good faith

by the Company as aforesaid shall operate as a complete and final

discharge of the Company’s liability to make payment under this

Policy for such claim.

e) A continuous and completed period of less than 24 hours of

Hospitalisation or Day Care Treatment consequent upon an

insured event shall be deemed to be a continuous and completed

period of 24 hours if such period extends to at least 12 hours.

8Fraud

If You or any of Your Family member make or progress any claim

knowing it to be false or fraudulent in any way, then this Policy will

be void and all claims or payments due under it shall be lost and the

premium paid shall become forfeited.

9 Renewal & Cancellation

a) Your Policy shall be renewable lifelong except on grounds of fraud,

moral hazard or misrepresentation or non-cooperation by the

insured.

b) This Policy may be renewed by mutual consent every year and in

such event, the Renewal premium shall be paid to Us on or before

the date of expiry of the Policy or of the subsequent Renewal

thereof.

c) In case of 0ur own Renewal a Grace Period of 30 days is

permissible and the Policy will be considered as continuous for the

purpose of Two year waiting period/Four year waiting periods. Any

Hospitalisation as a result of

Accident/disease contracted during

the break period will not be admissible under the Policy

d) In case of Hospi-Cash Policy, there will be no loading on premium

for adverse claims experience (except for Group policies ) .

e) We may cancel this insurance by giving You at least 15 days

written notice, and if no claim has been made then We shall refund

a pro-rata premium for the unexpired Policy Period.

f) You may cancel this insurance by giving Us at least 15 days written

notice, and if no claim has been made then We shall refund

premium on short term rates for the unexpired Policy Period as per

the rates detailed below.

Period on risk

Rate of premium refunded

Up to one month

75% of annual rate

Up to three months

50%of annual rate

Up to six months

25% of annual rate

Exceeding six months

Nil

g) For Family floater policies, in the event of the death of any of the

insured members, the cover ceases to exist for that insured and the

remaining members would continue to have the coverage until the

end of the Policy period.

h) In case of group policies the following would apply

i. Discount Percentage for favorable claim ratio (BONUS):Low

claim Ratio Discount at the following scale will be allowed on

the Total premium at Renewal only, depending upon the

incurred claims ratio for the entire group insured under the

Group Future Hospi-cash Policy for upto preceding three

years.

Incurred Claim Ratio under

the Group Policy

Discount Percentage

(%)

Up to 20 %

21-35%

36-50%

51-55%

ii. Loading Percentage for high claim ratio (MALUS):The Total

Premium payable at Renewal of the group Policy will be

loaded at the following scale depending upon the incurred

claims ratio for the entire group insured under the Group

Hospi-cash Policy for upto preceding three years.

Incurred Claim Ratio under

the Group Policy

Loading Percentage

(%)

Between 71% and 80%

Between 81% and 100%

Between 101% and 125%

Between 126% and 150%

115

Between 151% and 175%

150

Between 176% and 200%

180

Over 200%

Cover to be reviewed

i) The brochure/ prospectus mentions the premiums as per the age

slabs/ Sum Insured and the same would be charged as per the

completed age at every Renewal. The premiums as shown in the

brochure/ prospectus are subject to revision as and when approved

by the regulator. However such revised premiums would be

applicable only from subsequent Renewals and with due notice

whenever implemented.

10 Free Look Period

a. The insured will be allowed a period of at least 15 days from the

date of receipt of the Policy to review the terms and conditions

of the Policy and to return the same if not acceptable.

b. If the insured has not made any claim during the free look

period, the insured shall be entitled to-

i. A refund of the premium paid less any expenses incurred by

the Insurer on medical examination of the insured persons

and the stamp duty charges or;

ii. where the risk has already commenced and the option of return

of the Policy is exercised by the policyholder, a deduction

towards the proportionate risk premium for period on cover or;

iii. Where only a part of the risk has commenced, such

proportionate risk premium commensurate with the risk

covered during such period.

11 Portability

i. Portability will be granted to policy holders of a similar

Hospital Cash Policy (Fixed daily benefit Policy) of another

Insurer to Future Hospi Cash Policy as per Portability

guidelines.

ii. Portability will be granted subject to the Policyholder desirous

of porting his Policy to Future Hospi Cash Policy applying to

Future Generali India Insurance Company Ltd at least 45 days

before the premium Renewal date of his/her existing Policy.

iii. We will not be liable to offer Portability if policyholder fails to

approach Us at least 45 days before the premium Renewal

date.

iv. Where the outcome of acceptance of Portability is still awaited

from Us on the date of Renewal the existing policyholder

should extend his existing Policy with the existing Insurer on

a short period basis as per the Portability guidelines.

v. Portability will be allowed for all individual Hospital Cash

policies (Daily Benefit policies) issued by non-life insurance

companies including Family floater policies

vi. Individual members, including the Family members covered

under Group Future Hospi Cash of Future Generali India

Insurance Company shall have the right to migrate from such a

group Policy to an individual Future Hospi Cash Policy or a

Family Floater Policy

with the same Insurer.

12 Dispute Resolution

a) Any and all disputes or differences, which may arise under or in

relation to this Policy, relating to the quantum of any claim, liability

otherwise being admitted, shall be referred to arbitration in

accordance with Arbitration and Conciliation Act, 1996, within a

period of 30 days of either the Company or the Insured giving notice

in this regard.

b) The applicable law in and of the arbitration shall be Indian law.

c) The expenses of the arbitrator shall be shared between the parties

equally and such expenses along with all reasonable costs in the

conduct of the arbitration shall be awarded by the arbitrator to the

successful party, or where no party can be said to have been wholly

successful, to such party, as substantially succeeded.

d) It is agreed a Condition Precedent to any right of action or suit

upon this Policy that an award by such arbitrator or arbitrators shall

be first obtained.

e) In the event that these arbitration provisions shall be held to be

invalid then all such disputes shall be referred to the exclusive

jurisdiction of the Indian Courts.

13 Compliance with Policy Provisions

Failure by You or the Insured Person to comply with any of the

provisions in this Policy may invalidate all claims hereunder.

14 Territorial Limits and Law

a) We cover Hospital Cash benefit due to Accidental Bodily Injury or

Sickness sustained by the Insured Person during the Policy Period

anywhere in India only.

b) The construction, interpretation and meaning of the provisions of

this Policy shall be determined in accordance with Indian Law.

c) The Policy constitutes the complete contract of insurance. No

change or alteration shall be valid or effective unless approved in

writing by Us, for which approval shall be evidenced by an

endorsement on the Schedule.

HEALTH INSURANCE CLAIM FORM

ALL FIELDS IN THIS FORM ARE MANDATORY AND THE CLAIM WILL BE NOT BE PROCESSED IF ANY OF THE DETAILS ARE MISSING

Claim Number (For FGH Use Only)

POLICY / INSURED DETAILS

Policy No : _______________________________________________ Health Card No. of Patient ____________________________________________

Policy Start Date

_________________ Policy End Date __________________ Date of Joining the Policy

__________________________________

Corporate Name : ________________________________________________(Only for Group Policies) Employee ID ________________

_________

PERSONAL DETAILS OF EMPLOYEE/PROPOSER

Name of the Employee / Individual:

-Mail address of the Employee/Individual:

Mobile No:

Permanent Account Number (PAN):

CLAIMANT / PATIENT DETAILS

Name of the Patient:

Relationship with the Employee / Proposer Self Spouse Child Parent Others _________________

Date of Birth of Claimant: _______________________ Age _____________________ Years Gender Male Female

Residential Address

CLAIM DETAILS

CONSENT REQUIREMENT FOR ACCESS TO TREATMENT PAPERS / INDOOR CASE SHEETS / MEDICAL RECORDS / INVESTIGATOR VISIT

I hereby authorize Future Generali India Insurance or any agency / individual authorized by them to obtain copies or review in person all my medical records

including but not limited to admission notes, treatment sheets, indoor case papers, investigation reports, prescriptions and all other documents present in the

hospital case file. Details related to my past hospitalisations in your hospital can also be provided / shown to Future Generali or its authorized representatives. I

agree that all information provided above by me in the claim documents is true and that if I have provided any false or untrue information, my right to claim the

reimbursement of expenses shall be absolutely forfeited.

Name of Patient / Relative: ______________________________________________________

Relationship with Patient: ______________________________________________________

Signature of Patient / Relative: __________________________________________________

Date: DD_/_MM_/_YYYY

Total Claimed Amount: B

Claimed Amount in Words: Rupees ( B____________________________________________________________________________________________

1. Diagnosis

______________________________________

_________________

Admission Date: _______________ __Discharge Date :

_________________

. Name of Treating Doctor: ______________________________________

___

4. Mobile No.

of Treating Doctor

: _____________________________________

Name of Family Physician: ________________________________________

6. Mobile No.

of Family Physician: ___________________________________

Enclosure Check List :

1. Original Discharge Summary containing all relevant details

2. All Original Bills and their Receipts

3. Copies of all Reports & prescriptions

4. First Prescription / Consultation Letter from your Doctor.

Original Money Receipt duly signed with a Revenue Stamp.

Copy of Proposer/Employee Photo ID Proof & Address Proof

TOLL FREE PHONE: 1800 103 8889

TOLL FREE FAX: 1800 103 9998

E MAIL: fgh@futuregenerali.in

Please attach this form in Original to the hospital bill and other claim documents. Separate claim form required for each claim. PLEASE ENCLOSE A PHOTOCOPY OF THE

FUTURE GENERALI HEALTH ID CARD.

AUTHORIZATION FOR TRANSFER OF CLAIM AMOUNT BY NATIONAL ELECTRONIC FUND TRANSFER

Name as per Bank Account

Bank Name

Branch Name & Address

Branch Phone No.

Branch MICR Code

Branch IFSC Code for NEFT

( Please attach a Photocopy of a cheque or a blank cheque of your bank duly cancelled for ensuring accuracy of the bank name, branch name, account

number & name of account holder printed)

Account Type (Please Tick)

Savings Current Cash / Credit

Account No. (as appearing in

Cheque Book)

HR Authorization & Stamp

Bank Authorization & Stamp

Date from which the mandate should be effective: _______________________

I hereby declare that the particulars given above are correct and complete and request you to remit any amount due to me, if any to the aforesaid bank account. I

herewith further declare that if any transaction is delayed or not effected at all or is wrongly credited to any other account for reasons of incomplete or incorrect

information as provided above, I shall not hold Future Generali India Insurance Company Ltd (“Company“) or any of its directors, employees or agents responsible

for the same. I also declare that the remittance of any dues to the aforesaid bank account shall be considered as full and valid discharge of its obligations by the

company. I also undertake to advise any change in the particulars of my bank account to facilitate updation of records for the purpose of credit of any amount

due, through NEFT.

Name of Employee / Proposer: ____________________________________ Signature of Employee / Proposer: _______________________ Policy No.

__________________________________ Claimant Name: ____________________________________ Date: __________________

FEEDBACK AND SUGGESTIONS

We thank you for choosing Future Generali as your Insurance provider. We always strive to ensure that our service levels exceed our customer’s expectations. In

the spirit of this endeavour, we will greatly appreciate your valuable inputs and feedback. Kindly provide your feedback on your experience with Future Generali

and any suggestions for improving our services. We value your time and promise to evaluate your suggestions for improvement of our service.

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Future Generali India Insurance Company Limited

Registered office address : Indiabulls Finance Centre, Tower 3, 6th Floor, Senapati Bapat Marg, Elphinstone (W), Mumbai - 400 013

Corporate Identity No (CIN): U66030MH2006PLC165287 Telephone No 022 4097 6666 and Fax No 22 4097 6900

Email: fgcare@futuregenerali.in website address www.futuregenerali.in FGH-CF-02

TOLL FREE PHONE: 1800 103 8889

TOLL FREE FAX: 1800 103 9998

MAIL: fgh@futuregenerali.in

Grievance Redressal Procedures

Dear Customer,

At Future Generali we are committed to provide “Exceptional Customer-Experience” that you remember and return to fondly. We encourage

you to read your policy & schedule carefully. We want to make sure the plan is working for you and welcome your feedback.

What Constitutes a Grievance?

A “Grievance/Complaint” is defined as any communication that expresses dissatisfaction about an action or lack of action, about the

standard service/deficiency of service from Future Generali or its intermediary or asks for remedial action.

If you have a complaint or grievance you may reach us through the following avenues:

Help

- Lines

1800-220-233 /

1860-500-3333 /

022-67837800

care@futuregenerali.in

Website

www.futuregenerali.in

GRO at each Branch

Walk

-in to any of our branches and request to meet the Grievance Redressal Officer (GRO).

What can I expect after logging a Grievance?

x We will acknowledge receipt of your concern within 3 - business days.

x Within 2 - weeks of receiving your grievance, we shall revert to you the final resolution.

x We shall regard the complaint as closed if we do not receive a reply within 8 weeks from the date of receipt of response.

What do I do, if I am unhappy with the Resolution?

x You can write directly to our Customer Service Cell at our Head office::

Customer Service Cell

Customer Service Cell, Future Generali India Insurance Company Ltd.

Corporate & Registered Office:

- 6th Floor, Tower 3, Indiabulls Finance Center,

Senapati Bapat Marg, Elphinstone Road, Mumbai – 400013

Please send your complaint in writing. You can use the complaint form, annexed with your

policy.

Kindly quote your policy number in all communication with us. This will help us to deal with the matter faster.

How do I Escalate?

While we constantly endeavor to promptly register, acknowledge & resolve your grievance, if you feel that you are experiencing difficulty in

registering your complaint, you may register your complaint through the IRDA (Insurance Regulatory and Development Authority).

x CALL CENTER: TOLL FREE NUMBER (155255).

x REGISTER YOUR COMPLAINT ONLINE AT: HTTP://WWW.IGMS.IRDA.GOV.IN/

Insurance Ombudsman:

If you are still not satisfied with the resolution to the complaint as provided by our GRO, you may approach the Insurance

Ombudsman for a review. The Insurance Ombudsman is an organization that addresses grievances that are not settled to your

satisfaction. You may reach the nearest insurance ombudsman office. The list of Insurance Ombudsmen offices is as mentioned below.

Office of the

Ombudsman

Contact Details

Areas of Jurisdiction

AHMEDABAD

Insurance Ombudsman Office of the Insurance Ombudsman

2nd Floor, Ambica House, Nr. C.U.Shah College, 5, Navyug Colony, Ashram Road,

AHMEDABAD -

380 014

Tel: 079- 27546840 Fax: 079-27546142 E-mail: 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 - 462 023

Tel: 0755-2569201 Fax: 0755-2769203 E-mail: bimalokpalbhopal@airtelmail.in

Madhya Pradesh &

Chhattisgar

BHUBANESHWA

Insurance Ombudsman Office of the Insurance Ombudsman

62, Forest Park,

BHUBANESHWAR - 751 009

Tel: 0674-2596455 Fax: 0674-2596429 E-mail: ioobbsr@dataone.in

Orissa

CHANDIGARH

Insurance Ombudsman Office of the Insurance Ombudsman

S.C.O. No.101, 102 & 103, 2nd Floor, Batra Building, Sector 17

-D, CHANDIGARH - 160 017

Tel: 0172-2706468 Fax: 0172-2708274 E-mail: ombchd@yahoo.co.in

Punjab, Haryana, Himachal

Pradesh, Jammu &

Kashmir, UT of Chandigarh

CHENNAI

Insurance Ombudsman Office of the Insurance Ombudsman

Fatima Akhtar Court, 4th Floor, 453 (old 312), Anna Salai, Teynampet,

CHENNAI - 600 018

Tel:044

-24333668 /5284 Fax: 044-24333664 E-mail: chennaiinsuranceombud[email protected]om

Tamilnadu, UT- Pondicherry

Town and Karaikal

(which are part of UT of

Pondicherry)

NEW DELHI

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 E-mail: iobdelraj@rediffmail.com

Delhi & Rajashthan

GUWAHATI

Insurance Ombudsman Office of the

Insurance Ombudsman

Jeevan Nivesh, 5th floor Nr. Panbazar Overbridge, S.S. Road,

GUWAHATI - 781 001

Tel:0361

-2132204/5 Fax: 0361-2732937 E-mail: ombudsmanghy@rediffmail.com

Assam, Meghalaya,

Manipur,

Mizoram,

Arunachal Pradesh,

Nagaland and Tripura

HYDERABAD

Insurance Ombudsman Office of the Insurance Ombudsman

-2-46 , 1st Floor, Moin Court Lane, Opp. Saleem Function Palace, A.C.Guards, Lakdi-Ka-Pool,

HYDERABAD

- 500 004

Tel: 040-65504123 Fax: 040-23376599 E-mail: insombudhyd@gmail.com

Andhra Pradesh, Karnataka

and UT of Yanam

a part of

UT of Pondicherry

ERNAKULAM

Insurance Ombudsman Office of the Insurance Ombudsman

2nd Floor, CC 27/2603, Pulinat Building, Opp. Cochin Shipyard, M.G. Road,

ERNAKULAM - 682 015

Tel: 0484

-2358759 Fax: 0484-2359336 E-mail: iokochi@asianetindia.com

Kerala, UT of

(a) Lakshadweep,

(b) Mahe

- a part of UT of

Pondicherry

KOLKATA

Insurance Ombudsman Office of the Insurance Ombudsman

Floor, Hindusthan Bldg., Annexe, 4, C.R.Avenue, KOLKATA - 700 072

Tel: 033

-22124346 / (40) Fax: 033-22124341 E-mail : [email protected]n

West Bengal, Bihar,

Jharkhand and UT of

Andeman & Nicobar

Islands, Sikkim

LUCKNOW

Insurance Ombudsman Office of the Insurance Ombudsman

Jeevan Bhawan, Phase 2, 6th Floor, Nawal Kishore Road, Hazratganj,

LUCKNOW - 226 001

Tel: 0522

-2231331 Fax: 0522-2231310 E-mail: insombudsman@rediffmail.com

Uttar Pradesh and

Uttaranchal

MUMBAI

Insurance Ombudsman Office of the Insurance Ombudsman

Jeevan Seva Annexe, 3rd Floor, S.V.Road, Santacruz (W),

MUMBAI - 400 054

Tel: 022-26106928 Fax: 022-26106052 E-mail: ombudsmanmumbai@gmail.com

Maharashtra, Goa

The updated details of Insurance Ombudsman are available on IRDA website: www.irda.gov.in, on the website of General Insurance Council:

www.generalinsurancecouncil.org.in, our website www.futuregenerali.in

or from any of our offices.

Form for Request / Complaint / Feedback / Appreciation

I want to submit a REQUEST COMPLAINT SUGGESTION / FEEDBACK APPRECIATION

POLICY TYPE MOTOR HEALTH PERSONAL ACCIDENT OTHER

POLICY DETAILS POLICY NO CLAIM NO COVER NOTE HEALTH CARD EXISTING SERVICE REQUEST

CUSTOMER NAME

FIRST NAME MIDDLE NAME LAST NAME

ADDRESS

CITY PIN CODE

TEL NO. MOBILE NO.

Detailed description

D M

YYYY

Customer’s Signature Date

You may submit the form to the Nearest Branch Office or mail it to our Customer Service Cell at:

Customer Service Cell

Future Generali India Insurance Company Ltd.

Corporate & Registered Office: - 6th Floor, Tower 3, Indiabulls Finance Centre, Senapati Bapat Marg, Elphinstone Road, Mumbai – 400013

Care Lines: 1800-220-233 / 1860-500-3333 / 022-6783 7800 Email: fgcare@futuregenerali.in Website: www.futuregenerali.in

Office Use Only: Service / Case #

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