I. PREAMBLE
This coverage is issued to the Insured based totally at the notion and statement collectively with any
assertion, document or other file which shall be the basis of this agreement and shall be deemed to be
included herein, to Insurer upon fee of the premium and the belief thereof with the aid of the
Insurer. This policy in conjunction with the schedule data the settlement between Insurer and Insured and
units out the phrases of coverage and the responsibilities of every celebration.
II. DEFINITIONS
the following words or phrases shall have the which means ascribed to them wherever they appear on this
coverage, and references to the singular or to the masculine shall include references to the plural and to
the female wherever the context so allows:
- “twist of fate” method a surprising, unforeseen and involuntary event resulting from external, visible and
violent method. - ” injury” approach any accidental physical physical damage totally and without delay due to outside,
violent and visible means that is established and authorized by a scientific Practitioner but does
not encompass any illness or disorder. - “Age” way finished years as at the graduation Date of the coverage duration.
four. “bank” method a banking business enterprise which transacts the enterprise of banking in India or abroad. - “Beneficiary” In case of demise of the Insured man or woman, the Beneficiary method, until stipulated
in any other case by way of the Insured man or woman, the surviving spouse or instant blood relative of the
Insured character, mentally succesful and now not divorced, accompanied via the youngsters recognized or
adopted followed by means of the Insured character’s felony heirs. For all different advantages, the Beneficiary
means the Insured person himself except stipulated in any other case. - “Congenital Anomaly” Congenital Anomaly refers to a situation(s) which is gift considering the fact that
start, and that’s strange with regards to shape, shape or function.
a. internal Congenital Anomaly – Congenital anomaly which is not within the visible and
available parts of the body is called inner Congenital Anomaly
b. outside Congenital Anomaly – Congenital anomaly that’s inside the visible and
accessible parts of the frame is called outside Congenital Anomaly.
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- “reimbursement” method Sum Insured, general Sum Insured or percentage of the Sum Insured, as
appropriate.
eight. “situation Precedent” shall suggest a policy term or circumstance upon which the Insurer’s
liability under the coverage is conditional upon.
nine. “crucial illness” way an contamination, illness or a sickness or a corrective degree like most cancers of
precise severity, Open Chest Bag, Aorta Graft surgical procedure, Open coronary heart substitute or repair of
coronary heart Valves, Stroke resulting in permanent signs, First heart attack – Of particular
Severity, Kidney Failure Requiring ordinary Dialysis, primary Pulmonary Arterial
hypertension, fundamental Organ/ Bone Marrow Transplant, a couple of Sclerosis with Persisting
symptoms, Coma of certain Severity, overall Blindness and permanent Paralysis of Limbs all
as defined in Scope of cowl & advantages phase of this policy. - “crucial infection gain” approach the quantity distinctive in the schedule, which is the maximum
amount for which Insurer can be vulnerable to make price for any or all important ailments
protected subject to phrases & situations below this coverage.
eleven. “Disclosure to information norm”- the coverage will be void and all top class paid hereon
shall be forfeited to the enterprise, inside the occasion o f misrepresentation, mis-description or non-
disclosure of any fabric truth.
- “disease / infection” method a illness or a disease or pathological circumstance main to the
impairment of ordinary physiological function which manifests itself throughout the policy period
and calls for medical treatment by way of a medical practitioner.
a. Acute circumstance – Acute situation is a sickness, contamination or harm this is in all likelihood to reply
fast to treatment which targets to go back the individual to his or her kingdom of fitness
immediately earlier than suffering the ailment/infection/damage which leads to full healing.
b. chronic condition – A continual circumstance is described as a ailment, illness, or injury that
has one or extra of the subsequent characteristics
i. it desires ongoing or lengthy-term monitoring via consultations, examinations,
check-ups, and / or checks
ii. it wishes ongoing or lengthy-term control or remedy of signs and symptoms
iii. it requires Insured’s rehabilitation or for Insured to be mainly skilled to manage
with it
iv. it maintains indefinitely
v. it comes back or is likely to come back again. - “EMI or EMI quantity” manner and consists of the amount of month-to-month fee required to
repay the important quantity of mortgage and interest by means of the Insured as set forth within the amortization
chart mentioned in the mortgage agreement (or any amendments thereto) between the
financial institution/financial group and the Insured prior to the date of occurrence of the Insured event
underneath this coverage. For the cause of avoidance of doubt, it is clarified that any month-to-month
bills which can be overdue and unpaid by way of the Insured previous to the occurrence of the Insured
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occasion will now not be taken into consideration for the purpose of this policy and will be deemed as paid with the aid of the
Insured.
- “unfastened appearance period” approach on the first inception of the coverage, the Insured has a length of 15
days from the date of receipt of the files to check the phrases and conditions of the
policy. wherein the Insured disagrees to any of those phrases or situations, he has the option to
go back the policy mentioning the motives for his objection, whilst he shall be entitled to a reimbursement of
the top class paid, subject simplest to a deduction of Rs. a hundred/- in the direction of costs incurred by the
Insurer. - “Grace length” means the required time period right away following the top rate due
date at some point of which a price may be made to renew or hold a policy in force with out loss
of continuity advantages along with ready intervals and insurance of pre present illnesses. insurance
isn’t available for the duration for which no top class is obtained. - “hospital/Nursing domestic”: way any organization set up for in-patient care and day care
remedy of contamination and/or accidents and which has been registered as a clinic with the nearby
government under the clinical institutions (Registration and regulation) Act, 2010 or underneath
the enactments targeted underneath the agenda of section 56(1) of the stated Act OR complies with
all minimum standards as under:
a. has qualified nursing body of workers under its employment round the clock;
b. has at the least 10 in-patient beds in towns having a population of much less than 10,00,000 and
at least 15 in-patient beds in all other places;
c. has certified clinical practitioner(s) in fee spherical the clock;
d. has a totally prepared operation theatre of its own where surgical processes are carried
out;
e. continues every day data of patients and makes these accessible to the insurance
business enterprise’s authorized employees. - “Inpatient care” method remedy for which the insured individual has to live in a sanatorium for
greater than 24 hours for a blanketed event. - “Insured” method you/your self/the character (s) named in the time table, who has a permanent
area of residence in India and for whom the coverage is proposed and appropriate top rate
paid. For the purpose of avoidance of doubt it’s far clarified that the heirs, executors,
directors, successors or criminal representatives of the Insured may gift a claim on
behalf of the Insured to the organization. - “Insured event” means any occasion specially cited as blanketed below this policy.
- “Insurer” method Us/Our/We SBI popular insurance agency limited.