Arogya Sanjeevani Policy prospectus_V-1.5 - Edelweiss ...

AROGYA SANJEEVANI POLICY,

EDELWEISS GENERAL INSURANCE

COMPANY LIMITED

PROSPECTUS

YOUR POLICY SUMMARY

AROGYA SANJEEVANI POLICY, EDELWEISS GENERAL INSURANCE COMPANY LIMITED

PROSPECTUS

1

1. PREAMBLEThis Policy is a contract of insurance issued by Edelweiss General Insurance Company Limited ( herein after called the “ Company”) to the proposer mentioned in the Schedule ( hereinafter called the “Insured” ) to cover the person (s) named in the Schedule ( hereinafter called the “ Insured Persons”) . The policy is based on the statements and declarations provided in the proposal form by the proposer and is subject to receipt of requisite premium.

Arogya Sanjeevani Policy, Edelweiss General Insurance Company Limited I UIN: EDLHLIP20158V011920

Particular/Variant/Sum Insured Sum Insured (In Lakhs)Entry Age

Maximum Age at RenewalPolicy Term Premium Payment OptionsFamily Floater Combinations

Individual Policy

Maximum members under a single individual policy and who can be covered

Min `50 Thousand & Maximum 10 Lakhs (in multiples of `50,000)

Minimum entry age shall be 18 Years for Principal Insured and maximum age at entry shall be 65. There shall be no exit age.Dependent Child/children shall be covered from the age of 3 months to 25 years subject to the definition of ‘Family’Lifelong Renewability1 YearYearly, Half Yearly, Quarterly, MonthlySelf, Legally wedded Spouse, Parent(s), Parent(s) in law, Dependent Children (natural or legally adopted) between the age 3 months to 25 years Self, Spouse, Dependent Children, Dependent Parents, Dependent Parent-In-Laws, Brother, Sister, Grandmother, Grandfather.The 8 members can be a combination of Self, spouse, dependent children and dependent parents and dependent Parent-in-laws, Brother, Sister, Grandmother and Grandfather

BenefitHospitalization Expenses

Pre-HospitalizationPost-HospitalizationSublimit for room/doctors fee

Cataract TreatmentAYUSH

Pre Existing Disease

Cumulative bonus

Co Pay

Sr. No.1

234

56

7

8

9

Basis of offeringExpenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissibleTime limit of 24 hrs shall not apply when the treatment is undergone in a Day Care Centre.For 30 days prior to the date of hospitalizationFor 60 days from the date of discharge from the hospitalI .Room Rent, Boarding, Nursing Expenses all inclusive as provided by the Hospital / Nursing Home up to 2% of the sum insured subject to maximum of `5,000 /- per day.2.lntensive Care Unit (ICU) charges / Intensive Cardiac Care Unit (ICCU) chargesAll inclusive as provided by the Hospital / Nursing Home up to 5% of the sum insured subject to maximum of `10,000/-, per dayUp to 25% of Sum insured or `40,000/-, whichever is lower, per eye, under one policy year.Expenses incurred for Inpatient Care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines shall be covered up to sum insured , during each Policy year as specified in the policy schedule.Only PEDs declared in the Proposal Form and accepted for coverage by the company shall be covered after a waiting period of 4 yearsIncrease in the sum insured by 5% in respect of each claim free year subject to a maximum of 50% of SI. In the event of claim the cumulative bonus shall be reduced at the same rate.5% co pay on all claims

2. Features

3. Scope of Cover

2

4. BenefitsThe covers listed below are in-built Policy benefits and shall be available to all Insured Persons in accordance with the procedures set out in this Policy.

4.1. HospitalizationThe Company shall indemnify medical expenses incurred for Hospitalization of the Insured Person during the Policy year, up to the Sum Insured and Cumulative Bonus specified in the policy schedule, for,i. Room Rent , Boarding, Nursing Expenses as provided by the Hospital / Nursing Home up to 2% of the sum insured subject to maximum of `5,000/-, per day.ii. Intensive Care Unit (ICU)/ Intensive Cardiac Care Unit (ICCU) expenses up to 5% of sum insured subject to maximum of `10,000/- per day.iii. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly to the treating doctor I surgeon or to the hospitaliv. Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs , costs towards diagnostics, diagnostic imaging modalities and such similar other expenses.4.1.1. Other expensesi. Expenses incurred on treatment of cataract subject to the sub limits ii. Dental treatment, necessitated due to disease or injuryiii. Plastic surgery necessitated due to disease or injury iv. All the day care treatments (Details mentioned in Appendix II)v. Expenses incurred on road Ambulance subject to a maximum of `2,000/- per hospitalisation.Note:1. Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible. However, the time limit shall not apply in respect of Day Care Treatment2. In case of admission to a room/ICU/ICCU at rates exceeding the aforesaid limits, the reimbursement/payment of all other expenses incurred

Arogya Sanjeevani Policy, Edelweiss General Insurance Company Limited I UIN: EDLHLIP20158V011920

Benefit Illustration in respect of policies offered on Individual and Family floater basis

Premium (Rs.)

23,439 18,224

4,514 3,514

49,691

65603530Total

Sum insured (Rs.)

5,00,000 5,00,000 5,00,000 5,00,000

Premium (Rs.)

23,439 18,224

4,514 3,514

49,691

Discount, if any

5%5%5%5%

Premium after discount (Rs.)

22,267 17,313 4,288 3,338

47,206

Sum insured (Rs.)

5,00,000 5,00,000 5,00,000 5,00,000

Premium or consolidated premium for all members of family (Rs.)

23,439 18,224 4,514 3,514

49,691

Floater dis-count, if any

30%30%30%30%

Premium after discount (Rs.)

16,407 12,757 3,160 2,460

34,784

Sum insured (Rs.)

5,00,000

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading.Also, the premium rates shall be exclusive of taxes applicable

Age of the members insured

Coverage opted on individual basis covering each member of the family separately (at a single point in time)

"Total Premium for all members of the family is INR 49,691, when each member is covered separately.Sum insured available for each individual is Rs. 5,00,000."

"Total Premium for all members of the family is INR 47,206, when they are covered under a single policy.Sum Insured available for each family member is Rs.5,00,000."

"Total Premium when opted on a floater basis is INR 34,784.Sum Insured of Rs. 5,00,000 is available for the entire family."

Coverage opted on individual basis covering multiple members of the family under a single policy (Sum insured is available for each member of the family)

Coverage opted on family floater basis with overall - sum insured {Only one sum insured is available for the entire family)

at the Hospital, with the exception of cost of medicines, shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent/lCU/ICCU charges.4.2. AYUSH TreatmentThe Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.4.3. Cataract TreatmentThe Company shall indemnify medical expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum Insured or `40,000/-, whichever is lower, per each eye in one policy year.4.4. Pre HospitalizationThe company shall indemnify pre-hospitalization medical expenses incurred, related to an admissible hospitalization requiring inpatient care, for a fixed period of 30 days prior to the date of admissible hospitalization covered under the policy.4.5. Post HospitalisationThe company shall indemnify post hospitalization medical expenses incurred, related to an admissible hospitalization requiring inpatient care, for a fixed period of 60 days from the date of discharge from the hospital, following an admissible hospitalization covered under the policy.4.6. The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to 50% of Sum Insured, specified in the policy schedule, during the policy period:A. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)B. Balloon SinuplastyC. Deep Brain stimulationD. Oral chemotherapyE. Immunotherapy - Monoclonal Antibody to be given as injectionF. Intra vitreal injectionsG. Robotic surgeriesH. Stereotactic radio surgeriesI. Bronchical ThermoplastyJ. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)K. IONM - (Intra Operative Neuro Monitoring)L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.4.7. The expenses that are not covered in this policy are placed under List-I of Annexure-A. The list of expenses that are to be subsumed into room charges, or procedure charges or costs of treatment are placed under List-II , List-III and List-IV of Annexure-A respectively.

5. Cumulative Bonus (CB)Cumulative Bonus will be increased by 5% in respect of each claim free policy year (where no claims are reported), provided the policy is renewed with the company without a break subject to maximum of 50% of the sum insured under the current policy year. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. However, sum insured will be maintained and will not be reduced in the policy year.Notes:i. In case where the policy is on individual basis, the CB shall be added and available individually to the insured person if no claim has been reported. CB shall reduce only in case of claim from the same Insured Person.ii. In case where the policy is on floater bas is , the CB shall be added and available to the family on floater bas is , provided no claim has been reported from any member of the family. CB shall reduce in case of claim from any of the Insured Persons.iii. CB shall be available only if the Policy is renewed/ premium paid within the Grace Period.iv. If the Insured Persons in the expiring policy are covered on an individual basis as specified in the Policy Schedule and there is an accumulated CB for such Insured Person under the expiring policy, and such expiring policy has been Renewed on a floater policy basis as specified in the Policy Schedule then the CB to be carried forward for credit in such Renewed Policy shall be the one that is applicable to the lowest among all the Insured Personsv. In case of floater policies where Insured Persons Renew their expiring policy by splitting the Sum Insured in to two or more floater policies / individual policies or in cases where the policy is split due to the child attaining the age of 25 years , the CB of the expiring policy shall be

3Arogya Sanjeevani Policy, Edelweiss General Insurance Company Limited I UIN: EDLHLIP20158V011920


apportioned to such Renewed Policies in the proportion of the Sum Insured of each Renewed Policyvi. If the Sum Insured has been reduced at the time of Renewal, the applicable CB shall be reduced in the same proportion to the Sum Insured in current Policy.vii. If the Sum Insured under the Policy has been increased at the time of Renewal the CB shall be calculated on the Sum Insured of the last completed Policy Year.viii. If a claim is made in the expiring Policy Year, and is notified to us after the acceptance of Renewal premium any awarded CB shall be withdrawn

6. Waiting PeriodThe Company shall not be liable to make any payment under the policy in connection with or in respect of following expenses till the expiry of waiting period mentioned below:

6.1. Pre-Existing Diseases (Code- Excl01)a) Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 48 months of continuous coverage after the date of inception of the first policy with us.b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.c) If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI (Health Insurance) Regulations then waiting period for the same would be reduced to the extent of prior coverage.d) Coverage under the policy after the expiry of 48 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by us.6.2. First Thirty Days Waiting Period (Code- Excl03)i. Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.ii. This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.iii. The within referred waiting period is made applicable to the enhanced sum insured in the event of granting higher sum insured subsequently.6.3. Specific Waiting Period: (Code- Excl02)a) Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the expiry of24/48 months of continuous coverage, as may be the case after the date of inception of the first policy with the insurer. This exclusion shall not be applicable for claims arising due to an accident.b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.c) If any of the specified disease/procedure falls under the waiting period specified for pre-existing diseases, then the longer of the two waiting periods shall apply.d) The waiting period for listed conditions shall apply even if contracted after the policy or declared and accepted without a specific exclusion.e) If the Insured Person is continuously covered without any break as defined under the applicable norms on portability stipulated by IRDAI, then waiting period for the same would be reduced to the extent of prior coverage.A. 24 Months waiting period -

1. Benign ENT disorders2. Tonsillectomy3. Adenoidectomy4. Mastoldectomy5. Tympanoplasty6. Hysterectomy7. All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps8. Benign prostate hypertrophy9. Cataract and age related eye ailments10. Gastric/ Duodenal Ulcer11. Gout and Rheumatism12. Hernia of all types13. Hydrocele


14. Non Infective Arthritis15. Piles, Fissures and Fistula in anus16. Pilonidal sinus, Sinusitis and related disorders17. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident18. Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.19. Varicose Veins and Varicose Ulcers20. Internal Congenital Anomalies

B. 48 Months waiting period1. Treatment for joint replacement unless arising from accident2. Age-related Osteoarthritis & Osteoporosis

7. EXCLUSIONS The Company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:

7.1. Investigation & Evaluation (Code- Excl04)a) Expenses related to any admission primarily for diagnostics and evaluation purposes.b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment7.2. Rest Cure, rehabilitation and respite care (Code- Excl05)a) Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.7.3. Obesity/ Weight Control (Code- Excl06)Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:1) Surgery to be conducted is upon the advice of the Doctor2) The surgery/ Procedure conducted should be supported by clinical protocols3) The member has to be 18 years of age or older and4) Body Mass Index (BMI);a) Greater than or equal to 40 orb) Greater than or equal to 35 in conjunction with any of the following severe co morbidities following failure of less invasive methods of weight loss:

i. Obesity-related cardiomyopathyii. Coronary heart diseaseiii. Severe Sleep Apneaiv. Uncontrolled Type2 Diabetes

7.4. Change-of-Gender treatments: (Code- Excl07)Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.7.5. Cosmetic or plastic Surgery: (Code- Excl08)Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident , Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.7.6. Hazardous or Adventure sports: (Code- Excl09)Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing , horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.7.7. Breach of law: (Code- Excll0)Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.7.8. Excluded Providers: (Code-Excl11)Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and


disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim. 7.9. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12)7.10. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. (Code- Excl13)7.11. Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure (Code- Excl14)7.12. Refractive Error: (Code- Exc115)Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.7.13. Unproven Treatments: (Code- Excl16)Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.7.14. Sterility and Infertility: (Code- Excl17)Expenses related to sterility and infertility. This includes:i) Any type of contraception, sterilizationii) Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSIiii) Gestational Surrogacyiv) Reversal of sterilization7.15. Maternity Expenses (Code - Excl18):i. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.7.16. War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest , restraints and detainment of all kinds.

7.17. Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense. For the purpose of this exclusion:a) Nuclear attack or weapons means the use of any nuclear weapon or device or waste or combustion of nuclear fuel or the emission, discharge, dispersal, release or escape of fissile/ fusion material emitting a level of radioactivity capable of causing any Illness, incapacitating disablement or death.b) Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing any Illness, incapacitating disablement or death.c) Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death.7.18. Any expenses incurred on Domiciliary Hospitalization and OPD treatment 7.19. Treatment taken outside the geographical limits of India7.20. In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule (based on insured's consent), policyholder is not entitled to get the coverage for specified ICD codes.

8. Moratorium Period: After completion of eight continuous years under this policy no look back would be applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently completion of eight continuous years would be applicable from date of enhancement of sums insured only on the enhanced limits. After the expiry of Moratorium Period no claim under this policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The policies would however be subject to all limits, sub limits, co-payments as per the policy.


9.1 Notification of ClaimNotice with full particulars shall be sent to the Company/TPA (if applicable) as under:i. Within 24 hours from the date of emergency hospitalization required or before the Insured Person's discharge from Hospital, whichever is earlier.ii. At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.9.2 Documents to be submitted:The reimbursement claim is to be supported with the following documents and submitted within the prescribed time limit.i. Duly Completed claim formii. Photo Identity proof of the patientiii. Medical practitioner's prescription advising admissioniv. Original bills with itemized break-upv. Payment receiptsvi. Discharge summary including complete medical history of the patient along with other details.vii. Investigation/ Diagnostic test reports etc. supported by the prescription from attending medical practitionerviii. OT notes or Surgeon's certificate giving details of the operation performed (for surgical cases).ix. Sticker/Invoice of the Implants, wherever applicable.x. MLR(Medico Legal Report copy if carried out and FIR (First information report) if registered, where ever applicable.xi. NEFT Details (to enable direct credit of claim amount in bank account) and cancelled chequexii. KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelinesxiii. Legal heir/succession certificate, wherever applicablexiv. Any other relevant document required by Company/TPA for assessment of the claim.In addition:Note:I. The company shall only accept bills/invoices/medical treatment related documents only in the Insured Person's name for whom the claim is submitted2. In the event of a claim lodged under the Policy and the original documents having been submitted to any other insurer, the Company shall accept the copy of the documents and claim settlement advice, duly certified by the other insurer subject to satisfaction of the Company3. Any delay in notification or submission may be condoned on merit where delay is proved to be for reasons beyond the control of the Insured Person.

Type of ClaimReimbursement of hospitalization, day care and pre hospitalization expensesReimbursement of post hospitalization expenses

Sr. No.1

2

Prescribed Time limitWithin thirty days of date of discharge from hospital

Within fifteen days from completion of post hospitalization treatment

9. CLAIM PROCEDURE

1.1Procedure for Cashless claims:(i) Treatment may be taken in a network provider and is subject to pre authorization by the Company or its authorized TPA. (ii) Cashless request form available with the network provider and TPA shall be completed and sent to the Company/TPA for authorization. (iii) The Company/ TPA upon getting cashless request form and related medical information from the insured person/ network provider will issue pre-authorization letter to the hospital after verification. (iv) At the time of discharge, the insured person has to verify and sign the discharge papers, pay for non-medical and inadmissible expenses. (v) The Company / TPA reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant medical details. (vi)ln case of denial of cashless access, the insured person may obtain the treatment as per treating doctor's advice and submit the claim documents to the Company/ TPA for reimbursement.1.2 Procedure for reimbursement of claims:For reimbursement of claims the insured person may submit the necessary documents to TPA (if applicable)/Company within the prescribed time limit as specified hereunder.


9.3 Co-paymentEach and every claim under the Policy shall be subject to a Co-payment of 5% applicable to claim amount admissible and payable as per the terms and conditions of the Policy. The amount payable shall be after deduction of the co-payment.9.4 Claim Settlement (provision for Penal Interest)i. The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document.ii. In the case of delay in the payment of a claim, the Company shall be liable to pay interest from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate .iii. However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the Company shall settle the claim within 45 days from the date of receipt of last necessary document.iv. In case of delay beyond stipulated 45 days the company shall be liable to pay interest at a rate 2% above the bank rate from the date of receipt of last necessary document to the date of payment of claim.9.5 Services Offered by TPA (To be stated where TPA is involved)Servicing of claims, i.e., claim admissions and assessments, under this Policy by way of pre¬authorization of cashless treatment or processing of claims other than cashless claims or both, as per the underlying terms and conditions of the policy.TPA shall provide the following services,(i) Dispatch of Physical or E-card.(ii) Servicing of claims by way of preauthorization of cashless treatment or processing towards settlement of claims, as per the underlying terms and conditions of the respective policies and within the terms agreed.(iii) Wellness services for the members as per the terms and conditions of the policy.9.6 Payment of ClaimAll claims under the policy shall be payable in Indian currency only.

10. GENERAL TERMS & CONDITIONS

10.1 Disclosure of InformationThe Policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, mis-description or non-disclosure of any material fact.

10.2 Condition Precedent to Admission of LiabilityThe due observance and fulfilment of the terms and conditions of the policy, by the insured person, shall be a condition precedent to any liability of the Company to make any payment for claim(s) arising under the policy.10.3 Material ChangeThe Insured shall notify the Company in writing of any material change in the risk in relation to the declaration made in the proposal form or medical examination report at each Renewal and the Company may, adjust the scope of cover and/ or premium, if necessary, accordingly.10.4 Records to be MaintainedThe Insured Person shall keep an accurate record containing all relevant medical records and shall allow the Company or its representatives to inspect such records. The Policyholder or Insured Person shall furnish such information as the Company may require for settlement of any claim under the Policy, within reasonable time limit and within the time limit specified in the Policy10.5 Complete DischargeAny payment to the Insured Person or his/ her nominees or his/ her legal representative or to the Hospital/Nursing Home or Assignee, as the case may be, for any benefit under the Policy shall in all cases be a full, valid and an effectual discharge towards payment of claim by the Company to the extent of that amount for the particular claim10.6 Notice & Communicationi. Any notice, direction, instruction or any other communication related to the Policy should be made in writing.ii. Such communication shall be sent to the address of the Company or through any other electronic modes specified in the Policy Schedule.iii. The Company shall communicate to the Insured at the address or through any other electronic mode mentioned in the schedule.10.7 Territorial LimitAll medical treatment for the purpose of this insurance will have to be taken in India only.


10.8 Multiple Policies1. In case of multiple policies taken by an insured during a period from the same or one or more insurers to indemnify treatment costs, the policyholder shall have the right to require a settlement of his/her claim in terms of any of his/her policies. In all such cases the insurer if chosen by the policy holder shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen policy. 2. Policyholder having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed under any other policy/ policies, even if the sum insured is not exhausted. Then the Insurer(s) shall independently settle the claim subject to the terms and conditions of this policy.3. If the amount to be claimed exceeds the sum insured under a single policy after, the policyholder shall have the right to choose insurers from whom he/she wants to claim the balance amount.4. Where an insured has policies from more than one insurer to cover the same risk on indemnity basis, the insured shall only be indemnified the hospitalization costs in accordance with the terms and conditions of the chosen policy.10.9 FraudIf any claim made by the insured person, is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof, or if any fraudulent means or devices are used by the insured person or anyone acting on his/her behalf to obtain any benefit under this policy, all benefits under this policy shall be forfeited.Any amount already paid against claims which are found fraudulent later under this policy shall be repaid by all person(s) named in the policy schedule, who shall be jointly and severally liable for such repayment.For the purpose of this clause, the expression "fraud" means any of the following acts committed by the Insured Person or by his agent, with intent to deceive the insurer or to induce the insurer to issue a insurance Policy:-(a) the suggestion ,as a fact of that which is not true and which the Insured Person does not believe to be true;(b) the active concealment of a fact by the Insured Person having knowledge or belief of the fact;(c) any other act fitted to deceive; and(d) any such act or omission as the law specially declares to be fraudulent

The company shall not repudiate the policy on the ground of fraud, if the insured person / beneficiary can prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of material fact are within the knowledge of the insurer. Onus of disproving is upon the policyholder, if alive, or beneficiaries.

10.10. Cancellationa) The Insured may cancel this Policy by giving 15 days' written notice, and in such an event, the Company shall refund premium on short term rates for the unexpired Policy Period as per the rates detailed below.

Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the Insured person under the Policy.b) The Company may cancel the Policy at any time on grounds of mis-representation, non-disclosure of material facts, fraud by the Insured Person, by giving 15 days' written notice. There would be no refund of premium on cancellation on grounds of mis-representation, non-disclosure of material facts or fraud.10.11. Automatic change in Coverage under the policyThe coverage for the insured Person(s) shall automatically terminate:1. In the case of his/ her (Insured Person) demise.However the cover shall continue for the remaining Insured Persons till the end of Policy Period. The other insured persons may also apply to

Timing of CancellationUp to 30 days31 to 90 days3 to 6 months6 to 12 months

1 Year75.00%50.00%25.00%0.00%

Refund%Refund of Premium (basis Policy Period)


renew the policy. In case, the other insured person is minor, the policy shall be renewed only through any one of his/her natural guardian or guardian appointed by court. All relevant particulars in respect of such person (including his/her relationship with the insured person) must be submitted to the company along with the application. Provided no claim has been made, and termination takes place on account of death of the insured person, pro-rata refund of premium of the deceased insured person for the balance period of the policy will be effective.2. Upon exhaustion of sum insured and cumulative bonus, for the policy year. However, the policy is subject to renewal on the due date as per the applicable terms and conditions.10.12. Territorial .JurisdictionAll disputes or differences under or in relation to the interpretation of the terms, conditions, validity, construct, limitations and/or exclusions contained in the Policy shall be determined by the Indian court and according to Indian law.10.13. Arbitrationi. If any dispute or difference shall arise as to the quantum to be paid by the Policy, (liability being otherwise admitted) such difference shall independently of all other questions, be referred to the decision of a sole arbitrator to be appointed in writing by the parties here to or if they cannot agree upon a single arbitrator within thirty days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising 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 Act 1996 , as amended by Arbitration and Conciliation (Amendment) Act, 2015 (No. 3 of 2016).ii. It is clearly agreed and understood that no difference or dispute shall be preferable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of the policy.iii. It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon the policy that award by such arbitrator/arbitrators of the amount of expenses shall be first obtained.10.14. Migration:The Insured Person will have the option to migrate the Policy to other health insurance products/plans offered by the company as per extant Guidelines related to Migration. If such person is presently covered and has been continuously covered without any lapses under any health insurance product/plan offered by the company, as per Guidelines on migration, the proposed Insured Person will get all the accrued continuity benefits in waiting periods as per below:i. The waiting periods specified in Section 6 shall be reduced by the number of continuous preceding years of coverage of the Insured Person under the previous health insurance Policy.ii. Migration benefit will be offered to the extent of sum of previous sum insured and accrued bonus/multiplier benefit (as part of the base sum insured), migration benefit shall not apply to any other additional increased Sum Insured. For Detailed Guidelines on Migration, kindly refer the link: https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page=PageNo3987&flag=110.15. PortabilityThe Insured Person will have the option to port the Policy to other insurers as per extant Guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance plan with an Indian General/Health insurer as per Guidelines on portability, the proposed Insured Person will get all the accrued continuity benefits in waiting periods as under:i. The waiting periods specified in Section 6 shall be reduced by the number of continuous preceding years of coverage of the Insured Person under the previous health insurance Policy.ii. Portability benefit will be offered to the extent of sum of previous sum insured and accrued bonus (as part of the base sum insured), portability benefit shall not apply to any other additional increased Sum Insured.For Detailed Guidelines on Portability, kindly refer the link https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page=PageNo3987&flag=110.16. Renewal of PolicyThe policy shall ordinarily be renewable except on grounds of fraud, moral hazard, misrepresentation by the insured person. The Company is not bound to give notice that it is due for renewal.i. Renewal shall not be denied on the ground that the insured had made a claim or claims in the preceding policy yearsii. Request for renewal along with requisite premium shall be received by the Company before the end of the Policy Period.iii. At the end of the Policy Period, the policy shall terminate and can be renewed within the Grace Period to maintain continuity of benefits without Break in Policy. Coverage is not available during the grace period.iv. If not renewed within Grace Period after due renewal date, the Policy shall terminate.


10.17. Premium Payment in InstalmentsIf the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or Monthly, as mentioned in Your Policy Schedule/Certificate of Insurance, the following Conditions shall apply (notwithstanding any terms contrary elsewhere in the Policy)i. Grace Period of 15 days would be given to pay the instalment premium due for the Policy.ii. During such grace period, Coverage will not be available from the instalment premium payment due date till the date of receipt of premium by Company.iii. The Benefits provided under - “Waiting Periods", "Specific Waiting Periods" Sections shall continue in the event of payment of premium within the stipulated grace Period.iv. No interest will be charged If the instalment premium is not paid on due date. In case of instalment premium due not received within the grace Period, the Policy will get cancelled.10.18. Possibility of Revision of Terms of the Policy Including the Premium RatesThe Company, with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The insured person shall be notified three months before the changes are affected.10.19. Free look periodThe Free Look Period shall be applicable at the inception of the Policy and not on renewals or at the time of porting the policy.The insured shall be allowed a period of fifteen days from date of receipt of the Policy to review the terms and conditions of the Policy, and to return the same if not acceptable.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 Company on medical examination of the insured person and the stamp duty charges; orii. where the risk has already commenced and the option of return of the Policy is exercised by the insured, a deduction towards the proportionate risk premium for period of cover oriii. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period;10.20 Endorsements (Changes in Policy)i. This policy constitutes the complete contract of insurance. This Policy cannot be modified by anyone (including an insurance agent or broker) except the company. Any change made by the company shall be evidenced by a written endorsement signed and stamped.ii. The policyholder may be changed only at the time of renewal. The new policyholder must be the legal heir/immediate family member. Such change would be subject to acceptance by the company and payment of premium (if any). The renewed Policy shall be treated as having been renewed without break.The policyholder may be changed during the Policy Period only in case of his/her demise or him /her moving out of India.10.21. Change of Sum InsuredSum insured can be changed (increased/ decreased) only at the time of renewal or at any time, subject to underwriting by the Company. For any increase in SI, the waiting period shall start afresh only for the enhanced portion of the sum insured.10.22 .Terms and conditions of the PolicyThe terms and conditions contained herein and in the Policy Schedule shall be deemed to form part of the Policy and shall be read together as one document.10.23. Nomination:The policyholder is required at the inception of the policy to make a nomination for the purpose of payment of claims under the policy in the event of death of the policyholder. Any change of nomination shall be communicated to the company in writing and such change shall be effective only when an endorsement on the policy is made. For Claim settlement under reimbursement, the Company will pay the policyholder. In the event of death of the policyholder, the Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting nominee, to the legal heirs or legal representatives of the Policyholder whose discharge shall be treated as full and final discharge of its liability under the Policy.10.24 Pre-Policy Issuance Medical Check-Up We may ask you to undergo a pre-policy medical check-up, if You are aged 61 years and above. Wherever any pre-existing disease or any other adverse medical history is declared, such proposal will be subject to medical underwriting. Medical tests will be facilitated by us and conducted at Edelweiss General Insurance Company’s/ Our Service Provider’s empanelled network of diagnostic centres. We / Service Provider will contact you and fix up an appointment for the Medical Examination to be conducted at a time convenient to You. 50% of the cost of all such medical tests


will be borne by us if proposal is accepted.We may require the individual to undergo listed medical testsMER + CBC, ESR + RUA + Lipid Profile + Sr Creatinine + HbA1c + ECG + LFT• MER- Medical Examination Report• ECG- Electrocardiogram.• Lipid Profile - (Sr Cholesterol, Sr Triglycerides, Sr. HDL, Sr LDL, Ratio of T. Chol & HDL, Sr VLDL).• HbA1C –Glycosylated Haemoglobin.• RFT-- Serum Creatinine, BUN (Blood urea nitrogen)• LFT—SGOT, SGPT, GGT• CBC-Complete Blood Count, • RUA Routine Urinalysis

11. REDRESSAL OF GRIEVANCEIn case of any grievance the insured person may contact the company through• Website: www.edelweissinsurance.com, • Toll free: 1800120216216 / 180012000• E-mail: [email protected]• Courier: 5th Floor, Tower 3, Kohinoor City Mall, Kohinoor City, Kirol Road, Kurla (West), Mumbai 400 070

Contact Details for Senior Citizens:• Contact number: 02242312001• Email ID: [email protected]

Insured person may also approach the grievance cell at any of the company’s branches with the details of grievanceIf Insured person is not satisfied with the redressal of grievance through one of the above methods, insured person may contact the grievance officer at 1800120216216 and [email protected]

For updated details of grievance officer, kindly refer the link: https://www.edelweissinsurance.com/documents/20143/1081704/Service+Parameters+and+Grievance+Mechanism+15-04-21.pdf/114fd592-ad87-457a-d8c6-2e6cc6b9fd91?t=1618577820419

Grievance may also be lodged at IRDAI Integrated Grievance Management System - https://igms.irda.gov.in/.Insurance Ombudsman –The insured person may also approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance. The contact details of the Insurance Ombudsman offices have been provided as Annexure-A. [Insurers are advised to note the revised details of insurance ombudsman as and when amended as available in the website http://ecoi.co.in/ombudsman.html and ensure that updated details are prospectively incorporated in the policy documents for the information of the policyholders].

In case of any Grievance of the Complainant sent in a written communication to the Company at any of the touch points as mentioned, shall be addressed within 14 days of the receipt of the complaint. • For easy and faster response, please feel free to contact us onCall us at: 180012000 (Toll Free) or 02242312000 (Call charges applicable)Email us at: [email protected]

• Please feel free to contact our Grievance Cell onCall us at: 1800120216216Email: [email protected] Contact Details for Senior Citizens: • Contact number: 02242312001• Email ID: [email protected]: Edelweiss General Insurance Company Limited, Kohinoor City Mall, Tower 3, Kirol Road, Kurla West, Mumbai 400070


• The Grievance Redressal Officer Email: [email protected] us at: 022 4931 4422Address: Edelweiss General Insurance Company Limited, Kohinoor City Mall, Tower 3, Kirol Road, Kurla West, Mumbai 400070

If you are not satisfied with the response or do not receive a response from the Company, within 14 days of your complaint, you may approach the Grievance Cell of the Insurance Regulatory and Development Authority of India (‘IRDAI’) on the following contact details:

IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: 155255 Email ID: [email protected] Register online at: http://www.igms.irda.gov.in/

Address for communication for complaints by fax/paper: Consumer Affairs Department Insurance Regulatory and Development Authority of India Sy. No. 115/1, Financial District, Nanakramguda, Gachibowli Hyderabad - 500032

In case you are not satisfied with the response provided by the company or no response is received, you may approach the Insurance Ombudsman in your region for the resolution post 30 days from the date of registration of the complaint.

Details of the Insurance Ombudsman Offices are available on the link http://www.policyholder.gov.in/Addresses_of_Ombudsmen.aspx

The Complainant may approach the Office of the Insurance Ombudsman established by the Central Government of India as perRule 13 and Rule 14 of the Insurance Ombudsman Rules, 2017 (‘Ombudsman Rules’).

The following complaints can be lodged with the Insurance Ombudsman:1. Any partial or total repudiation of claims by an insurer;2. Any dispute in regard to premium paid or payable in terms of the policy;3. Any dispute on the legal construction of the policies in so far as such disputes relate to claims;4. Delay in settlement of claims;5. Non-issue of any insurance document to customers after receipt of premium.

Manner in which complaint is to be made Rule 14 of the Ombudsman Rules:-1. Any person who has a grievance against the Company, may himself or through his legal heirs make a complaint in writing to the Ombudsman within whose jurisdiction the branch or office of the Company complained against is located.2. The complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer against which the complaint is made, the fact giving rise to the complaint.3. No complaint to the Ombudsman shall lie unless:• the complainant had before making a complaint to the Ombudsman, made a written representation to the Company/insurer named in the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period of one month after the insurer concerned received his representation or the complainant is not satisfied with the reply given to him by the insurer;• the complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the representation of the complainant; and• the complaint is not on the same subject matter for which any proceedings before any court or Consumer Forum or arbitrator is pending or was so earlier.

Insurance Ombudsman –The insured person may also approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance. The contact details of the Insurance Ombudsman offices have been provided as Annexure-A.


Name

Product Type

Category of Cover

Sum insured

Policy Period

Eligibility

Grace Period

Hospitalisation Expenses

Pre Hospitalisation

Post Hospitalisation

Sublimit for room/doctors fee

Cataract Treatment

AYUSH

Pre Existing Disease

Cumulative bonus

Co Pay

Discounts

Arogya Sanjeevani Policy, Edelweiss General Insurance Company Limited

Individual/ Floater

Indemnity

Rs 50,000 & Maximum 10 Lacs (in multiples of Rs 50,000)

On Individual basis - SI shall apply to each individual family member

On Floater basis - SI shall apply to the entire family

1 year

Policy can be availed by persons between the age of 18 years and 65 years, as Proposer. Proposer

with higher age can obtain policy for family, without covering self.

Policy can be availed for Self and the following family members

i. Legally wedded spouse.

ii. Parents and Parents-in-law.

iii. Dependent Children ( i.e . natural or legally adopted) between the age 3 months to 25 years . If

the child above 18 years of age is financially independent, he or she shall be ineligible for

coverage in the subsequent renewals

For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period and for all

other modes of payment a fixed period of 15 days be allowed as grace period.

Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible

Time limit of 24 hrs shall not apply when the treatment is undergone in a Day Care Centre.

For 30 days prior to the date of hospitalization

For 60 days from the date of discharge from the hospital

I .Room Rent, Boarding, Nursing Expenses all inclusive as provided by the Hospital / Nursing

Home up to 2% of the sum insured subject to maximum of `5,000 /- per day.

2.lntensive Care Unit (ICU) charges / Intensive Cardiac Care Unit (ICCU) charges

All inclusive as provided by the Hospital / Nursing Home up to 5% of the sum insured subject to

maximum of ` 10,000/-, per day

Up to 25% of Sum insured or `40,000/-, whichever is lower, per eye, under one policy year.

Expenses incurred for Inpatient Care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha

and Homeopathy systems of medicines shall be covered up to sum insured , during each Policy

year as specified in the policy schedule.

Only PEDs declared in the Proposal Form and accepted for coverage by the company shall be covered

after a waiting period of 4 years

Increase in the sum insured by 5% in respect of each claim free year subject to a maximum of 50% of

SI. In the event of claim the cumulative bonus shall be reduced at the same rate.

5% co pay on all claims

Family Discounts 5% for 2 or more members covered on Individual basis.

• Employee Discount – 5% (Applicable for Edelweiss Group).

• On line Policy discount – 15% discount for the policies purchased online/through website / direct

channel. This benefit is extended to direct customers in lieu of the commission

12. TABLE OF BENEFITS


Mentioned below are contact details of Ombudsman:

Ombudsman and Addresses

CONTACT DETAILS JURISDICTION

AHMEDABADOffice of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor,Tilak Marg, Relief Road, Ahmedabad – 380 001.Tel.: 079 - 25501201/02/05/06Email:[email protected]

State of Gujarat,Union Territory of Dadra & Nagar Haveli &Union Territory of Daman and Diu.

BENGALURUOffice of the Insurance Ombudsman, Jeevan Soudha Building, PID No.57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar, 1st Phase,Bengaluru-560 078.Tel.:- 080-26652048 / 26652049Email:- [email protected]

State of Karnataka

BHOPALOffice of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal – 462 033.Tel.:- 0755-2769200/201/202, Fax:- 0755-2769203Email:- [email protected]

States of Madhya Pradesh and Chattisgarh

BHUBANESHWAROffice of the Insurance Ombudsman, 62, Forest park, Bhubneshwar – 751 009.Tel.:- 0674-2596461 / 2596455, Fax:- 0674-2596429Email:[email protected]

State of Odisha

CHANDIGARHOffice of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor,Batra Building, Sector 17 – D, Chandigarh – 160 017.Tel.:- 0172-2706196/ 2706468Fax:- 0172-2708274Email:- [email protected]

States of Punjab, Haryana, Himachal Pradesh, Union Territory of Jammu & Kashmir, Union Territory of Ladakh and Union Territory of Chandigarh

CHENNAIOffice of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453 , Anna Salai, Teynampet, CHENNAI – 600 018.Tel.:- 044-24333668 / 24335284Fax:- 044-24333664Email:- [email protected]

State of Tamil Nadu and Union Territories - Puducherry Town and Karaikal (which are part of Union Territory of Puducherry)

DELHIOffice of the Insurance Ombudsman, 2/2 A, Universal Insurance Building,Asaf Ali Road, New Delhi – 110 002.Tel.:- 011-23232481/23232481 Email:- [email protected]

State of Delhi

ERNAKULAMOffice of the Insurance Ombudsman, 2nd floor, Pulinat Building, Opp. Cochin Shipyard, M.G. Road, Ernakulum - 682 015.Tel.:- 0484-2358759/2359338Fax:- 0484-2359336Email:- [email protected]

State of Kerala, Union Territory of Lakshadweep and Mahe, a part of Puducherry

GUWAHATIOffice of the Insurance Ombudsman, 'Jeevan Nivesh’, 5th Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati – 781001(ASSAM).Tel.:- 0361- 2632204 / 2602205Email:- [email protected]

States of Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura

HYDERABADOffice of the Insurance Ombudsman, 6-2-46, 1st floor, "Moin Court" Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.Tel.:- 040- 67504123 / 23312122 Fax:- 040-23376599Email:- [email protected]

States of Andhra Pradesh, Telangana and Union Territory of Yanam - a part of Puducherry


CONTACT DETAILS JURISDICTION

JAIPUROffice of the Insurance Ombudsman, Jeevan Nidhi-II Bldg., Ground Floor,Bhawani Singh Marg, Jaipur - 302005.Tel.:- 0141-2740363Email:- [email protected]

State of Rajasthan

KOLKATAOffice of the Insurance Ombudsman, Hindustan Building Annexe, 4th floor, 4, C.R. Avenue, Kolkata - 700 072.Tel.:- 033-22124339 / 22124340, Fax:- 033-22124341Email:- [email protected]

States of West Bengal, Bihar, Sikkim and Union Territory of Andaman and Nicobar Islands

LUCKNOWOffice of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow-226 001.Tel.:- 0522-2231330 / 2231331,Fax:- 0522-2231310.Email:- [email protected]

Districts of Uttar Pradesh: Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur, Varansi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sulanpur, Maharajganj, Santkabirnagar, Azamgarh, Kaushinagar, Gorkhpur, Deoria, Mau, Chandauli, Ballia, Sidharathnagar

State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozabad, Gautam Budh Nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur

MUMBAIOffice of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054.Tel.:- 022- 26106552/ 26106960, Fax:- 022-26106052Email:- [email protected]

State of Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane

NOIDAOffice of the Insurance Ombudsman, Bhagwan Sahai Palace, 4th Floor, Main Road, Naya Bans, Sector-15, Distt: Gautam Budh Nagar, U.P-201301.Tel.: 0120-2514250 / 2514252 / 2514253 Email:- [email protected]

PATNAOffice of the Insurance Ombudsman, 1st Floor, Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna - 800 006. Tel.: 0612-2680952Email:- [email protected]

PUNEOffice of the Insurance Ombudsman, Jeevan Darshan Building, 3rd Floor,CTS Nos. 195 to 198, NC Kelkar Road, Narayan Peth, Pune - 411 030Tel: 020 -41312555Email:- [email protected]

State of Maharashtra, Area of Navi Mumbai and Thane, excluding Mumbai Metropolitan Region

States of Bihar and Jharkhand

Arogya Sanjeevani Policy, Edelweiss General Insurance Company Limited I UIN: EDLHLIP20158V011920 17

Baby food

Baby utilities charges

Beauty services

Belts/braces

Buds

Cold pack/hot pack

Carry bags

Email/ internet charges

Food charges (other than patient's diet provided by hospital)

leggings

Laundry charges

Mineral water

Sanitary pad

Telephone charges

Guest services

Crepe bandage

Diaper of any type

Eyelet collar

Slings

Blood grouping and cross matching of donors samples

Service charges where nursing charge also charged

Television charqes

Surcharges

Attendant charges

Extra diet of patient (other than that which forms part of bed

charge)

birth certificate

Certificate charges

Courier charges

Conveyance charges

Medical certificate

Medical records

Photocopies charges

Mortuary charges

Walking aids charges

Oxygen cylinder (for usage outside the hospital)

spacer

Spirometre

Nebulizer kit

Steam inhaler

Armsling

Thermometer

Cervical collar

Splint

Diabetic foot wear

Knee braces (long/ short/ hinged)

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Annexure-AList I - Items for which coverage is not available in the Policy

Knee immobilizer/shoulder immobilizer

Lumbo sacral belt

Nimbus bed or water or air bed charges

Ambulance collar

Ambulance equipment

Abdominal binder

Private nurses charges- special nursing charges

Sugar free tablets

Creams powders lotions (toiletries are not payable, only

prescribed medical pharmaceuticals payable)

ECG electrodes

Gloves

Nebulisation kit

Any kit with no details mentioned [delivery kit, orthokit,

recovery kit, etcl

Kidney tray

Mask

Ounce glass

Oxygen mask

Pelvic traction belt

Pan can

Trolly cover

Urometer, urine jug

Ambulance

Vasofix safety

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ItemSI. No. ItemSI. No.

The details of the excluded items can also be viewed on our website: www.edelweissinsurance.comLink: https://www.edelweissinsurance.com/contact-us


Hair removal cream

Disposables razors charges (for site preparations)

eye pad

Eye sheild

Camera cover

Dvd, cd charges

Gause soft

Gauze

Ward and theatre booking charges

Arthroscopy and endoscopy instruments

Microscope cover

Surgical blades, harmonicscalpel,shaver

Surgical drill

Eye kit

Eye drape

X-ray film

Boyles apparatus charges

Cotton

Cotton bandage

Surgical tape

Apron

Torniquet

Orthobundle, gynaec bundle

ItemSI. No.1

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Baby charges (unless specified/indicated)

hand wash

Shoe cover

Caps

Cradle charges

Comb

Eau-de-cologne/ room freshners

Foot cover

Gown

Slippers

Tissue paper

Tooth paste

Tooth brush

Bed pan

Face mask

Flex! Mask

Hand holder

Sputum cup

Disinfectant lotions

Luxury tax

Hvac

House keeping charges

Air conditioner charges

Im iv injection charges

Clean sheet

Blanket/warmer blanket

Admission kit

Diabetic chart charges

Documentation charges/ administrative expenses

Discharge procedure charges

Daily chart charges

Entrance pass/ visitors pass charges

Expenses related to prescription on discharge

File opening charges

Incidental expenses/ misc. Charges (not explained)

patient identification band/ name tag

Pulseoxymeter charges

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ItemSI. No.

List II - Items that are to be subsumed into Room Charges List III - Items that are to be subsumed into Procedure Charges

List IV - Items that are to be subsumed into costs of treatment

Admission/registration charges

Hospitalisation for evaluation/ diagnostic purpose

Urine container

Blood reservation charges and ante natal booking charges

Bipap machine

Cpap/ capo equipments

Infusion pump- cost

Hydrogen peroxide\spirit\ disinfectants etc

Nutrition planning charges - dietician charges- diet charges

Hiv kit

Antiseptic mouthwash

Lozenges

Mouth paint

Vaccination charges

Alcohol swabes

Scrub solutionisterillium

Glucometer& strips

Urine bag

ItemSI. No.1

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Appendix IIList of Day Care Treatments

Stapedotomy

Myringoplasty(type I tympanoplasty)

Revision stapedectomy

Labyrinthectomy for severe vertigo

Stapedectomy under GA

Ossiculoplasty

Myringotomy with grommet insertion

Tympanoplasty (type III)

Stapedectomy under LA

Revision of the fenestration of the inner ear.

Tympanoplasty (type IV)

Endolymphatic sac surgery for meniere's disease

Turbinectomy

Removal of tympanic drain under LA

Endoscopic stapedectomy

Fenestration of the inner ear

Incision and drainage of perichondritis

Septoplasty

Vestibular nerve section

Thyroplasty type I

Incision and drainage - haematoma auricle

Tympanoplasty (type II)

Keratosis removal under GA

Reduction of fracture of nasal bone

Excision and destruction of lingual tonsils

Conchoplasty

Thyroplasty type II

Tracheostomy

Excision of angioma septum

Turbinoplasty

Incision & drainage of retro pharyngeal abscess

Uvulopalatopharyngoplasty

Palatoplasty

Tonsillectomy without adenoidectomy

Adenoidectomy with grommet insertion

Adenoidectomy without grommet insertion

Vocal cord lateralisation procedure

Incision & drainage of para pharyngeal abscess

Transoral incision and drainage of a pharyngeal abscess

Tonsillectomy with adenoidectomy

Tracheoplasty ophthalmology

Incision of tear glands

Other operation on the tear ducts

Incision of diseased eyelids

Excision and destruction of the diseased tissue of the eyelid

Removal of foreign body from the lens of the eye.

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34

35

36

37

38

39

40

41

42

43

44

45

46

Day Care Procedure NameSI. No.Corrective surgery of the entropion and ectropion

Operations for pterygium rigid oesophagoscopy for dilation

of benign strictures

Corrective surgery of blepharoptosis

Removal of foreign body from conjunctiva

Biopsy of tear gland

Removal of foreign body from cornea

Incision of the cornea

Other operations on the cornea

Operation on the canthus and epicanthus

Removal of foreign body from the orbit and the eye ball.

Surgery for cataract

Treatment of retinal lesion

Removal of foreign body from the posterior chamber of the

eye

IV push chemotherapy

HBI-Hemibody radiotherapy

Infusional targeted therapy

SRT-Stereotactic arc therapy

SC Administration of growth factors

Continuous infusional chemotherapy

Infusional chemotherapy

CCRT-Concurrent chemo + RT

D radiotherapy

D conformal radiotherapy

IGRT- Image guided radiotherapy

IMRT- Step & shoot

Infusional bisphosphonates

IMRT- DMLC

Rotational Arc therapy

Tele gamma therapy

FSRT-Fractionated srt

VMAT-Volumetric modulated arc therapy

SBRT-Stereotactic body radiotherapy

Helical tomotherapy

SRS-Stereotactic radiosurgery

X-kKnife SRS

Gammaknife SRS

TBI- Total body radiotherapy

Intraluminal brachytherapy

Electron therapy

TSET-Total electron skin therapy

Extracorporeal irradiation of blood products

Telecobalt therapy

Telecesium therapy

External mould brachytherapy

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

Day Care Procedure NameSI. No.


Interstitial brachytherapy

Intracavity brachytherapy

D brachytherapy ORIF with plating- small long bones

Implant brachytherapy

Intravesical brachytherapy

Adjuvant radiotherapy

Afterloading catheter brachytherapy

Conditioning radiothearpy for BMT

Extracorporeal irradiation to the homologous bone grafts

Radical chemotherapy

Neoadjuvant radiotherapy

LDR brachytherapy

Palliative radiotherapy

Radical radiotherapy

Palliative chemotherapy

Template brachytherapy

Neoadjuvant chemotherapy

Adjuvant chemotherapy

Induction chemotherapy

Consolidation chemotherapy

Maintenance chemotherapy

HDR brachytherapy

Construction skin pedicle flap

Gluteal pressure ulcer-excision

Muscle-skin graft, leg

Removal of bone for graft

Muscle-skin graft duct fistula

Removal cartilage graft

Myocutaneous flap

Fibro myocutaneous flap

Breast reconstruction surgery after mastectomy

Sling operation for facial palsy

Split skin grafting under RA

Wolfe skin graft

Plastic surgery to the floor of the mouth under GA

AV fistula - wrist

URSL with stenting

URSL with lithotripsy

Cystoscopiclitholapaxy

ESWL

Haemodialysis

Bladder neck incision

Cystoscopy & biopsy

Suprapubiccystostomy

Percutaneous nephrostomy

Cystoscopy and "SLING" procedure.

TUNA- prostate

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

Day Care Procedure NameSI. No.Excision of urethral diverticulum

Removal of urethral stone

Excision of urethral prolapse

Mega-ureter reconstruction

Kidney renoscopy and biopsy

Ureter endoscopy and treatment

Vesico ureteric reflux correction

Surgery for pelvi ureteric junction obstruction

Anderson hynes operation

Kidney endoscopy and biopsy

Paraphimosis surgery

Injury prepuce- circumcision

Frenular tear repair

Meatotomy for meatal stenosis

Surgery for fournier's gangrene scrotum

Surgery filarial scrotum

Surgery for watering can perineum

Repair of penile torsion

Drainage of prostate abscess

Orchiectomy

Cystoscopy and removal of FB

Facial nerve physiotherapy

Nerve biopsy

Muscle biopsy

Epidural steroid injection

Glycerol rhizotomy

Spinal cord stimulation

Motor cortex stimulation

Stereotactic radiosurgery

Percutaneous cordotomy

Intrathecal baclofen therapy

Entrapment neuropathy release

Diagnostic cerebral angiography

VP shunt

Ventriculoatrial shunt

Thoracoscopy and lung biopsy

Excision of cervical sympathetic chain

Thoracoscopic

Laser ablation of barrett's oesophagus

Pleurodesis

Thoracoscopy and pleural biopsy

EBUS + Biopsy

Thoracoscopy ligation thoracic duct

Thoracoscopy assisted empyaema drainage

Pancreatic pseudocyst eus & drainage

Rf ablation for barrett'soesophagus

ERCP and papillotomy

138

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

181

182

183

184



Esophagoscope and sclerosant injection

EUS + Submucosal resection

Construction of gastrostomy tube

EUS+ Aspiration pancreatic cyst

Small bowel endoscopy (therapeutic)

colonoscopy ,lesion removal

ERCP

Colonscopy stenting of stricture

Percutaneous endoscopic gastrostomy

EUS and pancreatic pseudo cyst drainage

ERCP and choledochoscopy

Proctosigmoidoscopy volvulus detorsion

ERCP and sphincterotomy

Esophageal stent placement

ERCP + placement of biliary stents

Sigmoidoscopy w / stent

EUS + coeliac node biopsy

Infected keloid excision

Incision of a pilonidal sinus / abscess

Axillary lymphadenectomy

Abscess-decompression

Cervical lymphadenectomy

Inguinal lymphadenectomy

Suturing of lacerations

Maximal anal dilatation

Piles

A) Injection sclerotherapy

B) Piles banding

Liver abscess- catheter drainage

Fissure in ano-fissurectomy

Fibroadenoma breast excision

Oesophagealvaricessclerotherapy

ERCP - pancreatic duct stone removal

Perianal abscess I & D

Perianal hematoma evacuation

Fissure in anosphincterotomy

UGI scopy and polypectomyoesophagus

Breast abscess I & D

Feeding gastrostomy

Oesophagoscopy and biopsy of growth oesophagus

UGI scopy and injection of adrenaline, sclerosants -

bleeding ulcers

ERCP - bile duct stone removal

Ileostomy closure

Colonoscopy

Polypectomy colon

Splenic abscesses laparoscopic drainage

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

219

220

221

222

223

224

225

226

227

228

Day Care Procedure NameSI. No.UGI SCOPY and polypectomy stomach

Rigid oesophagoscopy for FB removal

Feeding jejunostomy

Colostomy

Ileostomy

Colostomy closure

Submandibular salivary duct stone removal

Pneumatic reduction of intussusception

Varicose veins legs - injection sclerotherapy

Rigid oesophagoscopy for plummer vinson syndrome

Pancreatic pseudocysts endoscopic drainage

ZADEK's nail bed excision

Subcutaneous mastectomy

Excision of ranula under GA

Eversion of Sac

A) Unilateral

B) Bilateral

Lord's plication

Jaboulay's procedure

Scrotoplasty

Surgical treatment of varicocele

Epididymectomy

Circumcision for trauma

Meatoplasty

Intersphincteric abscess incision and drainage

Psoas abscess incision and drainage

Thyroid abscess incision and drainage

TIPS procedure for portal hypertension

Esophageal growth stent

PAIR procedure of hydatid cyst liver

Tru cut liver biopsy

Photodynamic therapy or esophageal tumour and lung

tumour

Excision of cervical RIB

Laparoscopic reduction of intussusception

Microdochectomy breast

Surgery for fracture penis

Sentinel node biopsy

Parastomal hernia

Revision colostomy

Prolapsed colostomy- correction

Testicular biopsy

Laparoscopic cardiomyotomy( Hellers)

sentinel node biopsy malignant melanoma

Laparoscopic pyloromyotomy( Ramstedt)

arthroscopic repair of ACL tear knee

Closed reduction of minor fractures

229

230

231

232

233

234

235

236

237

238

239

240

241

242

243

244

245

246

247

248

249

250

251

252

253

254

255

256

257

258

259

260

261

262

263

264

265

266

267

268

269

270

271

272



Arthroscopic repair of PCL tear knee

Tendon shortening

Arthroscopic meniscectomy - knee

Reatment of clavicle dislocation

Rthroscopic meniscus repair

Haemarthrosis knee- lavage

Abscess knee joint drainage

Carpal tunnel release

Closed reduction of minor dislocation

Repair of knee cap tendon

ORIF with K wire fixation- small bones

Release of midfoot joint

Implant removal minor

K wire removal

POP application

Closed reduction and external fixation

Arthrotomy hip joint

Syme's amputation

Arthroplasty

Partial removal of RIB

Treatment of sesamoid bone fracture

Shoulder arthroscopy / surgery

Elbow arthroscopy

Amputation of metacarpal bone

Release of thumb contracture

Incision of foot fascia

Calcaneum spur hydrocort injection

Ganglion wrist hyalase injection

Partial removal of metatarsal

Repair / graft of foot tendon

Revision/removal of knee cap

Amputation follow-up surgery

Exploration of ankle joint

Remove/graft leg bone lesion

Repair/graft achilles tendon

Remove of tissue expander

Biopsy elbow joint lining

Removal of wrist prosthesis

Biopsy finger joint lining

Tendon lengthening

Treatment of shoulder dislocation

Lengthening of hand tendon

Removal of elbow bursa

Fixation of knee joint

Treatment of foot dislocation

Surgery of bunion

Intra articular steroid injection

273

274

275

276

277

278

279

280

281

282

283

284

285

286

287

288

289

290

291

292

293

294

295

296

297

298

299

300

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

319

Day Care Procedure NameSI. No.Tendon transfer procedure

Removal of knee cap bursa

Treatment of fracture of ulna

Treatment of scapula fracture

Removal of tumor of arm/ elbow under RA/GA

Repair of ruptured tendon

Decompress forearm space cystoscopy and removal of

polyp revision of neck muscle ( Torticollis release )

Lengthening of thigh tendons

Treatment fracture of radius & ulna

Repair of knee joint paediatric surgery

Excision juvenile polyps rectum

Vaginoplasty

Dilatation of accidental caustic stricture oesophageal

Presacral teratomas excision

Removal of vesical stone

Excision sigmoid polyp

Sternomastoid tenotomy

Infantile hypertrophic pyloric stenosis pyloromyotomy

Excision of soft tissue rhabdomyosarcoma

Mediastinal lymph node biopsy

High orchidectomy for testis tumours

Excision of cervical teratoma

Rectal-Myomectomy

Rectal prolapse (Delorme's procedure)

Orchidopexy for undescended testis

Detorsion of torsion testis

Lap.Abdominal exploration in cryptorchidism

EUA + Biopsy multiple fistula in ano

Cystic hygroma - injection treatment

Excision of fistula-in-ano

Hysteroscopic removal of myoma

D & C

Hysteroscopic resection of septum

Thermal cauterisation of cervix

Hysteroscopicadhesiolysis

LEEP

Cryocauterisation of cervix

Polypectomy endometrium

Hysteroscopic resection of fibroid

LLETZ

Conization

Polypectomy cervix

Hysteroscopic resection of endometrial polyp

Vulval wart excision

Laparoscopic paraovarian cyst excision

Uterine artery embolization

320

321

322

323

324

325

326

327

328

329

330

331

332

333

334

335

336

337

338

339

340

341

342

343

344

345

346

347

348

349

350

351

352

353

354

355

356

357

358

359

360

361

362

363

364

365



Bartholin cyst excision

Laparoscopic cystectomy

Hymenectomy ( imperforate hymen)

Endometrial ablation

Vaginal wall cyst excision

Vulval cyst excision

Laparoscopic paratubal cyst excision

Repair of vagina ( vaginal atresia )

Hysteroscopy, removal of myoma

TURBT

Ureterocoele repair - congenital internal

Vaginal mesh for POP

Laparoscopic myomectomy

Surgery for SUI

Repair recto- vagina fistula

Pelvic floor repair( excluding fistula repair)

URS + ll

Laparoscopic oophorectomy

Insert non- tunnel CV cath

Insert PICC cath ( peripherally inserted central catheter)

Replace PICC cath ( peripherally inserted central catheter )

Insertion catheter, intra anterior

IInsertion of portacath

366

367

368

369

370

371

372

373

374

375

376

377

378

379

380

381

382

383

384

385

386

387

388


Note: 1. Any surgery/procedure (not listed above) which due to advancement of medical science requires hospitalization for less than 24 hours will require prior approval from company/TPA.2. The standard exclusions and waiting periods are applicable to all of the above day care procedures / surgeries depending on the medical condition / disease under treatment. Only 24 hours hospitalization is not mandatory.Disclaimer: The Company’s Claims Team may modify /edit above list, consider other treatments as day care treatments depending on the treatment.

PROHIBITION OF REBATES (Under Section 41 of Insurance Act 1938)1. No person shall or offer to allow either directly of indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in accordence with the published prospectus or tables of the Insurer.

2. Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to `10 Lakhs.

The rate charts have been provided as Annexure-B


RATE CHART


Annexure-B1. Rate Chart(Exclusive of GST)

Age/Sum

Insured

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

100000

1,264

1,234

1,199

1,164

1,134

1,099

1,074

1,044

1,024

999

979

964

949

934

924

919

914

919

919

924

934

949

964

989

1,014

1,049

1,084

1,119

1,164

1,214

1,269

1,329

1,394

1,464

1,539

1,624

1,714

50000

999

974

944

919

894

869

844

824

804

789

774

759

749

739

729

724

719

724

724

729

739

749

764

779

799

824

854

884

919

954

999

1,044

1,094

1,149

1,209

1,274

1,344

150000

1,814

1,764

1,714

1,664

1,619

1,574

1,534

1,499

1,464

1,434

1,404

1,379

1,359

1,339

1,329

1,319

1,314

1,314

1,319

1,324

1,339

1,359

1,384

1,414

1,454

1,499

1,549

1,604

1,669

1,739

1,819

1,904

1,999

2,099

2,209

2,329

2,459

200000

2,199

2,139

2,079

2,019

1,964

1,914

1,864

1,819

1,779

1,739

1,704

1,679

1,649

1,629

1,614

1,599

1,594

1,594

1,599

1,609

1,629

1,649

1,684

1,719

1,764

1,819

1,884

1,954

2,029

2,114

2,209

2,314

2,429

2,554

2,689

2,834

2,989

250000

2,504

2,439

2,369

2,304

2,239

2,179

2,124

2,074

2,024

1,979

1,944

1,909

1,879

1,854

1,839

1,824

1,814

1,819

1,824

1,834

1,854

1,879

1,914

1,959

2,009

2,074

2,144

2,224

2,314

2,409

2,519

2,639

2,769

2,914

3,064

3,229

3,409

300000

2,759

2,679

2,604

2,534

2,464

2,399

2,339

2,279

2,229

2,179

2,139

2,104

2,069

2,044

2,024

2,009

1,999

2,004

2,009

2,019

2,039

2,069

2,109

2,159

2,214

2,284

2,359

2,449

2,549

2,654

2,774

2,909

3,049

3,209

3,379

3,559

3,759

350000

2,974

2,889

2,809

2,734

2,659

2,589

2,524

2,459

2,404

2,354

2,304

2,269

2,234

2,204

2,179

2,164

2,154

2,159

2,164

2,179

2,199

2,234

2,274

2,329

2,389

2,464

2,544

2,639

2,749

2,864

2,994

3,139

3,294

3,459

3,644

3,844

4,059

400000

3,164

3,079

2,989

2,909

2,829

2,754

2,684

2,619

2,559

2,504

2,454

2,414

2,379

2,344

2,324

2,304

2,294

2,299

2,304

2,319

2,344

2,379

2,424

2,479

2,544

2,624

2,709

2,814

2,924

3,049

3,189

3,339

3,509

3,689

3,884

4,094

4,324

450000

3,329

3,239

3,149

3,059

2,979

2,899

2,824

2,759

2,694

2,634

2,584

2,544

2,504

2,469

2,444

2,429

2,419

2,419

2,424

2,439

2,464

2,504

2,549

2,609

2,679

2,759

2,854

2,964

3,079

3,214

3,359

3,519

3,694

3,884

4,089

4,314

4,554

500000

3,479

3,384

3,289

3,199

3,114

3,029

2,954

2,884

2,819

2,754

2,704

2,659

2,614

2,584

2,554

2,539

2,529

2,529

2,534

2,554

2,579

2,619

2,664

2,729

2,799

2,889

2,984

3,099

3,224

3,359

3,514

3,679

3,864

4,064

4,279

4,514

4,764


37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

1,419

1,499

1,584

1,674

1,769

1,874

1,979

2,094

2,214

2,344

2,479

2,619

2,764

2,919

3,084

3,249

3,429

3,614

3,819

4,024

4,234

4,454

4,684

4,919

5,169

5,424

5,689

5,969

6,254

6,539

6,849

7,169

7,504

7,854

8,179

8,514

8,859

9,214

9,584

9,964

10,354

10,754

1,809

1,909

2,019

2,134

2,259

2,394

2,534

2,679

2,834

3,004

3,174

3,359

3,549

3,749

3,959

4,179

4,409

4,649

4,914

5,179

5,454

5,744

6,039

6,354

6,679

7,014

7,364

7,729

8,104

8,469

8,879

9,309

9,754

10,219

10,629

11,054

11,494

11,944

12,409

12,889

13,384

13,889

2,594

2,744

2,899

3,069

3,249

3,439

3,639

3,854

4,079

4,319

4,569

4,834

5,109

5,399

5,699

6,019

6,349

6,699

7,079

7,459

7,854

8,274

8,704

9,154

9,624

10,114

10,619

11,144

11,694

12,219

12,814

13,434

14,079

14,754

15,349

15,959

16,594

17,244

17,919

18,609

19,319

20,054

3,159

3,339

3,529

3,734

3,954

4,189

4,434

4,694

4,969

5,264

5,569

5,889

6,229

6,584

6,954

7,344

7,749

8,174

8,634

9,104

9,589

10,099

10,629

11,184

11,759

12,359

12,979

13,629

14,299

14,939

15,669

16,434

17,229

18,064

18,784

19,529

20,299

21,089

21,909

22,749

23,614

24,509

3,604

3,809

4,029

4,264

4,514

4,779

5,064

5,359

5,679

6,014

6,364

6,734

7,119

7,529

7,954

8,399

8,864

9,354

9,879

10,414

10,974

11,559

12,174

12,809

13,469

14,159

14,874

15,619

16,394

17,124

17,969

18,849

19,769

20,729

21,554

22,399

23,274

24,179

25,109

26,064

27,049

28,069

3,969

4,199

4,439

4,699

4,979

5,274

5,584

5,914

6,264

6,634

7,024

7,434

7,864

8,314

8,784

9,279

9,794

10,334

10,919

11,514

12,134

12,784

13,464

14,169

14,904

15,669

16,464

17,294

18,154

18,959

19,899

20,884

21,909

22,979

23,884

24,819

25,779

26,769

27,789

28,844

29,929

31,044

4,284

4,534

4,794

5,074

5,374

5,694

6,034

6,389

6,769

7,174

7,594

8,039

8,504

8,994

9,504

10,039

10,599

11,189

11,819

12,464

13,139

13,844

14,584

15,349

16,149

16,984

17,849

18,749

19,689

20,559

21,584

22,659

23,779

24,949

25,924

26,929

27,964

29,029

30,129

31,264

32,429

33,629

4,569

4,829

5,109

5,409

5,734

6,074

6,434

6,819

7,224

7,654

8,104

8,584

9,079

9,604

10,149

10,724

11,324

11,954

12,629

13,319

14,044

14,804

15,594

16,419

17,279

18,169

19,099

20,069

21,079

22,009

23,109

24,264

25,474

26,739

27,769

28,834

29,934

31,069

32,239

33,444

34,684

35,959

4,814

5,089

5,384

5,704

6,044

6,404

6,784

7,189

7,619

8,074

8,554

9,059

9,584

10,134

10,714

11,319

11,959

12,624

13,339

14,074

14,839

15,644

16,484

17,359

18,269

19,219

20,204

21,234

22,304

23,284

24,459

25,689

26,974

28,319

29,404

30,524

31,679

32,874

34,099

35,364

36,669

38,009

5,039

5,329

5,639

5,969

6,324

6,704

7,104

7,529

7,979

8,459

8,959

9,489

10,044

10,624

11,234

11,869

12,539

13,239

13,994

14,764

15,574

16,419

17,304

18,224

19,184

20,184

21,224

22,309

23,439

24,464

25,704

27,004

28,364

29,789

30,919

32,089

33,294

34,534

35,814

37,134

38,494

39,894


79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

11,164

11,589

11,699

11,809

11,919

12,034

12,144

12,259

12,369

12,484

12,599

12,714

12,829

12,944

13,059

13,179

13,294

13,414

13,534

13,654

13,774

13,894

14,014

14,139

14,259

14,384

14,509

14,634

14,759

14,884

15,009

15,134

15,264

15,389

15,519

15,649

15,779

15,909

16,039

16,169

16,304

16,434

14,414

14,954

15,089

15,229

15,374

15,514

15,654

15,799

15,944

16,089

16,234

16,379

16,524

16,674

16,824

16,969

17,119

17,269

17,424

17,574

17,729

17,884

18,034

18,189

18,349

18,504

18,664

18,819

18,979

19,139

19,299

19,459

19,624

19,784

19,949

20,114

20,279

20,444

20,609

20,779

20,944

21,114

20,809

21,584

21,789

21,994

22,199

22,404

22,609

22,819

23,029

23,239

23,449

23,659

23,874

24,089

24,304

24,524

24,739

24,959

25,179

25,399

25,624

25,844

26,069

26,294

26,524

26,749

26,979

27,209

27,439

27,674

27,909

28,139

28,379

28,614

28,849

29,089

29,329

29,569

29,814

30,059

30,299

30,549

25,424

26,369

26,614

26,864

27,114

27,364

27,614

27,869

28,124

28,379

28,639

28,899

29,159

29,419

29,684

29,949

30,214

30,479

30,749

31,019

31,289

31,559

31,834

32,109

32,384

32,664

32,944

33,224

33,504

33,789

34,074

34,359

34,644

34,934

35,224

35,514

35,809

36,099

36,399

36,694

36,989

37,289

29,114

30,189

30,469

30,749

31,034

31,319

31,609

31,899

32,189

32,479

32,774

33,069

33,364

33,664

33,964

34,264

34,569

34,874

35,179

35,484

35,794

36,104

36,414

36,729

37,044

37,359

37,679

37,999

38,319

38,644

38,969

39,294

39,619

39,949

40,279

40,609

40,944

41,279

41,614

41,954

42,294

42,634

32,194

33,374

33,684

33,994

34,309

34,624

34,939

35,254

35,574

35,894

36,219

36,544

36,869

37,199

37,529

37,859

38,194

38,524

38,864

39,199

39,539

39,879

40,224

40,569

40,914

41,264

41,614

41,964

42,319

42,674

43,029

43,389

43,749

44,109

44,474

44,839

45,204

45,574

45,944

46,314

46,689

47,064

34,869

36,139

36,474

36,809

37,144

37,484

37,824

38,164

38,509

38,854

39,204

39,549

39,904

40,254

40,609

40,969

41,324

41,684

42,049

42,409

42,779

43,144

43,514

43,884

44,259

44,634

45,009

45,389

45,769

46,149

46,534

46,919

47,309

47,699

48,089

48,479

48,874

49,274

49,669

50,069

50,474

50,879

37,274

38,624

38,979

39,334

39,694

40,054

40,414

40,779

41,144

41,509

41,879

42,254

42,624

42,999

43,379

43,754

44,139

44,519

44,904

45,294

45,679

46,069

46,464

46,859

47,254

47,654

48,054

48,454

48,859

49,264

49,674

50,084

50,494

50,909

51,324

51,744

52,159

52,584

53,004

53,429

53,859

54,289

39,389

40,809

41,179

41,554

41,929

42,309

42,689

43,069

43,454

43,839

44,224

44,614

45,009

45,404

45,799

46,194

46,594

46,999

47,404

47,809

48,219

48,629

49,039

49,454

49,869

50,289

50,709

51,129

51,554

51,984

52,409

52,839

53,274

53,709

54,144

54,584

55,024

55,464

55,909

56,359

56,804

57,259

41,334

42,814

43,199

43,589

43,984

44,379

44,774

45,174

45,574

45,974

46,379

46,784

47,194

47,604

48,019

48,434

48,849

49,269

49,694

50,114

50,539

50,969

51,399

51,829

52,264

52,704

53,139

53,579

54,024

54,469

54,914

55,364

55,814

56,269

56,724

57,179

57,639

58,104

58,564

59,034

59,499

59,969


Rate Grid for the additional Child for floater combinations beyond 3C Premium rates excluding service tax

Age/Sum

Insured

For all

ages

100000

731

50000

577

150000

1,039

200000

1,270

250000

1,462

300000

1,578

350000

1,732

400000

1,809

450000

1,924

500000

2,001

Age/Sum

Insured

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

550000

3,659

3,549

3,444

3,339

3,244

3,149

3,064

2,984

2,909

2,844

2,784

2,734

2,689

2,649

2,619

2,594

2,579

2,579

2,584

2,599

2,619

2,659

2,704

2,764

2,839

2,924

3,019

3,134

3,259

600000

3,839

3,719

3,594

3,484

3,374

3,274

3,174

3,089

3,004

2,934

2,864

2,809

2,759

2,714

2,679

2,654

2,634

2,629

2,634

2,644

2,664

2,699

2,744

2,804

2,874

2,959

3,059

3,169

3,294

650000

4,019

3,884

3,749

3,624

3,504

3,394

3,289

3,189

3,099

3,019

2,949

2,884

2,829

2,779

2,739

2,709

2,689

2,684

2,679

2,689

2,709

2,744

2,784

2,844

2,914

2,999

3,094

3,204

3,329

700000

4,199

4,049

3,904

3,764

3,634

3,514

3,399

3,294

3,194

3,109

3,029

2,959

2,899

2,844

2,804

2,769

2,744

2,734

2,729

2,734

2,749

2,784

2,824

2,884

2,949

3,034

3,129

3,244

3,364

750000

4,379

4,214

4,054

3,904

3,764

3,634

3,509

3,394

3,289

3,194

3,109

3,034

2,969

2,909

2,864

2,824

2,799

2,784

2,779

2,779

2,794

2,824

2,869

2,924

2,989

3,074

3,164

3,279

3,404

800000

4,479

4,309

4,144

3,989

3,844

3,709

3,579

3,464

3,359

3,259

3,169

3,094

3,024

2,964

2,919

2,879

2,849

2,834

2,829

2,829

2,844

2,874

2,919

2,974

3,039

3,124

3,224

3,334

3,464

850000

4,574

4,399

4,229

4,074

3,924

3,784

3,654

3,534

3,424

3,324

3,229

3,154

3,084

3,024

2,969

2,929

2,899

2,884

2,879

2,879

2,894

2,929

2,969

3,024

3,094

3,179

3,279

3,394

3,524

900000

4,674

4,494

4,319

4,154

4,004

3,859

3,724

3,604

3,489

3,384

3,294

3,214

3,139

3,079

3,024

2,984

2,954

2,939

2,929

2,929

2,944

2,979

3,019

3,079

3,149

3,234

3,334

3,454

3,584

950000

4,769

4,584

4,409

4,239

4,079

3,934

3,799

3,669

3,554

3,449

3,354

3,269

3,199

3,134

3,079

3,034

3,004

2,989

2,979

2,979

2,994

3,029

3,069

3,129

3,199

3,289

3,389

3,509

3,644

1000000

4,869

4,679

4,494

4,324

4,159

4,009

3,869

3,739

3,619

3,514

3,414

3,329

3,254

3,189

3,134

3,089

3,054

3,039

3,029

3,029

3,044

3,079

3,124

3,179

3,254

3,344

3,449

3,569

3,704

1 Adult/1 Child


29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

3,394

3,549

3,719

3,904

4,099

4,319

4,554

4,809

5,079

5,374

5,684

6,019

6,379

6,764

7,169

7,599

8,054

8,539

9,049

9,584

10,149

10,739

11,354

12,004

12,684

13,399

14,164

14,954

15,779

16,644

17,549

18,489

19,474

20,499

21,569

22,684

23,844

24,894

26,174

27,514

28,919

30,399

3,434

3,584

3,754

3,939

4,139

4,359

4,594

4,849

5,124

5,419

5,734

6,069

6,434

6,819

7,229

7,664

8,129

8,619

9,134

9,679

10,249

10,849

11,479

12,139

12,829

13,559

14,339

15,139

15,984

16,869

17,794

18,759

19,769

20,819

21,919

23,059

24,254

25,324

26,644

28,024

29,479

31,009

3,469

3,619

3,789

3,974

4,174

4,394

4,634

4,889

5,164

5,464

5,779

6,119

6,489

6,879

7,294

7,734

8,199

8,699

9,224

9,774

10,354

10,964

11,599

12,269

12,974

13,714

14,509

15,329

16,189

17,094

18,039

19,029

20,059

21,139

22,264

23,439

24,664

25,754

27,109

28,539

30,039

31,619

3,504

3,659

3,829

4,014

4,214

4,434

4,674

4,929

5,209

5,509

5,829

6,169

6,539

6,939

7,354

7,799

8,274

8,779

9,309

9,869

10,459

11,074

11,724

12,404

13,119

13,874

14,684

15,519

16,394

17,319

18,284

19,294

20,354

21,454

22,609

23,814

25,074

26,184

27,579

29,049

30,599

32,229

3,539

3,694

3,864

4,049

4,254

4,474

4,714

4,974

5,254

5,554

5,874

6,224

6,594

6,994

7,419

7,869

8,349

8,859

9,394

9,964

10,559

11,189

11,844

12,534

13,264

14,034

14,854

15,704

16,604

17,544

18,529

19,564

20,644

21,774

22,959

24,189

25,484

26,614

28,049

29,564

31,159

32,839

3,604

3,759

3,934

4,124

4,329

4,554

4,799

5,064

5,349

5,659

5,984

6,339

6,724

7,134

7,569

8,024

8,519

9,044

9,594

10,179

10,789

11,434

12,104

12,814

13,564

14,354

15,199

16,074

16,994

17,964

18,984

20,044

21,159

22,324

23,544

24,819

26,149

27,309

28,794

30,359

32,009

33,749

3,669

3,824

4,004

4,194

4,404

4,639

4,884

5,159

5,449

5,759

6,099

6,459

6,854

7,269

7,714

8,184

8,689

9,229

9,789

10,389

11,014

11,674

12,369

13,094

13,864

14,674

15,539

16,439

17,389

18,389

19,434

20,524

21,674

22,874

24,129

25,444

26,819

28,004

29,534

31,154

32,859

34,659

3,729

3,894

4,074

4,269

4,484

4,719

4,974

5,249

5,549

5,864

6,209

6,579

6,979

7,409

7,864

8,344

8,859

9,409

9,989

10,604

11,244

11,919

12,629

13,374

14,164

14,994

15,884

16,809

17,779

18,809

19,884

21,009

22,189

23,424

24,714

26,069

27,484

28,699

30,279

31,949

33,709

35,569

3,794

3,959

4,144

4,344

4,559

4,799

5,059

5,339

5,644

5,969

6,319

6,699

7,109

7,544

8,009

8,499

9,029

9,594

10,184

10,814

11,469

12,164

12,889

13,654

14,464

15,314

16,229

17,174

18,174

19,229

20,334

21,489

22,704

23,969

25,299

26,694

28,149

29,394

31,024

32,744

34,559

36,484

3,859

4,024

4,209

4,419

4,639

4,884

5,144

5,434

5,744

6,074

6,434

6,819

7,234

7,684

8,159

8,659

9,199

9,779

10,384

11,029

11,699

12,409

13,149

13,934

14,759

15,634

16,569

17,544

18,569

19,649

20,784

21,969

23,219

24,519

25,889

27,319

28,814

30,089

31,764

33,539

35,409

37,394


71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

31,549

32,739

33,969

35,234

36,544

37,889

39,279

40,709

42,184

43,704

44,114

44,529

44,944

45,364

45,789

46,214

46,639

47,074

47,504

47,944

48,379

48,824

49,269

49,714

50,164

50,619

51,074

51,534

51,994

52,459

52,924

53,394

53,869

54,344

54,824

55,304

55,789

56,274

56,764

57,254

57,749

58,249

32,179

33,394

34,644

35,934

37,269

38,644

40,064

41,529

43,039

44,589

45,024

45,464

45,909

46,354

46,799

47,254

47,709

48,169

48,634

49,099

49,569

50,039

50,519

50,999

51,479

51,969

52,459

52,954

53,449

53,949

54,454

54,959

55,474

55,989

56,504

57,024

57,549

58,079

58,609

59,144

59,684

60,224

32,809

34,044

35,319

36,634

37,994

39,399

40,849

42,344

43,889

45,479

45,939

46,399

46,869

47,339

47,814

48,294

48,779

49,264

49,759

50,254

50,754

51,259

51,769

52,279

52,794

53,314

53,839

54,369

54,904

55,439

55,979

56,524

57,074

57,629

58,189

58,749

59,314

59,884

60,459

61,034

61,619

62,204

33,444

34,699

35,994

37,334

38,724

40,154

41,634

43,164

44,739

46,369

46,849

47,339

47,829

48,329

48,829

49,334

49,849

50,364

50,884

51,409

51,939

52,474

53,014

53,559

54,109

54,664

55,224

55,789

56,359

56,929

57,509

58,089

58,679

59,274

59,869

60,469

61,079

61,689

62,304

62,929

63,554

64,184

34,074

35,349

36,669

38,034

39,449

40,909

42,419

43,979

45,594

47,254

47,764

48,274

48,794

49,314

49,844

50,379

50,914

51,459

52,009

52,564

53,129

53,694

54,264

54,844

55,424

56,014

56,609

57,204

57,809

58,419

59,034

59,659

60,284

60,914

61,549

62,194

62,839

63,494

64,154

64,819

65,489

66,164

35,009

36,319

37,669

39,069

40,514

42,009

43,559

45,154

46,804

48,509

49,034

49,564

50,099

50,644

51,189

51,744

52,299

52,864

53,434

54,009

54,594

55,179

55,774

56,369

56,974

57,584

58,204

58,824

59,449

60,084

60,724

61,369

62,019

62,674

63,334

63,999

64,674

65,354

66,039

66,729

67,424

68,124

35,949

37,284

38,669

40,099

41,579

43,109

44,694

46,329

48,019

49,764

50,309

50,854

51,409

51,969

52,534

53,109

53,684

54,269

54,859

55,454

56,059

56,664

57,279

57,899

58,524

59,159

59,794

60,439

61,089

61,744

62,409

63,079

63,749

64,429

65,119

65,809

66,509

67,214

67,924

68,639

69,359

70,089

36,889

38,254

39,664

41,129

42,644

44,209

45,829

47,504

49,234

51,019

51,579

52,144

52,719

53,299

53,879

54,474

55,069

55,674

56,284

56,899

57,524

58,149

58,789

59,429

60,074

60,729

61,389

62,059

62,729

63,409

64,094

64,789

65,484

66,189

66,899

67,619

68,339

69,069

69,804

70,549

71,299

72,054

37,829

39,219

40,664

42,159

43,709

45,309

46,964

48,679

50,449

52,274

52,854

53,439

54,029

54,624

55,229

55,839

56,454

57,079

57,709

58,344

58,989

59,639

60,294

60,954

61,624

62,304

62,984

63,674

64,369

65,074

65,779

66,499

67,219

67,949

68,684

69,424

70,174

70,929

71,689

72,459

73,234

74,014

38,764

40,189

41,664

43,189

44,774

46,409

48,099

49,854

51,659

53,529

54,124

54,729

55,334

55,949

56,574

57,204

57,839

58,484

59,134

59,789

60,454

61,124

61,799

62,484

63,174

63,874

64,579

65,289

66,009

66,734

67,469

68,209

68,954

69,704

70,464

71,234

72,009

72,789

73,574

74,369

75,169

75,979


113

114

115

116

117

118

119

120

58,749

59,249

59,759

60,264

60,779

61,289

61,809

62,329

60,769

61,319

61,874

62,429

62,989

63,549

64,114

64,684

62,794

63,389

63,989

64,589

65,199

65,809

66,424

67,044

64,819

65,459

66,104

66,754

67,409

68,069

68,734

69,399

66,844

67,529

68,219

68,919

69,619

70,324

71,039

71,759

68,834

69,544

70,264

70,989

71,719

72,454

73,199

73,944

70,824

71,564

72,309

73,064

73,819

74,584

75,354

76,129

72,814

73,579

74,354

75,134

75,919

76,714

77,514

78,319

74,804

75,599

76,399

77,209

78,024

78,844

79,669

80,504

76,794

77,614

78,444

79,279

80,124

80,974

81,829

82,689

Rate Grid for the additional Child for floater combinations beyond 3CPremium rates excluding service tax

Age/Sum

Insured

For all

ages

550000

2,040

600000

2,117

650000

2,155

700000

2,194

750000

2,271

800000

2,309

850000

2,348

900000

2,386

950000

2,425

1000000

2,463

Number of Members

2

3

4

5

6

>=7

Discount

20%

25%

30%

35%

40%

45%

2. Discounts/LoadingsDiscounts2.1. Family discountA discount of 5% on total premium will be given if two or more family members are covered under the same policy under the individual policy option. This is based on expected expense savings.2.2. Online DiscountA discount of 15% on total premium will be given considering the savings on commission.2.3. Edelweiss group employee discountA 5% discount on the premium if he/she is an employee of Edelweiss Group. This is based on expected expense savings.2.4. Family Floater discountThe below family floater discount would be applied on the total premium based on the number of people in the family.

Online and Edelweiss Group employee discount will be applied on total premium after family floater discount in floater policies.


1. Rate Chart(inclusive of GST)

Age/Sum

Insured

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

100000

1,492

1,456

1,415

1,374

1,338

1,297

1,267

1,232

1,208

1,179

1,155

1,138

1,120

1,102

1,090

1,084

1,079

1,084

1,084

1,090

1,102

1,120

1,138

1,167

1,197

1,238

1,279

1,320

1,374

1,433

1,497

1,568

1,645

1,728

1,816

1,916

2,023

50000

1,179

1,149

1,114

1,084

1,055

1,025

996

972

949

931

913

896

884

872

860

854

848

854

854

860

872

884

902

919

943

972

1,008

1,043

1,084

1,126

1,179

1,232

1,291

1,356

1,427

1,503

1,586

150000

2,141

2,082

2,023

1,964

1,910

1,857

1,810

1,769

1,728

1,692

1,657

1,627

1,604

1,580

1,568

1,556

1,551

1,551

1,556

1,562

1,580

1,604

1,633

1,669

1,716

1,769

1,828

1,893

1,969

2,052

2,146

2,247

2,359

2,477

2,607

2,748

2,902

200000

2,595

2,524

2,453

2,382

2,318

2,259

2,200

2,146

2,099

2,052

2,011

1,981

1,946

1,922

1,905

1,887

1,881

1,881

1,887

1,899

1,922

1,946

1,987

2,028

2,082

2,146

2,223

2,306

2,394

2,495

2,607

2,731

2,866

3,014

3,173

3,344

3,527

250000

2,955

2,878

2,795

2,719

2,642

2,571

2,506

2,447

2,388

2,335

2,294

2,253

2,217

2,188

2,170

2,152

2,141

2,146

2,152

2,164

2,188

2,217

2,259

2,312

2,371

2,447

2,530

2,624

2,731

2,843

2,972

3,114

3,267

3,439

3,616

3,810

4,023

300000

3,256

3,161

3,073

2,990

2,908

2,831

2,760

2,689

2,630

2,571

2,524

2,483

2,441

2,412

2,388

2,371

2,359

2,365

2,371

2,382

2,406

2,441

2,489

2,548

2,613

2,695

2,784

2,890

3,008

3,132

3,273

3,433

3,598

3,787

3,987

4,200

4,436

350000

3,509

3,409

3,315

3,226

3,138

3,055

2,978

2,902

2,837

2,778

2,719

2,677

2,636

2,601

2,571

2,554

2,542

2,548

2,554

2,571

2,595

2,636

2,683

2,748

2,819

2,908

3,002

3,114

3,244

3,380

3,533

3,704

3,887

4,082

4,300

4,536

4,790

400000

3,734

3,633

3,527

3,433

3,338

3,250

3,167

3,090

3,020

2,955

2,896

2,849

2,807

2,766

2,742

2,719

2,707

2,713

2,719

2,736

2,766

2,807

2,860

2,925

3,002

3,096

3,197

3,321

3,450

3,598

3,763

3,940

4,141

4,353

4,583

4,831

5,102

450000

3,928

3,822

3,716

3,610

3,515

3,421

3,332

3,256

3,179

3,108

3,049

3,002

2,955

2,913

2,884

2,866

2,854

2,854

2,860

2,878

2,908

2,955

3,008

3,079

3,161

3,256

3,368

3,498

3,633

3,793

3,964

4,152

4,359

4,583

4,825

5,091

5,374

500000

4,105

3,993

3,881

3,775

3,675

3,574

3,486

3,403

3,326

3,250

3,191

3,138

3,085

3,049

3,014

2,996

2,984

2,984

2,990

3,014

3,043

3,090

3,144

3,220

3,303

3,409

3,521

3,657

3,804

3,964

4,147

4,341

4,560

4,796

5,049

5,327

5,622

1 Adult/1 Child


37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

1,674

1,769

1,869

1,975

2,087

2,211

2,335

2,471

2,613

2,766

2,925

3,090

3,262

3,444

3,639

3,834

4,046

4,265

4,506

4,748

4,996

5,256

5,527

5,804

6,099

6,400

6,713

7,043

7,380

7,716

8,082

8,459

8,855

9,268

9,651

10,047

10,454

10,873

11,309

11,758

12,218

12,690

2,135

2,253

2,382

2,518

2,666

2,825

2,990

3,161

3,344

3,545

3,745

3,964

4,188

4,424

4,672

4,931

5,203

5,486

5,799

6,111

6,436

6,778

7,126

7,498

7,881

8,277

8,690

9,120

9,563

9,993

10,477

10,985

11,510

12,058

12,542

13,044

13,563

14,094

14,643

15,209

15,793

16,389

3,061

3,238

3,421

3,621

3,834

4,058

4,294

4,548

4,813

5,096

5,391

5,704

6,029

6,371

6,725

7,102

7,492

7,905

8,353

8,802

9,268

9,763

10,271

10,802

11,356

11,935

12,530

13,150

13,799

14,418

15,121

15,852

16,613

17,410

18,112

18,832

19,581

20,348

21,144

21,959

22,796

23,664

3,728

3,940

4,164

4,406

4,666

4,943

5,232

5,539

5,863

6,212

6,571

6,949

7,350

7,769

8,206

8,666

9,144

9,645

10,188

10,743

11,315

11,917

12,542

13,197

13,876

14,584

15,315

16,082

16,873

17,628

18,489

19,392

20,330

21,316

22,165

23,044

23,953

24,885

25,853

26,844

27,865

28,921

4,253

4,495

4,754

5,032

5,327

5,639

5,976

6,324

6,701

7,097

7,510

7,946

8,400

8,884

9,386

9,911

10,460

11,038

11,657

12,289

12,949

13,640

14,365

15,115

15,893

16,708

17,551

18,430

19,345

20,206

21,203

22,242

23,327

24,460

25,434

26,431

27,463

28,531

29,629

30,756

31,918

33,121

4,683

4,955

5,238

5,545

5,875

6,223

6,589

6,979

7,392

7,828

8,288

8,772

9,280

9,811

10,365

10,949

11,557

12,194

12,884

13,587

14,318

15,085

15,888

16,719

17,587

18,489

19,428

20,407

21,422

22,372

23,481

24,643

25,853

27,115

28,183

29,286

30,419

31,587

32,791

34,036

35,316

36,632

5,055

5,350

5,657

5,987

6,341

6,719

7,120

7,539

7,987

8,465

8,961

9,486

10,035

10,613

11,215

11,846

12,507

13,203

13,946

14,708

15,504

16,336

17,209

18,112

19,056

20,041

21,062

22,124

23,233

24,260

25,469

26,738

28,059

29,440

30,590

31,776

32,998

34,254

35,552

36,892

38,266

39,682

5,391

5,698

6,029

6,383

6,766

7,167

7,592

8,046

8,524

9,032

9,563

10,129

10,713

11,333

11,976

12,654

13,362

14,106

14,902

15,716

16,572

17,469

18,401

19,374

20,389

21,439

22,537

23,681

24,873

25,971

27,269

28,632

30,059

31,552

32,767

34,024

35,322

36,661

38,042

39,464

40,927

42,432

5,681

6,005

6,353

6,731

7,132

7,557

8,005

8,483

8,990

9,527

10,094

10,690

11,309

11,958

12,643

13,356

14,112

14,896

15,740

16,607

17,510

18,460

19,451

20,484

21,557

22,678

23,841

25,056

26,319

27,475

28,862

30,313

31,829

33,416

34,697

36,018

37,381

38,791

40,237

41,730

43,269

44,851

5,946

6,288

6,654

7,043

7,462

7,911

8,383

8,884

9,415

9,982

10,572

11,197

11,852

12,536

13,256

14,005

14,796

15,622

16,513

17,422

18,377

19,374

20,419

21,504

22,637

23,817

25,044

26,325

27,658

28,868

30,331

31,865

33,470

35,151

36,484

37,865

39,287

40,750

42,261

43,818

45,423

47,075

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

13,174

13,675

13,805

13,935

14,064

14,200

14,330

14,466

14,595

14,731

14,867

15,003

15,138

15,274

15,410

15,551

15,687

15,829

15,970

16,112

16,253

16,395

16,537

16,684

16,826

16,973

17,121

17,268

17,416

17,563

17,711

17,858

18,012

18,159

18,312

18,466

18,619

18,773

18,926

19,079

19,239

19,392

17,009

17,646

17,805

17,970

18,141

18,307

18,472

18,643

18,814

18,985

19,156

19,327

19,498

19,675

19,852

20,023

20,200

20,377

20,560

20,737

20,920

21,103

21,280

21,463

21,652

21,835

22,024

22,206

22,395

22,584

22,773

22,962

23,156

23,345

23,540

23,735

23,929

24,124

24,319

24,519

24,714

24,915

24,555

25,469

25,711

25,953

26,195

26,437

26,679

26,926

27,174

27,422

27,670

27,918

28,171

28,425

28,679

28,938

29,192

29,452

29,711

29,971

30,236

30,496

30,761

31,027

31,298

31,564

31,835

32,107

32,378

32,655

32,933

33,204

33,487

33,765

34,042

34,325

34,608

34,891

35,181

35,470

35,753

36,048

30,000

31,115

31,405

31,700

31,995

32,290

32,585

32,885

33,186

33,487

33,794

34,101

34,408

34,714

35,027

35,340

35,653

35,965

36,284

36,602

36,921

37,240

37,564

37,889

38,213

38,544

38,874

39,204

39,535

39,871

40,207

40,544

40,880

41,222

41,564

41,907

42,255

42,597

42,951

43,299

43,647

44,001

34,355

35,623

35,953

36,284

36,620

36,956

37,299

37,641

37,983

38,325

38,673

39,021

39,370

39,724

40,078

40,432

40,791

41,151

41,511

41,871

42,237

42,603

42,969

43,340

43,712

44,084

44,461

44,839

45,216

45,600

45,983

46,367

46,750

47,140

47,529

47,919

48,314

48,709

49,105

49,506

49,907

50,308

37,989

39,381

39,747

40,113

40,485

40,856

41,228

41,600

41,977

42,355

42,738

43,122

43,505

43,895

44,284

44,674

45,069

45,458

45,860

46,255

46,656

47,057

47,464

47,871

48,279

48,692

49,105

49,518

49,936

50,355

50,774

51,199

51,624

52,049

52,479

52,910

53,341

53,777

54,214

54,651

55,093

55,536

41,145

42,644

43,039

43,435

43,830

44,231

44,632

45,034

45,441

45,848

46,261

46,668

47,087

47,500

47,919

48,343

48,762

49,187

49,618

50,043

50,479

50,910

51,347

51,783

52,226

52,668

53,111

53,559

54,007

54,456

54,910

55,364

55,825

56,285

56,745

57,205

57,671

58,143

58,609

59,081

59,559

60,037

43,983

45,576

45,995

46,414

46,839

47,264

47,689

48,119

48,550

48,981

49,417

49,860

50,296

50,739

51,187

51,630

52,084

52,532

52,987

53,447

53,901

54,361

54,828

55,294

55,760

56,232

56,704

57,176

57,654

58,132

58,615

59,099

59,583

60,073

60,562

61,058

61,548

62,049

62,545

63,046

63,554

64,061

46,479

48,155

48,591

49,034

49,476

49,925

50,373

50,821

51,276

51,730

52,184

52,645

53,111

53,577

54,043

54,509

54,981

55,459

55,937

56,415

56,898

57,382

57,866

58,356

58,845

59,341

59,837

60,332

60,834

61,341

61,843

62,350

62,863

63,377

63,890

64,409

64,928

65,448

65,973

66,504

67,029

67,566

48,774

50,521

50,975

51,435

51,901

52,367

52,833

53,305

53,777

54,249

54,727

55,205

55,689

56,173

56,662

57,152

57,642

58,137

58,639

59,135

59,636

60,143

60,651

61,158

61,672

62,191

62,704

63,223

63,748

64,273

64,799

65,330

65,861

66,397

66,934

67,471

68,014

68,563

69,106

69,660

70,209

70,763



Rate Grid for the additional Child for floater combinations beyond 3C Premium rates including service tax @18%

Age/Sum

Insured

For all

ages

50000

681

100000

863

150000

1,226

200000

1,499

250000

1,725

300000

1,862

350000

2,044

400000

2,135

450000

2,270

500000

2,361

Age/Sum

Insured

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

550000

4,318

4,188

4,064

3,940

3,828

3,716

3,616

3,521

3,433

3,356

3,285

3,226

3,173

3,126

3,090

3,061

3,043

3,043

3,049

3,067

3,090

3,138

3,191

3,262

3,350

3,450

3,562

3,698

3,846

600000

4,530

4,388

4,241

4,111

3,981

3,863

3,745

3,645

3,545

3,462

3,380

3,315

3,256

3,203

3,161

3,132

3,108

3,102

3,108

3,120

3,144

3,185

3,238

3,309

3,391

3,492

3,610

3,739

3,887

650000

4,742

4,583

4,424

4,276

4,135

4,005

3,881

3,763

3,657

3,562

3,480

3,403

3,338

3,279

3,232

3,197

3,173

3,167

3,161

3,173

3,197

3,238

3,285

3,356

3,439

3,539

3,651

3,781

3,928

700000

4,955

4,778

4,607

4,442

4,288

4,147

4,011

3,887

3,769

3,669

3,574

3,492

3,421

3,356

3,309

3,267

3,238

3,226

3,220

3,226

3,244

3,285

3,332

3,403

3,480

3,580

3,692

3,828

3,970

750000

5,167

4,973

4,784

4,607

4,442

4,288

4,141

4,005

3,881

3,769

3,669

3,580

3,503

3,433

3,380

3,332

3,303

3,285

3,279

3,279

3,297

3,332

3,385

3,450

3,527

3,627

3,734

3,869

4,017

800000

5,285

5,085

4,890

4,707

4,536

4,377

4,223

4,088

3,964

3,846

3,739

3,651

3,568

3,498

3,444

3,397

3,362

3,344

3,338

3,338

3,356

3,391

3,444

3,509

3,586

3,686

3,804

3,934

4,088

850000

5,397

5,191

4,990

4,807

4,630

4,465

4,312

4,170

4,040

3,922

3,810

3,722

3,639

3,568

3,503

3,456

3,421

3,403

3,397

3,397

3,415

3,456

3,503

3,568

3,651

3,751

3,869

4,005

4,158

900000

5,515

5,303

5,096

4,902

4,725

4,554

4,394

4,253

4,117

3,993

3,887

3,793

3,704

3,633

3,568

3,521

3,486

3,468

3,456

3,456

3,474

3,515

3,562

3,633

3,716

3,816

3,934

4,076

4,229

950000

5,627

5,409

5,203

5,002

4,813

4,642

4,483

4,329

4,194

4,070

3,958

3,857

3,775

3,698

3,633

3,580

3,545

3,527

3,515

3,515

3,533

3,574

3,621

3,692

3,775

3,881

3,999

4,141

4,300

1000000

5,745

5,521

5,303

5,102

4,908

4,731

4,565

4,412

4,270

4,147

4,029

3,928

3,840

3,763

3,698

3,645

3,604

3,586

3,574

3,574

3,592

3,633

3,686

3,751

3,840

3,946

4,070

4,211

4,371

1 Adult/1 Child


29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

4,005

4,188

4,388

4,607

4,837

5,096

5,374

5,675

5,993

6,341

6,707

7,102

7,527

7,982

8,459

8,967

9,504

10,076

10,678

11,309

11,976

12,672

13,398

14,165

14,967

15,811

16,714

17,646

18,619

19,640

20,708

21,817

22,979

24,189

25,451

26,767

28,136

29,375

30,885

32,467

34,124

35,871

4,052

4,229

4,430

4,648

4,884

5,144

5,421

5,722

6,046

6,394

6,766

7,161

7,592

8,046

8,530

9,044

9,592

10,170

10,778

11,421

12,094

12,802

13,545

14,324

15,138

16,000

16,920

17,864

18,861

19,905

20,997

22,136

23,327

24,566

25,864

27,210

28,620

29,882

31,440

33,068

34,785

36,591

4,093

4,270

4,471

4,689

4,925

5,185

5,468

5,769

6,094

6,448

6,819

7,220

7,657

8,117

8,607

9,126

9,675

10,265

10,884

11,533

12,218

12,938

13,687

14,477

15,309

16,183

17,121

18,088

19,103

20,171

21,286

22,454

23,670

24,944

26,272

27,658

29,104

30,390

31,989

33,676

35,446

37,310

4,135

4,318

4,518

4,737

4,973

5,232

5,515

5,816

6,147

6,501

6,878

7,279

7,716

8,188

8,678

9,203

9,763

10,359

10,985

11,645

12,342

13,067

13,834

14,637

15,480

16,371

17,327

18,312

19,345

20,436

21,575

22,767

24,018

25,316

26,679

28,101

29,587

30,897

32,543

34,278

36,107

38,030

4,176

4,359

4,560

4,778

5,020

5,279

5,563

5,869

6,200

6,554

6,931

7,344

7,781

8,253

8,754

9,285

9,852

10,454

11,085

11,758

12,460

13,203

13,976

14,790

15,652

16,560

17,528

18,531

19,593

20,702

21,864

23,086

24,360

25,693

27,092

28,543

30,071

31,405

33,098

34,886

36,768

38,750

4,253

4,436

4,642

4,866

5,108

5,374

5,663

5,976

6,312

6,678

7,061

7,480

7,934

8,418

8,931

9,468

10,052

10,672

11,321

12,011

12,731

13,492

14,283

15,121

16,006

16,938

17,935

18,967

20,053

21,198

22,401

23,652

24,968

26,342

27,782

29,286

30,856

32,225

33,977

35,824

37,771

39,824

4,329

4,512

4,725

4,949

5,197

5,474

5,763

6,088

6,430

6,796

7,197

7,622

8,088

8,577

9,103

9,657

10,253

10,890

11,551

12,259

12,997

13,775

14,595

15,451

16,360

17,315

18,336

19,398

20,519

21,699

22,932

24,218

25,575

26,991

28,472

30,024

31,646

33,045

34,850

36,762

38,774

40,898

4,400

4,595

4,807

5,037

5,291

5,568

5,869

6,194

6,548

6,920

7,327

7,763

8,235

8,743

9,280

9,846

10,454

11,103

11,787

12,513

13,268

14,064

14,902

15,781

16,714

17,693

18,743

19,835

20,979

22,195

23,463

24,791

26,183

27,640

29,163

30,761

32,431

33,865

35,729

37,700

39,777

41,971

4,554

4,748

4,967

5,214

5,474

5,763

6,070

6,412

6,778

7,167

7,592

8,046

8,536

9,067

9,628

10,218

10,855

11,539

12,253

13,014

13,805

14,643

15,516

16,442

17,416

18,448

19,551

20,702

21,911

23,186

24,525

25,923

27,398

28,932

30,549

32,236

34,001

35,505

37,482

39,576

41,783

44,125

4,477

4,672

4,890

5,126

5,380

5,663

5,970

6,300

6,660

7,043

7,456

7,905

8,389

8,902

9,451

10,029

10,654

11,321

12,017

12,761

13,533

14,354

15,209

16,112

17,068

18,071

19,150

20,265

21,445

22,690

23,994

25,357

26,791

28,283

29,853

31,499

33,216

34,685

36,608

38,638

40,780

43,051


71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

37,228

38,632

40,083

41,576

43,122

44,709

46,349

48,037

49,777

51,571

52,055

52,544

53,034

53,530

54,031

54,533

55,034

55,547

56,055

56,574

57,087

57,612

58,137

58,663

59,194

59,730

60,267

60,810

61,353

61,902

62,450

63,005

63,565

64,126

64,692

65,259

65,831

66,403

66,982

67,560

68,144

68,734

37,971

39,405

40,880

42,402

43,977

45,600

47,276

49,004

50,786

52,615

53,128

53,648

54,173

54,698

55,223

55,760

56,297

56,839

57,388

57,937

58,491

59,046

59,612

60,179

60,745

61,323

61,902

62,486

63,070

63,660

64,256

64,852

65,459

66,067

66,675

67,288

67,908

68,533

69,159

69,790

70,427

71,064

38,715

40,172

41,676

43,228

44,833

46,491

48,202

49,966

51,789

53,665

54,208

54,751

55,305

55,860

56,421

56,987

57,559

58,132

58,716

59,300

59,890

60,486

61,087

61,689

62,297

62,911

63,530

64,155

64,787

65,418

66,055

66,698

67,347

68,002

68,663

69,324

69,991

70,663

71,342

72,020

72,710

73,401

39,464

40,945

42,473

44,054

45,694

47,382

49,128

50,934

52,792

54,715

55,282

55,860

56,438

57,028

57,618

58,214

58,822

59,430

60,043

60,663

61,288

61,919

62,557

63,200

63,849

64,504

65,164

65,831

66,504

67,176

67,861

68,545

69,241

69,943

70,645

71,353

72,073

72,793

73,519

74,256

74,994

75,737

40,207

41,712

43,269

44,880

46,550

48,273

50,054

51,895

53,801

55,760

56,362

56,963

57,577

58,191

58,816

59,447

60,079

60,722

61,371

62,026

62,692

63,359

64,032

64,716

65,400

66,097

66,799

67,501

68,215

68,934

69,660

70,398

71,135

71,879

72,628

73,389

74,150

74,923

75,702

76,486

77,277

78,074

41,311

42,856

44,449

46,101

47,807

49,571

51,400

53,282

55,229

57,241

57,860

58,486

59,117

59,760

60,403

61,058

61,713

62,380

63,052

63,731

64,421

65,111

65,813

66,515

67,229

67,949

68,681

69,412

70,150

70,899

71,654

72,415

73,182

73,955

74,734

75,519

76,315

77,118

77,926

78,740

79,560

80,386

42,420

43,995

45,629

47,317

49,063

50,869

52,739

54,668

56,662

58,722

59,365

60,008

60,663

61,323

61,990

62,669

63,347

64,037

64,734

65,436

66,150

66,864

67,589

68,321

69,058

69,808

70,557

71,318

72,085

72,858

73,643

74,433

75,224

76,026

76,840

77,655

78,481

79,313

80,150

80,994

81,844

82,705

43,529

45,140

46,804

48,532

50,320

52,167

54,078

56,055

58,096

60,202

60,863

61,530

62,208

62,893

63,577

64,279

64,981

65,695

66,415

67,141

67,878

68,616

69,371

70,126

70,887

71,660

72,439

73,230

74,020

74,823

75,631

76,451

77,271

78,103

78,941

79,790

80,640

81,501

82,369

83,248

84,133

85,024

45,742

47,423

49,164

50,963

52,833

54,763

56,757

58,828

60,958

63,164

63,866

64,580

65,294

66,020

66,757

67,501

68,250

69,011

69,778

70,551

71,336

72,126

72,923

73,731

74,545

75,371

76,203

77,041

77,891

78,746

79,613

80,487

81,366

82,251

83,148

84,056

84,971

85,891

86,817

87,755

88,699

89,655

44,638

46,278

47,984

49,748

51,577

53,465

55,418

57,441

59,530

61,683

62,368

63,058

63,754

64,456

65,170

65,890

66,616

67,353

68,097

68,846

69,607

70,374

71,147

71,926

72,716

73,519

74,321

75,135

75,955

76,787

77,619

78,469

79,318

80,180

81,047

81,920

82,805

83,696

84,593

85,502

86,416

87,337


113

114

115

116

117

118

119

120

69,324

69,914

70,516

71,112

71,719

72,321

72,935

73,548

71,707

72,356

73,011

73,666

74,327

74,988

75,655

76,327

74,097

74,799

75,507

76,215

76,935

77,655

78,380

79,112

76,486

77,242

78,003

78,770

79,543

80,321

81,106

81,891

78,876

79,684

80,498

81,324

82,150

82,982

83,826

84,676

81,224

82,062

82,912

83,767

84,628

85,496

86,375

87,254

83,572

84,446

85,325

86,216

87,106

88,009

88,918

89,832

85,921

86,823

87,738

88,658

89,584

90,523

91,467

92,416

90,617

91,585

92,564

93,549

94,546

95,549

96,558

97,573

88,269

89,207

90,151

91,107

92,068

93,036

94,009

94,995

Rate Grid for the additional Child for floater combinations beyond 3CPremium rates including service tax @ 18%

Age/Sum

Insured

For all

ages

550000

2,407

600000

2,498

650000

2,543

700000

2,589

750000

2,679

800000

2,725

850000

2,770

900000

2,816

950000

2,861

1000000

2,907

Number of Members

2

3

4

5

6

>=7

Discount

20%

25%

30%

35%

40%

45%

2. Discounts/LoadingsDiscounts2.1. Family discountA discount of 5% on total premium will be given if two or more family members are covered under the same policy under the individual policy option. This is based on expected expense savings.2.2. Online DiscountA discount of 15% on total premium will be given considering the savings on commission.2.3. Edelweiss group employee discountA 5% discount on the premium if he/she is an employee of Edelweiss Group. This is based on expected expense savings.2.4. Family Floater discountThe below family floater discount would be applied based on the number of people in the family.

Online and Edelweiss Group employee discount will be applied on total premium after family floater discount in floater policies.

Edelweiss General Insurance Company Limited, Corporate Office: 5th Floor, Tower 3, Kohinoor City Mall, Kohinoor City, Kirol Road, Kurla (West), Mumbai - 400 070, Registered Office: Edelweiss House, Off CST Road, Kalina, Mumbai -400 098, IRDAI Regn. No.: 159, CIN: U66000MH2016PLC273758, Reach us on: 1800 12000 (Toll-Free ) or 022 42312000 (Call charges applicable), Email: [email protected], Website: www.edelweissinsurance.com, Issuing/Corporate Office: +91 22 4272 2200, Grievance Redressal Officer: +91 22 4931 4422, Dedicated Toll-Free Number for Grievance: 1800 120 216216. Trade logo displayed above belongs to Edelweiss Financial Services Limited and is used by Edelweiss General Insurance Company Limited under license.