Reliance Critical Illness

Policy Wording

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reliancegeneral.co.in | 1800 3009 (toll free)

IRDAI Registration No. 103.
Reliance General Insurance Company Limited.
Registered Office & Corporate Office:
th
Reliance Centre, South Wing, 4 Floor,
Off. Western Express Highway, Santacruz (East), Mumbai
- 400 055.
UIN: RELHLGP08003V010708
Corporate Identity No.: U66603MH2000PLC128300.
Trade Logo displayed belongs to Anil Dhirubhai Ambani
Ventures Private Limited and used by Reliance General
Insurance Company Limited under License.
RGI/MCOM/CO/HL-23/PW/Ver. 1.2/180317
An ISO 9001:2015 Certified Company
Preamble 5. "Illness" means a sickness or a disease or pathological
condition leading to the impairment of normal physiological
WHEREAS the policyholder designated in the Schedule to this function which manifests itself during the Policy Period and
Reliance Critical Illness Policy having by a proposal and requires medical treatment.
declaration together with any statement, report or other
document which shall be the basis of the contract and shall be 6. "Injury" means accidental physical bodily harm excluding
deemed to be incorporated herein, has applied to Reliance illness or disease solely and directly caused by external,
General Insurance Company Limited (hereinafter called "the violent and visible and evident means which is verified and
Company") for the insurance hereinafter set forth and paid certified by a medical practitioner.
appropriate premium for the policy period as specified in the
Schedule. 7. “Insurer” means Company i.e., Reliance General
Insurance Co. Ltd.
NOW THIS POLICY WITNESSETH that subject to the terms,
conditions, exclusions and definitions contained herein or 8. "Insured Person/Insured" means the person specifically
endorsed or otherwise expressed hereon the Company, named as such in the Schedule to this Policy, who has a
undertakes, that if during the Policy Period as specified in the permanent place of residence in India and for whom the
Schedule, the Insured is diagnosed with any Critical Illness or insurance is proposed and the appropriate premium paid.
undergoes any surgery as specifically defined below, under the
9. Medical Advise” means any consultation or advice from a
Insured Event, then the Company will pay to the Insured or his
medical practitioner including the issue of any prescription
nominee/legal heir as the case may be the compensation benefit
or repeat prescription.
as mentioned in the schedule, for the period and to the extent of
the Sum Insured as specified in the Policy 10. "Medical Practitioner" is a person who holds a valid
registration from the Medical Council of any state or Medical
Definitions
Council of India and is thereby entitled to practice medicine
Any word or expression to which a specific meaning has been within its jurisdiction; and is acting within the scope and
assigned in any part of this Policy or the Schedule shall bear the jurisdiction of his license and should not be the policy holder/
same meaning wherever it appears. For purposes of this Policy, insured or close family member of the policyholder/ insured.
the terms specified below shall have the meanings set forth:
11. “Medically necessary treatment” is any treatment, tests,
1. “Accident(al)” is a sudden, unforeseen and involuntary medication, or stay in hospital or part of stay in a hospital
event caused by external, visible & violent means. which

2. Congenital Anomaly” refers to a condition(s) which is I. Is required for the medical management of the illness or
present since birth, and which is abnormal with reference to injury suffered by the insured;
form, structure or position.
II. Must not exceed the level of care necessary to provide
(a) Internal Congenital anomaly which is not in the visible safe, adequate and appropriate medical care in scope,
and accessible parts of the body. duration, or intensity;

(b) External Congenital anomaly which is in the visible III. Must have been prescribed by a medical practitioner;
and accessible parts of the body
IV. Must conform to the professional standards widely
3. "Hospital" means any institution established for in-patient accepted in international medical practice or by the
care and day care treatment of illness and / or injuries and medical community in India.
which has been registered as a hospital with the local
12. “Policy”is the Company's contract of insurance with the
authorities under the Clinical Establishments (Registration
policyholder providing cover as detailed in this Policy Terms
& Regulation) Act, 2010 or under enactments specified
& conditions, the Proposal Form, Policy Schedule,
under the Schedule of Section 56 (1) of the said Act or
Endorsements, if any and Annexures, which form part of the
complies with all minimum criteria as under:
contract and must be read together
i. has qualified nursing staff under its employment round
13. "Policy period"means the period between the start date
the clock;
and the end date as specified in the Schedule to this Policy
ii. has at least 10 inpatient beds, in towns having a or the cancellation of this policy, whichever is earlier
population of less than 10,00,000 and atleast 15
14. "Pre-existing Disease" means any condition, illness or
inpatient beds in all other places;
injury or related condition(s) for which the Insured/Insured
iii. has qualified medical practitioner(s) in charge round the person had signs or symptoms and/or were diagnosed
clock; and/or received medical advice/ treatment, within 48
months prior to the first policy under which the Insured
iv. has a fully equipped operation theatre of its own where Person was covered with us
surgical procedures are carried out
15. “Reasonable & Customary charges” means the charges
v. maintains daily records of patients and make these for services or supplies, which are the standard charges for
accessible to the Insurance company's authorized the specific provider and consistent with the prevailing
personnel. charges in the geographical area for identical or similar
services, taking into account the nature of the illness/injury
4. "Hospitalisation" means admission in a hospital for a involved.
minimum period of 24 consecutive hours for Inpatient care
except for day care treatment , where such admission could 16. "Schedule" means the document attached name so and to
be for a period of less than 24 consecutive hours. and the forming part of this Policy mentioning the details of

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 the Insured/ Insured Person/s, the Sum Insured, the period Major Organ/ Bone Marrow Transplant
and the limits to which benefits under the Policy are subject
to. I. The actual undergoing of a transplant of:
(i) One of the following human organs: heart, lung, liver,
17. "Sum Insured" means the sum as specified in the schedule,
kidney, pancreas, that resulted from irreversible end-
which sum represents the Company's maximum liability for
stage failure of the relevant organ, or
any or all claims under this Policy during the Policy period.
(ii) Human bone marrow using haematopoietic stem cells.
18. “Surgery”Surgery or Surgical procedure means manual
The undergoing of a transplant has to be confirmed by a
and/or operative procedure(s) required for treatment of an
specialist medical practitioner.
illness or injury, correction of deformities and defects,
diagnosis and cure of diseases, relief of suffering or II. The following are excluded:
prolongation of life, performed in a hospital or day care
centre by a medical practitioner (i) Other stem-cell transplants

19. "Unproven/ Experimental treatment" is treatment (ii) Where only islets of langerhans are transplanted
including drug experimental therapy, which is not based on Multiple Sclerosis with Persisting Symptoms
established medical practice in India, is treatment
experimental or unproven. I. The definite occurrence of multiple sclerosis. The diagnosis
must be supported by all of the following:
Scope Of Cover
(i) Investigations including typical MRI and CSF findings,
For the purpose of this Policy and the determination of the which unequivocally confirm the diagnosis to be
Company's liability under it , the Insured Event (Critical Illness) in multiple sclerosis
relation to an Insured Person/Insured shall mean any illness,
medical event or surgical procedure as specifically defined below (ii) There must be current clinical impairment of motor or
whose first signs or symptoms first commence more than 90 days sensory function, which must have persisted for a
after the commencement of Policy Period and is diagnosed , continuous period of atleast 6 months, and
occurs or conducted within the Policy Period and shall only (iii) Well documented clinical history of exacerbations and
include the following: remissions of said symptoms or neurological deficits
CATEGORY 1 with atleast two clinically documented episodes atleast
one month apart.
The payment of claim under this Category 1 shall be subject to
II. Other causes of neurological damage such as SLE and HIV
survival of the Insured Person for more than 30 days post
are excluded
diagnosis, occurrence or undergoing of the Insured Event
covered under this Category Third Degree Burns
Cancer of specified severity First occurrence of burns that affect the epidermis, dermis and
hypodermis, causing charring of skin or a translucent white
I. A malignant tumour characterized by the uncontrolled colour, with coagulated vessels visible just below the skin surface
growth & spread of malignant cells with invasion & usually resulting in extensive scarring and covering atleast 45%
destruction of normal tissues. This diagnosis must be of the body evidenced by any one of the following:
supported by histological evidence of malignancy &
confirmed by a pathologist. The term cancer includes - Hard, leather-like eschar, purple fluid and no sensation
leukemia, lymphoma and sarcoma. (insensate)

II. The following are excluded — - Conditions resulting in the skin or muscle being irretrievably
lost
(i) Tumors showing the malignant changes of carcinoma in
situ & tumors which are histologically described as pre- - Conditions resulting in charring of bones
malignant or non invasive, including but not limited to:
Aorta Graft Surgery
Carcinom in situ of breasts, Cervical dysplasia CIN-1,
CIN-2 & CIN-3. The actual surgical repair of an aortic aneurysm (an abnormal
bulge in the wall of the aortic blood vessel causing the aorta to
(ii) Any skin cancer other than invasive malignant dilate or widen and the aortic valve to leak leading to bursting of
melanoma arterial wall) for the first time by a surgeon. The diagnosis to be
(iii) All tumors of the prostrate unless histologically evidenced by any two of the following
classified as having a Gleason score greater than 6 or - Computerized tomography (CT) scan
having progressed to atleast clinical TNM classification
T2N0M0 - Magnetic Resonance Imaging (MRI) scan

(iv) Papilary Micro-carcinoma of the thyroid less than 1 cm - Echocardigraphy ( an ultrasound of the heart)
in diameter
- Angiography ( an x-ray of blood vessels)
(v) Chronic lymphocyctic leukaemia less than RAI stage 3 - Abdominal ultrasound
(vi) Microcarcinoma of the bladder CATEGORY 2
(vii)All tumors in the presence of HIV infection The payment of claim under this Category II shall be subject to
survival of the Insured Person for more than 60 days post

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diagnosis, occurrence or undergoing of the Insured Event 1. Pre-existing diseases / illness / injury / conditions – All
covered under this Category. diseases, illnesses, injuries which are pre-existing when the
cover incepts for the first time under this Policy.
Open Heart Replacement or Repair of Heart Valves
2. Critical illness contracted or evident through Sign and
The actual undergoing of open heart valve surgery is to replace or symptoms within 3 months of the inception date of this policy.
repair one or more heart valves, as a consequence of defects in, This exclusion doesn't apply for subsequent renewal with the
abnormalities of, or disease-affected cardiac valve(s). The Company without a break.
diagnosis of the valve abnormality must be supported by an
echocardiography and the realization of surgery has to be 3. Certification / diagnosis by a family member or any diagnosis
confirmed by a specialist medical practitioner. Catheter based that is not scientifically recognized.
techniques including but not limited to, ballon valvotomy/
valuloplasty are excluded. 4. Certification / diagnosis from a person not registered as
Medical Practitioners under respective medical councils.
Coma of Specified Severity
5. Accidental injury leading to any condition/complication that
A state of unconsciousness with no reaction or response to is not listed in Categories I and II dealt with under the scope
external stimuli or internal needs. This diagnosis must be of coverage above.
supported by evidence of all of the following
6. Any critical illness arising out of any congenital illness or
i No response to external stimuli continuously for atleast 96 condition or disorder whether internal or external.
hours
7. Critical illness/condition resulting, directly or indirectly,
ii Life support measures are necessary to sustain life; and caused by, contributed to or aggravated or prolonged by
child birth or from pregnancy or in consequence thereof.
iii Permanent neurological deficit which must be assessed
atleast 30 days after the onset of the coma 8. Any critical illness due to alcohol, smoking, other tobacco
intake or drug abuse.
The condition has to be confirmed by a specialist medical
practitioner. Coma resulting directly from alcohol or drug abuse is 9. Any treatment/surgery for change sex or any cosmetic
excluded surgery or treatment/surgery /complications/illness arising
as a consequence thereof.
Quadriplegia / Permanent Paralysis of all four limbs
10. Critical illness acquired as a consequence of Human
Total and irrecoverable loss of use of all four limbs as a result of Immuno-deficiency Virus (HIV) infection.
injury or disease of the brain or spinal cord. A specialist medical
practitioner must be of the opinion that the paralysis will be 11. Critical illness due to:
permanent with no hope of recovery and must be present for
more than 3 months. i) intentional self-injury, suicide or attempted suicide

Total Blindness ii) self exposure to needless perils except in an attempted

to save human life.
The existence of complete lack of form and light perception in
both eyes, clinically recorded as “NLP” , no light perception. 12. Proposer or any of his family members whilst engaging in
speed contest or racing of any kind (other than on foot),
This cover excludes bungee jumping, parasailing, ballooning, parachuting,
skydiving, paragliding, hang gliding, mountain or rock
1. Genetic defects that are congenital and develop into total climbing necessitating the use of guides or ropes, potholing,
blindness abseiling, deep sea diving using hard helmet and breathing
apparatus, polo, snow and ice sports.
2. Total Blindness caused due to intake of Methylated alcohol
(adulterated alchohol) 13. Disease critical illness, directly or indirectly, caused by or
arising form or attributable to foreign, invasion, act of foreign
Kidney Failure Requiring Regular Dialysis
enemies, hostilities (whether war be declared or not), civil
End stage renal disease presenting as chronic irreversible failure war, revolution, insurrection, military or usurped power, riot
of both kidneys to function, as a result of which either regular or civil commotion, act of terrorism.
renal dialysis (hemodialysis or peritoneal dialysis) is instituted or
14. Critical illness caused by ionizing radiation or contamination
renal transplantation is carried out. Diagnosis has to be
by radioactivity from any nuclear fuel or from any nuclear
confirmed by a specialist medical practitioner
waste from the combustion of nuclear fuel.
In case of kidney transplant under this condition the benefit shall
15. Critical illness, directly or indirectly, caused by or contributed
be payable under Major Organ Transplant (Category I) and not
to by nuclear weapons/materials or radioactive
under this Insured Event.
contamination.
Policy Exclusions
16. Any critical illness arising or resulting from the Import
General Exclusions committing any breach of law or participating in an actual or
attempted felony, riot, crime, misdemeanor or civil
The Company shall not be liable to make any payment for any commotion.
claim directly or indirectly caused by, based on, arising out of or
howsoever attributable to any of the following: 17. Reimbursement for any treatment of illness/procedure
performed outside India.

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No Claim will be payable in the event of death of the insured within - First Information Report/ Final Police Report, if
the stipulated survival period applicable under each category. applicable
Claims Procedure - Post mortem report, if available
The fulfillment of the terms and conditions of this Policy (including - Any other document as required by the Company to
the realization of premium by their respective due dates) in so far assess the Claim
as they relate to anything to be done or complied with by the
Policyholder or any Insured Person, including complying with the 4.4 Policyholder's / Insured Person's duty at the time of
following steps, shall be the condition precedent to the Claim
admissibility of the Claim.
a) The Policyholder / Insured Person must take
Upon the discovery or happening of any Illness / Injury that may reasonable steps or measure to avoid or minimize the
give rise to a Claim under this Policy, then as a condition quantum of any Claim that may be made under this
precedent to the admissibility of the Claim, the Policyholder/ Policy.
Insured Person shall undertake the following:
b) Forthwith intimate / file / submit a Claim in accordance
4.1 Claims Intimation with Clause 4 of this Policy.

In the event of any Illness or Injury or occurrence of any other c) If so requested by the Company, the Insured Person will
contingency which has resulted in an Insured Event resulting have to submit himself for a medical examination by the
in a Claim or may result in a Claim covered under the Policy, Company's nominated Medical Practitioner as often as
the Policyholder/ Insured Person, must notify the Company it considers reasonable and necessary. The cost of such
either at the call center or in writing immediately and within 7 examination will be borne by the Company.
days of occurrence of such insured event.
d) On occurrence of an insured event which will lead to a
The following details are to be provided to the Company at Claim under this Policy, the Policyholder/ Insured
the time of intimation of Claim: Person shall :

- Policy Number - Allow the Medical Practitioner or any of the

Company's representatives to inspect the medical
- Name of the Policyholder and Hospitalization records, investigate the facts
and examine the Insured Person.
- Name of the Insured Person in whose relation the Claim
is being lodged - Assist and not hinder or prevent the Company's
representatives in pursuance of their duties for
- Nature of Illness / Injury ascertaining the admissibility of the Claim under
the Policy
- Name and address of the attending Medical Practitioner
and Hospital If the Policyholder / Insured Person does not comply with the
provisions of these conditions all benefits under this Policy
- Date of Admission
shall be forfeited at the Company's option.
- Any other information as requested by the Company
4.5 Payment Terms
4.2 Claims Procedure
This Policy covers medical treatment taken within India, and
In case of any Claim for the Insured Events the list of payments under this Policy shall be made in Indian Rupees
documents as mentioned below shall be provided by the within India.
Policyholder/Insured Person, immediately but not later than
Claims shall not be admissible under this Policy unless the
15 days of discharge from the Hospital, at the Policyholder's/
Company has been provided with the complete
Insured Person's expense to avail the Claim.
documentation / information which the Company has
4.3 Claim Documents requested to establish its liability for the Claim, its
circumstances and its quantum unless the Policyholder /
The Policyholder / Insured Person shall submit to the Insured Person have complied with the obligations under
Company/ Network Hospital (as applicable) the following this Policy.
documents for or in support of the Claim:
The Policy will terminate forthwith on a claim being paid
- Duly completed and signed Claim Form, in original under any category where payment is for 100%
compensation benefit.
- Medical Practitioner's referral letter advising
Hospitalization The company's total liability in aggregate for all claims under
the policy for a specific insured shall not exceed the
- Medical Practitioner's prescription advising drugs / respective Sum Insured of that Insured.
diagnostic tests / consultation
Terms And Conditions
- Discharge card from the Hospital / Medical Practitioner
1. Duty of disclosure
- Original pathological / diagnostic test reports and
payment receipts The Policy shall be void and all premium paid hereon shall be
forfeited to the Company, in the event of misrepresentation,
- Indoor case papers mis-description or non-disclosure of any material fact.

07 08
 In the event of untrue or incorrect statements, indemnity from any other party to which the Company is/or
misrepresentation, mis-description or non-disclosure of any would become entitled upon the Company paying for a
material particulars in the proposal form, personal Claim under this Policy, whether such acts or things shall be
statement, declaration and connected documents, or any or become necessary or required before or after its payment.
material information having been withheld, or a Claim being Neither the Policyholder nor any Insured Person shall
fraudulent or any fraudulent means or device being used by prejudice these subrogation rights in any manner and shall
the Policyholder/ Insured Person or any one acting on his/ at his own expense provide the Company with whatever
their behalf to obtain a benefit under this Policy, the assistance or cooperation is required to enforce such rights.
Company may cancel this Policy at its sole discretion and the Any recovery the Company makes pursuant to this clause
premium paid shall be forfeited in its favor. shall first be applied to the amounts paid or payable by the
Company under this Policy and any costs and expenses
2. Observance of Terms and Conditions
incurred by the Company of effecting a recovery, where after
The due observance and fulfillment of the Policy Terms & the Company shall pay any balance remaining to the
Conditions and Endorsements of this Policy in so far as they Policyholder. This clause shall not apply to any Benefit
relate to anything to be done or complied with by the offered on fixed benefit basis.
Policyholder / Insured Person, shall be a condition
9. Contribution
precedent to any of the Company's liability to make any
payment under this Policy. Contribution is essentially the right of the Company to call
upon other Insurers liable to the same Insured to share the
3. Reasonable Care
costs of an indemnity claim on a rateable proportion of Sum
The Policyholder/ Insured Person shall take all reasonable Insured.
steps to safeguard the interests against any Illness / Injury
If at the time when any Claim arises under this Policy, there is
that may give rise to a Claim.
any other insurance which covers (or would have covered
4. Material Change but for the existence of this Policy), the same Claim (in whole
or in part), then the Company shall not be liable to pay or
The Policyholder shall immediately notify the Company in contribute more than its ratable proportion of any Claim.
writing of any material change in the risk on account of
change in occupation / business at his own expense and the This clause shall not apply to any Benefit offered on fixed
Company may adjust the scope of cover and/or premium, if benefit basis.
necessary, accordingly.
10. Fraudulent Claims
5. Records to be maintained
If a Claim is in any way found to be fraudulent, or if any false
The Policyholder/Insured Person shall keep an accurate statement, or declaration is made or used in support of such
record containing all relevant medical records and shall a Claim, or if any fraudulent means or devices are used by
allow the Company or its representative(s) to inspect such the Policyholder/Insured Person or anyone acting on his/
records. The Policyholder/Insured Person shall furnish such their behalf to obtain any benefit under this Policy, then this
information as the Company may require under this Policy at Policy shall be void and all claims being processed shall be
any time during the Policy Period and up to three years after forfeited for all Insured Persons and all sums paid under this
the policy expiration, or until final adjustment (if any) and Policy shall be repaid to the Company by the Policyholder/all
resolution of all Claims under this Policy. Insured Persons who shall be jointly liable for such
repayment.
6. No constructive Notice
11. Policy Disputes
Any knowledge or information of any circumstance or
condition in relation to the Policyholder/Insured Person Any and all disputes or differences under or in relation to
which is in possession of the Company and not specifically validity, construction, interpretation and effect to this Policy
informed by the Policyholder/Insured Person shall not be shall be determined by the Indian Courts and subject to
held to bind or prejudicially affect the Company Indian law.
notwithstanding subsequent acceptance of any premium.
12. Free Look Period
7. Complete discharge
The Policyholder would be given a period of 15 days (Free
Payment made by the Company to the Policyholder/adult Look Period) from the date of receipt of the Policy to review
Insured Person or the Nominee of the Policyholder or the the entire Policy. Where the Policyholder disagrees to any of
legal representative of the Policyholder or to the Hospital, as those terms or conditions, the Policyholder has the option to
the case may be, of any Medical Expenses or compensation return the Policy stating the reasons for his objection and the
or benefit under the Policy shall in all cases be complete and Policyholder shall be entitled to a refund of the premium
construe as an effectual discharge in favor of the Company. paid, provided no Claim has been incurred under this Policy,
subject only to a deduction of the expenses incurred by the
8. Subrogation Company on medical examination and the stamp duty
Subrogation shall mean the right of the Company to assume charges. In cases where the risk has already commenced
the rights of the Insured Person/Policyholder to recover when the option of returning this Policy is exercised, within
expenses paid out under the Policy that may be recovered the free look period, by the Policyholder, the refund of the
from any other source. premium paid will also be subject to a deduction for
proportionate risk premium for the period on cover. Where
The Policyholder/Insured Person shall at his own expense only part of the risk (e.g. only accidental hospitalization risk)
do or concur in doing or permit to be done all such acts and has commenced, such proportionate risk premium shall be
things that may be necessary or reasonably required by the calculated as commensurate with the risk covered during
Company for the purpose of enforcing and/or securing any such period.
civil or criminal rights and remedies or obtaining relief or

09 10
 This clause shall not be applicable on renewal of this Policy short period scales as mentioned below, provided no
and Portability cases. Claim has been made under the Policy by the
Policyholder/ Insured Person.
13. Renewal Notice
Refund % to be applied on Policy Premium
a) This Policy will automatically terminate at the end of the
Policy Period. All renewal applications should reach the Policy Tenure - > 1year
Company before the end of the Policy Period.
Cancellation date up to (x months) from Refund
b) Every renewal premium (which shall be paid and Policy Period Start Date
accepted in respect of this Policy) shall be so paid and
accepted upon the distinct understanding that no Up to 1 month 75.0%
alteration has taken place in the facts contained in the
proposal or declaration herein prior mentioned and that Up to 3 months 50.0%
nothing is known to the Policyholder/ Insured Person(s)
Up to 6 months 25.0%
that may result in enhancing the Company's risk.
c) This Policy may be renewed by mutual consent and in In case of demise of the Policyholder, this Policy shall
such event the renewal premium shall be paid to the continue till the end of Policy Period or next premium due
Company on or before the date of expiry of this Policy whichever is earlier. In case the other Insured Person want to
and in any case not later than the expiry of the Grace continue with the same Policy, the Company would renew
Period. the Policy providing all continuity benefits, subject to there
being atleast one adult member as an Insured Person who
Grace period refers to a period of 30 days immediately would then become the Policyholder. This will be subject to
following the premium due date during which a payment the Company receiving a written application in this regard
can be made to renew this Policy without loss of before Policy Period End Date.
continuity benefits such as Waiting Periods and
For long term contracts (greater than 1 year), the Company
coverage of Pre-existing Disease. Coverage is not
shall, from the date of receipt of notice cancel the Policy after
available for the period for which Premium is not
retaining proportionate premium for the covered period and
received by the Company
30% of the premium relating to the balance premium for the
The Company shall not be liable for any Claims incurred unexpired period.
during such period.
15. Limitation Period
d) Ordinarily renewals will not be refused by the Company In no case whatsoever the Company shall be liable for any
except on ground of fraud, moral hazard or Claim under this Policy, if the requirement of Clause 4 above
misrepresentation. are not complied with, unless the Claim is the subject of
e) Renewal premium can vary subject to prior regulatory pending action; it being expressly agreed and declared that if
approval. the Company shall disclaim liability for any Claim hereunder
and such Claim shall not within 12 calendar months from the
f) Renewal Discount date of the disclaimer have been made the subject matter of
a suit in court of law then the Claim shall for all purposes be
a) For Annual Policy equivalent to 5%, on cumulative
deemed to have been abandoned and shall not thereafter be
basis, of renewal premium for each continuous
recoverable hereunder.
claim free year will be offered as No claim Discount
subject to maximum up to 50%, where the Policy 16. Communication
which is claim free & is renewed without a break.
Any communication meant for the Company must be in
b) For Policy with 3 year Term : 10% on cumulative writing and be delivered to its address shown in the Policy
basis on every claim free block of 3 completed Schedule. Any communication meant for the Policyholder
years renewable for a further period of 3 years will will be sent by the Company to his last known address or the
be offered as No claim Discount subject to a address as shown in the Policy Schedule.
maximum discount of up to 50%, of the renewal
All notifications and declarations for the Company must be in
premium where the Policy which is claim free is
writing and sent to the address specified in the Policy
renewed without a break.
Schedule. Agents are not authorized to receive notices and
g) This policy shall not be renewed and the Insured shall declarations on the Company's behalf.
not be eligible for any new Critical Illness or similar
Notice and instructions will be deemed served 10 days after
policies if a claim is paid or admitted under this Policy
posting or immediately upon receipt in the case of hand
14. Cancellation / Termination delivery, facsimile or e-mail.

- The Company may at any time, cancel this Policy on 17. Alterations in the Policy
grounds as specified in Clause “Duty of Disclosure” This Policy constitutes the complete contract of insurance.
above , by giving 15 days' notice in writing by Registered No change or alteration shall be valid or effective unless
Post Acknowledgment Due / recorded delivery to the approved in writing by the Company, which approval shall be
Policyholder at his last known address. evidenced by a written endorsement signed and stamped by
- The Policyholder may also give 15days' notice in the Company.
writing, to the Company, for the cancellation of this 18. Cause of Action
Policy, in which case the Company shall from the date of
receipt of the notice, cancel the Policy and refund the Claims shall be payable under this Policy only if the cause of
premium for the unexpired period of this Policy at the action arises in India.

11 12
19. Overriding effect of Policy Schedule 24. Payment of Interest
In case of any inconsistency in the terms and conditions in In case of delay of seven days or more in payment of claim
this Policy vis-a-vis the information contained in the Policy after the acceptance by the insured, the Company will pay
Schedule, the information contained in the Policy Schedule interest on the claim amount at a rate which is 2% above the
shall prevail. bank rate for the period of delay
20. Electronic Transactions 25. Pre- policy Health check-up
The Policyholder/ Insured Person agrees to adhere to and The prospect whose medical test is conducted and for whom
comply with all such terms and conditions as the Company the company grants an insurance cover under this policy and
may prescribe from time to time, and hereby agrees and whose name specifically appears as Insured person in the
confirms that all transactions effected by or through facilities schedule, the company shall reimburse 50% of the cost of
for conducting remote transactions including the Internet, such medicals conducted at the Company's designated
World Wide Web, electronic data interchange, call centers, centre.
tele-service operations (whether voice, video, data or
26. Arbitration Clause
combination thereof) or by means of electronic, computer,
automated machines network or through other means of If any dispute or difference shall arise as to the quantum to be
telecommunication, established by or on behalf of the paid under this Policy (liability being otherwise admitted)
Company, for and in respect of the Policy or its terms, or the such difference shall independently of all other questions be
Company' sother products and services, shall constitute referred to the decision of a sole arbitrator to be appointed in
legally binding and valid transactions when done in writing by the parties thereto or if they cannot agree upon a
adherence to and in compliance with the Company's terms single arbitrator within 30 days of any party invoking
and conditions for such facilities, as may be prescribed from arbitration, the same shall be referred to a panel of three
time to time. arbitrators, comprising of two arbitrators, one to be
appointed by each of the parties to the dispute/difference
21. Special Provisions
and the third arbitrator to be appointed by such two
Any special provisions subject to which this Policy has been arbitrators and arbitration shall be conducted under and in
entered into and endorsed in the Policy or in any separate accordance with the provisions of the Arbitration and
instrument shall be deemed to be part of this Policy and shall Conciliation Act,1996.
have effect accordingly.
It is clearly agreed and understood that no difference or
22. Portability dispute shall be referable to arbitration, as hereinbefore
provided, if the Company has disputed or not accepted
Portability means transfer by an individual health insurance liability under or in respect of this Policy.
policyholder (including family cover) of the credit gained for
pre-existing conditions and time bound exclusions if he/she It is hereby expressly stipulated and declared that it shall be
chooses to switch from one Insurer to another. a condition precedent to any right of action or suit upon this
Policy that the award by such arbitrator/arbitrators of the
If the Policyholder/ Insured Person renew with the Company, amount of the loss or damage shall be first obtained.
without break, any similar individual health insurance policy
from any insurance company registered with IRDA, then the 27. Grievances
Waiting Periods as defined in exclusions shall be reduced by If the Policyholder has a grievance that the Policyholder
the number of years of continuous coverage under such wishes the Company to redress, the Policyholder may
health insurance policy with the previous insurer(s). contact the Company with the details of his grievance
The Company's total liability for payment of all claims in through:
aggregate, incurred during the Policy Period, on account of Website : https://reliancegeneral.co.in
Portability shall not exceed Sum Insured Limit for Portability
as defined in Policy Schedule e-mail : rgicl.services@relianceada.com
The Waiting Periods as defined in policy exclusions shall be Telephone : 1800-3009
applicable individually for each Insured Person and Claims
Post/Courier : Any branch office, the
shall be assessed accordingly.
correspondence address, during
23. Withdrawal/Revision/Modification of the Product normal business hours
The Company reserves the right to withdraw, revise or Write to us at : Reliance General Insurance,
modify this product /policy in the future. (Correspondence Only) Correspondence Unit, 301-302,
Corporate House RNT Marg,
The revision/modification may be in respect of Benefits, Opp. Jhabua Tower, Indore,
coverages, premiums, policy terms and conditions &/or Madhya Pradesh, India – 452001
exclusions.
For further details on Grievance redressal procedure please
In the event of any such withdrawal of product the company refer: https://reliancegeneral.co.in/Insurance/About-
will notify in advance to the policyholder providing him the
Us/Grievance-Redressal.aspx
option to port to the specified existing health products of the
company with continuity benefit. If the Policyholder is not satisfied with the Company's redressal
of the Policyholder's grievance through one of the above
In the event of any revision or modification of the
product/terms of policy/premium , the company will notify the methods, the Policyholder may approach the nearest Insurance
policyholder 3 months in advance of such changes. Ombudsman for resolution of the grievance. The contact details
of Ombudsman offices are mentioned below:

13 14
Ombudsman Office Ombudsman Office

Jurisdiction Office Address Delhi DELHI - Shri Sudhir Krishna

Office of the Insurance Ombudsman,
Gujarat, AHMEDABAD - Shri Kuldip Singh 2/2 A, Universal Insurance Building,
Dadra & Nagar Office of the Insurance Ombudsman, Asaf Ali Road,
Haveli, Jeevan Prakash Building, 6th floor, New Delhi – 110 002.
Daman and Tilak Marg, Relief Road, Tel.: 011 - 23232481/23213504
Diu. Ahmedabad – 380 001. Email: bimalokpal.delhi@ecoi.co.in
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@ecoi.co.in
Assam, GUWAHATI - Shri Kiriti .B. Saha
Karnataka BENGALURU - Smt. Neerja Shah Meghalaya, Office of the Insurance Ombudsman,
Office of the Insurance Manipur, Jeevan Nivesh, 5th Floor,
Ombudsman,Jeevan Soudha Building,PID Mizoram, Nr. Panbazar over bridge, S.S. Road,
No. 57-27-N-19Ground Floor, 19/19, 24th Arunachal Guwahati – 781001(ASSAM).
Main Road,JP Nagar, Ist Phase, Pradesh, Tel.: 0361 - 2632204 / 2602205
Bengaluru – 560 078. Nagaland and Email: bimalokpal.guwahati@ecoi.co.in
Tel.: 080 - 26652048 / 26652049 Tripura
Email: bimalokpal.bengaluru@ecoi.co.in
Andhra HYDERABAD - Shri I. Suresh Babu
Madhya BHOPAL - Shri Guru Saran Shrivastava Pradesh, Office of the Insurance Ombudsman,
Pradesh Office of the Insurance Ombudsman, Telangana, 6-2-46, 1st floor, "Moin Court",
Chattisgarh Janak Vihar Complex, 2nd Floor, Yanam and Lane Opp. Saleem Function Palace,
6, Malviya Nagar, Opp. Airtel Office, part of Territory A. C. Guards, Lakdi-Ka-Pool,
Near New Market, Bhopal – 462 003. of Pondicherry. Hyderabad - 500 004.
Tel.: 0755 - 2769201 / 2769202 Tel.: 040 - 67504123 / 23312122
Fax: 0755 - 2769203 Fax: 040 - 23376599
Email: bimalokpal.bhopal@ecoi.co.in Email: bimalokpal.hyderabad@ecoi.co.in
Orissa BHUBANESHWAR -
Rajasthan JAIPUR - Smt. Sandhya Baliga
Shri Suresh Chandra Panda
Office of the Insurance Ombudsman,
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
62, Forest park,
Bhawani Singh Marg,
Bhubneshwar – 751 009.
Jaipur - 302 005.
Tel.: 0674 - 2596461 /2596455
Tel.: 0141 - 2740363
Fax: 0674 - 2596429
Email: Bimalokpal.jaipur@ecoi.co.in
Email: bimalokpal.bhubaneswar@ecoi.co.i
n

Punjab, CHANDIGARH -
Haryana, Dr. Dinesh Kumar Verma Kerala, ERNAKULAM - Ms. Poonam Bodra
Himachal Office of the Insurance Ombudsman, Lakshadweep, Office of the Insurance Ombudsman,
Pradesh, S.C.O. No. 101, 102 & 103, 2nd Floor, Mahe-a part of 2nd Floor, Pulinat Bldg.,
Jammu Batra Building, Sector 17 – D, Pondicherry. Opp. Cochin Shipyard, M. G. Road,
&Kashmir, Chandigarh – 160 017. Ernakulam - 682 015.
Chandigarh Tel.: 0172 - 2706196 / 2706468 Tel.: 0484 - 2358759 / 2359338
Fax: 0172 - 2708274 Fax: 0484 - 2359336
Email: bimalokpal.chandigarh@ecoi.co.in Email: bimalokpal.ernakulam@ecoi.co.in

Tamil Nadu, CHENNAI - Shri M. Vasantha Krishna

Pondicherry Office of the Insurance Ombudsman,
West Bengal, KOLKATA - Shri P. K. Rath
Town and Fatima Akhtar Court, 4th Floor, 453,
Sikkim, Office of the Insurance Ombudsman,
Karaikal (which Anna Salai, Teynampet,
Andaman Hindustan Bldg. Annexe, 4th Floor,
are part of CHENNAI – 600 018.
&Nicobar 4, C.R. Avenue,
Pondicherry) Tel.: 044 - 24333668 / 24335284
Islands. KOLKATA - 700 072.
Fax: 044 - 24333664
Tel.: 033 - 22124339 / 22124340
Email: bimalokpal.chennai@ecoi.co.in
Fax : 033 - 22124341
Email: bimalokpal.kolkata@ecoi.co.in

15 16
Ombudsman Office Ombudsman Office

Districts of LUCKNOW - State of NOIDA - Shri Chandra Shekhar Prasad

Uttar Pradesh : Shri Justice Anil Kumar Srivastava Uttaranchal Office of the Insurance Ombudsman,
Laitpur, Jhansi, Office of the Insurance Ombudsman, and the Bhagwan Sahai Palace
Mahoba, 6th Floor, Jeevan Bhawan, Phase-II, following 4th Floor, Main Road,
Hamirpur, Nawal Kishore Road, Hazratganj, Districts of Naya Bans, Sector 15,
Banda, Lucknow - 226 001. Uttar Pradesh: Distt: Gautam Buddh Nagar,
Chitrakoot, Tel.: 0522 - 2231330 / 2231331 Agra, Aligarh, U.P-201301.
Allahabad, Fax: 0522 - 2231310 Bagpat, Tel.: 0120-2514250 / 2514252 / 2514253
Mirzapur, Email: bimalokpal.lucknow@ecoi.co.in Bareilly, Bijnor, Email: bimalokpal.noida@ecoi.co.in
Sonbhabdra, Budaun,
Fatehpur, Bulandshehar,
Pratapgarh, Etah, Kanooj,
Jaunpur,Varan Mainpuri,
asi, Gazipur, Mathura,
Jalaun, Meerut,
Kanpur, Moradabad,
Lucknow, Muzaffarnagar,
Unnao, Oraiyya,
Sitapur, Pilibhit,
Lakhimpur, Etawah,
Bahraich, Farrukhabad,
Barabanki, Firozbad,
Raebareli, Gautambodha
Sravasti, nagar,
Gonda, Ghaziabad,
Faizabad, Hardoi,
Amethi, Shahjahanpur,
Kaushambi, Hapur, Shamli,
Balrampur, Rampur,
Basti, Kashganj,
Ambedkarnaga Sambhal,
r, Sultanpur, Amroha,
Maharajgang, Hathras,
Santkabirnagar Kanshiramnag
, Azamgarh, ar,
Kushinagar, Saharanpur.
Gorkhpur,
Deoria, Mau, Bihar, PATNA - Shri N. K. Singh
Ghazipur, Jharkhand Office of the Insurance Ombudsman,
Chandauli, 1st Floor,Kalpana Arcade Building,,
Ballia, Bazar Samiti Road,
Sidharathnagar Bahadurpur,
Patna 800 006.
Goa, MUMBAI - Shri Milind A. Kharat Tel.: 0612-2680952
Mumbai Office of the Insurance Ombudsman, Email: bimalokpal.patna@ecoi.co.in
Metropolitan 3rd Floor, Jeevan Seva Annexe,
Region S. V. Road, Santacruz (W), Maharashtra, PUNE - Shri Vinay Sah
excluding Navi Mumbai - 400 054. Area of Navi Office of the Insurance Ombudsman,
Mumbai Tel.: 022 - 26106552 / 26106960 Mumbai and Jeevan Darshan Bldg., 3rd Floor,
&Thane Fax: 022 - 26106052 Thane C.T.S. No.s. 195 to 198,
Email: bimalokpal.mumbai@ecoi.co.in excluding N.C. Kelkar Road, Narayan Peth,
Mumbai Pune – 411 030.
Metropolitan Tel.: 020-41312555
Region. Email: bimalokpal.pune@ecoi.co.in

The updated details of Insurance Ombudsman are available on

IRDA website: www.irdai.gov.in, on the website of General
Insurance Council: www.giccouncil.in, our website
www.reliancegeneral.co.in

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