nationalinsuranceindia.nic.co.in Gramin Suswasthya Micro Insurance Policy : National Company

Organization : National Insurance Company Ltd
Facility : Gramin Suswasthya Micro Insurance Policy

Home Page : https://nationalinsuranceindia.nic.co.in/portal/page/portal/Corporate/Home
Terms & Conditions : https://www.statusin.in/uploads/22689-GraminSuswasthyaBima.pdf

Gramin Suswasthya Micro Insurance Policy

Section I : Hospitalization Expenses
1.1 Subject to the terms, conditions, exclusions and definitions contained herein or endorsed or otherwise expressed hereon,

Related : National Insurance Company Gramin Suraksha Bima Policy : www.statusin.in/22700.html

the Company undertakes that if during the period stated in the Schedule any Insured Person shall contract any disease or suffer from any illness (herein after called DISEASE) or sustain any bodily injury through accident (hereinafter called INJURY)

If such disease or injury shall require any such insured person upon the advice of a duly qualified Physician/Medical Specialist/Medical Practitioner (hereinafter called MEDICAL PRACTITIONER) or of a duly qualified Surgeon ( hereinafter called SURGEON) to incur Hospitalization Expenses for Medical/Surgical treatment at any Nursing Home/Hospital in India as herein defined (hereinafter called HOSPITAL) as an inpatient the Company will pay through TPA to the Hospital / Nursing Home or Insured person the amount of such expenses subject to limits as are reasonably and necessarily incurred in respect thereof by or on behalf of such Insured Person but not exceeding the Sum Insured for that person/family (all claims in aggregate) in one period of Insurance stated in the schedule hereto.

1.2 In the event of any claim becoming admissible under this scheme, the company will pay through TPA to the Hospital/ Nursing Home or insured person the amount of such expenses as would fall under different heads subject to limits mentioned below and as are reasonably and necessarily incurred thereof by or on behalf of such insured person.

Maternity Expenses Benefit Extension :
The maximum benefit allowable under this clause will be up to Rs.1, 000/- for Normal Delivery and 3500/- for caesarean delivery.

Delivery of first two living children of the insured/spouse will be covered under this benefit. Special conditions applicable to maternity expenses benefit extension.

i) These benefits are applicable only if the expenses are incurred in hospital/nursing home as inpatient in India.

ii) A waiting period of nine months is applicable for payment of and claim relating to normal delivery or caesarean section or abdominal operation for extra uterine pregnancy.

This waiting period may be relaxed only in the case of delivery, miscarriage or abortion induced by accident or other medical emergency

iii) Claims in respect of deliveries for only first two children and/or operations associated therewith will be considered in respect of any one Insured person covered under the policy or any renewal thereof.

Those insured person who are already having two or more living children will not be eligible for this benefit

iv) Expenses incurred in connection with voluntary medical termination of pregnancy during the first twelve (12) weeks from the date of conception are not covered.

v) Pre-natal and post-natal expenses are not covered unless admitted in hospital/nursing home and treatment is taken there.

Section II : Personal Accident
A. If the Insured and his/her spouse shall sustain any bodily injury resulting solely and directly from accident caused by outward, violent and visible means, and if such injury shall within six calendar months of its occurrence lead to death then the Company shall pay a sum of Rs.25, 000/-in each case.

B. All necessary and reasonable medical expenses incurred by the insured and his/her spouse in the Outpatient Dept.

Of a Hospital or Nursing Home immediately after the accident giving rise to a claim under this policy and relevant to the injuries sustained thereof then the Company shall pay to the insured an amount not exceeding in the aggregate the sum of Rs.3000/-during the policy period.

Exclusions :
A) Payment or compensation in respect of death directly or indirectly arising out of or contributed to by or traceable to any disability already existing on the date of commencement of this policy.

B) Death arising directly or indirectly from or traceable to :
1. Intentional self injury, suicide or attempted suicide
2. Pregnancy or any complication in consequence thereof

3. Whilst engaging in aviation or Ballooning, whilst mounting into dismounting, from or traveling in any Balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world or engaging in hazardous sports of any kind whatsoever.

4. Whilst under the influence of intoxication, liquor or drugs
5. Directly or indirectly caused by venereal diseases or insanity

6. Arising or resulting from the insured committing any breach of law with criminal intent.
7. War and war like perils, nuclear perils, radioactivity and the like.

Conditions applicable to Sections –I & II :
1. Every notice of communication to be given or made under this policy shall be delivered in writing at the address of the TPA office as shown in the Schedule.

2. The premium payable under this policy shall be paid in advance. No receipt for premium shall be valid except on the official form of the Company signed by the duly authorized official of the Company.

The due payment of premium and the observance and fulfillment of the terms provisions conditions and endorsement of this policy by the Insured person in so far as they relate to anything to be done or complied with by the Insured Person shall be condition precedent to any liability of the Company to make any payment under this policy.

No waiver of any terms provisions conditions and endorsement on this policy shall be valid unless made in writing and signed by an authorized official of the Company.

3.Upon the happening of any event, which may give rise to a claim under this policy notice with full particulars shall be sent to the TPA named in the Schedule immediately and in case of emergency within 24 hours of Hospitalization.

4.All supporting documents relating to the claim must be filed with TPA within 7 days from the date of discharge from the hospital