Conditions applicable to the Policyholder
The Policyholder mentioned so in the Policy Schedule to this Policy has:
by way of submitting a Proposal applied to the Reliance General Insurance Company Limited (hereinafter called “the Company”) for this insurance policy and has disclosed all the relevant information required by the Company for deciding on the question of acceptance of this Proposal and issuance of this Policy
paid appropriate premium and has agreed to undertake to pay subsequent premiums, if any, by their due dates.
Conditions applicable to the Company:
The Company upon accepting the Proposal and receiving all the premiums by their due dates and realization thereof, undertakes that if during the Policy Period as specified in the Policy Schedule any Claim occurs which becomes admissible and payable under this Policy then the Company shall pay for such Claim as per the terms, conditions, coverage, exclusions, and definitions as mentioned in this Policy.
Any word or expression to which a specific meaning has been assigned in any part of this Policy or the Schedule shall bear the same meaning wherever it appears. For purposes of this Policy, the terms specified below shall have the meaning set forth:
"Accident" means sudden, unforeseen, and involuntary event caused by external, visible and violent means.
"Air Travel" means travel by an airline/aircraft for the purpose of flying therein as a passenger.
“Bank Rate” means bank rate fixed by the Reserve Bank of India (RBI) at the beginning of the financial year in which claim has fallen due.
"Burglary" means an act involving the unauthorized or forcible entry to or exit from the Insured/ Insured Person 's home in India or any attempt thereat, with intent to commit crime.
"Common Carrier" means any scheduled commercial airline or ship or vessel operating under a license from the relevant authority for the transportation of passengers for hire.
"Company" means Reliance General Insurance Company Limited.
“Complainant” means a policyholder or prospect or any beneficiary of an insurance policy who has filed a Complaint or Grievance against the Company or a Distribution Channel.
“Complaint or Grievance” means written expression (includes communication in the form of electronic mail or other electronic scripts), of dissatisfaction by a Complainant with insurer, Distribution Channels, intermediaries, insurance intermediaries or other regulated entities about an action or lack of action about the standard of service or deficiency of service of such insurer, Distribution Channels, intermediaries, insurance intermediaries or other regulated entities.
“Cover” means an insurance contract whether in the form of a policy or a cover note or a Certificate of Insurance or any other form as approved by the Authority to evidence the existence of an insurance contract;
"Deductible" means a cost sharing requirement under a health insurance policy that provides that the insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the Sum Insured. (Insurers to define whether the deductible is applicable per year, per life or per event and the manner of applicability of the specific deductible)
“Dental Treatment” means a treatment related to teeth or structures supporting teeth including examinations, fillings (where appropriate), crowns, extractions, and surgery.
“Distribution Channels” means persons and entities authorised by the Authority to involve in sale and service of insurance products. For the purpose of this Policy, it means the Distribution Channels who is an Intermediary of the Company
“Emergency Care” means management for an illness or injury which results in symptoms which occur suddenly and unexpectedly and requires immediate care by a medical practitioner to prevent death or serious long term impairment of the insured person’s health.
"Employee" means any person in the regular service of the Insured during the period of insurance whom the Insured compensates by salary and/or wages and whom the Insured has the right to govern in the performance of such service. Employee shall also include a principal officer and / or a director.
"Family" means the Insured, his/her lawful spouse below the age of 60 years and maximum of two (2) dependent children (including stepchildren and adopted children) below the age of 21 years.
"Felonious Assault" means an act of violence against the Insured / Insured Person or a travelling companion requiring medical treatment in Hospital.
"Hijack" means any unlawful seizure or exercise of control, by force or violence or threat of force or violence and with wrongful intent, of the common carrier in which the Insured / Insured Person is travelling.
"Hospital" means any institution established for in-patient care and day care treatment of illness and/or injuries and which has been registered as a hospital with the local authorities under Clinical Establishments (Registration and Regulation) Act 2010 or under enactments specified under the Schedule of Section 56(1) of the said act Or complies with all minimum criteria as under:
has qualified nursing staff under its employment round the clock;
has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient beds in all other places;
has qualified medical practitioner(s) in charge round the clock;
has a fully equipped operation theatre of its own where surgical procedures are carried out;
maintains daily records of patients and makes these accessible to the insurance company’s authorized personnel;
“Hospitalization” means admission in a Hospital for a minimum period of 24 consecutive ‘In-patient Care’ hours except for specified procedures/ treatments, where such admission could be for a period of less than 24 consecutive hours.
“Illness” means a sickness or a disease or pathological condition leading to the impairment of normal physiological function and requires medical treatment.
Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/ illness/ injury which leads to full recovery
Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the following characteristics:
It needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
it needs ongoing or long-term control or relief of symptoms
it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
it continues indefinitely
it recurs or is likely to recur
“Inclement weather” means any severe, catastrophic weather conditions which delay the scheduled arrival or departure of a common carrier but not including normal, seasonal climatic/weather changes.
“Injury” means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent, visible and evident means which is verified and certified by a Medical Practitioner.
“Inpatient care” means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.
"Insurer" means Company i.e., Reliance General Insurance Co. Ltd.
"Insured Person/Insured" means the person specifically named as such in the Schedule, who has a permanent place of residence in India and for whom the insurance is proposed, and the appropriate premium paid.
"Insurable Event" means an event, loss or damage for which the Insured/ Insured Person is entitled to benefit/s under this Policy.
"Loss" means loss or damage.
“Medical Advice” means any consultation or advice from a Medical Practitioner including the issuance of any prescription or follow-up prescription.
“Medical Expenses” means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.
“Medical Practitioner” means a person who holds a valid registration from the Medical Council of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within its scope and jurisdiction of license.
Medical Practitioner for Mental Illness shall be in accordance with The Mental Healthcare Act, 2017.
The registered practitioner should not be the Policyholder/Insured or their close family member.
“Medically necessary treatment” means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which:
is required for the medical management of the illness or injury suffered by the insured;
must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity;
must have been prescribed by a medical practitioner;
must conform to the professional standards widely accepted in international medical practice or by the medical community in India.
“Notification of claim” means the process of intimating a claim to the insurer or TPA through any of the recognized modes of communication.
“OPD treatment” means the one in which the Insured visits a clinic / hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day care or in-patient
"Period of Insurance" means the period from commencement of insurance cover to the end of the insurance cover or actual trip duration or full utilization of the maximum number of travel days per trip as specified in the Schedule whichever ends earlier.
“Policy Period” means the period between the start date and the end date as specified in the Schedule to this Policy or the cancellation of this policy, whichever is earlier.
"Policy” is the Company’s contract of insurance with the Policyholder providing cover as detailed in this Policy Wordings, the Proposal Form, Policy Schedule, Endorsements, if any and Annexures, and which form part of the contract and must be read together.
“Policyholder” means the person who is the proposer and whose name specifically appears in the Schedule as such.
“Pre-existing Disease” means any condition, ailment, injury or disease:
That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or
For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.
“Proposal Form” means a form to be filled in by the Prospect in written or electronic or any other format as approved by the Authority, for furnishing all material information as required by the insurer in respect of a risk, in order to enable the insurer to take informed decision in the context of underwriting the risk, and in the event of acceptance of the risk, to determine the rates, advantages, terms and conditions of the cover to be granted.
“Prospect” means any person who is potential customer of an insurer and is likely to enter into an insurance contract either directly with the insurer or through a Distribution Channel.
“Prospectus” means a document either in physical or electronic or any other format issued by the insurer to sell or promote the insurance products.
“Reasonable and Customary charges” means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury involved.
"Return Destination" means the place to which the Insured / Insured Person is scheduled to return from his/her trip.
"Schedule" means the document attached name so and to and the forming part of this Policy mentioning the details of the Insured/ Insured Person/s, the Sum Insured, the period and the limits to which benefits under the Policy are subject to.
"Strike" means stoppage of work (a) announced, organized and sanctioned by a labor union and (b) which interferes with the normal departure and arrival of a common carrier inclusive of work slowdowns, lockouts and sickouts.
"Sum Insured" means the maximum amount of coverage, as specified in the Schedule, that the Insured/ Insured Person is entitled to in respect of each benefit and as applicable under this Policy.
“Surgery or Surgical Procedure” means manual and / or operative procedure (s) required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure of diseases, relief from suffering and prolongation of life, performed in a hospital or day care centre by a medical practitioner.
"Terrorism/Terrorist Incident" means any actual or threatened use of force or violence directed at or causing damage, injury, harm or disruption, or the commission of an act dangerous to human life or property, against any individual, property or government, with the stated or unstated objective of pursuing economic, ethnic, nationalistic, political, racial or religious interests, whether such interests are declared or not. Robberies or other criminal acts, primarily committed for personal gain and acts arising primarily from prior personal relationships between perpetrator(s) and victim(s) shall not be considered terrorist activity. Terrorism shall also include any act, which is verified or recognized by the relevant Government as an act of terrorism.
"Travel Agent"means the Travel Agent, tour operator, or other entity from which the Insured purchases his/her Insurance Policy or travel arrangements, and includes all officers, employees, and affiliates of the Travel Agent, tour operator or other entity.
“Trip Duration” means the period of time commencing from the date when the Insured / Insured Person travels out of his/her original place of residence in India and ending on the date of his/her return to his/her original place of residence in India, both days inclusive, and calculated according to Indian Standard Time (IST).
"Valuables" mean photographic, audio, video, computer and any other electronic equipment, telecommunications and electrical equipment, telescopes, binoculars, antiques, watches, jewelry, furs and articles made of precious stones and metals.
The Company hereby agrees subject to the terms, conditions and exclusions herein contained or otherwise expressed, to compensate, indemnify, pay and / or reimburse in manner provided in this Policy, benefits to the Insured Person for loss or damage described hereunder up to the limit of Sum Insured as specified in the Policy Schedule.
This Section describes the Covers, Terms and Conditions, Exclusions applicable to the Benefits that are generically available under this product. However, the specific details of the Benefit available under the specific Policy of a given Insured is as per the Plan opted by the Policyholder during the Proposal stage. The Plan is a predefined set of Cover and Limits as mentioned in the Policy Schedule.
3.1 Personal Accident
What it covers
The Company shall compensate the Insured / Insured Person or their legal heir as the case may be, for any injury (whilst on a trip covered by this Policy) solely and directly caused by accident occurring during the period of insurance resulting in permanent disablement or death within 12(twelve) calendar months of occurrence of such injury.
The Sum Insured shall be the maximum liability of the Company under this benefit.
Subject to the above, the Company shall pay to the Insured / Insured Person the sum or sums as set forth in the Table of Benefits given alongside:
The disablement occurs within one year of the accident.
The disablement must be confirmed and claimed for prior to the expiry of a period of 3 months since occurrence of the disablement.
Notwithstanding anything contained in this Policy, the Company shall not be liable for compensation under more than one of the clauses (a) to (d) in the Table of Benefits hereinabove, in the same period of disablement of the Insured / Insured Person.
The Company shall not be liable to make any payment under this benefit in respect of the following:
Accidents due to mental disorders or disturbances of consciousness, strokes, fits or convulsions which affect the entire body and pathological disturbances caused by the mental reaction to the same.
Damage to health caused by curative measures, radiation, infection, poisoning except where these arise from an accident.
Any payment under this benefit whereby the Company's liability would exceed the sum payable in the event of death.
Any other claim after a claim for death has been admitted by the Company and becomes payable.
Any claim which arises out of an accident connected with the operation of an aircraft or which occurs during parachuting except when the Insured / Insured Person is flying as a passenger on a multi engine, commercial aircraft.
Payment of compensation in respect of death, injury or disablement of the Insured / Insured Person (i) from intentional self-injury, suicide or attempted suicide, (ii) whilst under the influence of intoxication, liquor or drugs, (iii) directly or indirectly, caused by venereal diseases, AIDS or insanity, (iv) whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world (v) arising or resulting from the Insured / Insured Person committing any breach of law with or without criminal intent.
Death or disablement resulting, directly or indirectly, caused by, contributed to or aggravated or prolonged by childbirth or pregnancy or in consequence thereof, venereal disease or infirmity.
Payment of compensation in respect of death, injury or disablement of the Insured / Insured Person due to or arising out of or directly or indirectly connected with or traceable to war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, seizure, capture, arrests, restraints and detainments of all Kings, Princes and people of whatsoever nation, condition or quality.
Payment of compensation in respect of, death of, or bodily injury or illness to the Insured / Insured Person directly or indirectly caused by or contributed to by or arising from –
i) ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel and for the purposes hereof, combustion shall include any self-sustaining process of nuclear fission;
ii) nuclear weapons material.
Any exclusion mentioned in the 'General Exclusions' section of this Policy.
In the event of partial loss or impairment of the function of one of the above parts of the body or senses, the appropriate proportion of the percentage stated in the Table of Benefits will be considered for payment.
If the accident impairs a number of physical or mental functions, the degree of disablement given in the Table of Benefits will be added together, but the amount payable shall not exceed 100% of the Sum Insured specified in the Schedule.
If the accident affects parts of the body or senses whose loss or inability to function is not dealt with above, the governing factor in determining the benefit amount in such a case will be the degree to which the normal physical or mental capabilities are impaired, solely from a medical point of view, as ascertained by Panel Doctor of the Emergency Assistance Service Provider.
If the accident affects any physical or mental function, which was already impaired beforehand, a deduction will be made equal in amount for this prior disablement.
If the Insured / Insured person dies for a reason unconnected with the accident within a year of the accident for whatever reason, and if a claim for disablement payment had arisen, then the payment will be made in accordance with the degree of disablement which would have been expected to exist from the findings of the last medical examination made.
In the event of permanent disablement, the Insured / Insured Person will be under obligation:
To have himself/herself examined by the Panel Doctors appointed by the Company Emergency Assistance Service Provider and the Company will pay the costs involved thereof.
To authorize doctors providing treatment or giving expert opinion and any other authority to supply the Company any information that may be required on the condition of the Insured / Insured Person.
If the above obligations are not met with due to whatsoever reason, the Company shall be relieved of its liability to compensate under this benefit.
3.2 Emergency Medical Expenses for injury
Hospitalization (Accident)
The Company shall pay or reimburse to the Insured / Insured Person expenses incurred for availing immediate emergency medical assistance required on account of any injury sustained or contracted whilst on a trip but not exceeding the Sum Insured as specified in the Schedule.
The deductible in respect of this benefit will be applicable for each separate claim and shall be of an amount as specified in the Schedule.
In the event, the Insured/Insured Person shall contract any injury during the period of insurance and if such injury shall upon the written medical advice of a Medical Practitioner require any such Insured/Insured Person, to incur hospitalisation within the period of insurance at any Hospital, for the medically necessary treatment of the Insured/Insured Person, then the Company will indemnify the Insured/Insured Person, for the amount of such medical expenses, which should be reasonable & customary charges, and are incurred by or on behalf of such Insured/Insured Person for in manner, for the period and to the extent of the Sum Insured as specified in this Policy. The company’s total liability in aggregate for all claims paid under this Benefit shall not exceed the Sum Insured.
In-patient treatment in a Hospital/Nursing Home at the place the Insured/Insured Person is staying at the time of occurrence of an insurable event.
Medical aid prescribed by a Physician as necessary part of the treatment for broken limbs or injuries (e.g. plaster casts, bandages and walking aids)
Out-patient treatment, provided, the same is critical and cannot be deferred till the Insured/Insured Person's return to the original place of residence. (This benefit is payable as per Sum Insured limit mentioned in the policy schedule against the cover.)
Radiotherapy, heat therapy or photo therapy and other such treatment prescribed by a physician.
X-Ray, diagnostic tests and all reasonable costs towards diagnostic methods and treatment of all injury provided these pertain to the diagnosed injury due to which hospitalization was deemed necessary.
What it does not cover
Any Hospitalization for treatment of pre-existing disability, illness, condition or injury.
Any Hospitalization due to an Illness /Injury where the treatment is undertaken by a family member and self-medication or any treatment that is not scientifically recognized.
Vaccination and inoculation of any kind unless forming part of treatment for Injury due to an Accident as prescribed by the Medical Practitioner.
Vitamins and tonics unless forming part of treatment for Injury /Illness as prescribed by the Medical Practitioner.
Aesthetic treatment, cosmetic surgery and plastic surgery unless necessitated due to Accident or as a part of any Injury.
Treatment taken from persons not registered as Medical Practitioners under respective Medical Councils.
Any treatment taken outside India.
Whilst engaged in adventure sports activity.
Experimental, unproven or non-standard treatment.
Emergency Evacuation
The Company shall reimburse
The extra costs of medically necessary and prescribed transportation/medical evacuation of the Insured/Insured Person from the location of the incident to the original place of residence of Insured/Insured Person or the nearest Hospital up to the limit of Sum Insured as opted by the Insured/Insured Person in the event that it is not possible to guarantee adequate medical treatment within a reasonable distance of the Insured/Insured Person's current location and consequently his health would be in jeopardy as confirmed by the attending medical Practitioner.
The additional extra costs for an accompanying person, up to the limit of Sum Insured as opted by the Insured/Insured Person if it is medically necessary that the Insured/Insured Person be accompanied; this might be a physician, nurse, immediate family member (limited to father / mother / spouse / children) or colleague.
If the Insured/Insured Person is required to be transported from a medical point of view, it shall be the decision of the Company in consultation with the attending Medical Practitioner whether the Insured/Insured Person is to be repatriated to the original place of residence or not.
The extra costs under “transportation” above are:
in the event of transportation to the original place of residence, the additional costs arising for the return trip home as a consequence of the insured event;
The company’s total liability in aggregate for all claims paid under this Benefit shall not exceed the Sum Insured as mentioned in the Schedule.
3.3 Daily Allowance in case of Hospitalization
What it Covers
In the event of hospitalization of the Insured / Insured Person for more than specified number of days as mentioned in the schedule due to injury contracted or sustained within the period of insurance whilst on the trip, the company will pay to the Insured / Insured person a daily allowance, subject otherwise to all other terms, conditions and Exclusions of the Policy.
This benefit is payable up to the limit of the Sum Insured as specified in the Schedule provided that a valid claim should have been admitted under the Emergency Medical Expenses Benefit of the Policy.
3.4 Missed Connection
The Company shall indemnify to the Insured / Insured person upto the sum insured specified in the schedule of the policy, in the event of delay of arrival at the airport due to Accident of the vehicle in which Insured Person was travelling causing the Insured person to miss the boarding of the regular scheduled domestic flight .The Company will reimburse the additional expenses incurred in booking the new flight tickets maximum upto the sum insured limit in the policy schedule subject to there is no refund made by the airlines on the missed flight.
Missed Connection cover can be claimed only if the destination is specified as "airport" at the beginning of a booked ride only. This cover is only payable during the "period of insurance" and is applicable for non-refundable expenses of domestic flights subject to the estimated time of arrival (ETA) to the Airport departure is 90min before the scheduled departure time of flights for "Daily Rides" and 120 min before the scheduled departure time of flights for "International " Travel.
What it does not cover –
This benefit does not cover any loss other than those mentioned in the coverage’s above.
Any payable claim under any other sections of the policy.
Loss caused by any other exclusion mentioned in the General Exclusions.
Special Condition –
The common carrier shall certify that the Insured person has missed the flight through a missed flight certificate.
Benefits for Ticket Loss will be in excess of any amount paid or payable by the Common Carrier, if any.
The next flight booked should be scheduled within 24 hours of the original scheduled departure time with the same destination mentioned in the original ticket .
The new flight booking time and date should be later than the original flight’s date and time. Any new flight booked before the original flight’s date and time will be excluded under the policy.
The policy is valid only if the new flight booked by the Insured person is in the same airline class and sector of the original ticket. The company shall cover only economy class tickets falling under the same class of the original ticket.
The new flight ticket can only be purchased for the Insured Person who has missed the flight under the policy and cannot be transferred to another Individual.
General Exclusions (Applicable to all sections of this policy)
Without prejudice to anything contained in this policy, the company shall not be liable to make any payment in respect of:
Any claim relating to events occurring before the commencement of the cover or otherwise outside of the period of insurance.
Any claim relating to expenses incurred for the treatment of pre-existing disease / conditions / illness / injury.
Treatment if that be the sole reason or one of the reasons for the insured/insured person’s travel and temporary stay in his/her current location.
Any claim if the insured/insured person
Is traveling against the advice of a physician;
Is receiving, or is on a waiting list to receive, specified medical treatment declared in the physician’s report or Certificate;
Has received terminal prognosis for a medical condition;
Is taking part in a naval, military or air force operation
Deductibles as specified in the schedule
Any claim arising out of illnesses or injury that the insured/insured person
Has caused intentionally or by committing a crime or as a result of drunkenness or
Addiction (drugs, alcohol)
Any claim arising out of mental disorder, anxiety, stress, depression, venereal disease or any loss, directly or indirectly, attributable to HIV (Human Immuno Deficiency Virus) and/or any HIV related illness including AIDS (Acquired Immuno Deficiency Syndrome) and/or any mutant derivative or variations thereof howsoever caused.
Illness and accidents that are results of war and war like occurrence or invasion, acts of foreign enemies, hostilities, civi l war, rebellion, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power, active participation in riots, confiscation or nationalization or requisition of or destruction of or damage to property by o r under the order of any government or local authority.
Suicide or attempted suicide, intentional self-inflicted Injury or acts of self-destruction, whether the Insured Person is medically sane or insane.
Any act of terrorism which means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or governments(s), committed for political, religious, ideological, or ethnic purposes or reasons including the intention to influence any government and / or to put the public, or any section of the public, in fear,
Any failure to take reasonable precautions to avoid a claim under the Policy following a mass media or government issued warning.
Any claim arising from damage to any property or any loss or expense whatsoever resulting or arising from or any consequential loss, directly or indirectly, caused by or contributed to or arising from:
Lionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel or
The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
Any claim arising out of sporting activities in so far as they involve the training or participation in competitions of professional or semi-professional sports persons, unless declared beforehand and necessary additional premium paid.
General Conditions (Applicable to all sections of this policy)
The Conditions mentioned herein shall affect all the Benefits of this Policy.
Entry Ages: Minimum and Maximum age of the Insured Person shall be 6 months up to 80 years.
Precautions: The Insured / Insured Person shall take all reasonable precautions to prevent illness and injury in order to minimize claims. Failure to do so will prejudice the Insured/Insured Person's claim under this Policy.
Information about the Insured Trip: The Insured / Insured Person shall provide the Company with the details of the trip and other information as may be required by the Company from time to time.
Operation of Deductible: Deductible will be charged for each separate incident reported for claims payment, even though the claim may be registered under the same benefit more than once.
Extension of Policy: There is no extension of policy applicable beyond the policy period.
Making a claim:
What is to be done in case of a claim?
The Insured / Insured Person shall immediately contact the Help Line of the Company stating necessary details. The details of phone numbers and Help Line are given in the Schedule.
The Insured /Insured Person needs to contact the Help Line number as soon as possible and inform in case the Insured/ Insured Person is/will be filing any claim, even if assistance is not required. The Company will not be liable to pay any claim that has not been informed by the Insured /Insured Person to the Help Line of the Company.
The Help Line of the Company will verify the identity of the caller by asking appropriate information
In the event of a illness / injury where it is not possible to contact the Help Line before consulting a Physician or going to the Hospital, the Insured / Insured Person shall contact the Help Line as soon as possible. In either case, when being admitted as a patient, the Insured/Insured Person shall show the concerned Physician or personnel this Policy.
In case of Emergency Medical Expenses the Company's liability will only attach if these are incurred with the approval of the Company.
In case of all other claims, there shall be necessary prior intimation to the Helpline of the Company, stating the incident/loss.
Claim Settlement: How to get the claim paid?
If the procedure stated above is complied with, the Company will guarantee to the Hospital/other providers the costs of hospitalization, transportation for emergency services, transportation home of the Insured/ Insured Person including accompanying person, if any. All costs will be directly settled by the Company on the Company's behalf and the same shall constitute due discharge of the Company’s obligations hereunder.
If the Hospital / other providers do not accept the guarantee of payment from the Company, the Company cannot be held liable for the same. The cost will then have to be borne by the Insured / Insured Person and the same will then be reimbursed by the Company on submission of required documents.
All claims shall be paid in India in Indian Rupees.
Confirmation from the Master policy holder that the registered app customer opting for Insurance was riding as a passenger.
Claim Documentation- What documents need to be submitted?
Personal Accident
Accidental Death Claim –
Completely filled and signed Claim form, in original
Booking reference & Ride details
Attested FIR document/Police papers
Attested Postmortem Report
Attested Death Certificate
Original Cancelled CTS 2010 cheque for NEFT with KYC documents of Claimant.
Legal Heir Certificate (Incase nomination not declared under the policy)
PTD/PPD claim -
Complete hospital treatment records
Disability certificate issued by Senior Medical Officer mentioning the disability percentage.
Original Cancelled CTS 2010 cheque for NEFT with KYC documents of Insured
Emergency Medical Expenses for Injury
Hospital discharge summary / treatment records along with medical bill copies
OPD treatment due to Injury
Doctor Investigation report along with Doctors consultation report and Pharmacy bills
Hospital Treatment records along with discharge summary
Emergency transportation bill proof on the name of insured
Daily Allowance in case of Hospitalization due to injury
Hospital treatment records along with discharge summary
Attested FIR document
Missed Connection
Copy of flight ticket along with proof of missed flight confirmation
New Flight Booking with original ticket
Reason for missed flight connection with supporting documents
Obligations of the Insured /Insured Person:
Claims for benefits must be submitted to the Company not later than one (1) month after the completion of the treatment or transportation home, or in the event of death, after transportation of the mortal remains/ burial.
The Insured / Insured Person shall provide to the Company on demand any information that is required to determine the occurrence of the insurable event or the Company's liability to pay the benefits. In particular, upon request, proof shall be furnished of the actual commencement date of the trip.
If requested to do so by the Company, the Insured / Insured Person is obliged to undergo a medical examination by a physician designated by the Company.
The Company is authorized by the Insured / Insured Person to take all measures that are suitable for loss prevention and claim minimization which includes the Insured / Insured Person's transportation back to his/her original place of residence.
The Company shall be released from any obligation to pay benefits under this Policy, if any, of the aforementioned obligations are breached by the Insured /Insured Person.
Transfer and Set-off of Claims:
If the Insured / Insured Person has any outstanding claims against third parties, such claims shall be transferred in writing to the Company up to the amount for which the reimbursement of costs is made by the Company in accordance with the terms hereunder.
In so far as an Insured / Insured Person receives compensation for costs he/she has incurred either from third parties liable for damages or as a result of other legal circumstances, the Company shall be entitled to set off this compensation against the insurance benefits payable, if any.
Claims to the insurance benefits may be neither pledged nor transferred by the Insured / Insured Person.
No sum payable under this Policy shall carry any interest /penalty.
In the event of the Insured/Insured Person's death, the Company shall have the right to demand the submission of a postmortem/autopsy report.
Standard Terms and Conditions (applicable To All Benefits under the Policy):
Conditions precedent to the contract
Disclosure to information norm
The Policy shall be void and all premium paid hereon shall be forfeited to the Company, in the event of misrepresentation, misdescription or non-disclosure of any material fact. In the event of untrue or incorrect statements, misrepresentation, misdescription or non-disclosure of any material particulars in the proposal form, personal statement, declaration and connected documents, or any material information having been withheld, or a Claim being fraudulent or any fraudulent means or device being used by the Policyholder/ Insured Person or any one acting on his/ their behalf to obtain a benefit under this Policy, the Company may cancel this Policy at its sole discretion and the premium paid shall be forfeited in its favour.
Observance of terms and conditions
The due observance and fulfilment of the Policy Terms & Conditions and Endorsements of this Policy in so far as they relate to anything to be done or complied with by the Policyholder / Insured Person, shall be a condition precedent to any of the Company’s liability to make any payment under this Policy.
Pre-policy Health Check up
The full costs of any pre-policy health check up wherever required shall be borne by the Policy Holder / Insured Person.
Assignment of Indemnity
Indemnity, if any, in case of the loss of life of the Insured is then payable to the nominee named in the Proposal Form provided such nominee survives after the Insured ; otherwise, indemnity is payable to Insured’s estate. All other indemnities of this Policy are payable to the Insured. Any payment that the Company make in good faith pursuant to this provision shall fully discharge the Company to the extent of the payment.
Consent of the Nominee
Consent of the nominee, if any, shall not be a pre-requisite for any change of nominee or to any other changes in this Policy.
Arbitration Clause
If any dispute or difference shall arise as to the quantum to be paid under this 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 thereto or if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising of 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.
Conditions when a Claim arises
Complete discharge
Payment made by the Company to the Policyholder/ adult Insured Person or the Nominee of the Policyholder or the legal representative of the Policyholder or to the Hospital, as the case may be, of any Medical Expenses or compensation or benefit under the Policy shall in all cases be complete and construe as an effectual discharge in favour of the Company.
Duties of the Insured / Insured Person
Duties of the Insured Person on the occurrence of any loss, within the scope of this Policy the Insured Person shall be:
Forthwith file / submit a Claim Form in accordance with 'Claim Procedure'.
Allow the Surveyor or any agent of the Company to inspect the lost / damaged properties premises /goods.
Assist and not hinder or prevent the Company or any of its agents in pursuance of their duties.
Not to abandon the insured property / items in the premises, nor take any steps to rectify / remedy the damage before the same has been approved by the Company or any of its agents or the Surveyor. If the Insured Person does not comply with this provision of this Clause, all benefits under this Policy shall be forfeited, at the option of the Company.
Right to inspect
If required by the Company, an agent / representative of the Company including a loss assessor, or a Surveyor appointed in that behalf shall in case of any loss or any circumstances that have given rise to the claim to the Insured Person be permitted at all reasonable times to examine into the circumstances of such loss.
The Insured Person shall on being required so to do by the Company produce all books of accounts, receipts, documents relating to or containing entries relating to the loss or such circumstance in his possession and furnish copies of or extracts from such of them as may be required by the Company so far as they relate to such claims or will in any way assist the Company to ascertain in the correctness thereof or the liability of the Company under this Policy.
Position after a claim
The Insured Person shall not be entitled to abandon any insured property whether the Company has taken possession of the same or not. As from the day of receipt of the claim amount by the Insured Person, the Sum Insured for the remainder of the Policy Period shall stand reduced by the amount of the compensation.
Subrogation
Subrogation shall mean the right of the Company to assume the rights of the Insured Person/Policyholder to recover expenses paid out under the Policy that may be recovered from any other source.
The Policyholder/ Insured Person shall at his own expense do or concur in doing or permit to be done all such acts and things that may be necessary or reasonably required by the Company for the purpose of enforcing and/or securing any civil or criminal rights and remedies or obtaining relief or indemnity from any other party to which the Company is/or would become entitled upon the Company paying for a Claim under this Policy, whether such acts or things shall be or become necessary or required before or after its payment
Neither the Policyholder nor any Insured Person shall prejudice these subrogation rights in any manner and shall at his own expense provide the Company with whatever assistance or cooperation is required to enforce such rights. Any recovery the Company makes pursuant to this clause shall first be applied to the amounts paid or payable by the Company under this Policy and any costs and expenses incurred by the Company of affecting a recovery, where after the Company shall pay any balance remaining to the Policyholder. This clause shall not apply to any Benefit offered on fixed benefit basis.
Indemnity
The Company may at its option, if applicable reinstate, replace or repair the property or premises lost or damaged or any part thereof instead of paying the amount of loss or damage or may join with any other insurer in so doing.
The Company shall not be bound to reinstate exactly or completely but only as circumstances permit and in reasonably sufficient manner. In no case shall the Company be bound to expend more in reinstatement than it would have cost to reinstate such property as it was at the time of the occurrence of such loss or damage and in any event not more than the sum Insured Person thereon.
If in any case the Company shall be unable to reinstate or repair the insured property/item, because of any law or other regulations in force affecting insured property or otherwise, the Company shall, in every such case, only be liable to pay such sum as would be requisite under this Policy.
Contribution in case of Multiple Policies
In case of multiple policies which provide fixed benefits, on the occurrence of the insured event in accordance with the terms and conditions of the policies, each insurer shall make the claim payments independent of payments received under other similar polices.
If two or more policies are taken by an insured during a period from 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 who has issued the chosen policy 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.
Claims under other policies may be made after exhaustion of Sum Insured in the earlier chosen Policy / Policies
If the amount to be claimed exceeds the sum insured under a single policy after considering the deductibles or co-pay, the policyholder shall have the right to choose insurers from whom he/she wants to claim the balance amount.
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.
Fraudulent claims
If a Claim is in any way found to be fraudulent, or if any false statement, or declaration is made or used in support of such a Claim, or if any fraudulent means or devices are used by the Policyholder / Insured Person or anyone acting on his/ their behalf to obtain any benefit under this Policy, then this Policy shall be void and all claims being processed shall be forfeited for all Insured Persons and all sums paid under this Policy shall be repaid to the Company by the Policyholder / all Insured Persons who shall be jointly liable for such repayment.
Limitation Period
In no case whatsoever the Company shall be liable for any Claim under this Policy, if the requirement of Clauses5 vii, ix, x above are not complied with, unless the Claim is the subject of pending action; it being expressly agreed and declared that if the Company shall disclaim liability for any Claim hereunder and such Claim shall not within 12 calendar months from the 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 deemed to have been abandoned and shall not thereafter be recoverable.
Payment of Interest
The Company shall make the payment of claim that has been admitted as payable under the Policy terms and conditions within 30 days of submission of all necessary documents / information and any other additional information required for the settlement of the claim.
All claims will be settled in accordance with the applicable regulatory guidelines, including IRDA of India (Protection of Policyholders Interests Regulation), 2002. In case of any delay in payment as stated herein, The Company will pay an interest at the prevalent bank rate plus 2 % at the beginning of the financial year in which claim is settled.
For the purpose of this clause, bank rate' shall mean the existing bank rate as notified by Reserve Bank of India, unless the extent regulation requires payment based on some other prescribed interest rate .
Conditions for renewal of the contract
Withdrawal/Revision/Modification of the Product
The Company reserves the right to withdraw, revise or modify this product / policy in the future. The revision/modification may be in respect of Benefits, coverages, premiums, policy terms and conditions &/or exclusions. In the event of any such withdrawal of product the company will notify in advance to the policyholder providing him the option to port to the specified existing health products of the company with continuity benefit.
Renewal Conditions
This Policy expires at the end of the Policy Period. This Policy covers a given Insured Trip as stated in the Policy Schedule; there is no commitment, obligation or requirement that is binding on the Company to offer the Policyholder an option to renew this Policy.
Conditions applicable during the contract
Reasonable Care
The Insured Person shall take all reasonable steps to safeguard the interests of the Insured Person against accidental loss or damage that may give rise to a claim.
Material change
The Policyholder shall immediately notify the Company in writing of any material change in the risk at their own expense and the Company may adjust the scope of cover and/or premium, if necessary, accordingly. ‘Material change’ shall include but not limited to travelling dates, destination, purpose of the Insured Trip, destination of the Insured Trip, health condition of the Insured, Immediate Family members or Travelling Companion, age of the Insured or matters of similar nature.
Records to be maintained
The Policyholder/ Insured Person shall keep an accurate record containing all relevant medical & other relevant records and shall allow the Company or its representative(s) to inspect such records. The Policyholder/ Insured Person shall furnish such information as the Company may require under this Policy at any time during the Policy Period and up to three years after the policy expiration, or until final adjustment (if any) and resolution of all Claims under this Policy.
No constructive Notice
Any knowledge or information of any circumstance or condition in relation to the Policyholder/ Insured Person which is in possession of the Company and not specifically informed by the Policyholder / Insured Person shall not be held to bind or prejudicially affect the Company notwithstanding subsequent acceptance of any premium
Special Provisions
Any special provisions subject to which this Policy has been entered into and endorsed in the Policy or in any separate instrument shall be deemed to be part of this Policy and shall have effect accordingly.
Electronic Transactions
The Policyholder/ Insured Person agrees to adhere to and comply with all such terms and conditions as the Company may prescribe from time to time, and hereby agrees and confirms that all transactions effected by or through facilities for conducting remote transactions including the Internet, World Wide Web, electronic data interchange, call centres, teleservice operations (whether voice, video, data or combination thereof) or by means of electronic, computer, automated machines network or through other means of telecommunication, established by or on behalf of the Company, for and in respect of the Policy or its terms, or the Company’s other products and services, shall constitute legally binding and valid transactions when done in adherence to and in compliance with the Company’s terms and conditions for such facilities, as may be prescribed from time to time.
Cancellations
The Company may at any time, cancel this Policy, by giving 7 days notice in writing by Registered Post Acknowledgment Due to the Insured Person at his last known address in which case the Company shall be liable to repay on demand a rateable proportion of the premium for the unexpired term from the date of the cancellation. Cause of Action No claim shall be payable under this Policy where the cause of action arises in India, unless otherwise specifically provided in the Policy Schedule.
Policy Disputes
Any and all disputes or differences under or in relation to validity, construction, interpretation and effect to this Policy shall be determined by the Indian Courts and subject to Indian law.
Communication
Any communication meant for the Company must be in writing and be delivered to its address shown in the Policy Schedule. Any communication meant for the Policyholder will be sent by the Company to his last known address or the address as shown in the Policy Schedule. All notifications and declarations for the Company must be in writing and sent to the address specified in the Policy Schedule. Agents are not authorized to receive notices and declarations on the Company’s behalf. Notice and instructions will be deemed served 10 days after posting or immediately upon receipt in the case of hand delivery, facsimile or e-mail.
Overriding effect of the Policy Schedule
In case of any inconsistency in the terms and conditions in this Policy vis-à-vis the information contained in the Policy Schedule, the information contained in the Policy Schedule shall prevail.
Change of Nominee
No change of nominee under this Policy shall bind the Company, unless consent thereto is formally endorsed thereon by the Company’s authorized officer.
Free Look Period
This Policy covers a given Insured Trip as stated in the Policy Schedule, there is no commitment, obligation or requirement that is binding on the Company to offer the Policyholder a Free Look period.
Customer Services
If at any time the Insured Person requires any clarification or assistance, the Insured Person may contact either the Help Line of the Emergency Assistance Service Provider or the Policy issuing office of the Company at its address during normal office hours.
Grievances
In case of any grievance the Insured Person may contact the Company through:
Website: www.reliancegeneral.co.in
E-mail: rgicl.services@relianceada.com
Telephone Number: 022 4890 3009 (Paid)
Dedicated Senior Citizen helpline: 022-33834185 (paid line)
Fax: +91 22 3303 4662
Courier: Any branch office, the correspondence address, during normal business hours
Write to us at: Reliance General Insurance, (Correspondence Only) Correspondence Unit, Winway Building, 2nd& 3rdFloor, , 11/12, Block no 4, Old no-67, South Takoganj, Indore, Madhya Pradesh, India – 452001
Insured Person may also approach the Grievance Cell at any of the Company’s branches with the details of grievance.
If Insured Person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may contact the grievance officer at:
Grievance Redressal Officer
The Grievance Cell,
Reliance General Insurance Co. Limited
No. 1-89/3/B/40 to 42/ks/301, 3rd floor,
Krishe Block, Krishe Sapphire, Madhapur
Hyderabad – 500 081
Grievance Redressal officer email ID: rgicl.headgrievances@relianceada.com
(For updated details of grievance officer, kindly refer the link Grievance Redressal )
If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured person may approach the office of the Insurance Ombudsman of the respective area/region for redressal of the grievance as per Insurance Ombudsman Rules 2017. The contact details of the Insurance Ombudsman offices have been mentioned in Annexure B.
Grievance may also be lodged at lRDAl Integrated Grievance Management System https://bimabharosa.irdai.gov.in/
The updated details of Insurance Ombudsman are available on IRDA website: www.irdai.gov.in, on the website of General Insurance Council: www.gicouncil.in, our website www.reliancegeneral.co.in
