United India Insurance Company Limited

Corporate Identity Number: U93090TN1938GOI000108

Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

INDIVIDUAL HEALTH INSURANCE POLICY

CUSTOMER INFORMATION SHEET (CIS)
Guide to the CIS
▪ This document has been prepared to give you a brief and quick introduction to your Individual Health Insurance Policy.
▪ The CIS must be read concurrently with Policy Wording as there are references to various clauses in the Policy Wordings.
▪ The CIS only provides a summary of the key features of the policy. Please refer to your Policy Schedule along with the Policy Wordings for
complete information on what your policy covers.
(Description is illustrative and not exhaustive )

POLICY
TITLE DESCRIPTION CLAUSE
NUMBER
Product
Individual Health Insurance Policy -
Name

1. Indemnity-based health insurance product for you and your family that offers a wide cover.
2. Coverage on Individual Sum Insured basis meaning each Insured Person has their own SI.
Product
3. 3 plans – Platinum/Gold/Senior Citizen. Please note that the plan you are under is based -
Description
on the age of entry in the policy.
4. Cashless hospitalisation in a network spanning 14000+ hospitals.

BASE COVERS
1. In-Patient Hospitalisation Expenses III.A.1
i. Covers hospitalisation expenses for a minimum period of 24 hours. These include
expenses for Room Rent, ICU/ICCU and other associated medical expenses.
ii. All Day Care Treatments are covered
iii. Covers hospitalisation expenses for an Organ Donor’s treatment for the harvesting of
organ which is donated to Insured Person.
2. Pre-Hospitalisation and Post-Hospitalisation Expenses
Covers expenses incurred in the 30 days prior to hospitalisation and in the 60 days post III.A.2
hospitalisation subject to a maximum of 10% of Sum Insured for Pre & Post combined (this
sub-limit is only for Gold & Senior Citizen plans).

3. Domiciliary Hospitalisation III.A.3

Covers expenses incurred for availing treatment at home which would otherwise require
What am I hospitalisation.
covered for?
4. Ayurvedic Treatment III.A.4
Covers expenses incurred for availing treatment under Ayurvedic system of medicine in a
registered AYUSH Hospital.

5. Road Ambulance
III.A.5
Covers expenses incurred on transportation of the Insured Person by Road Ambulance to a
Hospital for treatment in an Emergency up to Rs. 2,500 per person per policy period.
6. Modern Treatment Methods & Advancement in Technologies III.A.6
Covers expenses for advanced medical procedures such as Robotic Surgeries, Oral
Chemotherapy, Deep Brain Stimulation, Bronchial Thermoplasty, Stereotactic Radio
Surgeries, etc.

7. Cost of Health Check-Up

Insured Person is entitled to a health check-up for a block of every three claim-free years. III.A.7

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Individual Health Insurance Policy – Customer Information Sheet

UIN: UIIHLIP24089V052324
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

OPTIONAL COVERS
1. Daily Cash Allowance on Hospitalisation III.B.1
A cash amount will be paid daily to the Insured Person for every continuous and completed
period of 24 hours of Hospitalisation. Daily cash benefit amount varies based on Sum
Insured opted.

The following is a partial list. Please refer to Policy Wordings for the complete list of
exclusions.
1. Admission primarily for investigation & evaluation (Code – Excl04) IV.B.4
2. Admission primarily for rest cure, rehabilitation, and respite care (Code – Excl05) IV.B.5
3. Expenses related to the treatment for correction of eyesight due to refractive error less IV.B.15
than 7.5 dioptres. (Code – Excl15)
What are
the major 4. Any expenses incurred on Out-patient treatment (OPD treatment) IV.C.3
exclusions in 5. Congenital External Diseases or Defects or anomalies IV.C.8
the policy? IV.C.9
6. Cost of hearing aids; including optometric therapy
7. Dental treatment or surgery of any kind unless necessitated by disease or accident and IV.C.11
requiring hospitalisation
8. Intentional self-inflicted Injury or attempted suicide IV.C.12
9. Routine eye-examination expenses, cost of spectacles, contact lenses IV.C.13
10. Vaccination or inoculation of any kind unless it is post animal bite IV.C.18

Initial Waiting Period: 30 days for all illness (not applicable on renewal or for accidents) IV.A.3
Waiting
Period Specific Waiting Periods
(not 1. 24 months for certain specified diseases/procedures/treatments IV.A.2 Table A
applicable 2. 48 months for certain specified diseases/procedures/treatments IV.A.2 Table B
under
Platinum Pre-Existing Diseases: Covered after forty-eight (48) months of continuous coverage. IV.A.1
Plan) (Note: the above waiting periods are applicable only for Gold & Senior Citizen plans)
1. Cashless facility for treatment in network hospitals V.B.5.ii.a
2. Reimbursement for treatment in non-network hospitals V.B.5.iii.a
Payment 3. Reimbursement for domiciliary hospitalisation, pre–hospitalisation and post– V.B.5.iii.b
Basis hospitalisation claims
4. Reimbursement for Cost of Health Check-up. V.B.5.iii.c
5. For Daily Cash, fixed benefit amount will be paid to the Insured Person. III.B.1
In case of a claim, this policy requires you to share expenses exceeding the following sub-limits:
1. In-Patient Hospitalisation expenses
Room Rent 1% of Sum Insured per day
III.A.1.i
ICU/ICCU charges 2% of Sum Insured per day
III.A.1.ii
III.A.(1.1)
Proportionate Payment Clause: In case of admission to a room at rates exceeding the
aforesaid limits, the payment of all associated medical expenses incurred at the Hospital
Loss Sharing
shall be effected in the same proportion as the admissible rate per day bears to the actual
rate per day of Room Rent. III.A.(1.2)
2. Cataract (only for Gold & Senior Citizen plan)
25% of Sum Insured subject to a maximum of Rs. 40,000/- per eye
III.A.(1.2)
3. Hernia & Hysterectomy (only for Gold & Senior Citizen plan)
25% of Sum Insured subject to a maximum of Rs. 1,00,000 per surgery/hospitalisation

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Individual Health Insurance Policy – Customer Information Sheet

UIN: UIIHLIP24089V052324
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

4. Major Surgeries (only for Gold & Senior Citizen plan) III.A.(1.2)
up to 70% of the Sum Insured for surgeries including Cardiac Surgeries; Brain Tumour
Surgeries; Pace Maker Implantation for Sick Sinus Syndrome; Cancer Surgeries; Hip, Knee,
Joint Replacement Surgery; Organ Transplant.

5. Pre-Hospitalisation and Post-Hospitalisation Expenses (combined) (only for Gold & Senior III.A.2
Citizen plan)
10% of Sum Insured
Annexure – 3
6. Domiciliary Hospitalisation
Sum Insured (in Rs.) Annual Limit (in Rs.)

50,000 10,000

75,000 15,000

100,000 20,000

125,000 23,750

150,000 27,250

175,000 31,250

200,000 35,000

225,000 37,500

250,000 40,000

275,000 42,500

300,000 45,000

325,000 47,500

350,000 – 1,000,000 50,000

1,500,000 75,000

2,000,000 100,000

7. Road Ambulance III.A.5

Rs. 2,500 per person per policy period

8. Health Check-Up III.A.7

Up to 1% of average Sum Insured of preceding 3 policy years, subject to a maximum of Rs.
5,000 per person per policy period.

9. Deductible - Daily Cash Allowance III.B.1

Deductible equivalent to Daily Cash Allowance for the first 48 hours Hospitalisation

1. The policy is ordinarily life-long renewable, except on grounds of fraud, misrepresentation,

or non-disclosure of material facts by the Insured.
2. Renewal is subject to request for renewal and requisite premium in full having been
Renewal
received before the end of the policy period and realisation of premium. Clause V.A.15
Conditions
3. At the end of policy period, the policy shall terminate, and a grace period of 30 days is
provided to renew policy to maintain continuity benefits. Coverage is not available during
Grace period.

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Individual Health Insurance Policy – Customer Information Sheet

UIN: UIIHLIP24089V052324
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

4. Renewal shall not be denied on the ground that the Insured had made a claim or claims in
the preceding policy years. No loading shall apply at renewal based on your claims
experience.

1. The Policyholder may cancel the policy by giving 15 days’ written notice and UIIC shall
refund premium for the unexpired policy period as per short period rate table given in Policy
Wordings.
Cancellation Clause V.A.1
2. UIIC may cancel the policy at any time on grounds of misrepresentation, fraud, or non-
disclosure of material facts by the Insured Person, by giving 15 days’ written notice. There
is no refund of premium in such an event.
1. Health Check-Up
Renewal
Insured Person is entitled to health check-up for a block of every 3 claim-free years, subject III.A.7
Benefits
to 1% of average Sum Insured of preceding 3 policy years.
1. Notification: Please notify the TPA/UIIC in writing within 24 hours from the date of V.B.5.i
emergency hospitalisation required or before discharge from Hospital, whichever is earlier;
at least 48 hours prior to admission in Hospital in case of planned Hospitalisation.
2. Cashless Procedure:
i. Intimate TPA of the claim using toll-free number given in health ID card. V.B.5.ii
ii. Upon admission in hospital, cashless request form shall be completed and sent to TPA
for authorisation. After verification, TPA issues pre-authorisation letter.
iii. At the time of discharge, the Insured Person shall verify and sign the discharge papers
and pay for non-medical and inadmissible expenses.
iv. Hospital Network details can be obtained at: https://uiic.co.in/en/tpa-ppn-network-
How to hospitals
Claim? 3. Reimbursement Procedure:
V.B.5.v
i. Submit the necessary documents to TPA/UIIC within the prescribed time limit as
mentioned below:
Type of Reimbursement Prescribed Time Limit
Claim
Hospitalisation, and Pre- Within 15 days of date of discharge from hospital
Hospitalisation expenses
Cost of Health Check-up Within 15 days of Health Check-up
Post Hospitalisation Within 15 days from completion of post
expenses Hospitalisation treatment

Policy Servicing
Please contact your Policy issuing office, details of which are mentioned in your Policy
Schedule.
Grievance/Complaints
In case of any grievance, you may contact UIIC through:
Policy a. Website: www.uiic.co.in
Servicing/ b. Toll Free Number: 1800 425 333 33 Clause V.A.14
Grievance/ c. E-Mail: [email protected]
Complaints
You may also approach the grievance cell at any of our branches with details of the grievance.
Alternatively, you may lodge a complaint at the IRDAI Integrated Grievance Management
System (https://igms.irda.gov.in/) OR approach the Office of the Insurance Ombudsman in
your respective Area/Region. Details of Insurance Ombudsman offices have been provided as
Annexure – 3 in the Policy Wordings.

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Individual Health Insurance Policy – Customer Information Sheet

UIN: UIIHLIP24089V052324
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545

1. Free Look Period: You are allowed a period of 15 days from date of receipt of the policy V.A.7
document to review its terms and conditions and to return the policy if not acceptable to
you. This is not applicable on renewals.
2. Renewability: The policy can be renewed annually throughout the lifetime of the insured. V.A.15
In the event of break in the policy a grace period of 30 days is allowed. However, the policy
will not be available for renewal once Lump Sum Benefit for HIV/AIDS is paid.
3. Change of Sum Insured: The Insured Person can apply for an enhancement of Sum Insured V.B.4
at the time of renewal. The acceptance of such enhancement would be at the discretion of
Insured’s
UIIC. All waiting periods as defined in the Policy shall apply for the incremental portion of
Rights
the Sum Insured from the effective date of enhancement of such Sum Insured.
4. Migration: Insured Person has the option to migrate the policy to other health insurance V.A.8
products/plans offered by UIIC by applying at least 30 days before the policy renewal date…
5. Portability: Insured Person has the option to port the entire policy to an Super Top Up V.A.12
Medicare product offered by another Insurer by applying at least 45 days before policy
renewal date. Portability is subject to underwriting.
6. Turn Around Time (TAT): For reimbursement claims, the company shall settle or reject a
V.A.2
claim within 30 days from date of receipt of last necessary document.
1. Disclosure of Information
i. Policyholder is required to disclose all material information such as, but not limited to, I
pre-existing diseases/conditions, medical history, etc. as sought in the Proposal form and
other connected documents.
ii. Non-disclosure, misrepresentation or misdescription of such information may result in V.A.5
claim not being paid and shall make the policy void and all premium paid thereon shall
Insured’s be forfeited to UIIC.
Obligations iii. The Insured shall notify the policy issuing office in writing, of any material change, such V.B.8.iii
as change in occupation, during the policy period.
2. Nomination
Policyholder is required at the inception of the policy to make a nomination for the purpose V.A.11
of payment of claims under the policy in the event of death of the Policyholder.

Legal Disclaimer Note: The information must be read in conjunction with the policy document. In case of any conflict between
the CIS and the policy document, the terms and conditions mentioned in the policy shall prevail.

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Individual Health Insurance Policy – Customer Information Sheet

UIN: UIIHLIP24089V052324