policy

Risk Assumption Letter

Ref No.: W392102438
Date: 12-Nov-2021

Dear Sir / Madam

We thank you for placing your confidence with ICICI Lombard for your Insurance needs.

Please find attached herewith Policy No. : 4065/SM/159301439/01/000 which has been issued based on the
details furnished by the applicant.

Name of the Applicant: AVINA JAIN

Date of Birth: XX-XX-1986
Mailing Address: 2301, B WING, HDIL METROPOLIS, ANDHERI WEST, MUMBAI,
MAHARASHTRA NEAR DN NAGAR METRO STATION,, NEAR DN NAGAR
METRO STATION, MUMBAI, MAHARASHTRA - 400053
Mobile No.: 97******09
Product Name: SECURE MIND
Period of Insurance: From 00:00 hrs 14-Nov-2021 To 23:59 hrs 13-Nov-2024
Policy Duration (years): 3
Details of any Pre Existing
Disease/ Medical condition/
physical deformity H/o of
hospitalization, surgery or
medication if any:
Insured Details

Nominee
Relations Sum
Name of the Date Of Age in Sum Nominee Relations
hip with Occupation Insured
Insured Birth Years Insured Name hip with
Applicant Basis
Applicant
DR AVINA 07-May-198 Self ABHINAV
SELF 35 1200000 Fixed BROTHER
JAIN 6 Employed JAIN
Please go through the details as furnished in the format and the policy document. Please confirm that same
are in order.

In case there is any discrepancies/ variations, you are requested to write back to us immediately at
[email protected] or contact at 24 hour helpline number 1800 2666 for necessary changes/
rectification.

In the absence of any communication from you in this connection within a period of 15 days of receipt of this
letter, we would take it that the issued policy is in order and as per your proposal.

Thanking You,
Yours Sincerely,

D:/CLICK/images/Sanjay_Dutta.png

Authorized Signatory

Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2025.01.28 16:51:18
IST
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 1 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
Secure Mind
ICICI Lombard General Insurance Company Limited ("the Company"), having received a Proposal and the premium from the
Proposer named in the Schedule referred to herein below, and the said Proposal and Declaration together with any statement,
report or other document leading to the issue of this Policy and referred to therein having been accepted and agreed to by the
Company and the Proposer as the basis of this contract do, by this Policy agree, in consideration of and subject to the due
receipt of the subsequent premiums, as set out in the Schedule with all its Parts, and further, subject to the terms and
conditions contained in this Policy, as set out in the Schedule with all its Parts that on proof to the satisfaction of the Company
of the compensation having become payable as set out in Part I of the Schedule to the title of the said person or persons
claiming payment or upon the happening of an event upon which one or more benefits become payable under this Policy, the
Sum Insured/ appropriate benefit will be paid by the Company.
0
Applicant Name AVINA JAIN Policy No. 4065/SM/159301439/01/000
Address 2301, B WING, HDIL Period of Insurance From 00:00 hrs 14-Nov-2021 To
METROPOLIS, ANDHERI WEST, 23:59 hrs 13-Nov-2024
MUMBAI, MAHARASHTRA NEAR
DN NAGAR METRO STATION,,
NEAR DN NAGAR METRO Policy Tenure (in Years) 3
STATION, MUMBAI,
MAHARASHTRA - 400053
Contact No. 97******09 Loan Account Number NA
Email Address DR*********@GMAIL.COM Policy Issuing Office Prabhadevi, Mumbai
Previous Policy No. 4065/SM/159301439/00/000 Policy Issued On 16-Nov-2021
GSTIN Number (Customer) Service Branch Name Mumbai
Servicing Branch Address 414, ICICI LOMBARD HOUSE, Invoice Number 1011211011359
VEER SAVARKAR MARG, NEAR
SIDDHI VINAYAK TEMPLE MAIN
GATE, PRABHADEVI, MUMBAI,
400025, MAHARASHTRA

Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/ Close relatives/Associates of PEPs*? No

Insured Details

Nominee
Relations Age Pre Sum
Name of the Date Of Occupati Sum Nominee Relations
hip with in Gender Existing Insured
Insured Birth on Insured Name hip with
Applicant Years illness Basis
Applicant
DR AVINA 07-May-198 Self ABHINAV BROTHE
SELF 35 Female 1200000 Fixed
JAIN 6 Employed JAIN R
2. Details of the Insured Event along with the Benefits (as per table below):

No. Coverage
Sum Insured (Rs)
Section Insured Event Applicable
a) First Diagnosis of the below-mentioned Illnesses more specifically described Self
below:
1) Cancer of specified severity
2) Kidney failure requiring regular Dialysis
3) Multiple Sclerosis with persisting symptoms;
4) Benign Brain Tumor
5) Parkinson's Disease before the age of _50 years
I. Major Medical
6) Alzheimer's Disease before the age of 50 Years_ 1200000
Illness & Procedures
7) End Stage Liver Disease
b) Undergoing for the first time of the following surgical procedures, more
specifically described below:
1) Major Organ / BoneMarrow Transplant;
2) Open heart replacement orrepair of heart valves.
3) Open chest CABG
4) Surgery of Aorta;
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 2 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
 c) Occurrence for the first time of the following medical events more specifically
described below:

1) Stroke resulting in permanent symptoms;

2) Permanent Paralysis of Limbs;
3) First Heart Attack- of specified Severity
4) Major Burns;
5) Loss of Speech;
6) Deafness
7) Coma of specified severity
a) Death of the Insured on accountof anAccident
II. Personal Accident
b) Permanent Total Disablementof the Insured due toaccident.

3. Additional Clause(s)(if any)

AC1- For Reducing Sum Insured Covers; AC2- Premium Refunds AC3 –Survival period
In case of Loss of Job Cover, the definition of EMI refers to the EMI or Pre EMI on the loan or the Sum Insured, whichever is
lower, on the date of the Insured Event.
Notwithstanding anything contained herein to the contrary, it is hereby declared and agreed that the policy stands extended to
include any insured event as covered under the policy, arising out of or due to Act(s) of Terrorism excepting where the
insured is involved as perpetrator/aide.
Premium Details

Basic Premium 14446.43 Stamp Duty 1

CGST % 9 CGST Amount 1300.18
SGST % 9 SGST Amount 1300.18
Total Tax Payable 2600.36 Total Premium 17047
Place of Supply MAHARASHTRA

IL GSTIN Registration No. Category The stamp duty of Rs.1 paid vide receipt/challan no.
General Business Services CSD17520214442 dated 01-Nov-2021
27AAACI7904G1ZN
997133
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of
the said sub-rule.

Agent/Broker Details yes

Agent ICICI BANK LIMITED Agent CA0112 Agent Contact 0018002666

Name Code No.
Important Notes:
1. Insurance cover will start only on receipt of complete premium by ICICI Lombard General Insurance Company Limited.
2. Insurance cover is subject to the terms and conditions mentioned in the Policy wordings provided to you with this Certificate.
3. On renewal of policy benefits and terms & conditions of policy including premium may be subject to change.
4. The above covers would not be applicable for persons occupied in underground mines, explosives and electrical installations
on high tension lines.
5. Major exclusions: Intentional self-injury, suicide or attempted suicide whilst under the influence of intoxicating liquor or drugs,
Any loss arising from an act made in breach of law with or without criminal intent.
6. The claimant can contact us at Toll Free Number 1800-2-666 or Email us at [email protected] for lodging the
claim.
7. Claim Notification address: IL Health Care, Secure Mind Claims, ICICI LOMBARD HEALTHCARE ICICI BANK TOWER,
PLOT NO. 12 FINANCIAL DISTRICT, NANAKRAM GUDA, GACHIBOWLI, HYDERABAD
This policy has been issued based on the details furnished by the policyholder. Please review the details furnished in the policy certificate and confirm that same
are in order. In case of any discrepancy/ variation, you are requested to call us immediately at our toll free no. 1800 2666 or write to us at
[email protected]. In the absence of any communication from you within the period of 15 days of receipt of this document, the policy would be
deemed to be in order and issued as per your proposal. All refunds and claim payment will be done through NEFT only. In case of addition of member/ increase in
sum insured, fresh waiting period will be applicable to new member/ increased sum insured. This policy certificate is to be read with the policy wordings, as one
contract or any word or expression to which a specific meaning has been attached in any part of this policy shall bear the same meaning wherever it may appear.
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 3 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
Scan QR Code for Customer Information Sheet and Policy Wordings

109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 4 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
Premium Certificate- For the purpose of deduction under Section 80D of Income Tax (Amendment) Act, 1986

To,

AVINA JAIN

This is to certify that the Company has received `17047 towards premium for Major Medical Illness & Procedures for the period
from 14-Nov-2021 to 13-Nov-2024

Policy Certificate No: 4065/SM/159301439/01/000

Premium Details

Basic Premium 14446.43 Stamp Duty 1

CGST % 9 CGST Amount 1300.18
SGST % 9 SGST Amount 1300.18
Total Tax Payable 2600.36 Total Premium 17047
Place of Supply MAHARASHTRA
Issuing office : Mumbai
GSTIN Reg. No : 27AAACI7904G1ZN
HSN/SAC code : 997133/GENERAL INSURANCE SERVICES/GENERAL INSURANCE SERVICES

Note: This certificate must be surrendered to the Insurance Company in case of Cancellation of the policy or for the issuance of
a fresh certificate in the case of any alteration in the policy.
To Register your claim or for any issue, please call our 24x7 toll free number (you can call on this number by mobile also): Call
Centre No: - 18002666

109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 5 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
 SECURE MIND

Customer Information Sheet/ Know Your Policy

This document provides key information about your policy. You are advised to go through your policy document.
Description Policy Clause
S.No
Number
1. Name of Insurance Product/Policy
Secure Mind
2. Policy Number
4065/SM/159301439/01/000
3. Type of insurance Product/Policy

This is a Benefit Policy

4. Sum Insured (Basis)

This is an individual policy where sum insured mentioned is for the insured as per
policy certificate
5. Policy Coverage (Policy Clause Number/s)
Part II of the
Section I: MAJOR MEDICAL ILLNESS & PROCEDURES
Schedule Clause
• First Diagnosis of the below-mentioned Illnesses specifically described below: 2.
• Cancer of specified severity
• Kidney failure requiring regular dialysis; Benefits Under
• Multiple Sclerosis with persisting symptoms; or the Policy
• Benign Brain Tumor 2.1 Section I
• Parkinson’s Disease before the age of 50 years 2.2 Section II
• Alzheimer’s Disease before the age of 50 years 2.3 Section III
• End stage Liver Disease
• Undergoing for the first time of the following surgical procedures, more specifically
described below :
• Major Organ/ Bone Marrow Transplant
• Open heart replacement or repair of heart valves
• Open chest CABG
• Surgery of Aorta
• Occurrence for the first time of the following medical events more specifically described
below:
• Stroke resulting in permanent symptoms
• Permanent Paralysis of Limbs
• First Heart Attack- of specified severity
• Major Burns
• Loss of Speech
• Deafness
• Coma of Specified Severity
SECTION II : PERSONAL ACCIDENT
• Accidental Death - Solely due to an injury, within 12 months from the date of accident.
• Permanent Total Disablement (PTD) - Solely due to an injury within 12 months from the
date of the accident.
SECTION III: LOSS OF JOB
Insured event: In this section, the term 'Insured Event' in relation to any Insured shall mean
termination from employment, dismissal, temporary suspension or retrenchment imposed on
him by the employer during the policy period due to the insured person suffering an illness or
injury resulting from an accident following the employer's rules and regulations.
o The policy coverage for the insured will end if a claim is accepted for Major Medical Illness
Procedure, or Personal Accident (Any 1). In such cases, no benefits will be paid under other
sections of this policy.
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 6 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
 This cover maybe opted at policy inception by Salaried Individuals only.
(Please refer the policy wordings for complete details)
Exclusions (What the policy does not cover): Part II Of The
6. Schedule Clause
The Company shall not be liable under this policy for,
• Any Pre-existing Disease - Any Insured Event arising on account of or in connection with 2.1.4 Exclusions
Applicable To
any Pre-existing Disease.
Section I Clause
• For events in this section that occurred before the policy started or within the first three
2.2.3 Exclusions
months of coverage. Applicable To
• Any medical procedure or treatment, which is not medically necessary or not performed by Section II
a Doctor Clause 2.3.3
• Payment under more than one of the categories specified (Death or Permanent Total Exclusions
Disablement) in the benefit payable in respect of the Insured. Applicable to
• For any Permanent Total Disability if medical care, treatment, or advice was recommended Section III
or received from a doctor, or if the insured suffered or had the disability before the policy
period started.
• Payment of compensation in respect of death, injury or disablement of Insured Person
o From intentional self-injury, suicide or attempted suicide.
o Whilst under the influence of intoxicating liquor or drugs.
o Payment of compensation in respect of death or Permanent Total Disablement
arising/resulting from any Illness to anyone Insured.The Company shall not be liable to
make any payment under Section III (Loss of Job)
• If the insured is terminated, dismissed, temporarily suspended, or retrenched from
employment due to dishonesty, fraud, or poor performance.
• Unemployment at the time of inception of the policy period or arising within first three
months of inception of the policy period.
• No claims for unemployment will be considered for casual, temporary, seasonal, or
contractual jobs, or for employees not on the direct rolls of the employer.
• Under this Section in the event of termination, dismissal, temporary suspension or
retrenchment from employment of the Insured as a result of any reason other than that
arising from an illness or injury due to an accident.
(Please refer policy wordings for complete details).
GENERAL EXCLUSIONS APPLICABLE TO THE POLICY:
The Company shall not be liable for any loss or damage under this Policy:
1. Arising or resulting from the Insured committing any breach of the law with criminal intent Part II Of The
Schedule
2. Events directly or indirectly related to war, invasion, acts of foreign enemies, hostilities GENERAL
(whether war is declared or not), civil war, rebellion, revolution, insurrection, mutiny, military EXCLUSIONS
or usurped power, seizure, capture, arrests, restraints and detainment of all Heads of State APPLICABLE TO
and citizens of any nation and acts of terrorism. THE POLICY
3. Clause 3
Events directly or indirectly caused from ionizing radiation or contamination by radioactivity
from nuclear fuel, nuclear waste, or the combustion of nuclear fuel.
The term 'combustion' includes any self-sustaining process of nuclear fission
4. Directly or indirectly caused by or arising from nuclear weapon materials.
5. Directly or indirectly caused from usage, consumption or abuse of alcohol and/or drugs.
6. Arising out of or as a result of any act of self-destruction or self inflicted injury, attempted
suicide or suicide.
7. Any consequential or indirect loss or expenses arising out of or related to any Insured
Event.
8. Arising out of or resulting directly or indirectly due to or as a consequence of pregnancy or
treatment traceable to pregnancy and childbirth, abortion and its consequences, tests and
treatment relating to infertility and invitro fertilization
9. Arising out of or resulting directly or indirectly while serving in any branch of the Military or
Armed Forces of any country during war or warlike operations
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 7 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
 10. The policy excludes any loss, damage, cost, or expenses arising directly or indirectly from
an act of terrorism. This includes losses regardless of other contributing causes or events.
Additionally, it excludes losses related to actions taken to control, prevent, suppress or in a
nay way relating to action taken with respect to any act of terrorism.
(Please refer to the policy wordings for complete details)

7. Waiting Period

• Time period during which specified diseases/treatments are not covered It is counted Part II of The
from the beginning of the policy coverage Schedule Clause
2.1.4 Exclusions
Applicable To
Initial Waiting Period
Section I Clause
2.2.3 Exclusions
• The Major Medical Illness and Procedures benefit and Loss of Job benefit will have a waiting
Applicable To
Period of 3 months.
Section II
• The Insured is covered for Accidental Death and Permanent Total Disability from Day 1 of Clause 2.3.3
Policy Inception. Exclusions
Applicable To
Specific Waiting Period: NA Section III
Pre-Existing Diseases:Any Insured Event arising on account of or in connection with any
Pre-Existing Disease will not be covered.

8. Financial Limits of coverages

I Sub-limit/ Limit (It is a predefined limit and the insurance company will not pay any
amount in excess of this limit)
NA

II Co-payment (It is a specified amount/ percentage of the admissible claim amount to be

paid by policyholder/ insured)
NA

III Deductible (It is a specified amount: up to which an insurance company will not pay
any claim, and which will be deducted from total claim amount claim amount is more
than the specified amount):
30 days deductible shall be applicable under section III Loss of Job

IV Any Other limit

NA

9. Claims / Claims Procedure Part II of the

The settlement of claims would be done by the Company within 15 days after the receipt claim Schedule Clause
along with claim form and necessary documents, any rejections if done, would be provided with 4.6 Settlement/
proper reasons by the Company. Rejection of
Claim
On occurrence of any event that may give rise to a Claim under this Policy, You shall-
Notify Us immediately on toll free number 1800 2666 or on our website www.icicilombard.com or
email us at [email protected] along with the completed and signed Claim form
the Insured must provide all the relevant documents specified in the policy wordings, within 30
days.

List of excluded providers/delisted hospitals is available on our website

https://www.icicilombard.com/docs/default-source/apps/healthclaims/assets/files/delisted-hospital-
list.pdf

Download the Claim Form here

https://echannel-wf.icicilombard.com/docs/default-source/apps/healthclaims/assets/files/claim-
form-greater-then-1-lac.pdf
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 8 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
 10. Policy Servicing
Contact us via:
Website: https://www.icicilombard.com/customer-support
IL TakeCare App
WhatsApp: 7738282666
Toll-free number: 1800 2666

Email: [email protected]

For details of Company officials kindly visit our website For details of Company officials
kindly visit our website https://www.icicilombard.com/customer-support

In case You are aggrieved in any way, You may contact us through Our website www.
icicilombard.com (Customer Support section “Grievance Redressal”) or call us at toll Free no:
1800 2666, or email to [email protected]
11. Grievances/Complaints

In case of any grievance the insured person may contact the Company through
Website: www.icicilombard.com Toll free: 1800 2666 Email: [email protected]
PART III OF
ICICI Lombard General Insurance Co. Ltd. Ground floor- Interface 11, Sixth floor- Interface 16 ,
SCHEDULE
Office no 601 & 602, New linking Road, Malad (West), Mumbai – 400064

There is an interactive voice response (IVR) facility for senior citizens’ grievance redressal for
easy and faster resolution

lnsured person may also approach the grievance cell at any of the company's branches with Standard Terms
the details of grievance. For branch details, please visit and Conditions
https://www.icicilombard.com/docs/default- Clause 18
source/policy-wordings-product-brochure/final-gro-mapping.pdf. Grievances

lf lnsured person is not satisfied with the redressal of grievance ,insured person may contact
the grievance redressal officer at the details provided in the below link:

https://www.icicilombard.com/grievanceredressal.com

lf lnsured person is not satisfied with the redressal of grievance, the insured person may also
approach Insurance Regulatory and Development Authority of India (IRDAI) through the Bima
Bharosa Portal - https://bimabharosa.irdai.gov.in/ or IRDA Grievance Call Centre(IGCC) at their
toll free no. 1800 4254 732 / 155255

Insured may also approach Insurance Ombudsman, subject to vested jurisdiction, for the
redressal of grievance. Details of Insurance Ombudsman offices are available at IRDAI
website: www.irdai.gov.in, or on the Company’s website at www.icicilombard.com or on https:
//www.cioins.co.in/Ombudsman

12 Things to remember Part III of the

• Free Look Cancellation: schedule Clause
14. Free Look
Up Period
Every insured of new health insurance policies, except for those policies with tenure of less
than a year, shall be provided a free look period of 30 days beginning from the date of receipt
of policy document, whether received electronically or otherwise, to review the terms and
conditions of such policy. If the insured cancels the policy within free look period then the
insured shall be entitled to a refund of the premium paid subject only to a deduction of a
proportionate risk premium for the period of cover and the expenses, if any, incurred by the
insurer on medical examination of the insured and stamp duty charges.
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 9 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
 Part III of the
Schedule Clause
15. “Renewal
Notice”
• Policy Renewal : Part II Clause 1
• A health insurance policy shall be renewable except on grounds of established fraud or non- Grace period &
disclosure or misrepresentation by the insured, provided the policy is not withdrawn and also Renewal
subject to Moratorium conditions as provided in the policy.
• . The Company shall condone a delay in renewal up to the grace period from the due date of
renewal without considering such condonation as a break in policy

• Waiting periods will not be applicable (subject to No Break In Policy)

• Migration and Portability: In case of migration of this policy with the Company, the insured
can transfer the credits gained to the extent of the Sum Insured and benefits available in the
previous policy to the migrated policy.
The Company may underwrite the proposal in case of migration, if the insured is not
continuously covered for 36 months.

o The insured has the choice to port his / her policies from one Insurer to another.
An Insured desirous of porting his/her policy to another insurer shall apply to such insurer to
port the entire policy along with all the members of the family, if any, at least 30 days before,
but not earlier than 60 days from the due date for renewal.
The insured is entitled to transfer the credits gained to the extent of the sum insured and the PART III OF
benefits available in the previous policy, subject to the underwriting policy of the Company SCHEDULE
The company shall decide and communicate on the proposal upon receipt of information from Standard Terms
Existing insurer within prescribed timelines. and Conditions
This benefit is not applicable for enhanced sum insured CLAUSE 20,21

• Moratorium Period: After completion of sixty continuous months of coverage (including PART III OF
portability and migration) in health insurance policy, no policy and claim shall be contestable by SCHEDULE
the Company on grounds of non-disclosure, misrepresentation, except on grounds of Standard Terms
established fraud. This period of sixty continuous months is called as moratorium period. The and Conditions
moratorium would be applicable for the sums insured of the first policy. Wherever, the sum CLAUSE 19
insured is enhanced, completion of sixty continuous months would be applicable from the date
of enhancement of sums insured only on the enhanced limits

13. Your Obligations PART III OF

Incontestability and Duty of Disclosure SCHEDULE
The Policy shall be null and void and no benefit shall be payable in the event of untrue or
incorrect statements, misrepresentation, mis-description or on non- disclosure in any material Standard Terms
particular in the proposal form, personal statement, declaration and connected documents, or and Conditions
any material information having been withheld, or a claim being fraudulent or any fraudulent 1.Incontestability
means or devices being used by the Insured or any one acting on his behalf to obtain any and Duty of
benefit under this Policy. Disclosure

Declaration by the Policy Holder:

I have read the above and confirm having noted the details.
109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 10 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com
 Place:

Date: Signature of the Policy Holder

NOTE: In case of any conflict, the terms and conditions mentioned in the policy document shall prevail.

109/20150907/274

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Secure Mind UIN: ICIHLIP21401V032021
Mailing Address: Registered Office Address: Toll free no. : 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: : 86552 22666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email : [email protected] 11 / 11
Link Road, Malad (West), Mumbai - 400 064 Prabhadevi, Mumbai - 400 025. Website : www.icicilombard.com