United India Insurance Co. Ltd.- HEALTH INSURANCE POLICY – SENIOR CITIZENS

5.11     If the Company, as per terms and conditions of the policy shall disclaim liability to the Insured for any claim hereunder and if the Insured shall not within 12 calendar months from the date or receipt of the notice of such disclaimer notify the TPA/ Company in writing that he does not accept such disclaimer and intends to recover his claim from the TPA/Company then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.

1. All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency.
2. PAYMENT OF CLAIM

All claims under this policy shall be payable in Indian currency. All medical treatments for the purpose of this insurance will have to taken in India only. Payment of claim shall be made through TPA to the Hospital/Nursing Home or the Insured Person as the case may be.

7 NO CLAIM DISCOUNT

The insured shall be entitled for No Claim Discount of 5% for every claim free year subject to a maximum of 25% provided the policy is renewed continuously without break.
N.B:   No Claim Discount will be lost fully if policy is not renewed within the grace period allowed under the policy.

8 COST OF HEALTH CHECK UP

The insured shall be entitled for reimbursement of the cost of Medical check-ups once at the end of block of every three underwriting years provided there are no claims reported during the block. Such reimbursement shall be restricted to 1% of the average SI of the preceding three years.

9. REASONABLE AND NECESSARY EXPENSES

1. For a networked hospital, it shall mean the rate pre-agreed between Networked Hospital and the TPA for surgical / medical treatment that is necessary, customary and reasonable for treating the condition for which the insured person was hospitalised
2. For any other hospital, it shall mean the cost of surgical / medical treatment that is necessary, customary and reasonable for treating the condition for which insured person was hospitalised to the extent relatable to such condition.