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| Senior Citizens Health Insurance (Mediclaim Policy) in India |
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| 6- Senior Citizens Mediclaim Policies - United India Insurance Co. Ltd. |
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5.10 If any dispute or difference shall arise as to the quantum to be paid under the 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 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.
It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the
Company has disputed or not accepted liability under or in respect of this Policy.
It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy that
award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained. |
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5.1 Every notice or communication regarding hospitalisation or claim to be given or made under this Policy shall be delivered in writing at the address of the TPA office as shown in the Schedule. Other matters relating to the policy may be communicated to the policy issuing office.
5.2 The premium payable under this Policy shall be paid in advance. No receipt for Premium shall be valid except on the official form of the company signed by a duly authorised official of the company. The due payment of premium and the observance and fulfilment of the terms, provisions, conditions and endorsements of this Policy by the Insured Person in so far as they relate to anything to be done or complied with by the Insured Person shall be a condition precedent to any liability of the Company to make any payment under this Policy. No waiver of any terms, provisions, conditions and endorsements of this policy shall be valid unless made in writing and signed by an authorised official of the Company. |
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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.
- All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency.
- 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
- 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
- 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.
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| 10. IRDA REGULATIONS: This policy is subject to Regulations of IRDA (Protection of Policyholders’ Interest) Regulations, 2002 as amended from time to time. |
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| 11. GRIEVANCE REDRESSAL: In the event of the policyholder having any grievance relating to the insurance, he/she may contact any of the Grievance Cells at Regional Offices of the Company or Office of the Insurance Ombudsman under the jurisdiction of which the Policy Issuing Office falls. |
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