| 8- Universal Health Insurance Policy from United India - Health Insurance Below Poverity Line (BPL) Families |
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| Source: Website of Universal Sompo General Insurance Company Limited |
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| Applicable to SECTION –II |
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| 4.11 |
Payment or compensation in respect of death directly or indirectly arising out of or contributed to by or traceable to any disability already existing on the date of commencement of this policy. |
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| 4.12 |
Death injury or disablements arising directly or indirectly from or traceable to: |
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(i)Intentional self injury, suicide or attempted suicide
(ii)Pregnancy or in consequence thereof
(iii)Whilst engaging in aviation or Ballooning, whilst mounting into dismounting from or travelling in any Balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world.
(iv)Whilst under the influence of intoxication, liquor or drugs
(v)Directly or indirectly caused by venereal diseases or insanity
(vi)Arising or resulting from the insured committing any breach of law with criminal intent
(vii)War and war like perils, nuclear perils, radioactivity etc. |
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| v |
CONDITIONS APPLICABLE TO SECTIONS – I & II: |
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| 1. |
Every notice or communication 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. |
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| 2. |
The premium payable under this Policy shall be paid in advance. |
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| 3. |
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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| 4. |
Upon the happening of any event which may give rise to a claim under this Policy notice with full particulars shall be sent to the TPA named in the schedule immediately and in case of emergency within 24 hours of Hospitalisation. |
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| 5. |
All supporting documents relating to the claim must be filed with TPA within 7 days from the date of discharge from the hospital. |
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Note: Waiver of this Condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time-limit. |
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The Insured Person shall obtain and furnish the TPA with all original bills, receipts and other documents upon which a claim is based and shall also give the TPA/ Company such additional information and assistance as the TPA/ Company may require in dealing with the claim. |
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| 6. |
In case of death of earning member of the family due to accident a post-mortem report must be submitted along with other documents of proof of death. |
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| 7. |
Any medical practitioner authorised by the TPA/ Company shall be allowed to examine the Insured Person in case of any alleged injury or disease requiring Hospitalisation when and so often as the same may reasonably be required on behalf of the Company. |
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