RIDE SAFE TRAVEL INSURANCE

Part II of the Policy

“This part of Policy contains the entire list of covers available under the product. However, this policy shall be applicable only for those covers which are mentioned in Part I of the Policy Schedule and for which premium has been accepted by the Company. In any case, details mentioned in Part I of the Policy Schedule shall supersede the details mentioned in Part II of the Policy Schedule.”

For the purposes of this Policy and endorsements, if any, the terms mentioned below shall have the meaning set forth:

Where the context so requires, references to the singular shall also include references to the plural and references to any gender shall include references to all genders. Further any references to statutory enactment include subsequent changes to the same.

Definitions

“Accident” means a sudden, unforeseen and involuntary event caused by external, visible and violent means.

“Assistance Service Provider (ASP)” means such person or persons as may be appointed by the Company from time to time to provide assistance to the Insured in terms of this Policy.

“Ambulance” Ambulance means a road vehicle operated by a licensed/authorised service provider and equipped for the transport and paramedical treatment of a person requiring medical attention.

“Alternative treatments” are forms of treatments other than treatment "Allopathy" or "modern medicine" and includes Ayurveda, Unani, Sidha and Homeopathy in the Indian context.

“Age/Aged” Age or Aged means completed years as at the Commencement Date.

“Baggage and Personal Effects” means luggage and personal possessions like hand baggage or any other baggage belonging to and/or in the lawful custody of the Insured during the Trip.

“Burglary” means any theft following upon actual, forcible and violent entry of and / or exit from the premises with intent to commit a felony and includes housebreaking.

“Cashless Facility” means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the Network Provider by the insurer to the extent pre-authorization is approved.

“City of Residence of the Insured” shall mean and include any city, town or village in which the Place of Residence of the Insured is currently located.

“Comatose State/ Coma” is a state of unconsciousness, whereby a person is not able to respond to external stimuli and cannot initiate voluntary actions.

“Company/We/Our/Us” means the ICICI Lombard General Insurance Company Limited.

“Common Carrier” means any

1. Any bus, coach, ferry, helicopter, hovercraft, hydrofoil, ship, taxi, cab, tram, monorail or train or any other vehicle as specified provided and operated by a carrier duly licensed for the regular transportation of fare paying passengers and/or cargo; and
2. Any aircraft provided and operated by and air line or an air charter company which is duly licensed for the regular transportation of fare paying passengers and/or cargo

“Condition Precedent” shall mean a policy term or condition upon which the Insurer's

liability under the policy is conditional upon.

“Contents” - In so far as it relates to household (Contents of Property insured), it shall mean the following equipments not used for business purposes and owned by the Insured or his family or for which the Insured and/or his family is legally responsible for –

• electronic equipment, household appliances, house hold goods such as furniture, kitchen utensils, fixtures, fittings and interior decorations;

• personal effects such as clothes and other articles of personal nature likely to be worn, used or carried but excluding money but including jewelry and valuables. The term shall exclude cash and/or currency and/or cheques

“Contribution” is essentially the right of an insurer to call upon other insurers liable to the same insured to share the cost of an indemnity claim on a rateable proportion of Sum Insured. This clause shall not apply to any Benefit offered on fixed benefit basis.

“Co-Payment” is a cost-sharing requirement under a health insurance Policy that provides that the policyholder/ insured will bear a specified percentage of the admissible claim amount. A co-payment does not reduce the Sum Insured.

Coverage Period Coverage Period means the period specified in the Certificate of Insurance

which commences on the coverage commencement date specified in the Certificate of Insurance and ends on the coverage expiry date specified in the Certificate of Insurance.

“Day Care Centre” means any institution established for day care treatment of illness and/or injuries or a medical setup within a hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner and must comply with all minimum criteria as under-

1. has qualified nursing staff under its employment;
2. has qualified medical practitioner(s) in charge;
3. has a fully equipped operation theatre of its own where surgical procedures are carried out;
4. maintains daily records of patients and makes these accessible to the insurance company’s authorized personnel

“Day Care Treatment” refers to medical treatment, and/or surgical procedure which is:

1. undertaken under general or local anesthesia in a hospital/day care centre in less than 24 hours because of technological advancement, and
2. which would have otherwise required a hospitalization of more than 24 hours.

Treatment normally taken on an out-patient basis is not included in the scope of this definition.

“Deductible” is a cost-sharing requirement under the policy that provides that the insurer will not be liable for a specified rupee amount or for a specified number of days/hours in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the Sum Insured. The deductible is applicable per event.

“Dental Treatment” is treatment carried out by a dental practitioner including examinations, fillings (where appropriate), crowns, extractions and surgery excluding any form of cosmetic surgery/implants.

“Dentist” means the insured’s attending dentist or surgeon who is registered or licensed to practice dentistry under the laws of the country in which they practice, other than the policyholder; or the insured; or a member of the immediate family of the insured; or an employee of the policy holder.

“Dependent Child(ren)” means an insured and their Spouse’s legal child(ren)including step or legally adopted child(ren)) as long as they are under nineteen (19) years of age or under twenty-five (25) years of age while they are full-time students at an accredited institution of higher learning and in either case, are primarily dependent upon the Insured for maintenance and support. Dependent Child(ren) also means an Insured’s legal child(ren) of any age who are Permanently mentally or physically incapable of self-support and are permanently living with the insured.

“Disclosure to Information Norm” means the policy shall be void and all premium paid hereon shall be forfeited to the Company, in the event of misrepresentation, mis-description or non-disclosure of any material fact.

“Disease” shall mean an affliction of the bodily organs having a defined and recognized pattern of symptoms that first manifests itself during the Period of Insurance and for which immediate treatment by a Medical Practitioner is necessary.

“Doctor” means an Insured’s attending doctor or specialist who is registered or licensed to practice medicine under the laws of the country in which they practice, other than:

• The Policyholder; or
• The insured; or
• A member of the immediate family of the insured; or
• An Employee of the Policyholder

The term Doctor specifically excludes persons practicing in non-allopathic fields.

“Electronic Equipment” means any computer (including but not limited to laptops, notebooks and tablets)or communication device such as mobile phones, global positioning devices, personal music/recording/gaming devices, cameras and other electronic items of a similar nature as deemed by Us, which are intended for either personal or business use.

“Emergency” shall mean a medical condition of the Insured arising out of a severe Illness (where applicable) or Injury contracted or sustained by the Insured which results in symptoms which occur suddenly and unexpectedly, and requires immediate medical treatment by a Medical Practitioner to prevent death or serious long term impairment of the Insured Person’s health.

“Family” means the Insured, his/her lawful spouse and their dependent child(ren).

“Geographical Scope of Cover” shall mean the country(ies) or geographical boundaries in which the coverage under the Policy is valid.

“Hospital” means any institution established for in-patient care and day care treatment of illness and/or injuries and which has been registered as a hospital with the local authorities and complies with all minimum criteria as under:

1. has qualified nursing staff under its employment round the clock;
2. has qualified medical practitioner(s) in charge round the clock;
3. has a fully equipped operation theatre of its own where surgical procedures are carried out;
4. maintains daily records of patients and makes these accessible to the insurance company’s authorized personnel.

“Hospitalization” means admission in a Hospital for a minimum period of 24 In patient Care consecutive hours except for specified procedures/ treatments, where such admission could be for a period of less than 24 consecutive hours. 

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“Illness” mean a sickness or a disease or pathological condition leading to the impairment of normal physiological function which manifests itself during the Policy Period and requires medical treatment.

1. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery.
2. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the following characteristics:—it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and / or tests—it needs ongoing or long-term control or relief of symptoms— it requires your rehabilitation or for you to be specially trained to cope with it—it continues indefinitely—it comes back or is likely to come back.

“Immediate Family Member” shall mean an Insured's lawful spouse; parents and children including stepchildren and children legally adopted by the Insured under nineteen(19) or children under twenty five (25) years of age while they are full-time students at an accredited institution of higher learning and in either case are primarily dependent upon the insured for maintenance and support ; siblings; parents; sister(s) in law, brother(s) in law; parents-in-law; legal guardian; ward; step-parents, half-brother, half-sister, fiancé(e), niece, nephew, uncle, aunt, stepchild, grandparent or grandchild

“Injury” means accidental physical bodily harm excluding illness or disease, solely and directly caused by external, violent and visible and evident means which is verified and certified by a Medical Practitioner.

“Inpatient care” means treatment for which the insured person has to stay in a hospital

for more than 24 hours for a covered event.

“Inpatient Treatment” means any medical treatment rendered to the Insured at a Hospital in connection with any Injury resulting in Hospitalization.

“Insured(s)/ Insured Person(s)” shall mean the person(s) whose name(s) are specifically appearing as such in the Policy Schedule and who has booked the ride, purchased insurance, and/or is travelling in the common carrier.

“Insurable Event” shall mean an event, loss or damage for which the Insured shall be compensated under this Policy.

“Intensive Care Unit” means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.

“Life Threatening Medical Condition” refers to a medical condition suffered by the insured which has the following characteristics:

1. Markedly unstable vital parameters (blood pressure, pulse, temperature and respiratory rate)
2. Acute impairment of one or more vital organ systems (involving brain, heart, lungs, Liver, Kidneys and pancreas)
3. Critical care being provided, which involves high complexity decision making to assess, manipulate and support vital system function(s) to treat single or multiple vital organ failure(s) and requires interpretation of multiple physiological parameters and application of advanced technology
4. Critical care being provided in critical care area such as coronary care unit, intensive care unit, respiratory care unit, or the emergency department.

“Loss” means items which are unrecoverable due to circumstances outside the control of the Policyholder or insured.

“Medical Advice” means any consultation or advice from a Medical Practitioner including the issue of any prescription or repeat prescription.

“Medical Practitioner” Medical Practitioner means a person who holds a valid registration from the Medical Council of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within its scope and jurisdiction of license

“Medical Evacuation” means immediate transportation of the Insured suffering an Injuryto the nearest Hospital where appropriate medical treatment can be obtained, Scenarios which necessitates the Medical Evacuation of the Insured are:

1. Current hospital where Insured is taking treatment is not equipped enough or lack facilities to carry out further treatment of the Insured
2. Insured suffering an Injury is stuck or stranded in a remote area which lacks Hospital and the Insured has to be transported to the nearest Hospital on an Emergency basis

“Medical Expenses” means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of an Illness(wherever applicable) or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.

“Medically necessary” treatment is defined as any treatment, tests, medication, or stay in hospital or part of a stay in hospital which

- is required for the medical management of the illness(wherever applicable) or injury suffered by the insured;

- must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity;

- must have been prescribed by a medical practitioner,

- must conform to the professional standards widely accepted in international medical practice or by the medical community in India.

“Minor Child(ren)” are the child(ren) of the Insured including stepchild/ stepchildren of the Insured and child/ children legally adopted by the Insured below the age of 18 years.

“Missed Flight/Common Carrier” shall mean the failure of the Insured to travel by a flight or a Common Carrier being part of the Trip as per the Policy Schedule.

“Money” means coins, bank notes, postal and money orders, travellers’ and other cheques, letters of credit, automatic teller machine cards, credit cards, petrol and other coupons etc. in the possession or control of the insured.

“Mugging” shall mean a violent, unprovoked assault or attack by someone upon the Insured covered in this Policy, especially with the intent to rob the Insured.

“Natural Calamities” would be any major adverse event resulting from the natural geological processes of the Earth including and limited to floods/inundation, hurricanes/ tempest, tornadoes, volcanic eruptions, earthquakes, tsunamis.

"Network Provider” means hospitals enlisted by an insurer or by an ASP and insurer together to provide medical services to an insured on payment by a cashless facility.

 “Nominee” means the person(s) nominated by the Insured Person to receive the benefits under this Policy payable on the death of the Insured Person caused by an Accident. For the purpose of avoidance of doubt it is clarified that if the Insured Person is a minor, his legal guardian shall appoint the Nominee.

“Non- Network” means any hospital, day care centre or other provider that is not part of the network.

“Notification of Claim” Notification of claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes of communication.

“Outpatient Treatment or OPD” is one in which the Insured visits a clinic/hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day care or in-patient.

“Passenger/s” Person who is travelling in the common carrier and is insured under the policy availed by the insured person.

“Place of Destination” means the destination place where the journey of the Insured, forming part of the Trip, is scheduled to be concluded through a Common Carrier.

“Place of Origin” means the starting point / place from where the Insured’s Trip is scheduled to be undertaken through a Common Carrier which is the main mode of travel during the Trip.

“Place of Residence of the Insured” means the dwellings the Insured is normally residing in currently, and declared as the residential address of the Insured

“Policy” means Policyholder’s proposal, the Policy Schedule and other parts of the Policy, Company's covering letter to the Insured and any endorsement attaching to or forming part hereof, either at inception or during the Period of Insurance.

“Policyholder” means the person(s) or the entity named in Policy Schedule to this Policy who executed the Policy Schedule and is (are) responsible for payment of premium(s) on behalf of the Insured Person or otherwise.

“Post-hospitalisation Medical Expenses” Post-hospitalization Medical Expenses means medical expenses incurred during predefined number of days immediately after the insured person is discharged from the hospital provided that:

1. Such Medical Expenses are for the same condition for which the insured person’s hospitalization was required, and
2. The inpatient hospitalization claim for such hospitalization is admissible by the insurance company.

“Pre-existing Disease” means any condition, ailment, injury or disease:

• That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or
• For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.

“Reasonable and Customary Charges” means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness/injury involved.

“Renewal” defines the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for treating the renewal continuous for the purpose of all waiting periods.

“Self Driven-Rental Vehicle” Any vehicle hired or rented by the insured for the purpose of self-driven travel.

“Room Rent” means the amount charged by a hospital for the occupancy of a bed on per day (24 hours) basis and shall include associated medical expenses.

“Risk Commencement Date” Risk Commencement Date means the date specified in the Certificate of Insurance on which Our coverage under the Policy in respect of the Insured Person named in the Certificate of Insurance commences.

“Subrogation” shall mean the right of the insurer to assume the rights of the insured person to recover expenses paid out under the policy that may be recovered from any other source.

“Surgery or Surgical Procedure” means manual and / or operative procedure (s) required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure of diseases, relief of suffering or prolongation of life, performed in a hospital or day care centre by a Medical Practitioner.

“Sum Insured” means the maximum amount of coverage in respect of the claims during the Period of Insurance in connection with each of the items of coverage, as specified in Part I of the Schedule to this Policy.

“Sound Natural Tooth” means natural tooth that either is unaltered or is fully restored to its normal function, is Disease-free and has no decay.

“Spouse” means a Insured Person’s legally wedded husband or wife

“Travel Period/Trip” Travel Period/Trip means the period of time within the Coverage Period commencing from when the Insured Person leaves for the original departure point to commence the journey in the Common Carrier on which he/she is booked to travel as a passenger, and ending when the Insured Person returns to the original departure point in case of return journey or destination in case of a one way journey, subject to the maximum period of time specified in the Certificate of Insurance. If the Certificate of Insurance specifies that the Policy will only apply to the period during which the Insured Person is travelling on the Common Carrier, then the Travel Period will be limited to commencing from when the Insured Person boards the Common Carrier and ending when the Insured Person alights from the Common Carrier.

Terrorism: means any actual or threatened use of force or violence directed at or causing damage, injury, harm or disruption, or commission of an act dangerous to human life or property, against any individual, property or government, with the stated or unstated objective of pursuing economic, ethnic, nationalistic, political, racial or religious interests, whether such interests are declared or not. Robberies or other criminal acts, primarily committed for personal gain and acts arising primarily from prior personal relationships between perpetrator(s) and victim(s) will not be considered as an Act of Terrorism. Act of Terrorism also includes any act, which is verified or recognised by the (relevant) government as an act of terrorism.

“Unforeseen Events/Illness” are those events which cannot be anticipated or predicted and does not include acute exacerbation of pre existing conditions/disease/illness or pre-exisitng condition in itself.

“Unproven/Experimental treatment” is treatment including but not limited to drug experimental therapy which is not based on established medical practice in India, is treatment experimental or unproven. These treatments are excluded under the policy.

“Valuables” shall mean:

1. Electronic and electrical equipments including, but not limited to, photographic equipments, audio equipments, video equipments, computers, mobile phones and similar equipment/gadgets
2. Telescopes, binoculars, spectacles, sunglasses

• Watches, jewelry and gems, furs and articles made of gold, silver and other precious stones and metals

1. Antiques, moulds, designs and other collectibles, sculptures, manuscripts, stamps, collection of stamps, rare books, medals, artificial teeth, prosthetic limbs, hearing aids, membership cards, travel tickets, event tickets, personal Travel documents, business goods or samples or documents
2. ATM Cards, debit cards, credit cards, bonds, bank treasury or promissory notes, bills of exchange, cheques, banker’s cheques, demand drafts, cash and any other securities.

“You/Your” You/Your means the policyholder and/or insured named in the Schedule who has concluded this Policy with Us

Scope of cover

The Company hereby agrees, subject to the terms, exclusions and conditions herein contained or otherwise expressed herein, to compensate the Insured for any loss or damage sustained or incurred by such Insured and as described under different Benefits hereunder but not exceeding the Sum Insured as applicable to the respective Sections as specified in the Policy Schedule.

The Deductible as indicated against each Section in the Policy Schedule shall be borne by the Insured in respect of each claim or series of claims arising out of one event.

All benefits in this policy might be subject to co-pay, co-insurance and franchise, wherever necessitated by the Insured, and subject to acceptance by us and consequent incorporation of the same in Part I of the Policy Schedule.

COVER1: HOSPITALIZATION EXPENSES FOR INJURY/ACCIDENTAL MEDICAL EXPENSE

If an Insured Person suffers an Injury due to an Accident that occurs during the Travel Period and that Injury solely and directly requires the Insured Person to be hospitalized or undergo Day Care Treatment, then we will reimburse the reasonable and customary charges incurred for emergency hospitalization and medical treatment undertaken up to limit specified in Certificate of Insurance / Part I of the Policy Schedule.

If we have accepted a claim under this cover, we will also reimburse Post-hospitalization Medical Expenses incurred for up to 90 days immediately following the Insured Person’s discharge from Hospital, or upto the number of days as specified in the Certificate of Insurance / Part I of the Policy Schedule. The deductible excess in respect of this benefit will be applicable for each separate claim, and shall be of an amount as specified in Part I of the Schedule to this Policy.

This Benefit will be payable provided that:

1. The Hospitalization or Day Care Treatment is for Medically Necessary Treatment and is commenced and continued on the written advice of the treating Medical Practitioner;
2. The Insured Person is admitted to Hospital or undergoes Day Care Treatment within 7 days of the occurrence of the Accident;
3. We will reimburse only those Medical Expenses that are in-excess of the Deductible for each period of Hospitalization;
4. We will reimburse only those Medical Expenses and Post-hospitalization Medical Expenses that are Reasonable and Customary Charges.
5. The Company shall reimburse the following Hospitalization expenses :
6. Accommodation, boarding and nursing expenses;
7. Diagnostics, tests and / or examination charges;
8. Physician, surgeon, anesthetist fees;
9. Cost of medicines provided by the Hospital / purchased from a registered pharmacy other than the Hospital as prescribed by the Medical Practitioner attending on the Insured;

EXCLUSIONS APPLICABLE TO COVER 1

In addition to the General Exclusions listed in this Policy, the Company shall not be liable to make any payment towards expenses incurred by the Insured in connection with or in respect of:

1. Treatment of any Illness or disease or any Pre-Existing Disease
2. Beauty and / or cosmetic treatment and/or reconstructive plastic surgery in any form or manner
3. Any treatment related to general debility, convalescence, and rest or recuperation at a spa or health resort, sanatorium, convalescence home or similar institution.
4. Any Injury arising out of or as a consequence of mental or psychiatric disorders.
5. Rehabilitation and/or physiotherapy expenses or the cost of prostheses/ prosthetics (artificial limbs) or any Services provided by chiropractor.
6. Routine physical tests and / or examination of any kind not consistent with or incidental to the diagnosis and treatment of any Illness or Injury either in a Hospital or as an Outpatient.
7. Vaccination and inoculation of any kind, unless it is post animal/insect bite.
8. Expenses on supplements, vitamins and tonics unless forming part of treatment for Injury as certified by the attending Medical Practitioner
9. Personal comfort, convenience and hygiene related items and services.
10. Any condition/instances/scenarios where there is no active line of treatment taken by the insured.
11. Any alternative Treatments apart from Ayurveda, Unani, Sidha and Homeopathy treatments.

12. Any out-of-pocket expenses for necessary medical aids relating to the hospitalization of the Insured due to an injury, unless specifically included as an extension under Benefit 1- ‘Hospitalization expenses due to Injury’, and the same is mentioned in Part I of the policy schedule.

• CLAIMS PROCEDURE APPLICABLE TO COVER 1:

In the event of the insured sustaining any Injury necessitating an Emergency treatment in Hospital, he/she should report the contingency/ claim to the Assistant Service Provider / TPA/Us on the toll free number provided in the “Claim Procedure-General” section.

Documents to be submitted in support of the claim:

1. Medical reports and discharge summary issued by the Hospital furnishing the name of the Insured, period of treatment and details of treatment rendered.(In Original or Scan copies/photo attested by the hospital)
2. Bills / receipts(In Original) for:

1. Charges paid towards Hospital accommodation, nursing facilities and other medical services rendered;
2. Fees paid to the medical practitioner, special nursing charges, etc;
3. Charges incurred towards any and all test and / or examinations rendered in connection with the treatment;
4. Charges incurred towards medicines or drugs purchased from a registered pharmacy other than the Hospital duly supported by the prescriptions of the Medical Practitioner attending on the Insured.

1. Police First Incidence Report (FIR), in case of any road traffic accident or third-party involvement
2. Post-mortem report in the event of the death of Insured.
3. And any other document as may be appropriately applicable for the claims preferred under this section of the Policy.

6. Claim form, either filled manually or digitally by the insured.

In respect of all claims payable hereunder, the Company may make settlement either in the form of cashless treatment facility or by reimbursement of the amount of claim to the Insured, at its sole discretion. Cashless treatment facility cannot be demanded by the Insured as a matter of right.

COVER 2- HOSPITAL DAILY ALLOWANCE

If an Insured Person suffers an Injury due to an Accident that occurs during the Travel period and which solely and directly requires the Insured Person to be hospitalized, then We will pay the daily amount specified in the Policy Certificate against this cover for each continuous and completed 24 hours of Hospitalization of the Insured Person.

The deductible excess in respect of this benefit will be applicable for each separate claim, and shall be of an amount as specified in Part I of the Schedule to this Policy.

This Cover shall be payable subject to the following:

1. The Hospitalization is for Medically Necessary Treatment and is commenced and continued on the written advice of the treating Medical Practitioner.
2. We shall not be liable to pay the daily amount for more than 7days or the maximum number of days as specified in the Policy Certificate for each Insured Person,

• Our liability to make any payment under this cover shall be in excess of the per event Deductible or per event Franchise stated in the Policy Certificate, if applicable.

1. We shall not be liable to make any payment under this cover, if the Hospitalization has commenced prior to the commencement of the Period of Cover.

If we have admitted a Claim under this cover, then on the Insured Person/Nominee’s advance written request, We may pay the amount directly to the Hospital where the Insured Person was treated, provided that We are able to offer Cashless Facility at that Hospital. If the payment due under this Base Benefit is more than the amount payable to the Hospital, then the balance amount shall be paid directly to the Insured Person/Nominee. Cashless treatment facility cannot be demanded by the policy holder as a matter of right.

EXCLUSIONS APPLICABLE TO Cover 2

1. Any dental treatment or dental surgery of any kind unless necessitated due to an Accident or specifically covered and specified in the Policy Schedule/Policy Certificate.
2. Any alternative treatments not covered under AYUSH as instituted in a government hospital or any institutes recognised by the government and/or accredited by Quality Council of India / National Accreditation Board of Health
3. All cosmetic/plastic/aesthetic surgeries including lasik surgery, unless necessitated due to Accident.
4. Intentional self injury, suicide or attempt to suicide.

CLAIMS PROCEDURE APPLICABLE TO COVER NO. 2:

On the occurrence of an Insured Event which may give rise to a claim under the Policy, We shall be provided with the following necessary and mandatory information and documentation specified in relation to the Base Benefit being claimed within 30 days of the occurrence of the Insured Event:

DOCUMENTS NEEDED IN CASE OF A CLAIM

1. Indoor case papers from the Hospital mentioning the diagnosis, date and time of admission and discharge, past medical and surgical history with duration.
2. Hospital discharge summary filled and attested by Hospital.
3. First Information Report (F.I.R.) copy / medico-legal case papers - notarized/ attested by a gazetted officer in case of an Injury.
4. KYC Documents of the Insured Person and claimant
5. Claim form, either filled manually or digitally by the insured.

• Any other document as required by Us to investigate the claim or Our obligation to make payment for it.

COVER 3- PERSONAL ACCIDENT

Cover 3. A Accidental Death

If an Insured Person suffers an Injury due to an Accident that occurs during the Travel Period and if this Injury solely and directly results in the Insured Person’s death within 365 days from the date of the Accident, then we will pay the event amount specified in the Policy Certificate

In the event of a claim acceptance under this Benefit in respect of an Insured Person, if the amount due under this Benefit and claims already admitted under the Policy in respect of the Insured Person cumulatively exceeds the Sum Insured, then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured. On the acceptance of a claim under this Benefit and payment being made under any applicable Benefits, all cover(s) under this Policy shall immediately and automatically cease in respect of that Insured Person. 

CLAIMS PROCEDURE APPLICABLE TO COVER 3.A:

DOCUMENTS NEEDED IN CASE OF A CLAIM

1. a) Personal Accident (PA) Claim form duly digitally filled & signed by the claimant
2. b) Death certificate - Notarized/ Attested by a gazetted officer
3. c) F.I.R – Notarized / Attested by a gazetted officer
4. d) Police Final charge sheet/ Court Final order - Notarized/ attested by a Gazetted

Officer - if applicable - notarized/ Attested by a gazetted officer

1. f) Post Mortem Report - Notarized/ Attested by a gazetted officer
2. g) Other Document as per Case details - Copy of Treatment papers; if hospitalized,
3. h) Cancelled Cheque with NEFT Mandate form - duly filled in by the claimant and bank
4. I) Claim form, either filled manually or digitally by the claimant
5. j) Any other document as required by Us or the TPA to investigate the

Claim or Our obligation to make payment for it

Cover 3. B Permanent Total Disability

If an Insured Person suffers an Injury due to an Accident that occurs during the Travel Period which solely and directly results in Permanent Total Disability of the Insured Person which is of the nature specified below, We shall pay to the Insured Person (or his Nominee / legal heir)such a sum as compensation as specified hereunder, in the manner indicated below, on the occurrence of any of the following losses, provide such losses to the Insured Person are total and irrecoverable losses which result solely and directly from an Injury occurring during Travel Period, within 365 days from the date of Accident resulting in such Injury. Provided that the date of occurrence of the Accident falls within the Policy Period:

1. i) Loss of Use of both eyes, or Physical Separation/ Loss of Use of two entire hands or two entire feet, or one entire hand and one entire foot, or of such Loss of Use of one eye and such Physical Separation/ Loss of Use of one entire hand or one entire foot, then the Sum Insured as stated in the Part I of the Schedule to this Policy hereto as applicable to such Insured Person.
2. ii) Physical Separation/ Loss of Use of two hands or two feet, or of one hand and one foot, or of Loss of Use of one eye and Loss of Use of one hand or one foot, then the Sum Insured as stated in Part I of the Schedule to this Policy hereto as applicable to such Insured Person.

iii) If such Injury shall as a direct consequence thereof, permanently, and totally, disable the Insured Person from engaging in any employment or occupation of any description whatsoever, then the Sum Insured as stated in Part I of the Schedule to this Policy hereto as applicable to such Insured Person.

This Cover will be payable provided that:

1. The Permanent Total Disability continues for a period of at least 180 days from the commencement of the Permanent Total Disability, and We are satisfied at the expiry of the 180 days that there is no reasonable medical hope of improvement;
2. If the Insured Person dies before a claim has been admitted under this Cover , then no amount will be payable under this Cover ;
3. If the Insured Person suffers Injuries resulting in more than one of the Permanent Total Disabilities specified in the table above, then Our maximum, total and cumulative liability under this Cover shall be limited to the Sum Insured and PTD Sum Insured, if applicable;
4. If a claim is accepted under this Cover in respect of an Insured Person and the amount due under this Cover and claims already admitted under the Policy in respect of the Insured Person cumulatively exceeds the Sum Insured, then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured;
5. If We have admitted a claim for Permanent Total Disability in accordance with this Cover, then We shall not be liable to make any payment under the Policy on the death of the Insured Person, if the Insured Person subsequently dies;
6. On the acceptance of a claim under this Cover Benefit, all cover(s) under this Policy shall immediately and automatically cease in respect of that Insured Person after the payment of any other applicable Cover Benefits.

CLAIMS PROCEDURE APPLICABLE TO COVER 3.B:

DOCUMENTS NEEDED FOR CLAIM

1. Claim form duly filled & signed by You
2. Disability certificate - by an authorized Medical Practitioner Stating percentage of disablement
3. F.I.R. and Panchnama wherever applicable (original or certified copies)
4. Medical report
5. Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner
6. Original bills from chemists supported by proper prescription
7. Investigation reports like laboratory test, X-rays and reports essential for confirmation of the type and percentage of disability and payment receipts
8. Photo of Insured Person showing the disability
9. Any other document as may be required by Us

Cover 3. C- Permanent Partial Disability

If an Insured Person suffers an injury due to an Accident that occurs during the Travel Period and that Injury solely and directly results in Permanent Partial Disability of the Insured person, we shall pay the Insured Person (or his Nominee / legal heir),such Sum Insured as mentioned in Part I of the Schedule to this Policy as applicable to such Insured Person in the manner indicated below, on the occurrence of any of the following losses, provided such losses to the Insured Person are irrecoverable losses and result in Loss of Use or Physical Separation which arises solely and directly from an Injury, within 365 days from the date of Accident resulting in such Injury.

For the purpose of this Benefit, Permanent Partial Disablement means total and/or partial irrecoverable loss of use or the actual loss by physical separation of the body parts as specified in the table below:

This Benefit will be payable provided that:

1. The Permanent Partial Disability continues for a period of at least 180 days from the commencement of the Permanent Partial Disability and We are satisfied at the expiry of the 180 days that there is no reasonable medical hope of improvement;
2. If the Insured Person suffers a loss that is not of the nature of Permanent Partial Disability specified in the table above, then Our medical advisors will determine the degree of disability and the amount payable, if any;
3. We will not make any payment under this Benefit if We have already paid or accepted any claims under the Policy in respect of the Insured Person and the total amount paid or payable under the claims is cumulatively greater than or equal to the Sum Insured for that Insured Person;
4. On the acceptance of a claim under this Benefit, the Insured Person’s insurance cover under this Policy shall continue, subject to the availability of the Sum Insured.

CLAIMS PROCEDURE APPLICABLE TO COVER 3.C:

DOCUMENTS NEEDED FOR CLAIM

1. a) PA Claim form duly digitally filled & signed by Insured/ Claimant
2. b) MLC OR F.I.R.OR PANCHNAMA- Notarised/ Attested by a gazetted officer
3. c) Disability Certificate issued by Authorised civil surgeon- Original/ Notarised/ Attested

by a gazetted officer

1. d) Treatment papers, X-rays films / laboratory test reports and other diagnostic

reports to support the claim and percentage of disability

1. e) Medical report
2. f) Colour Photograph of the injured reflecting disability
3. g) Claim form, either filled manually or digitally by the insured/claimant
4. h) Any other document as required by Us or the TPA to investigate the Claim or Our obligation to make payment for it

COVER 4- LOSS OF BAGGAGE & PERSONAL EFFECTS

We will reimburse the actual loss upon the declaration of the customer, upto the limit of Loss of Baggage & Personal Effects specified in the Certificate of Insurance/ Part I of the Policy Schedule incurred in relation to the permanent and total loss of the Insured Person’s luggage and personal possessions during the Travel Period.

The deductible excess in respect of this benefit will be applicable to each separate claim, and shall be of an amount as specified in Part I of the Schedule to this Policy.

This Benefit will be payable provided that:

1. Such a loss should have happened due to circumstances beyond the control of the insured e.g. accident of the common carrier in which the insured is travelling, mugging, theft, hold up, etc.
2. The Insured Person provides Us with a written proof of ownership for any item lost which is valued at more than the sum insured amount specified against this benefit in the Certificate of Insurance / Part I of the Policy Schedule.
3. The Insured Person provides Us with a certified copy of the police report filed
4. We will reimburse only those losses that are Reasonable and Customary Charges.

EXCLUSIONS APPLICABLE TO COVER 4:

We shall not be liable to reimburse any expenses under this Cover Benefit for:

1. Any loss or destruction which will be paid or refunded by the Common Carrier, agent or any other provider of travel and/or accommodation
2. Any loss of Valuables, Money, any kinds of securities or tickets, electronic equipment unless specified in Part I of the Policy Schedule (Policy Certificate)
3. Any loss of luggage and personal possessions amounting to a partial loss or not amounting to a permanent and total loss
4. Any actual or alleged loss or destruction arising from detention, confiscation or distribution by customs, police or other public authorities.
5. Any loss due to theft, burglary or mugging etc. which is not reported to the police authorities within 24 hours of such an incident and a written report being obtained in that regard

GENERAL EXCLUSIONS (APPLICABLE TO ALL BENEFITS UNDER THE POLICY):

The Company shall not liable for any loss or damages:

1. In relation to the events occurring prior to the Date of Commencement of Insurance or after the Date of
2. Expiry of Insurance or Travel period as mentioned in Part I of the Schedule to this Policy.

2. If the claim be in any respect fraudulent, or if any false declaration be made or used in support thereof or if any fraudulent means or devices are used by the Insured or any one acting on his behalf to obtain any benefit under the Policy or if the loss or damage be occasioned by the willful act, or with the connivance of the Insured, all benefits under this Policy shall be forfeited.

3. If the Insured:
4. Is traveling against the advice of a Medical Practitioner;
5. Is receiving, or is on a waiting list to receive, specified medical treatment declared in a Medical Practitioner’s report or certificate;
6. Has received terminal prognosis for a medical condition;
7. Is taking part in a naval, military or air force operation;

4. In relation to events arising:

• out of any intentional self-Injury, suicide or attempted suicide, intoxication by liquor or drugs.

• due to involvement or participation of the Insured directly or indirectly in murder, or criminal assault or the like or any breach of law.

• out of mental disorder, anxiety, stress, depression, venereal disease or any loss directly or indirectly attributable to HIV (Human Immuno Deficiency Virus) and/or any HIV related Illness including AIDS (Acquired Immuno Deficiency Syndrome) and/or any mutant derivative or variations thereof howsoever caused.

5. Injury that are results of war and warlike occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power, active participation in riots, confiscation or nationalization or requisition of or destruction of or damage to property by or under the order of any government or local authority;

6. In relation to events arising from damage to any property or any loss or expense whatsoever resulting or arising from or any consequential loss directly or indirectly caused by or contributed to or arising from:
7. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel or
8. The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.

7. Pertaining to involvement or participation in activities that are against local laws, rules and/ or regulations specified by any government agency.

8. Any alternative Treatments not covered under AYUSH as instituted in a government hospital or any institute recognized by the government and/or accredited by Quality council or India/National accreditation board of health.

GENERAL CONDITIONS (APPLICABLE TO ALL BENEFITS UNDER THIS POLICY)

1. The insurance under the Policy shall not attach to any Trip that shall have commenced prior to the Date of Commencement of Insurance or Travel period by the common carrier as specified in Part I of the Schedule under the Policy.

2. Cancellation of the Policy - At the request of the Policyholder, the Policy will be cancelled any time prior to the beginning of the travel period as specified in Part I of the Schedule to the Policy. Full premium amount will be refunded. Once the trip has commenced, no cancellations can be accepted.

3. No cancellation of the cover pertaining to an Insured will be allowed in case the Insured has reported a claim under any of the sections of this Policy prior to the date and time of notice of cancellation and that stands admitted by the Insurer for any amount whatsoever.

4. Deductible shown against the respective items of cover in the schedule of the Policy shall be applied separately for each and every claim referred under the respective sections.

5. The Insured shall, at all times, act as if uninsured and shall take all steps as are necessary to avoid occurrence of any contingency covered hereunder and to avert and / or minimize a loss otherwise payable under the Policy.

CLAIM PROCEDURE – GENERAL: APPLICABLE TO ALL BENEFITS UNDER THIS POLICY

1. On facing a contingency which shall result in a claim under any of the Sections under this Policy, immediate notice thereof shall be given by the Insured to Us through our In-house claim processing team / Third Party Administrator as appointed by the Company on the details of which are furnished hereunder and after furnishing to them the identity as required by them shall get the claim registered. Failure to send such immediate notice may prejudice the Insured’s claim under the Policy.

(Details of in-house claim processing team/TPA are as provided in the policy certificate).

Our Toll Free– 1800 2666 

Email Id – customersupport@icicilombard.com

2. Documents of claim appropriate for each contingency and the consequent loss as listed in the respective sections of this Policy shall be forwarded to e Us /Third Party Administrator and in no case beyond a period of 30 days from the date of such return. In case the Trip is terminated anytime before the completion of the Trip covered hereunder, the Insured shall submit all the documents as soon as such termination shall take place, and in no case beyond a period of 30 days from the date of such termination.

3. While simultaneously lodging a claim under the relevant section under this Policy the Insured shall also take all steps to recover the loss from whosoever has been responsible for such loss caused to the Insured. The Insured shall then pursue his / her claim with the Company for the amount in excess of what has been recovered thereon. If the claim shall in advance of any such recovery have been settled under this Policy, the Insured shall undertake to repay to the credit of the Company the surplus of any amount that he / she recovered jointly under Policy as also from other sources. The appropriate documents in connection with such steps taken by the Insured vis-à-vis the agencies responsible for the loss as more explicitly described under the respective sections shall be submitted to the Company as and when available.

4. If at anytime during the Period of Insurance, or anytime thereafter, the Insured shall commit any fraud or resort to fraudulent means to recover any claim under this Policy, Insured’s right to all benefits under this Policy shall be forfeited.

5. Claim Documentation:

In addition to the documents as specified and provided under each cover herein above, any other document(s) that the Company requires from the Insured to process the claim and prove the authenticity of the loss may be asked for. If these additional documents are not submitted, then the Company will be relieved of its liability to pay the claim. If the Third Party Administrator or the Company request that bills/vouchers in a local language/ vernacular be accompanied by an appropriate translation, then the costs of such translation must be borne by the Insured.

6. Obligations of the Insured:

Claims for insurance must be submitted to Us / the Third Party Administrator not later than one (01) month after the completion of the treatment or transportation to the City of Residence, or in the event of death, after transportation of the mortal remains/ burial.

The Insured shall provide Us / the Third Party Administrator on demand any information that is required to determine the occurrence of the insurable event or the Company's liability to pay the benefits..

If requested to do so by Us/Third Party Administrator, the Insured shall be obliged to undergo a medical examination by a Medical Practitioner designated by Us/ Third Party Administrator.

We /The Third Party Administrator is authorized by the Insured to take all measures that are suitable for loss prevention and claim minimization, which includes the Insured's transportation back to the City of Residence or to the Place of Origin of the Insured.

The Company shall be released from any obligation to pay insurance benefits if any of the aforementioned obligations are breached by the Insured.

7. Transfer and Set-off of Claims:

If the Insured has any outstanding claims against third parties, such claims shall be transferred in writing to the Company up to the amount for which the reimbursement of costs is made by the Company in accordance with the terms hereunder.

In so far as an Insured receives compensation for costs he/she has incurred either from third parties liable for damages or as a result of other legal circumstances, the Company shall be entitled to set off this compensation against the insurance benefits payable, if any.

Claims to the insurance benefits may be neither pledged nor transferred by the Insured.

8. No sum payable under this Policy shall carry any interest / penalty.

9. In addition to the documents specified under the individual covers, the insured/claimant may be required to submit the following:
10. KYC documents of the insured/claimant
11. Account details for electronic fund transfer (EFT mandate form and/or cancelled cheque)
12. Any other documents required by us to investigate the claim.

10. All claims documentation specified within the relevant Section of the Policy for the Base Benefit/Extension being claimed must be submitted in full. The final decision to waive the requirement for any specified claim documents rests with Us.

11. If any Claim is not made within 30 days of the Insured Event, then We will condone such delay on merits only where the delay has been proved to be for reasons beyond the insured/claimant’s control.

12. The directions, advice and guidance of the treating Medical Practitioner shall be followed by the Insured Person.

13. We shall make the payment of Claim that has been admitted as payable by Us under the Policy within 30 days of submission of the last necessary documents and information required for the settlement of the Claim. All Claims will be investigated (as required) and settled in accordance with the applicable regulatory guidelines, including the IRDAI (Protection of Policyholders Interests) Regulations, 2017 and any rejections if done, would be provided with proper reasons by Us within 30 days of submission of the last necessary document/information.

14. In case of delay in payment of any Claim that has been admitted as payable by Us under the Policy, beyond the time period as prescribed under IRDAI (Protection of Policyholders Interests) Regulations, 2017, We shall pay interest at a rate which is 2% above the bank rate where “bank rate” shall mean the bank rate fixed by the Reserve Bank of India at the beginning of the financial year in which Claim has fallen due.

15. The admissible Claim amount will be calculated post applicability of Deductible, Co-pay, Sub-limit if any and as specifically defined in Policy Schedule.

16. You/the Insured Person must take all reasonable steps or measures to minimise the quantum of any Claim that may be covered under the Policy. If so requested by Us, the Insured Person will have to undergo a medical examination from Our nominated Medical Practitioner, as and when We consider reasonable and necessary to obtain an independent opinion for the purpose of processing any Claim. The cost of such examination will be borne by Us

17. Any notice or declaration for Your attention shall be deemed served if sent by Us to You at Your latest known address.

18. Any payment due to You under this Policy shall be paid to You by Us. However, We also reserve Our right to pay the Claim directly to the Hospital or to the Nominee (as named in the Policy Schedule). The receipt by You or Hospital or the claimant/Nominee shall be considered as a complete discharge of Our liability against any Claim under the Policy.

19. We shall have no liability under this Policy, once the Sum Insured, as stated in the Policy Schedule, is exhausted by You.

Cashless Facility

Cashless Facility is only available at specific Network Providers (The list of Network Providers is available on Our website). In order to avail of Cashless facility, the following procedure must be followed:

1. a) Insured Person/claimant must contact Us or Our in house claim processing team or TPA accompanied with full particulars namely, Policy Number, Insured Person’s name, relationship with Insured Person, nature ofIllness Injury, name and address of the Medical Practitioner/ Hospital, and any other information that may be relevant to the Illness Injury/ Hospitalization.

1. b) The request must be made at least within 24 hours of Hospitalization.

1. c) In case, the amount payable under a Benefit/Extension is more than the actual expenses incurred by the Insured Person at the Network Provider, there will be a part payment upto the actual expenses to the Network Provider, and remaining claim payment will be made to the Insured Person.

1. d) To avail of Cashless facility, the Insured Person/claimant is required to produce the policy certificate (physical or online), as provided with this Policy, subject to the terms and conditions for the usage of the said certificate

1. e) We will respond to your request with our approval, declination or request for further documentation in 4 hours. Please note that rejection of a pre-authorization request is in no way construed as rejection of coverage or treatment. The Insured Person can proceed with the treatment, settle the hospital bills and submit the claim for a possible reimbursement, within the prescribed timelines, which shall be considered subject to the Policy limits and relevant conditions.

Settlement/Rejection of Claim –The settlement of claims would be done by Us within 30 days after the receipt of last necessary documents/information, any rejections if done, would be provided with proper reasons by Us. The role of the TPA (if any) would be limited to facilitate the flow of information between You and Us.

Part III of the Policy

STANDARD TERMS AND CONDITIONS:

1. Incontestability and Duty of Disclosure:

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 particular in the proposal form, personal statement, declaration and connected documents, or any material information having been withheld, or a claim being fraudulent or any fraudulent means or devices being used by the Insured or any one acting on his behalf to obtain any benefit under this Policy.

1. Reasonable Care

The Insured shall take all reasonable steps to safeguard the interests of the Insured against loss or damage that may give rise to a claim.

3. Observance of terms and conditions

The due observance and fulfillment of the terms, conditions and endorsement of this Policy in so far as they relate to anything to be done or complied with by the Insured, shall be a condition precedent to any liability of the Company to make any payment under this Policy.

4. Material change

The Insured shall immediately notify the Company by fax and in writing of any material change in the risk, and cause at his own expense such additional precautions to be taken as circumstances may require to ensure safe operation of the Insured items or trade or business practices thereby containing the circumstances that may give rise to the claim, and the Company may adjust the scope of cover and / or premium if necessary, accordingly.

5. Records to be maintained

The Insured shall keep an accurate record containing all relevant particulars and shall allow the Company to inspect such record. The Insured shall within one month after the expiry of the Policy furnish such information as the Company may require.

6. No constructive Notice

Any knowledge or information of any circumstances or condition in connection with the Insured in possession of any official of the Company shall not be the notice to or be held to bind or prejudicially affect the Company notwithstanding subsequent acceptance of any premium.

7. Notice of charge etc.

The Company shall not be bound to take notice or be affected by any notice of any trust, charge, lien, assignment or other dealing with or relating to this Policy, but the payment by the Company to the Insured or his legal representative of any compensation or benefit under the Policy shall in all cases be an effectual discharge to the Company.

8. Special Provisions

Any special provisions subject to which this Policy has been entered into and endorsed in the Policy or in any separate instrument shall be deemed to be part of this Policy and shall have effect accordingly.

9. Overriding effect of Part II of the Schedule

The terms and conditions contained herein and in Part II of the Schedule shall be deemed to form part of the Policy and shall be read as if they are specifically incorporated herein; however in case of any inconsistency of any term and condition with the scope of cover contained in Part II of the Schedule, then the term(s) and condition(s) contained herein shall be read mutatis mutandis with the scope of cover/terms and conditions contained in Part II of the Schedule and shall be deemed to be modified accordingly or superseded in case of inconsistency being irreconcilable.

10. Duties of the Insured on occurrence of loss

On the occurrence of any loss, within the scope of cover under the Policy the Insured shall:

1. Forthwith file/submit a Claim Form in accordance with 'Claim Procedure' Clause as provided in Part II of the Schedule.
2. Allow the surveyor or any agent of the Company to inspect the lost/damaged properties premises /goods or any other material items, as per 'the Right to Inspect' (Clause 12) as provided in this Part.
3. Assist and not hinder or prevent the Company or any of its agents in pursuance of their duties under 'Rights of the Company On Happening Of Loss Or Damage' Clause as provided in this Part.
4. Not abandon the Insured property/item premises, nor take any steps to rectify/remedy the damage before the same has been approved by the Company or any of its agents or the Surveyor.

If the Insured does not comply with the provisions of this Clause or other obligations cast upon the Insured under this Policy, in terms of the other clauses referred to herein or in terms of the other clauses in any of the Policy documents, all benefits under the Policy shall be forfeited, at the option of the Company.

11. Right to inspect

If required by the Company, an agent/representative of the Company including a loss assessor or a Surveyor appointed in that behalf shall in case of any loss or any circumstances that have given rise to the claim to the Insured be permitted at all reasonable times to examine into the circumstances of such loss. The Insured shall on being required so to do by the Company produce all books of accounts, receipts, documents relating to or containing entries relating to the loss or such circumstance in his possession and furnish copies of or extracts from such of them as may be required by the Company so far as they relate to such claims or will in any way assist the Company to ascertain in the correctness thereof or the liability of the Company under the Policy.

12. Position after a claim

The Insured shall not be entitled to abandon any insured item/property whether the Company has taken possession of the same or not. As from the day of receipt of the claim amount by the Insured as determined by the Company to be fit and proper, the Sum Insured for the remainder of the Period of Insurance shall stand reduced by the amount of the compensation.

13. Indemnity

The Company may at its option, if applicable reinstate, replace or repair the property or premises lost or damaged or any part thereof instead of paying the amount of loss or damage or may join with any other insurer in so doing. The Company shall not be bound to reinstate exactly or completely but only as circumstances permit and in reasonably sufficient manner. In no case shall the Company be bound to expend more in reinstatement than it would have cost to reinstate such property as it was at the time of the occurrence of such loss or damage and in any event not more than the Sum Insured thereon.

If in any case the Company shall be unable to reinstate or repair the Insured property/item hereby Insured, because of any law or other regulations in force affecting Insured property or otherwise, the Company shall, in every such case, only be liable to pay such Sum as would be requisite under the Policy.

14. Subrogation

In the event of payment under this Policy, the Company shall be subrogated to all the Insured's rights or recovery thereof against any person or organization , and the Insured shall execute and deliver instruments and papers necessary to secure such rights.

The Insured and any claimant under this Policy shall at the expense of the Company do and concur in doing and permit to be done, all such acts and things as may be necessary or required by the Company, before or after Insured's indemnification, in enforcing or endorsing any rights or remedies, or of obtaining relief or indemnity, to which the Company shall be or would become entitled or subrogated.

15. Condition of Average

If the insured property be collectively of greater value than the Sum Insured thereon, then the Insured shall be considered as being his own insurer for the difference, and shall bear a rateable proportion of the loss or damage accordingly. Every item, if more than one in the Policy, shall be separately subject to this condition.

16. Contribution

If at the time when any Claim arises under this Policy, there is any other insurance which covers (or would but for the existence of this Policy) and the amount to be claimed exceeds the sum insured under a single policy after considering the deductibles or co-pay, in the same Claim (in whole or in part), then We shall not be liable to pay or contribute more than Our rateable proportion of any Claim.

However, this condition shall not be applicable for all the benefit based covers under the Policy, as applicable.

17. Fraudulent claims

If any claim is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof, or if any fraudulent means or devices are used by the Insured or anyone acting on his/her behalf to obtain any benefit under this Policy, or if a claim is made and rejected and no court action or suit is commenced within twelve months after such rejection or, in case of arbitration taking place as provided therein, within twelve (12) calendar months after the Arbitrator or Arbitrators have made their award, all benefits under this Policy shall be forfeited.

18. Cancellation/termination

 (a) Disclosure to information norm

The Policy shall be void and all premium paid hereon shall be forfeited to the Company, in the event of misrepresentation, mis-description or non-disclosure of any material fact. (b) You may cancel this Policy at any time prior to the beginning of the travel period as specified in Part I of the Schedule to the policy and full premium amount will be refunded. Once the trip has commenced, no cancellations can be accepted. 

19. Policy Disputes

Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions contained herein is understood and agreed to by both the Insured and the Company to be subject to Indian Law. Each party agrees to submit to the exclusive jurisdiction of the High Court of Mumbai and to comply with all requirements necessary to give such Court the jurisdiction. All matters arising hereunder shall be determined in accordance with the law and practice of such Court.

20. Arbitration clause

If any dispute or difference shall arise as to the quantum to be paid under this 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 to the dispute/difference, 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. Arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996 (and as amended hereinafter)

It is clearly agreed and understood that no difference or dispute shall be referable to arbitration, as hereinbefore 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 with respect to the quantum dispute that the award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.

21. The Standard list of Excluded Items would be as per the Guidelines on Standardisation in Health Insurance dated July 29, 2016. In case of any variation, such specific list would be annexed along with the policy documents. The list of excluded items is also available on our website………….

22. Notices

Any notice, direction or instruction given under this Policy shall be in writing and delivered by hand, post, or facsimile to In case of the Insured, at the address specified in Part I of the Schedule.

In case of the Company:

 ICICI Lombard General Insurance Company Limited . ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025

Notice and instructions will be deemed served 7 days after posting or immediately upon receipt in the case of hand delivery, facsimile or e-mail.

23. Customer Service

If at any time the Insured requires any clarification or assistance, the Insured may contact the offices of the Company at the address specified, during normal business hours.

24. Grievances

In case you are aggrieved in any way, you should do the following

400025. For resolution of any query or grievance, Insured may contact the respective branch office of The Company or may call us at toll free no. 1800 2666 or email us at customersupport@icicilombard.com or write to us at ICICI Lombard General Insurance Company Ltd. ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai- 400025.

1. If you are not satisfied with the resolution provided, you may approach us at the subsection “Grievance Redressal “ on our website www.icicilombard.com (Customer Support section).

iii. In case Your complaint is not fully addressed by the insurer, You may use the Integrated Greivance Management System (IGMS) for escalating the complaint to IRDAI. Through IGMS You can register your complain online and track its status. For registration please visit IRDAI website www.irda.gov.in. If the issue still remains unresolved, You may, subject to vested jurisdiction, approach Insurance Ombudsman for the redressal of the grievance.

The details of Insurance Ombudsman are available below:

The updated details of Insurance Ombudsman are also available on IRDA website: www.irdaindia.org on the website of Office of the Executive Council of Insurers (formerly GBIC): www.ecoi.co.in , website of the company www.icicilombard.com or from any of Our offices.