ees BOL INTER OFFICE MEMORANDUM. From, a To, ‘The General Manager The General Managet/ All NBGS Third Party Products Division The Zonal Manager! All Zones | Head Office All SMECCs, All RBCs, Alll Branches Ref. No. HO: TPPD: BM: 22-23: 195 Date: 30.12.2022 Reliance General Insurance Co. Ltd. Group Mediciaim Policy with revised feature Introduction of Co-pay for claim settlement “Group Mediclaim policy” — UIN No: RELHLGP21523V022021 Our Bank is having Corporate Agency tie-up with General Insurer ‘Reliance General Insurance Co. Ltd’ (RGICL) for Soliciting and procuring of General & Health insurance Products. We have been distributing various Insurance Products of RGICL like Group Mediclaim Policy, Group Personal accident through all our branches. RGICL has offered a Group Family Floater product named as “Reliance Group Mediclaim policy” (UIN: RELHLGP21523V022021) in continuation of Reliance BO! ‘Swasthya Bima family floater product vide (IOM Ref. No. HO: TPPD: CP: 2021-22) dated 05.02.2022. As per the Group Mediclaim policy, facility to automatically port the Reliance BO! ‘Swasthya Bima RBSB policy after due date upon renewal without fresh Application Form is provided. This Product also has a feature of Death coverage by Accident only up to the Sum Insured Amount which is governed by the Policy wording of Group Personal Accident (GPA)(UIN: RELPAGP01001V010001) & Master Policy No. $20292129140000259 As per RGICL, the offering in this Group Policy has been customised by adding the PA policy cover under Reliance Group Personal Accident Policy with Reliance Group Mediclaim holders. Hence, the same is getting issued along with Group Mediclaim Policy only wherein both the policy renewal date is same. In all such cases UIN No. of product remains same and it does not differ. Reliance Group Mediclaim Policy has been one of the Successful product for the Group Health Insurance Customers and RBSB Customers However, in this changing & ever evolving conditions vis-é-vis increase in ICR (Insurance Claim Ratio), Company has introduced the inclusion of Go-Pay in the Policy for sustainability of the portfolio. The financial year wise Gross Written premium (GWP), Net Incurred Claim (NIC), & year wise Loss are mentioned below: BOI-Swasthya Bima LR (financial een Remtcin erent) Gur aeEhcr fee i) Ors) Fy 21-22 FY 20-21 FY 19-20 [Actual FiguresEach and Every claim under: ficy wil biected to a Co-payment of 30% , applicable to claim amount admissible and payable as per the terms and conditions of the Policy. The Feature will be effective from 01.01.2023. The amount payable will be after deduction of the applicable co- Payment. Therefore, itis requested to take note of the modification in Policy terms and elso update the Customers about the modification while offering Fresh and Renewal Policy. The other features of the Group Accident Policy is as per the Policy wording & Master Policy No. 920292128140000289, no change in the policy has been proposed. Indicative Features are mentioned in the ANNEXURE 1 We reiterate the following points while distributing the products: Branches not to adopt any coercive method while selling of third party products. Bank's regulation w.r.t. AML and combating financial terrorism in selling Third Party products should be strictly adhered to * Suitability of the products to customer is to be ensured & officials must not resort to mis-selling / force selling. + No Term Loan account to be debited for investment in any TPP Product, Classification: InternalANNEXURE 1 The main features of the Group Mediclaim Policy are mentioned below: Sum Insured : | 7 Lakhs, 2 Lakhs, 3 Lakhs, 4 Lakhs and 5 Lakhs only. ee ‘Co-Payment: | Each and every claim under the Policy will be subject to a Co-payment of 30% applicable to claim amount admissible and payable as per the terms and conditions of the Policy. The amount payable will be after deduction of the | applicable co-payment. [Pre- ~~ | 30 days before hospitalization. Hospitalizatio expenses: Post 60 days after hospitalization. Hospitalizatio n expenses In-Patient if during the Policy Period any of the Insured Person undergoes Hospitalization Treatment: | for Inpatient Treatment on the written advice of a Medical Practitioner, then the Company will indemnify the Policyholder/Insured Person for the below incurred Medical Expenses: ‘+ Room Rent (Please refer room rent clause) © Nursing * Medical Practitioner(s), * Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, + Medicines, drugs and Consumables + Diagnostic procedures + The cost of prosthetic and other devices or equipment if implanted intemally during a Surgical Procedure Day care ‘Standard Day-care procedures requiring less than 24hrs of hospitalization - Treatment : procedures covered as per RGICL list. Any day care procedure covered with / without pre-auth in network or non | network hospital. Any new medical procedures or drugs that replace less than 24 hour hospitalization to be included as Day Care Procedure Room Rent: / Room rent eligibility with Twin Sharing basis rents including RMO and Nursing charges and other associated charges capped as mentioned - 1% of Sum | Insured for Normal Room and 2% of Sum Ineured for ICU/ICCU and NICU In the event of insured person getting admitted in a higher category of accommodation the insured person shall bear proportion of the entire. hospital Bill/ Medical Expenses in proportion of the (Room Rent/ICU actually incurred ~ Room Rent of the entitled room category) | Room Rent actually incurred‘This shall be applicable to all the Medical Expenses incurred during the stay in Hospital. Domiciliary This benefit covers payment of Medical Expenses incurred during the Policy Period for Medically Necessary Treatment pertaining to Domiciliary Hospitalisatio | tospitalisation of the Insured Person provided that: n The payment under Domiciliary hospitalisation benefit shall be limited to 10% of the Sum Insured as specified in the Cerificate of Insurance/Schedule, and shall, in no case cover expenses incurred for: a. Treatment of any of the following diseasesiiliness/injury = Asthma © Bronchitis ® Chronic nephritis and nephritic syndrome ‘+ Diarrhea & all types of dysenteries including gastroenteritis. Diabetes mellitus and insipidus + Epilepsy © Hypertension * Influenza, cough and cold * All psychiatric or psychosomatic disorders * Pyrexia of unknown origin for less than 10 days © Tonsillitis and upper respiratory tract infection including laryngitis & pharangitis * Arthritis, gout and rheumatism. Donor Expenses: The Company will indemnify the Policyholderiinsured Person up to 60% of Base ‘Sum Insured as mentioned in the Certificate of Insurance/Policy Schedule, for the Medical Expenses incurred, during hospitalization, in respect of the donor for any organ transplant surgery conducted during the Policy Period, provided: + The organ donation is in accordance with The Transplantation of Human Organs Act, 1994 (amended) and other applicable laws and rules. * The Company has admitted the Insured Person's claim under the Policy. + The organ donated is for the Insured Person's use. The Company will not pay the donor's Pre-hospitalization and Post-hospitalization expenses or any other Medical Expenses for the donor consequent to the harvesting Re- It is agreed that one re-instatement up to the 25% Base Sum Insured will be! instatement of] automatically done after the Base Sum Insured have been utilized completely for Base Insured: ‘Sum| Claims incurred under the Policy for the Policy Period, provided that: i. Fora claim to be admissible under Re-instated Sum Insured it should be admissible under the Benefit Inpatient treatment, Domiciliary Hospitalisation.Day Care,Ayush Treatment HIV/AIDS AND Modern Treatment ji, The payment of claims in aggregate under Re-instated Sum Insured during Policy Period shall be Upto 25% of Base Sum InsuredThe Reinstatement Benefit Sum Insured cannot be used for any claim for Which a claim has arisen out or is a consequence of or its related to or is a complication of an Illness or Accident for which a claim has already been admitted under the current Policy in relation to an Insured Person. iv. The Re-instated Sum Insured for a Policy Period can be utilized only after the Base Sum Insured has been completely exhausted in that Policy Period. v. The unutilized Re-instated Sum Insured cannot be carried forward to any subsequent Policy Period, vi, The Sum Insured will be restored only once in a Policy Period [Ambulance | The cover indemnnifies the Insured Person upto Rs 1000 per hospitalization on Charges : availing Ambulance services offered by a Hospital or by an Ambulance service provider on Inpatient hospitalization Ayush The Company will pay the medical expenses for the in-patient treatment that is Treatment : taken under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, subject to: i. The Company's maximum liability per Policy Period shall be limited to 10% of the Sum Insured as mentioned in the Certificate of Insurance/Schedule, and ji, The Company has accepted an in-patient Hospitalisation for the Insured Person lil, The AYUSH treatment should be carried out in an AYUSH Hospital as defined under the Policy. iv, Pre Hospitalisation and Post Hospitalisation Expenses, Day Care Treatments and Domiciliary Hospitalisation expenses are not payable under this benefit. ¥. All preventive and rejuvenation treatments (non-curative in nature) including, without limitation, treatments that are not medically necessary This includes but not limited to treatments at Spa, Massages and Health Rejuvenation Procedure. ‘This benefit is subject to terms, conditions, deductible, co-payment, limitations and exclusions mentioned in the Peliay. The Company will pay for hospitalization expenses requiring more than 24 hours of admission because of ailments related to HIV/AIDS conditions ‘The Company will indemnify the Insured Person up fo 50% of Base Sum Insured for the Medical Expenses incurred during the Policy period on Inpatient Treatment or Day Care Treatment of below mentioned Modern Treatment Methods — + Uterine Artery Embolization and HIFUBalloon Sinuplasty Deep Brain Stimulation Oral Chemotherapy Immunotherapy-Monoclonal Antibody to be given as injection Intra Vitreal injections Robot surgeries Stereotactic radio surgeries Bronchial Thermoplasty \Vaporization of the prostrate (Green laser treatment or holmium laser treatment) IONW- (Intra Operative Neutro Monitoring) Stem Cell therapy: Including Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered | Natal Personal ‘Accidental Death - (AD) Accident: —_| if such injury shall within twelve calendar months of its occurrence be the sole (Individual _| Nd direct cause of the death of the Insured Person Basis For Proposer) Maternity Not applicable Ben (Normal & C- Section) New Born Not applicable. Baby Cover from Day 4: [Pre and Post | Not applicable. Expenses : Ailment Cataract per eye covered upto 20% of Sum Insured or Rs 40000 whichever is Capping : lower. (Cataract claims are subjected to Pre-authorization) First Thirty days Waiting period: Expenses related to the treatment of any illnesswithin 30 days from the first policy commencementdate shall be excluded except claims arising due toan accidental injury, provided the same are covered, Pre- Existing Disease: Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with us. If there is any Break in Policy then the waiting periods including that for Pre- existing Disease shall be applicable afresh and the look-back period of 4 years for Pre-existing Disease shall be counted from the fresh Certificate Period Start Date.Waiting Period of 12/24 months Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the expiry of 12 or 24 months of continuous coverage, as may be the case after i. the date of inception of the first policy with the insurer, This exclusion shall not be applicable for claims arising due to an Accident. ji. Incase of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase. iii, If any of the specified disease/procedure falls under the waiting period specified for Pre-existing diseases, then the longer of the two waiting periods shall apply. iv. The waiting period for listed conditions shall apply even if contracted after the policy or declared and accepted without a specific exclusion. v. Ifthe Insured Person is continuously covered without any Break as defined under the applicable norms on portability stipulated by IRDAI, then waiting Period for the same would be reduced to the extent of prior coverage. List for 12 months Waiting Period a. Cataract Benign Prostatic Hypertrophy ©. Myomectomy, Hysterectomy or menorthagia or fibromyoma unless | because of malignancy d. Dilation and curettage Hernia, hydrocele, congenital internal anomaly/diseases Skin and all intemal tumors/cysts/nodulesipolyps of any kind including breast lumps unless malignant/adenoids and hemorrhoids: g. Fissure / Fistula in anus, Hemorrhoids / Piles, Pilonidal Sinus, any ‘abscess related to Anal region, Gastric and Duodenal Ulcers h. Nasal Septum Deviation, Sinusitis and related disorders i. Dialysis required for chronic renal failure j. Gastric and Duodenal ulcers =e List for 24 months Waiting Period a. Arthritis if non-infective, Osteoarthritis and Osteoporosis, Gout, Rheumatism & all vertebrae Disorders including but not limited to Spondylitis, Spondylosis, Spondylolisthesis & Intervertebral Disc Prolapse, Joint Replacement Surgery b. Benign ear, nose and throat (ENT) Disorders and Surgeries (including but not limited to Adenoidectomy, Mastoidectomy , Tonsillectomy and Tympanoplasty) ©. Surgery of Genito urinary system unless necessitated by malignancy 4d. Kidney Stone/ Ureteric Stone/ Lithotripsy / Gall Bladder Stone - Varicose veins and varicose ulcers Exclusions: ‘The company is not liable to make any payment under the policy ,in respect of any expenses incurred in connection with or in respect of :-7. Expenses related to any admission primarily for diagnostics and evaluation Purposes. 2. Rest Cure, rehabilitation and respite care, admission primarily for enforced bed rest and not for receiving treatment. 3. Obesity / Weight Control-Expenses related to the surgical treatment of obesity that does not fuffl all the below conditions: * Surgery to be conducted is upon the advice of the Doctor + The surgery/Procedure conducted should be supported by clinical protocols + The member has to be 18 years of age or older and * Body Mass Index (BMI); — greater than or equal to 40 or — greater than or equal to 35 in conjunction with any of the following severe co-morbicities following failure of less invasive methods of |_| weight loss + Obesity-related cardiomyopathy * Coronary heart disease | * Severe Sleep Apnea * Uncontrolled Type2 Diabetes 4, Change-of-Gender treatments-Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex. 5. Cosmetic or plastic Surgery-Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an ‘Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured certified by the attending Medical Practitioner. 6. Hazardous or Adventure sports-Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving. 7. Breach of law-Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent. 8. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof 8. Dietary supplements and substances that can be purchased without prescription, ineluding but not limited to Vitamins, minerale and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure 10. Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness71. Refractive Error-Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters. 12, Sterility and Infertility-Expenses related to sterility and infertility. This includes any type of sterilization, Assisted Reproduction, Gestational Surrogacy and Reversal of sterilization 19, Maternity Expenses-Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy. 14. War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil wer, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds 418. Circumcision unless necessary for treatment of a disease not excluded hereinabove or as may be necessitated due to an accident. 16. Cost of spectacles, contact lenses and hearing aids. 17. Dental treatment or surgery of any kind unless requiring hospitalisation. 18. Convalescence, general debility, ‘run-down’ condition 19. Treatment for congenital external disease or defects or anomalies, 20. Any venereal disease any intentional self-injury 21. Any expenses related to Non-allopathic treatment, except for AYUSH treatment 22. Any RMO charges are not payable. 23. Any paramedics charges other than Nursing charges and standalone physiotherapist charges are not covered, Applicable to Personal Accident 1, Payment of benefits shall not be available in respect of death, injury or disablement directly or indirectly arising out of or contributed to by or traceable to any disability existing on the date of issue of the policy. Intentional self-injury, suicide or attempted suicide or whilst under the influence of intoxicating liquor or drugs. Venereal disease or insanity. Servicing -on duty with any armed forces. War, war-like situation, invasion or in consequence thereof or nuclear risk. Payment of compensation in respect of death, permanent total disablement. of Insured person arising or resulting from the Insured Person committing any breach of law with criminal intent. 7. Crew of aircraft and ship: naval, military, air force personnel, policemen, firemen, fishermen are excluded from scope of this policy. 8. Perils of the sea are excluded from the scope of the policy, 9. Any loss sustained while performing or participeting in any of the following occupations or events shall not be covered - Working in mines, explosives, electrical installations on high tension electric lines, racing, circus personnel, skiing, mountaineering, hunting, gliding, river rafting, winter sports, ice hockey, polo and occupations of similar hazard related to Risk Category 3. x Pano Rest all Terms and conditions strictly as per Group Mediclaim and Group Personal Accident Insurance Policy of RGICL.L ‘Ailments/Gon | Septoplasty, Cochlear Implant or related aids, RFOMIR - Rotational Field ditions not Quantum Magnetic Resonance Device - Cytotron, C3R, Bariatric surgery, Pocorede Injection Avastin / Lucentis / Macugen, Ozone Therapy, Enhanced External Counter Pulsation Therapy (ECP), Rejuvenation therapy, Lasik Surgery are not covered under the policy. [Conditions : Policy to be issued only to active Account holders of Bank of India, The Premium will be paid by respective account holders only. The Master Policy will be in the name of Bank Of India . Only Ai same is to be excluded from the scheme. In case of multiple accounts in same or different branch setups, the total liability for RGICL will not exceed Sum insured limit as mentioned under each policy provided account holder has paid premium for each account. Customer ID will act as @ unique identification number for such type of cases. 6. Full premium is to be submitted at inception of the policy. Dependents to be covered are to be declared before policy commencement date. Deletion of PONa in case of dependent 7. Dependents to be declared at inception of policy only. Mid-term change in ‘Sum insured /addition of lives not allowed (except for new born baby subject to availabilty of family slot and newly wedded spouse subject to declaration to insurance company). Once customer has opted for family definition the same is to be continued till END of the policy period, Mid-term inclusion of dependent in the same policy will not be allowed, pplicable to Personal Accident Policy 1. This policy will be valid only to the account holder of Bank of India on Individual basis 2. The policy will be on named basis 3. The Company's total liability for per person in aggregate shall not exceed ‘Sum Insured mentioned against that Policy / cover irrespective of no. of Covers/ of policies he or she is covered. In such case the first policy issued will be considered. 4. Individual sum insured cannot be more than 100 times of the monthly gainful income or sum insured specified whichever is less, subject to condition that no customer is involved in any hazardous activity 5. At the time of claims settlement ITR/BOA/C's (books of accounts) will be Verified, ifthe actual income is less than the income declared claims will be settled at substandard basis 6. Claim proceeds shall be given to the Insured/nominee / family / legal heir of the deceased person as the case may be. ‘Acoourts wil be considered - in ease of Ciarmant Accounts the | lives is allowed only in case of death or divorce or financial non-dependency | 7. Inthe event of any incorrect representation, the liability shall be upon the Policyholder All other terms and conditions are as per the Reliance General Insurance for Bank Customers as per the Policy Documents.