This document summarizes a health insurance plan called HDFC Life Health Assure. It offers benefits like inpatient hospitalization coverage, day care procedures, pre and post hospitalization coverage, ambulance coverage, and more. Policyholders can choose between individual or family floater plans, silver or gold plan options, and sums insured ranging from Rs. 3-10 lakhs. The plan provides additional benefits like multiplier increases to coverage amounts for claim-free years and restore benefits that replenish coverage amounts. It allows flexibility to add or remove family members and make policy alterations over time.

1. Health PlanAssure
Health Assured. Pride Secured.
Certified Corporate Agent:

2. PLANBENEFITS
HDFC Life Health Assure Plan provides a host of benefits. The benefits you
getwilldependupontheplanoptionyouhavechosenasmentionedbelow:
PLAN TYPE
PLAN OPTION
SUM INSURED
BENEFITS
Day Care Benefit ¹⁰ Covered Covered
EmergencyAmbulance Covered Covered
Not Covered Not Covered
Not Covered
Not Covered
Single Life FAMILY FLOATER
Inpatient ¹⁹
Hospitalisation
Covered Covered
Pre and Post
&Hospitalisation ³¹ ³⁰
Covered Covered
Donor Expense
Benefit
Covered Covered
Hospital¹⁵
Cash Benefit
Wellness Benefit
SILVERSILVER GOLDGOLD
Benefits
within
Annual
Limit²
Maternity Benefit ²¹ Covered
Covered
Covered
Not
Covered
Not
Covered
Covered
Covered
` 3
LAKHS
` 3
LAKHS
` 7
LAKHS
` 5
LAKHS
` 5
LAKHS
` 10
LAKHS
Additi-
onal
Benefit
3.Eligible Family Members – Under the Family Floater plan type, you may
cover your spouse, children, both parents and parents-in-law subject to
underwriting norms.
AGE* AT ENTRY (Yrs.)
MINIMUM
POLICY TERM
18 for adults and
policyholder
91 days for
dependent children
MAXIMUM
PREMIUM
FREQUENCY
Whole life plan
70 Annual
PLANDETAILS
2.Plan Eligibilities – Age and policy term limits for HDFC Life Health Assure
Planareasfollows:
*AgeLastBirthday
Choose your Plan Type – Individual or Family Floater
Choose your Plan Option – Gold or SilverStep 2
Step 1
36
Choose the Sum InsuredStep 3
In today’s fast paced & stressful life you are striving hard to give best of
everything to your family. Yet you never know when you or your family may
have to face any medical emergencies. If at all such situation arises, it puts
pressure on your immediate cash flows. In the absence of adequate health
insuranceprotection theremaybeaneedtoliquidateassetsorborrowmoney
to pay medical expenses²³. Moreover in such situations other financial
commitments of regular savings may take back seat thus impacting
achievementsofanylongtermfinancial goals. Eventhecostofmedical careis
increasingdaybyday.
While it is important for you to adopt a healthy life style, it is also important to
have a health insurance plan which will take care of some of the medical
expensesthatyoumayincur.
HDFC Life presents HDFC Life Health Assure Plan, a comprehensive, pure
protection health insurance plan that reimburses medical expenses incurred
inahospital. Theplanoffersyouthefollowingkeyfeatures:
• Coverforwholeoflife
• Option to increase the Sum Insured subject to the maximum limit or
upgrade the type of plan, subject to underwriting on the completion of
threepolicyyearsandeverythreeyearsthereafter
• Cashless ClaimService⁵atspecified Network²⁶Hospitals acrossIndia
• HasslefreeClaimReimbursementProcess
• PremiumGuaranteefor3yearsevenifyoumakeaclaim
• Automaticallydoublesyour coverafter2claimfreeyears
• ChoiceofIndividual CoverandFamilyFloaterCovers
• Flexibility to choose Restore Benefit Option , by paying additional
premiumsunderallPlanOptions.
• For policies with Sum Insured ofRs 5Lakhs &above, additional flexibility to
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chooseRoomRentEnhancementOption ,bypayingadditional premiums.
PLANDETAILS
1. Plan Type – You have flexibility to customize a plan as per your & your
family’sneeds.
Sum Insured is the maximum amount of claim per policy per year that can be
availed. This amount may increase in subsequent years due to Multiplier
Benefit(pleaserefertotheMultiplier BenefitSectionfordetails.).
3 EASY STEPS TO OWN YOUR PLAN
BenefitsDescription
The plan will cover eligible actual medical expenses under the benefits
described below up to the applicable Annual Limit only. The amount payable
under all the benefits described below will be added to determine utilization
ofAnnualLimit.
1. Inpatient Hospitalization Benefit¹⁹ – If you or any of your insured
familymembersuffersanillness¹⁷ ormeetsanaccident¹andishospitalized
for a period exceeding 24 hours, this benefit will reimburse medical
expensesincurredbythelifeinsuredon:
I. Room Rent³⁵, which will be paid on actual expenses incurred subject to a
per day limit of 1% of Sum Insured for hospitalisation¹⁶ in regular
rooms/wards and 2% of Sum Insured for hospitalization in an intensive
care unit (ICU)²⁰.If the Room Rent Enhancement is opted for, the limit of
1% of Sum Insured will not apply provided the room chosen for
treatmentisastandardprivateroom.
ii. NursingCharges,Surgeons’,Anesthetists’,DieticiansandotherDoctors’
HEALTH INSURANCE PLAN:
A Mediclaim Plan Guide for Prospective Policy Holders
PLAN
OPTION
MINIMUM MINIMUM
Silver
Gold
3 Lakhs
5 Lakhs
3 Lakhs
5 Lakhs
3 Lakhs
7 Lakhs
5 Lakhs
10 Lakhs
MAXIMUM MAXIMUM
SINGLE LIFE FAMILY FLOATER
SUM INSURED (`)

3. 7 Lakhs
Benefit Value (Per Insured Member) (`) 500 700 1000
5 Lakhs 10 LakhsPolicy Sum Insured (`)
• This benefit isnotavailable tolivesinsuredwhich wereincluded inthe
family floater policy as dependent children and/or dependent adults
otherthanthespouseofPolicyholder
• Expenses of new born child/baby²⁷ from a successful delivery will be
not be payable under this benefit. No reimbursements for any
vaccinationswillbedone.
7.Hospital Cash Benefit – If you have taken Gold plan option (Individual or
Family Floater) and are admitted to a hospital for period exceeding 24
continuous hours, then we will pay Hospital Cash Benefit for each day of
hospitalization. This benefit is not a stand-alone benefit and shall be paid
along with settlement of claim payable under Inpatient Hospitalisation
BenefitandispayablefromwithintheAnnualLimit.
fees(providedthesameisincluded withinthehospitalisationbill)
iii. Investigation charges including pathology, radiology and other
diagnostic testsduringhospitalisation
iv. Cancertreatmentincluding chemotherapyandradiotherapy
v. Cost of Artificial Limbs, subject to maximum of Rs. 25,000 per life
insuredperannum
vi. ICU charges, Anesthesia, blood, oxygen, operation theatre charges,
surgical appliances, medicines and drugs, diagnostic materials and X-
Rays, dialysis, cost of pacemaker, Angioplasty stents, Heart prosthetic
valvesandjointreplacementimplants
Theclaimwouldbesubjectto:
• Themaximumofsuminsured,
• Applicable sub-limits, ifany
• Any other exclusions applicable to the type of expense claimed or the
typeofailmentasmentionedherewith.
Pleaserefertosection30ofAnnexure1formoredetails.
2.Day Care Benefit¹⁰ – We will pay actual permissible medical expenses
incurred upon undergoing any of the Day Care procedures listed in
Annexure 2 where 24 hour hospitalisation is not necessary. Any other
procedures which do not require the minimum 24 hour hospitalisation due
to subsequent advancement in Medical Technology will be considered
under Day Care Benefit only if they are preauthorized. This list can be
modified fromtimetotimesubjecttopriorapprovalfromIRDA.
&
3.Pre and Post Hospitalisation Benefit³¹ ³⁰– We will pay the actual
medical expenses incurred by you up to 30 days prior to the date of
admission and 60 days from the date of discharge of Inpatient
Hospitalisation orDayCareBenefit, subject tomaximum amountof10% of
policy Sum Insured. This benefit will be payable only if the Inpatient
HospitalisationBenefitorDayCareBenefitispayable.
4.Emergency Ambulance Benefit – We will pay the actual expenses
incurred up to Rs. 2,000 per policy year per insured member towards
ambulance service provided to transport the insured member who is
admitted in the hospital. This benefit is payable only in case the
hospitalisation is in an ICU or Emergency ward/care³⁹ of the hospital and
theInpatientHospitalisationBenefitiseligible forpayment.
5.Donor Expense Benefit – We will pay the actual medical expenses
incurredduring the procedureofdonation ofanorgan provided the insured
member is a recipient of the organ. This includes any hospitalisation
expense incurred by the Donor. However we will not pay the cost of the
organ. Pre and Post hospitalisation expenses incurred by the insured
memberonly(whoisrecipientoftheorgan)willbepayable.
6.Maternity Benefit²¹ – If you have taken Gold Family Floater option, then
we will reimburse the actual medical expenses incurr ed by the insured life
towards Hospitalisation as an inpatient due to pregnancy or any
complications thereof, including delivery and medical termination of
pregnancy. The total medical expenses that we will reimburse will be
subject to a maximum limit of 3% of the Sum Insured per pregnancy,
providedthat:
• The policy is a family floater policy wherein the female insured life is
eitheraPolicyholder herselforspouseofPolicyholder
• The lifeinsured(female life)has been coveredinthe family floaterpolicy
foratleastthreecontinuousyears.
Thisbenefitissubjecttofollowingadditional conditions:
• Preandposthospitalisationexpenseswillnotbepayable
• This benefit shall be available only for two episodes of pregnancy in
lifetime ofinsured life, including new policies taken bythe lifeinsured
withthecompany
7 Lakhs
Per Day Amount (`) 500 700 1000
5 Lakhs 10 LakhsPolicy Sum Insured (`)
WELLNESS BENEFIT
IfyouhavetakenGoldplanoption(IndividualorFamilyFloater)wewillprovide
you Wellness Health check-up Vouchers which can be redeemed at any of the
network diagnostic center/providers towards Health Check-up. These
WellnessVoucherswillbearavalueequalto0.1%ofSumInsuredandmustbe
utilizedwithin1yearofissue. TheseWellnessVoucherswillnotbeexchanged
for cash and are not transferrable and have to be utilized only by the life
insured. These Wellness Vouchers will be provided every three years starting
from second policy year. HDFC Life will ensure a valid Wellness voucher is
honoured. The value of these Wellness Vouchers does not reduce your
AnnualLimit.
MULTIPLIER BENEFIT⁸
In case you do not make any claim for any of the insured member in any policy
year,wewillrewardyouwithaMultiplierLimitequalto50%ofyourpolicySum
Insured in the following year. If you do not make any claim even in the second
consecutive year, your Multiplier Limit will increase to 100% of policy Sum
Insured. Thus your Annual Limit may increase to maximum of 200% of your
policySumInsuredincasetherearenoclaimsintwoconsecutiveyears.
Similarly, if you make a claim in any year, in the following year we will reduce
the Multiplier Limit by 50% of your policy Sum Insured. Claims in two
consecutive years will reduce the Multiplier Limit to 0%. However at no point
will the Annual Limit fall below your policy Sum Insured, irrespective of any
numberofclaimsinthepreviousyear.
Following is an illustration of How Multiplier Benefit multiplies your coverage
iftherearenoclaimsinanyyear:
In case if the policyholder decides to increase the Sum Insured, the multiplier
benefit will apply separately for the original Sum Insured and increased
amountbasedontherespectiveclaim-freedurations(inyears)
AFTER ONE CLAIM
FREE POLICY YEAR
Sum Insured 10 Lakhs 10 Lakhs 10 Lakhs
AFTER TWO
CONSECUTIVE CLAIM
FREE POLICY YEARS
Multiplier Limit Nil 5 Lakhs 10 Lakhs
Annual Limit 10 Lakhs 15 Lakhs 20 Lakhs
AT
INCEPTION

4. RESTOREBENEFIT
If the Basic Sum Insured and multiplier benefit (ifany)isexhausted dueto
claims made and paid during the Policy Year or made during the Policy Year
and accepted as payable, then it is agreed that a Restore Sum Insured (equal
to 100% of the Basic Sum Insured) will be automatically available for the
particular policyyear,providedthat:
• The Restore Sum Insured will be enforceable only after the basic sum
insured including the multiplier bonus ha ve been completely exhausted in
thatyear
• TheRestoreSumInsuredcanbeusedforclaimsmadebytheInsuredPerson
inrespectofthefollowingbasicbenefitscoveredbythepolicy:
• InpatientHospitalizationBenefit
• Pre-Hospitalization
• Post-Hospitalization
• DayCareProcedures
• OrganDonor
• EmergencyAmbulance
• The Restore Sum Insured can be used for only future claims made by the
Insured Person and not against any claim for an illness/disease (including
itscomplications) forwhich aclaim hasbeenpaidinthecurrentpolicyyear.
• NoMultiplier BenefitwillapplytotheRestoreSumInsured.
• TheRestoreSumInsuredcanbeusedforMultiple claims inthePolicyyearof
restoration until the restored Sum Insured is exhausted. However, the
restoration of Sum Insured will happen only once in a Policy Year and once
exhaustedtherewillbenosubsequentrestoration.
• If the Restore Sum Insured is not utilized in a Policy Year, it shall not be
carriedforwardtoanysubsequent PolicyYear.
If the Policy is a Family Floater, then the Restore Sum Insured will only be
available In respect of claims made by those Insured Persons who were
InsuredPersonsunderthePolicybeforetheSumInsuredwasexhausted.
TheRestoreBenefitOptioncanonlybeoptedattheinceptionofthepolicy.
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ROOMRENTENHANCEMENT
• The product has a sub-limit on room rent equal to 1% of the Sum Insured.
The Policyholder can instead opt for an enhanced limit, wherein the Sum
Insured linked sub limit shall not be applied as long as a standard private
roomisoptedfor.
• This optional benefit can only be opted for Sum Insured of Rs 5 Lakhs and
aboveandissubjecttothepaymentofadditional premiums.
• The Room Rent Enhancement Option can only be opted at the inception of
thepolicy.
DeathofLifeInsured
• In case of death of a Life Insured the coverage will cease from date of
death of the Life Insured without any refund of Premium. In case of
FamilyFloaterPolicies theeldest oftheremaining members willbecome
the main life insured and the Policy will continue to remain in-force for
surviving LivesInsured.
• Upon receiving intimation from Policyholder about the death of Life
Insuredalong withdeathcertificateprior tonextPremium DueDate,the
Premium payable on the next Premium Due Date shall be calculated on
thesurviving LivesInsuredforwhomthecoverageshallcontinue.
• There is no death benefit payable upon death of the Life Insured.
However a claim for covered benefits incurred prior to death of Life
Insuredwillbepayablesubjecttotermsandconditions statedherein.
This plan isapureprotection health indemnity plan and itdoes notprovide
any life cover. The plan also does not provide any maturity value or
surrendervalue.
OTHERBENEFITS
BenefitsonDeath
DeathofPolicyholder
• In case of Single Life option where Life Insured is the Policyholder himself,
the Policy will automatically terminate upon death of the Policyholder.
TherewillbenorefundofPremium.
• In case of Policy with Single Life option where Life Insured is not the
Policyholder himself and in Family Floater Policy, the Policy shall continue
to remain in-force for surviving Lives Insured up to the next Premium Due
Date.Anyofthesurviving LivesInsuredeligible tocontractcanmakeafresh
application and can continue the cover from such Premium Due Date. We
will issue a new Policy with continuity of benefits and without any fresh
underwriting atthethenprevailingpremiumrates,termsandconditions.
OPTIONS
Thefollowingoptionsareavailableundertheproduct:
• ConversionOptionfromFamilyFloatertoSingleLife
• ConversionOptionfromSingleLifetoFamilyFloater
• Option to increase the Sum Insured subject to the maximum limit or
upgradethetypeofplan,subjecttounderwriting
• Option toadd anewmember orremoveamember under aFamily Floater
plansubjecttotermsandconditions
• Miscellaneous alterations; namely, change of address, correction in
Name, correction in Date of Birth, change of Address, change of
Nominee/ Appointee,issuanceofduplicatepolicy.
Conversion from Family Floater to Single Life will be allowed where the
customer need justifies the same such as divorce, death etc. The option to
increase the Sum Insured or upgrade the type of plan or to convert plan
option shall be available on the completion of three policy years and every
three years thereafter. The option to add or remove a member under a
Family Floater plan shall be available on every policy anniversary.
Upgrading the type of plan represents a switch by the policyholder from a
‘Silver’ plan option to a ‘Gold’ plan option. Any increase in sum insured or
upgrade ofplan type asaresult ofexercising anyofthe aboveoptions shall
be subject to applicable underwriting requirements. In addition,
exclusions relating to pre-existing conditions and waiting periods shall
apply to the extent of increased sum insured or additional benefits from
theeffectivedateofalteration.
In case of death of the main life under Family Floater policies, the eldest of
theremaining memberswillbecomethemainlifeandthepolicycontinues.
A Family Floater policy will be converted to a Single Life policy on policy
anniversaryifonlyonememberremainsundertheFamilyFloaterpolicy.
Conversion OptionforDependentChildren
The plan offers the flexibility for children covered under family floater
plans who have attained the age of 18 years to convert their cover in to a
separate policy with continuity of benefits and without any fresh
underwriting up to the Sum Insured in the family floater policy wherein
theywereoriginally covered.
Any addition of life into the (converted) new policy shall also be subject to
underwriting norms and all time bound exclusions and waiting period shall
applyforsuchaddedlives.
Pleasenotethatthefollowingoptionsarenotavailableundertheproduct:
• OptiontodowngradefromGoldplantoSilverplan
• Option to reduce the Sum Insured except in case of transfer from
FamilyFloatertoSingleLife

5. WAITINGPERIODANDEXCLUSIONS
Waiting period will apply to ALL Insured Members individually covered under
theplanaspertheirdateofentryintothepolicy.
30DaysWaiting Period
We will not pay any medical expenses incurred by the life insured within 30
days of the coverage effective date or reinstatement effective date
whichever occurs later, except where such medical expenses are incurred for
treatment of a condition caused by an Accident. This waiting period does not
reapplyifthepolicyisrenewedwithoutabreak.
TwoYearsWaiting Period
Following conditions and treatments thereof are covered only after 24
consecutivemonths ofcontinuous coverage haveelapsed sincethe coverage
effective date. In case of revival or reinstatement of the policy, only the
remaining part,ifany,ofthewaitingperiodapplies.
ThreeYearWaitingPeriod
We will not pay any claim under the Maternity Benefit until 36 months of
continuous coverage have elapsed since the coverage effective date. In case
of revival or reinstatement of the policy, only the remaining part, if any, of the
waitingperiodapplies.
Pre-ExistingConditions³²
Benefits under this policy will not be available for any Pre-Existing
condition(s) as defined above, until 36 consecutive months of continuous
coverage have elapsed since coverage effective date. In case of revival or
reinstatement of the policy, only the remaining part, if any, of the 36 month
waitingperiodapplies.
PermanentExclusions
PleaserefertoAnnexure1
GRACEPERIOD¹⁴
Premium(s) due on this policy should be paid on or before the premium due
date. You are advised to pay the premium in time to continue enjoying the
benefits of this policy. However, in case you are unable to do so, you have a
grace period of 30 days after the premium due date within which you can pay
the due premium. If you pay the due premium within grace period the policy
willcontinuewithoutanybreak.
Followingconditionswillapplyduringgraceperiod.
• The cover under the policy shall remain in-force during the grace period;
howeveryouwillnotbeentitledtousethecashlessclaimsservice.
• Claims that occur during grace period can be submitted to us for
reimbursement if you renew the policy by paying the necessary premium
withingraceperiod.
• The cash less claims service will resume after you have paid the renewal
premiumwithinthegraceperiod.ENT
Adenoid and Tonsillar Disorder Surgery of gallbladder and bile duct stones
Thyroid surgery for benign conditions All types of Hernia, Hydrocele
Functional endoscopic sinus surgery Hemorrhoids, Anal Fissure, Fistula,
Rectal prolapse, pilonidal sinus
Gastrointestinal
Deviated Nasal Septum / Nasal &
Paranasal Sinus Disorders
Gastric/Duodenal Ulcer
Varicocele, spermatocele
Treatment for Chronic renal failure or
end stage renal failure
Orthopaedic
Carpal tunnel syndrome
Gynaecological Urogenital
Benign breast disorder Surgery of urinary stones
Myomectomy, Hysterectomy with or
without Bilateral salphingo-
Opherectomy excluding malignancy
Benign enlargement of prostate gland
Cataract and age related eye conditions.
Actual expenses incurred subject to a
maximum of ` 20,000 per eye per life
insured per annum will be paid towards
Cataract after the Waiting period
Knee/Joint Replacement Surgery
(other than caused by an accident).
For Knee replacement, Actual
expenses incurred subject to a
maximum of ` 1.5 Lakhs whichever is
lower, per life insured per knee per
annum will be payable after the
waiting period is over.
PIVD(unless due to accident)
Osteoporosis, Gout and Rheumatism
Osteoarthritis and Degenerative
joint disorders
Others
Skin conditions
Varicose Veins/Ulcers
Vitrectomy/Detachment surgery for
Retinopathy
Diabetes and related treatments
LAPSEANDREINSTATEMENT
PolicyLapse
If you do not pay due premium before the expiry of grace period, the policy will
lapse with effect from the premium due date and any claims that occur after
premium due date (including claims that may occur during grace period) will
notbeadmissible. Allbenefitsunderthispolicywillcease.
PolicyRe-instatement
If your policy is lapsed, you may request us in writing to reinstate your policy
within 2 consecutive years from the date of discontinuance of the policy.
During this period the policyholder shall be entitled to revive the policy which
was discontinued due to non - payment of premium. We will consider
reinstating your policy as per the board approved underwriting policy.
Followingconditionswillapply:
• The reinstatement request is required to be made for all surviving lives
originally covered under the lapsed policy and should be accompanied with
pending premium amount along with any interest that is advised by us. The
currentinterestrateusedforrevivalis10.5%p.a.
• The reinstatement request will require fresh evidence of insurability. We
may request for additional information or may ask for medical examination
before taking a decision on the reinstatement of the Policy. Cost of such
medicalexaminationhastobebornebyyou.
• Any agreement to reinstate would at least be subject to the all lives insured
providing satisfactory evidence of good health. Reinstatement request will
attractthefollowing:
o Initial30dayWaitingPeriodwillapplyafresh.
o If the policy is revived within 60 days, only the remaining part of all time
bound exclusionsandwaitingperiodswillapply.
o Ifthepolicyisrevivedafter60days,alltimeboundexclusionsandwaiting
periodswillbeappliedafresh.
CONVENIENTCLAIMPROCESS²⁹
You or any of the lives insured in your family have the option to avail Cashless
ClaimServiceorclaimthemedicalexpensesincurredasReimbursement.
Cashless Claims Service:
• YoumayavailtheCashless Claims Serviceatanyofthenetworkhospitals as
identifiedbyusandempanelled byourappointedThirdPartyAdministrator
(TPA). You and all lives insured will be provided with a Health Identity Card
with a unique membership ID which will enable you to avail of Cashless
ClaimsService.
• You will also be provided with a list of network hospitals, where you can
avail the Cashless Claim Service. You may contact the TPA to get an update
onthemostcurrentlistofnetworkhospitals ortofindoutahospital located
nearesttoyourplaceofresidence.

6. • In case of a planned hospitalisation, you are advised to seek pre-
authorization from the TPA prior to taking admission at any network
hospital.
• Atthetimeofadmission, youwillneedtoproducetheHealthIdentityCard.
• The network hospital will contact the TPA for pre-authorisation of the
Cashless ClaimService.
• If Cashless Claim Service is authorised, you will not be billed by the hospital
totheextentoftheamountpre-authorizedbytheTPA.
• On discharge, you are expected to verify the hospital bills for its accuracy
and sign it. Any additional amount that you may have to pay at the time of
discharge (over and above the amount pre-authorized), can be claimed by
you by submitting the necessary claim documents to our TPA within 7 days
ofdischarge.
• In case of a medical emergency (cardiac condition or accident resulting in
admission to an ICU or emergency ward), the TPA must be notified within
24hoursofadmission.
• If the Cashless Claim Service is denied for any unforeseen reason, you may
submit your claim as Reimbursement Claim after you have discharged from
thehospital.
We may change the TPA or alter the terms and conditions for
Cashless Claims Service. The latest terms and conditions will be
available on our website. Please refer the same before making a
cashless claimrequest.
ReimbursementClaims (NonCashless Hospitalisation):
If you wish to get admitted to a hospital that is out of network or not avail the
Cashless Claim Service, then you may submit your claim to us or with our TPA
alongwithrelevantclaimdocumentsandoriginal bills.
• Youhavetogetadmittedaspertheprocedureofthehospital.
• You have to intimate us or the TPA about the hospitalisation before being
discharged.
• Ondischargeyouwillhavetosettlethehospital bill.
• Within 7daysofdischarge, youhavetosubmit the claim documentstousor
theTPA.
Hospital CashBenefit(Goldplan):
If you opt for Gold Plan under this policy and we agree to pay the Inpatient
Hospitalisation benefit, Hospital Cash Benefit will also become payable to
you for the number of days you spend in the hospital (excluding the first 24
hours).
If you avail Cashless Claim Service, then the amount payable under Hospital
CashBenefitwillbepaidtoyouonlyafterreceiptofallclaimdocumentsbyour
TPApostyourdischargefromthehospital.
If you do not avail Cashless Claim Service, then the Hospital Cash Benefit will
bepaidalongwiththeclaimforInpatientHospitalisationBenefit
CostSharing
Co-payment⁷
Co-payment of 20% shall apply in non-network hospitals. The balance
amountshallbepaidbyus,subjecttoAnnualLimit.
Pro-rationofClaims
In instances if you opt for a room having rent higher than the eligible room
rent,then:
• expenses which vary based on the room category (for e.g. doctor/nursing
charges) will be pro-rated in the ratio of eligible room rent divided by actual
roomrent
• other expenses such as pharmacy, consumables etc. will not be pro-
rated.
Nomination
You can nominate a person to receive the benefit under this policy. During
your lifetime and while your policy is in force, you may at any time, by
written notice to us, designate any person or persons as a nominee to
whom we shall pay eligible residual benefits under this policy upon your
unfortunate death. If nominee is a minor then Appointee will receive the
claimamountsecuredbythePolicyonbehalfoftheNominee.
Assignment
Aspertheprevailingregulations,assignmentofthispolicyisnotallowed.
TaxBenefits
Youmaybeeligiblefortaxbenefitsundersection80DoftheIncomeTaxAct
1961. The maximum deduction that can be claimed currently is Rs. 35,000
(Inclusive of additional deduction of Rs. 20,000 in case of insurance on the
health of the parent(s) who are senior citizens), subject to the provisions
containedtherein.
Theabove-mentionedtax-benefitsaresubjecttochangesinthetaxlaws.
CancellationintheFree-Lookperiod⁴
In case you are not agreeable to any of the terms and conditions, you have
the option of returning the policy to us stating the reasons thereof, within
15 days from the date of receipt of the policy. The Free - Look period for
policies purchased through distance marketing (as defined by IRDA) will be
30 days. On receipt of your letter along with the original policy documents,
we shall arrange to refund you the premium amount paid subject to
deduction of the proportionate risk premium for the period on cover, the
expenses incurred by us on medical examination and stamp duty. A policy
once returned shall not be revived, reinstated or restored at any point of
timeandanewproposalwillhavetobemadeforanewpolicy.
PolicyLoansarenotavailableonthisplan.
PremiumReview&Guarantee:
Theproductisawholeoflifeplan.Asrequiredbyprevailingregulations,the
premiums shall remain unchanged for a period of three years from the date
of issue. Upon the completion of three policy years, the premiums shall be
revised for a further block of three years, based on the then prevailing
tabular premium rates and the attained age of the lives insured. Premiums
shall, therefore, be unchanged for each block of three years and will be
revisedeverythreeyears.
Any revision in the tabular premium rates shall be subject to prior approval
fromtheIRDA.
OptiontoincreasetheSumInsuredorupgradethetypeofplan
The option to increase the Sum Insured or upgrade the type of plan shall be
available on the completion of three policy years and every three years
thereafter.
Non-Disclosure:
Section 45 of the Insurance Act, 1938 states:
No policy of life insurance effected before the commencement of this Act
shall after the expiry of two years from the date of commencement of this
Act and no policy of life insurance effected after the coming into force of
this Act shall, after the expiry of two years from the date on which it was
effected be called in question by an insurer on the ground that statement
This will apply irrespective of whether you are admitted into a network or
non-networkhospital.
Illustrationofapplicability ofCo-payandPro-rationofClaims
20% Co-pay
Pro-ration
TYPE OF PAYMENT
TO BE BORNE BY YOU
NETWORK
HOSPITAL
No Yes
NON NETWORK²⁸
HOSPITAL
Yes Yes

7. onthepolicy,norshallanypersontakingoutorrenewingorcontinuingapolicy
accept any rebate, except such rebate as may be allowed in accordance with
thepublishedprospectusesortablesoftheinsurer.Providedthatacceptance
by an insurance agent of commission in connection with a policy of life
insurance taken out by himself on his own life shall not be deemed to be
acceptanceofarebateofpremiumwithinthemeaningofthissub-sectionifat
the time of such acceptance the insurance agent satisfies the prescribed
conditionsestablishingthatheisabonafideinsuranceagentemployedbythe
insurer.
Any person making default in complying with the provisions of this section
shallbepunishablewithfinewhichmayextendtofivehundredrupees.
ServiceTax:
As per the Service Tax Laws, service tax is applicable on the life insurance
premium and also on the charges. Any other indirect tax or statutory levy
becoming applicable in future may become payable by you by any method we
deem appropriate including by levy of an additional monetary amount in
additiontothepremium.
madeintheproposalorinanyreportofamedicalofficer,orreferee,orfriendof
the insured, or in any other document leading to the issue of the policy, was
inaccurate or false, unless the insurer shows that such statement was on a
material matter or suppressed facts which it was material to disclose and that
it was fraudulently made by the policy holder and that the policy holder knew
at the time of making it that the statement was false or that it suppressed
factswhichitwasmaterialtodisclose:
Providedthatnothinginthissectionshallpreventtheinsurerfromcallingfor
proof of age at any time if he is entitled to do so, and no policy shall be deemed
tobecalledinquestionmerelybecausethetermsofthepolicyareadjustedon
subsequent proof that the age of the life insured was incorrectly stated in the
proposal.
ProhibitionofRebates:
Section41oftheInsuranceAct,1938states:
No person shall allow or offer to allow, either directly or indirectly, as an
inducement to any person to take out or renew or continue an insurance in
respectofanykindofriskrelatingtolivesorpropertyinIndia,anyrebateofthe
whole or part of the commission payable or any rebate of the premium shown
HDFC Standard Life Insurance Company Limited. In partnership with Standard Life Plc
Registered Office: HDFC Standard Life Insurance Company Limited, Lodha Excelus, 13 Floor, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi, Mumbai-400 011.
Insurance is the subject matter of the solicitation. This Life Insurance product is underwritten by HDFC Standard Life Insurance Company Limited. This document has no
monetary value at any time and is not a proof of any contract with HDFC Standard Life Insurance Company Limited. and HDFC LifeHDFC Life is the name of the brand
HealthAssure Plan is the name of the plan. This version of the product brochure invalidates all previous printed versions for(Form No. P 501-105-01, UIN: 101N087V02)
this particular plan. This product brochure is indicative of the terms, warranties, conditions and exclusions contained in the insurance policy. HDFC Bank Ltd. Certified
CorporateAgentNo.:933982.HDFC StandardLifeInsuranceCompanyLimited.RegistrationNo. 101.ARN: PP/08/2014/5206.
CIN No. U99999MH2000PLC128245
BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS
IRDA clarifies to public that
• IRDA or its officials do not involve in activities like sale of any kind of insurance or financial products nor invest premiums.
• IRDA does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along with details of phone call, number

8. 14. Dentaltreatments¹¹
AnydentaltreatmentorsurgeryunlessnecessitatedduetoanAccident.
15. RoutineEye(s)and(Ear)ailments
Costofroutineeyeandearexaminations,costofspectacles,laser
surgeryforcorrectionofrefractoryerrors,contactlenses,hearingaids,
denturesandartificialteeth.
16. HIV/AIDS
AnytreatmentforortreatmentarisingfromHumanImmunodeficiency
Virus(HIV)orAcquiredImmuno-DeficiencySyndrome(AIDS),including
anyconditionthatisrelatedtoHIVorAIDS.
17. SexuallytransmittedDiseaseandotherSexualproblems
a) Treatmentforanysexuallytransmitteddisease,includingGenital
Warts,Syphilis,Gonorrhoea,GenitalHerpes,Chlamydia,PubicLice
andTrichomoniasis.
b) Treatmentofanysexualproblemincludingimpotence(irrespectiveof
thecause)andsexchanges/genderreassignmentsorerectile
dysfunction.
18. Circumcision
Circumcisionunlessnecessaryforthetreatmentofadiseaseor
necessitatedbyanAccident.
19. BirthControlandAssistedReproduction
a) Anytypeofcontraception,sterilizationandfamilyplanning
b) Treatmenttoassistreproduction,includingIVFtreatment
20. Pregnancy
Anytreatmentarisingfromortraceabletopregnancy(including
voluntarytermination),miscarriage(unlessduetoanAccidentor
Illness),childbirth,maternity(includingcaesareansection),abortionor
complicationsofanyofthese.
Thisexclusiondoesnotapplyincaseofectopicpregnancyand
pregnancyeligibleforpaymentunder'MaternityBenefit'asdescribedin
thispolicy
21. Pre and post hospitalisation expense exclusion for Maternity
Benefit
ThePreandPostHospitalizationexpensewillnotbepayableincaseof
MaternityBenefitclaim.
22. Psychologicaldisorders
Any expense incurred on Treatment of mental illness, stress, psychiatric
orpsychologicaldisorder.
23. CongenitalConditions⁶
TreatmentofanyCongenitalAnomalyorillnessordefectsoranomaliesor
treatmentrelatingtobirthdefects
24. Itemsofpersonalcomfortandnonmedicalexpenses
Itemsofpersonalcomfortandconvenience,includingbutnotlimitedto:
a) Telephone, television, diet charges (unless included in room rent)
personal attendant or barber or beauty services, baby food,
cosmetics, napkins, toiletry items, guest services and similar
incidental expenses or services.
b)Private nursing/attendant's charges incurred during Pre
HospitalisationorPost-Hospitalisation.
c) Non-prescribeddrugsandmedicalsupplies
d)Issue of medical certificate and examinations as to suitability for
employmentortraveloranyothersuchpurpose.
e)Any charges incurred to procure any treatment/Illness related
documentspertainingtoanyperiodofhospitalisation/Illness.
f) External and or durable medical/non medical equipment of any kind
used for diagnosis and or treatment including CPAP, CAPD, Infusion
pump
g)Ambulatorydevicesi.e.walkers,crutches,beltsandbraces(maybepaid
specifically for cases who have undergone surgery of thoracic or
Annexure1
PermanentExclusions
Unless expressly stated to the contrary in this Policy, we will not make any
paymentforanyclaiminrespectofanyLifeInsuredifitisdirectlyorindirectly-
causedby,arisesfromorisinanywayattributabletoanyofthefollowing:
1. TreatmentreceivedoutsideIndia
Anymedicalexpensesincurredfororarisingoutoftreatmenttaken
outsideIndia
3&38
2. NonAllopathicandExperimentalTreatment
a) AnyNon-Allopathictreatment
b) Treatment provided by a medical practitioner who is not recognized by
theMedicalCouncilofIndia
c) Experimental,investigationalorunproventreatment,devicesand
pharmacologicalregimens
3. BreachofLaw
Any Illness or Injury¹⁸ directly or indirectly resulting or arising from or
occurring during commission of any breach of any law by the Life Insured
withanycriminalintent.
4. ConflictsandDisasters
War, or any act of War, invasion, act of foreign enemy, war like operations
(whether war be declared or not), civil war, usurped act, rebellion,
revolution, insurrection, nuclear weapons / materials, chemical and
biologicalweaponsandradiationofanykind.
5. MilitaryServices
Involvementinthenaval,military,orairforceoperations
6. Aviation
A direct consequence of participation by the Life insured in any flying
activity other than on a scheduled commercial airline as a bona fide
passenger(whetherfarepayingornot),pilotorcrewmember.
7. HazardousActivities
Life Insured’s participation or involvement in racing, diving, scuba diving,
parachuting,hang-gliding,rockormountainclimbing.
8. SelfInflictedinjuriesorattemptedsuicide
Treatmentfor,orarisingfrom,aninjurythatisintentionallyself-inflicted,
includingattemptedsuicide.
9. SubstanceMisuseandDe-addiction
The abuse or the consequences of the abuse of intoxicants or
hallucinogenic substances such as intoxicating drugs (not prescribed by
Registered Medical Practitioner) and alcohol, including smoking cessation
programs and the treatment of nicotine addiction or any other substance
abusetreatmentorservices,orsupplies.
10.RehabilitationandConvalescence
Convalescence, rest cure, sanatorium treatment, rehabilitation
measures, private duty nursing, respite care, long-term nursing care or
custodialcare,generaldebilityorexhaustion(“run-downcondition”)
11.Cosmetictreatments
Aesthetic treatment, cosmetic surgery or plastic surgery or related
treatment of any description including any complications attributable to
such treatments other than as may be necessitated due to an Accident,
cancerorburns.
12.SleepandObesity
Weight management services and treatment, vitamins and tonics related
to weight reduction programmes including treatment of obesity
(including morbid obesity) and any treatment related to sleep disorder or
sleepapnoeasyndrome.
13.HormoneReplacementTherapy
MedicalexpensesincurredbyLifeInsuredforanytypeofhormone
replacementtherapy

9. lumbarspine)collars,caps,splints,slings,braces,stockingsofanykind,
diabeticfootwear, glucometer/thermometerandsimilaritemsand
alsoanymedicalequipmentwhichissubsequentlyusedathome.
h)NurseshiredinadditiontotheHospital'sownstaff.
25.PreliminarydiagnosticsandExamination
a) Charges incurred primarily for diagnostic, X-ray or laboratory
examination not consistent with or not incidental to the diagnosis and
treatment of positive existence or presence of any Illness or Injury for
whichInpatienthospitalisation/DayCaretreatmentisrequired.
This exclusion does not apply to health checkups undertaken within
thescopeofWellnessBenefit.
b)Any Hospitalisation primarily for investigation and /or diagnosis
purpose.
13
26.DomiciliaryTreatment/Hospitalisation
Any expenses arising out of Domiciliary Treatment/Hospitalisation.
Domiciliary treatment means any treatment not taken in the confines of a
hospital.
27.ExpensesofLifeInsuredasDonor
Expenses related to donor screening, treatment, including surgery³⁷ to
remove organs from a donor in the case of transplant surgery, where the
lifeinsuredactsasadonor.
Thisexclusionwillnotapplywherelifeinsuredisanorganrecipient
28.StemCellBanking
Stemcellimplantation,harvesting,storageoranykindoftreatmentusing
stemcells.
29.FailuretotakeReasonableMedicalCare²²
We are not obliged to make payment for any claim or that part of any claim
that could have been avoided or reduced if the Life Insured had taken
reasonable care, or that is brought about or contributed to by the Life
Insured failing to follow the directions, advice or guidance provided by a
RegisteredMedicalPractitioner²⁴
30.ExpensesOtherthanReasonableandCustomaryMedically
Necessary²⁵
a) Any treatment or part of a treatment that is not of a reasonable and
customarycharge,notmedicallynecessary,drugsortreatmentswhichare
notsupportedbyaprescription.
b) Charges related to a Hospital stay not expressly mentioned as being
covered, including but not limited to charges for admission, discharge,
administration,registration,documentationandfiling
31.Immunisation&Nutritionaltreatment
All preventive care, vaccination including inoculation and immunizations
(except in case of post-bite treatment), any physical, psychiatric or
psychological examinations or testing, enteral feedings (infusion
formulae via a tube into the upper gastrointestinal tract) and other
nutritionalandelectrolytesupplements,unlesscertifiedtoberequiredby
the attending Registered Medical Practitioner as a direct consequence of
anotherwisecoveredclaim.
32. Others
Apart from the above mentioned exclusions, we are covering all other
scenarios,proceduresorconditions.

10. ANNEXURE2:
LISTOFDAYCAREPROCEDURES
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Operationsonretinalmembrane
Photocoagulationofretinafordetachment
Destructionoflesionofretina
Fixationofretina
Evaluationofretina
Destructionofsubretinallesion
Operationsonposteriorsegmentofeye
Operationsonthyroglossaltissue
Excisionofparathyroidgland
Excision of external ear lesions
Extirpationoflesionofexternalear
Exenterationofmastoidaircells
Attachmentofboneanchoredhearingprosthesis
Repairofeardrum
Drainageofmiddleear
Reconstructionofossicularchain
Stapedectomy
Extirpationoflesionofmiddleear
Rhinoplastyfortraumaticinjuries
Therapeuticoperationsonseptumofnose
Therapeuticoperationsonturbinateofnose
Surgicalarrestofbleedingfrominternalnose
Operationsonunspecifiednasalsinus
Caldwelllucsurgery
Operationsonadenoid
Therapeuticendoscopicoperationsonpharynx
Microtherapeuticendoscopicoperationsonlarynx
PetrousApicectomy
Therapeutic fibreoptic endoscopic operations on lower
respiratorytract
Partialexcisionoflip
Extirpationoflesionoflip
Dentaloperationsasaresultofaccidents
Excisionofdentallesionofjaw
Extirpationoflesionoftongue
Lingualfrenotomy/frenoplasty
Extirpationoflesionofpalate
Palatoplastyforpurepalataldefects
Excisionoftonsil
Excisionofsalivarygland
Extirpationoflesionofsalivarygland
Openextractionofcalculusfromsalivaryduct
Fibreopticendoscopicextirpationoflesionofoesophagus
TherapeuticDrainageofspinalcanal
Operationsonspinalnerveroot
Excisionofperipheralnerve
Destructionofperipheralnerve
Extirpationoflesionofperipheralnerve
Microsurgicalrepairofperipheralnerve
Carpaltunnelrelease
Canalofguyonrelease
Cubitaltunnelrelease
Neurostimulationofperipheralnerve
Excisionofsympatheticnerve
Chemicaldestructionofsympatheticnerve
Radiofrequency controlled thermal destruction of sympathetic
nerve
Extirpationoflesionoforbit
Therapeuticoperationsoneyebrow
Therapeuticoperationsoncanthus
Extirpationoflesionofeyelid
Excisionofredundantskinofeyelid
Reconstructionofeyelid
Correctionofdeformityofeyelid
Correctionofptosisofeyelid
Incisionofeyelid
Operationson lacrimalgland
Connection betweenlacrimalapparatusandnose
Operationson nasolacrimal duct
Operationsonmusclesofeye
Extirpationoflesionofconjunctiva
Repairofconjunctiva
Extirpationoflesionofcornea
Closureofcornea
Incisionofcornea
Excisionofsclera
Bucklingoperationsforattachmentofretina
Excisionofiris
Filteringoperationsoniris
Incisionofiris
Extirpationofciliarybody
Extracapsularextractionoflens
Incisionofcapsuleoflens
InsertionofProsthesisoflens
Operationsonvitreousbody
NERVES
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EYE
EAR, NOSE & THROAT
GASTROINTESTINAL

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Operationsonvaricocele
Extirpationoflesionofpenis
Dialysis
OperationsonBartholingland
Extirpationoflesionofvulva
Extirpationoflesionoffemaleperineum
Excisionofbandofvagina
Culdotomy
Extirpationoflesionofvagina
OperationsonpouchofDouglas
Excisionofcervixuteri
Destructionoflesionofcervixuteri
Abdominalexcisionofuterus
DilatationandCurettageofuterus
Therapeuticendoscopicoperationsonuterus
Therapeuticendoscopicoperationsonovary
Operationsonbroadligamentofuterus
Incisionofbreast
Microscopicallycontrolledexcisionoflesionofskin
Photodynamictherapyofskin
Curettageoflesionofskin
Photodestructionoflesionofskin
Flapoperationstorelaxcontractureofskin
Split autograft ofskin
Sutureofskinofheadorneck
Extirpationofnailbed
Excision of nail
Fascial release
Partial excision of chest wall
Puncture of pleura
Closed reduction of fracture of bone and internal fixation
Excision of ganglion
Re-excision of ganglion
Operations on bursa
Transposition of tendon
Excision of tendon
Primary repair of tendon
Secondary repair of tendon
Tendon release
Adjustment to length of tendon
Excision of sheath of tendon
Excision of muscle
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Fibreoptic endoscopic extirpation of lesion of upper
gastrointestinal tract
Therapeutic endoscopic operations on duodenum
Artificialopening into jejunum
Therapeuticendoscopicoperationsonjejunum
Endoscopicextirpationoflesionofcolon
Endoscopic extirpation of lesion of lower bowel using fibreoptic
sigmoidoscope
Endoscopic extirpation of lesion of sigmoid colon using rigid
sigmoidoscope
Manipulationofrectum
Excisionoflesionofanus
Destructionoflesionofanus
Excisionofhaemorrhoid
Destructionofhaemorrhoid
Dilationofanalsphincter
Drainagethroughperinealregion
Excisionofpilonidalsinus
Arteriovenousshunt
Combinedoperationsonvaricoseveinofleg
Ligationofvaricoseveinofleg
Injectionintovaricoseveinofleg
Transluminaloperationsonvaricoseveinofleg
Therapeutictransluminaloperationsonvein
Therapeuticendoscopicoperationsoncalculusofkidney
Percutaneouspunctureofkidney
Extracorporealfragmentationofcalculusofkidney
Therapeuticureteroscopicoperationsonureter
Extracorporealfragmentationofcalculusofureter
Operationsonuretericorifice
Percutaneousuretericstentprocedures
Opendrainageofbladder
Endoscopicextirpationoflesionofbladder
Endoscopicoperationstoincreasecapacityofbladder
Urethralcatheterisationofbladder
Vaginaloperationstosupportoutletoffemalebladder
Therapeuticendoscopicoperationsonoutletoffemalebladder
Endoscopicresectionofoutletofmalebladder
Repairofurethra
Therapeuticendoscopicoperationsonurethra
Urethralmeatalsurgery
Extirpationoflesionofscrotum
Extirpationoflesionoftestis
Operationsonhydrocelesac
Operationsonepididymis
BLOOD VESSELS
URINARY SYSTEM & GENITAL ORGANS
SKIN
LUNGS
GYNAECOLOGY
MUSCLES / BONES / TENDONS

12. CurrentlyonlytheabovementionedDayCareProceduresarecoveredundertheproduct.
Any other procedures which do not require the minimum 24 hour hospitalisation due to advancement in Medical Technology will be considered under Day Care
Benefit. HoweverclaimsforsuchnewDayCareprocedureswillhavetobepreauthorizedbyus.
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RepairofMuscle
Releaseofcontractureofmuscle
Facial bone fracture fixation
Excision of mandible
Fixation of mandible
Decompression of fracture of spine
Denervation of spinal facet joint of vertebra
Manipulation of spine
Joint manipulation
Extirpation of lesion of bone
Angulation periarticular division of bone
Primary open reduction of fracture of bone and intramedullary
fixation
Primary open reduction of fracture of bone and extramedullary
fixation
Secondary open reduction of fracture of bone
Fixation of epiphysis
Skeletal traction of bone
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Therapeutic puncture of bone
Excision reconstruction of joint
Fusion of joint of toe
Primary open reduction of traumatic dislocation of joint
Primary closed reduction of traumatic dislocation of joint under GA
Open operations on synovial membrane of joint
Open operations on semilunar cartilage
Stabilising operations on joint
Release of contracture of joint
Soft tissue operations on joint of toe
Debridement and irrigation of joint
Therapeutic endoscopic operations on semilunar cartilage
Therapeutic endoscopic operations on cavity of knee joint
Amputation of toe
Radiotherapy delivery
Delivery of chemotherapy for neoplasm
Delivery of oral chemotherapy for neoplasm
CANCER
Annexure 3: Important terminology
In order to understand the benefits offered by HDFC Life Health Assure Plan it is important that you understand following terminologies:
8. Cumulative Bonus: Cumulative Bonus shall mean any increase in the
sumassuredgrantedbyuswithoutanassociatedincreaseinpremium.
9. Day Care Centre: Day Care Centre means any institution established for
day care treatment of illness and/ or injuries or a medical set -up 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
asunder:-
i. hasqualifiednursingstaffunderitsemployment;
ii. hasqualifiedmedicalpractitioner(s)incharge
iii. has a fully equipped operation theatre of its own where surgical
proceduresarecarriedout
iv. maintains daily records of patients and will make these accessible to
theInsurancecompany'sauthorizedpersonnel.
10. Day Care Treatment: Day Care Treatment refers to medical treatment,
and/orsurgicalprocedurewhichis:
Undertaken under General or Local Anesthesia in a hospital/day care
9
centre inlessthan24hrsbecauseoftechnologicaladvancement,and
 Which would have otherwise required a hospitalization of more than
24hours.
Treatment normally taken on an out-patient basis is not included in the
scopeofthisdefinitionofDayCareTreatment.
11. DentalTreatment:Dentaltreatmentistreatmentcarriedoutbyadental
practitionerincludingexaminations,fillings(whereappropriate),crowns,
extractions and surgery excluding any form of cosmetic surgery /
implants.
12. Disclosuretoinformationnorm: ThePolicyshallbevoidandall
premiumspaidhereonshallbeforfeitedtotheCompany,intheeventof
misrepresentation, mis-description or non-disclosure of any material
fact.
1. Accident: An accident is a sudden, unforeseen and involuntary
eventcausedbyexternalandvisibleandviolentmeans.
2. Annual Limit: Annual Limit is the amount which defines our maximum
liability under this policy, in any policy year. The Annual Limit is the sum
total of the Sum Insured and the increase in the sum assured due to
Multiplier Benefit. At inception or reinstatement of a lapsed Policy, the
valueoftheAnnualLimitwillbeequaltotheSumInsured.
3. Alternative treatments: Alternative treatments are forms of
treatments other than treatment "Allopathy" or "modern medicine" and
includesAyurveda,Unani,SidhaandHomeopathyintheIndiancontext.
4. Cancellation:Cancellationdefinesthetermsonwhichthepolicycontract
can be terminated either by the insurer or the insured by giving sufficient
noticetootherwhichisnotlowerthanaperiodoffifteendays.
5. Cashless service: Cashless facility means the TPA / Insurer may
authorize upon the definition insured's request for the direct settlement
ofadmissibleclaimasperagreedchargesbetweenNetworkhospitalsand
the TPA / Insurer. In such cases, the TPA/ Insurer will directly settle all
eligible amounts with the Network Hospitals and the Insured person may
not have to pay any bills after the end of the treatment at hospital to the
extenttheclaimiscoveredunderthePolicy.
6. CongenitalAnomaly:CongenitalAnomalyreferstoacondition(s)
which is present since birth, and which is abnormal with reference to
form,structureorpositions.
 Internal Congenital Anomaly: Congenital Anomaly which is not in
thevisibleandaccessiblepartsofthebody.
 External Congenital Anomaly: Congenital Anomaly which is in the
visibleandaccessiblepartsofthebody.
7. Co-Payment: A co-payment is a cost sharing requirement under this
product that provides that the policyholder/Life insured will bear a
specified percentage of admissible claim amounts. A co-payment does
not reduce the sum insured.

13. 13. Domiciliary Hospitalisation: Domiciliary treatment means medical
treatment for an illness/disease /injury which in normal course would
require care and treatment at a hospital but is actually taken while
confinedathomeunderfollowingcircumstances:
 The condition of the patient is such that he/she is not in a condition to
beremovedtoahospital,or
 The patient takes treatment at home on account of non availability of
roominahospital.
14. Grace Period: Grace period means the specified period of time
immediately following the premium due date during which a payment can
be made to renew or continue a policy in force without loss of continuity
benefits such as waiting periods and coverage of preexisting diseases.
Coverageisnotavailablefortheperiodforwhichnopremiumisreceived.
15. Hospital: A Hospital means any institution established for inpatient care
and day care treatment of illness and/or injuries and which has been
registered as a hospital with the local authorities under the Clinical
Establishments (Registration and Regulation) Act; 2010 or under the
enactments specified under the Schedule of Section 56 (1) of the said Act
ORcomplieswithallminimumcriteriaasunder:
 has qualified nursing staff under its employment round the clock;
 hasatleast10in-patientbedsin townshavingapopulationoflessthan
10,00,000 and at least 15 in-patient beds in all other places;
 has qualified medical practitioner(s) in charge round the clock;
 has a fully equipped operation theatre of its own where surgical
proceduresarecarriedout;
 Maintainsdailyrecordsofpatientsandwillmaketheseaccessibletothe
InsuranceCompany'sauthorisedpersonnel.
16. Hospitalisation: Hospitalisation means admission in a Hospital for a
minimum period of 24 inpatient care consecutive hours except for
specified procedure / treatments, where such admission could be for a
periodoflessthan24consecutivehours.
17. Illness: Illness means a sickness or a disease or pathological condition
leading to the impairment of normal physiological condition which
manifestsitselfduringthePolicyPeriodandrequiresmedicaltreatment.
 Acutecondition-Acuteconditionisadisease,illnessorinjurythatis
likelytorespondquicklytotreatmentwhichaimstoreturnthepersonto
his or her state of health immediately before suffering the
disease/illness/injurywhichleadstofullrecovery
 Chroniccondition-Achronicconditionisdefinedasadisease,illness,
orinjurythathasoneormoreofthefollowingcharacteristics:
o Itneedsongoingorlong-termmonitoringthroughconsultations,
examinations,check-ups,and/ortests
o Itneedsongoingorlong-termcontrolorreliefofsymptoms
o Itrequiresyourrehabilitationorforyoutobespeciallytrainedto
cope withit
o Itcontinuesindefinitely
o Itcomesbackorislikelytocomeback.
18. Injury: Injury means accidental physical bodily harm excluding illness o
disease solely and directly caused by external, violent and visible and
evidentmeanswhichisverifiedandcertifiedbyaMedicalPractitioner.
19. Inpatient:Inpatientmeanstreatmentforwhichthelifeinsuredstaysina
hospitalformorethan24hoursforacoveredevent.
20. Intensive Care Unit (ICU): Intensive Care Unit (ICU) means an identified
section,wardorwingofahospitalwhichisundertheconstantsupervision
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
ordinaryandotherwards.
21. Maternityexpense:MaternityExpensesshallinclude:
 Medical Treatment Expenses traceable to childbirth (including
complicated deliveries and caesarean sections incurred during
hospitalization)
 Expenses towards lawful medical termination of pregnancy during the
PolicyPeriod
22. Medical Advice: Any consultation or advice from a Medical Practitioner
includingtheissueofanyprescriptionorrepeatprescription.
23. MedicalExpenses:MedicalExpensesmeansthoseexpensesthataLife
Insured has necessarily and actually incurred for medical treatment on
accountofIllnessorAccidentontheadviceofMedicalPractitioner,aslong
asthesearenomorethanwouldhavebeenpayableiftheLifeInsuredhad
notbeeninsuredandnomorethanotherhospitalsordoctorsinthesame
localitywouldhavechargedforsamemedicaltreatment.
24. Medical Practitioner: A Medical Practitioner is a person who holds a
valid registration from the Medical Council of any State or Medical Council
India and is thereby entitled to practice medicine within its jurisdiction;
andisactingwithinthescopeandjurisdictionoflicense. Thepersonmust
be qualified in allopathic system of medicine and shall not be the Life
Insuredhimself/herself.
25. Medically Necessary: Medically Necessary treatment is defined as any
treatment, tests, medication, or stay in hospital or part of a stay in
hospitalwhich:
 isrequiredforthemedicalmanagementoftheillnessorinjurysuffered
bytheinsured;
 must not exceed the level of care necessary tonrovide safe, adequate
andappropriatemedicalcareinscope,duration,orintensity;
 musthavebeenprescribedbyamedicalpractitioner
 must conform to the professional standards widely accepted in
internationalmedicalpracticeorbythemedicalcommunityinIndia.
26. NetworkHospitals/DiagnosticCentre/Providers–Network
Hospitals/DiagnosticCentre/ProvidersmeansHospitalsorhealthcare
providersenlistedbyUsorbyourThirdPartyAdministrator(TPA)andUs
togethertoprovidemedicalservicestoourLivesInsuredonpaymentbya
cashlessfacility.Thislistofnetworkhospitalsissubjecttoamendment
fromtimetotimeandthelatestlistisavailablewithUsandourTPAonour
respectivewebsites.
27. New Born Baby: A Newborn Baby/Child means baby born during the
policyperiodandisagedbetween1dayand90days,bothdaysinclusive.
28. Non- Network Hospitals: Non Network Hospitals is any hospital, day
carecentreorotherproviderthatisnotpartofthenetwork.
29. Notification of Claim: Notification of claim is the process of notifying a
claim to us or TPA by specifying the timelines as well as the address /
telephonenumbertowhichitshouldbenotified.
30. Post hospitalization Medical Expenses: Medical Expenses incurred
immediatelyaftertheLifeInsuredisdischargedfromthehospital
providedthat
 Such Medical Expenses are incurred for the same condition for which
theLifeInsured's hospitalisationwasrequired,and
 The Inpatient Hospitalization claim/ Day Care Benefit claim for such
hospitalisationisadmissiblebyUs.
31. Pre hospitalisation Medical Expenses: Medical Expenses incurred
immediatelybeforetheLifeInsuredishospitalisedprovidedthat:
 Such Medical Expenses are incurred for the same condition for which
theLifeInsured'shospitalisationwasrequired,and
 TheInpatientHospitalizationclaim/DayCareBenefitclaimforsuch
hospitalizationisadmissiblebyUs
32. Pre-Existing Disease: Any condition, ailment or injury or related
condition(s)forwhichyouhadsignsorsymptoms,and/orwere

14. diagnosed,and/orreceivedmedicaladvice/treatmentwithin48months
topriortothefirstpolicyissuedbyus.
33. Reasonable and Customary Charges: Reasonable and Customary
Charges means the charges for the services or supplies, which are the
prevailing charges in the geographical area for identical or similar
services, taking into account the nature of the illness / injury involved .
34. Renewal: 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.
35. Room rent: Room Rent shall mean the amount charged by a hospital for
the occupancy of a bed on per day (24 hours) basis and shall include
associated medical expenses.
36. Sum Insured: Sum Insured is the face value of the policy contracted
betweenyouandus.
37. Surgery: 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.
38. Unproven/Experimental treatment: Unproven/Experimental
treatment is treatment, including drug Experimental therapy, which is
based on established medical practice in India, is treatment
experimental or unproven.
39. Emergency Care / Ward – Emergency care means management for a
severe illness or injury which results in symptoms which occur suddenly
and unexpectedly, and requires immediate care by a medical
practitioner to prevent death or serious long term impairment of the
Life Insured's health.

15. Notes :

16. Insurance is the subject matter of the solicitation. This version of the policy brochure invalidates any previous versions for the same plan. HDFC Standard Life
Insurance Company Limited. IRDA Registration No. 101. ARN: PP/08/2014/5206
w.e.f. August 2014/VER.8.1
Registered Office: HDFC Standard Life Insurance Company Limited, Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi, Mumbai-400 011.
HDFC Standard Life Insurance Company Limited. In partnership with Standard Life Plc
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