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Cococure POLICY WORDINGS 1.1 1.2 1.3 1.4 1.5

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Cococure POLICY WORDINGS 1.1 1.2 1.3 1.4 1.5 COCOCure POLICY WORDINGS This is Your COCOCure Policy, which has been issued by Us, relying on the Information disclosed by You in Your Proposal for this Policy or its preceding Policy/Policies of which this is a Renewal. The terms set out in this Policy and its Schedule will be the basis for any claim or benefit under this Policy. 1. DEFINITIONS The words defined in this document are assigned specified meanings and they are appearing in italics. Wherever the context permits, the singular will be deemed to include the plural, one gender shall be deemed to include the other genders and references to any statute shall be deemed to refer to any replacement or amendment of that statute. 1.1 Accident or Accidental - means a sudden, unforeseen and involuntary event caused by external, visible and violent means. 1.2 Admissible claim amount - means the amount that is admissible as per policy terms and conditions before applying deductible/co-payment. Any deductible/co-payment will be applied on the admissible claim amount. The amount so arrived after application of deductible/co-payment, will be payable under the policy but not exceeding the Sum Insured. 1.3 Adventure Sports – Adventure sports (also called action sports, aggro sports, and extreme sports) are a popular term for certain activities perceived as having a high level of inherent danger. These sports / activities often involves speed, height, a high level of physical exertion and highly specialised gear such as racing on wheels or horseback, power boat racing, ski racing, hunting or equestrian activities, big game hunting, rock climbing/trekking/mountaineering, winter sports, Skydiving, Parachuting, paragliding/parapenting, Scuba Diving, ski doo riding, cavin/pot holing, bungee jumping, hell skiing, ski acrobatics, ski jumping, water ski jumping, ice hockey, ice speedway, ballooning, hand gliding, river rafting, black water rafting, yachting or boating outside coastal waters, canoeing involving rapid waters, micro-lighting, riding or driving in races or rallyies, piloting aircraft, power lifting, quad biking, river boarding, river bugging, rodeo, roller hockey. 1.4 Age or Aged – means completed age in years as at the Policy Commencement Date. 1.5 Any one Illness - means continuous period of Illness and it includes relapse within 45 days from the date of last consultation with the Hospital/Nursing Home where treatment was taken. 1.6 Authority means the Insurance Regulatory and Development Authority of India established under the provisions of section 3 of the Insurance Regulatory and development authority Act, 1999 (41 of 1999). COCOCure | UIN : NAVHLIP21369V022021 Registered & Corporate Office: Navi General Insurance Limited (Formerly DHFL General Insurance Limited) 402, 403 & 404, A & B Wing, 4th Floor, Fulcrum, Sahar Road, Next to Hyatt Regency, Andheri (E), Mumbai -400099 Toll-free number: 1800 123 0004 8200 | Fax: 022-4001 8251 | Website: www.naviinsurance.com | Email: [email protected] CIN: U66000MH2016PLC283275 | IRDAI Registration Number: 155 Page 1 of 78 1.7 AYUSH Hospital means a healthcare facility wherein medical / surgical / para – surgical treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s) comprising of any of the following – a. Central or State Government AYUSH Hospital; or b. Teaching hospital attached to AYUSH College recognized by the Central Government / Central Council of Indian Medicine / Central Council for Homeopathy; or c. AYUSH hospital, standalone or co – located with in-patient healthcare facility of any recognised system of medicine, registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered AYUSH Medical Practitioner and must comply with all the following criterion : i. Having atleast 5 in-patient beds; ii. Having qualified AYUSH Medical Practitioner in charge round the clock; iii. Having dedicated AYUSH therapy sections as required and / or has equipped operation theatre where surgical procedures are to be carried out; iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorised representative. 1.8 AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre (PHC), Dispensary, Clinic, Polyclinic or any such health centre which is registered with the local authorities, wherever applicable and having facilities for carrying out treatment procedures and medical or surgical/para-surgical interventions or both under supervision of registered AYUSH Medical Practitioner(s) on day care basis without inpatient services and must comply with all the following criterion : i. Having qualifies registered AYUSH Medical Practitioner(s) in charge; ii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures are to be carried out; iii. Maintaining daily records of the patients and making them accessible to the insurance company's authorised representative. 1.9 Base Sum Insured means the amount stated in the Policy Schedule. 1.10 Complaint or Grievance means written expression (includes communication in the form of electronic mail or other electronic scripts), of dissatisfaction by a Complainant with Insurer, distribution channels, intermediaries, insurance intermediaries or other regulated entities about an action or lack of action about the standard of service or deficiency of service of such Insurer, distribution channels, intermediaries, insurance intermediaries or other regulated entities. 1.11 Complainant means a Policyholder or prospect or any beneficiary of an insurance Policy who has filed a Complaint or Grievance against an Insurer or a distribution channel. 1.12 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. COCOCure | UIN : NAVHLIP21369V022021 Registered & Corporate Office: Navi General Insurance Limited (Formerly DHFL General Insurance Limited) 402, 403 & 404, A & B Wing, 4th Floor, Fulcrum, Sahar Road, Next to Hyatt Regency, Andheri (E), Mumbai -400099 Toll-free number: 1800 123 0004 8200 | Fax: 022-4001 8251 | Website: www.naviinsurance.com | Email: [email protected] CIN: U66000MH2016PLC283275 | IRDAI Registration Number: 155 Page 2 of 78 1.13 Condition Precedent - means a Policy term or condition upon which the Insurer`s liability under the Policy is conditional upon. 1.14 Congenital Anomaly - means a condition which is present since birth, and which is abnormal with reference to form, structure or position. (a) Internal Congenital Anomaly – congenital anomaly which is not in the visible and accessible parts of the body. (b) External Congenital Anomaly - congenital anomaly which is in the visible and accessible parts of the body. 1.15 Cumulative Bonus – means any increase or addition in the Sum Insured granted by the Insurer without an associated increase in premium. 1.16 Co-Payment - means 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. 1.17 Day Care Centre - means any institution established for Day Care Treatment of Illness and / or Injuries or a medical setup with a Hospital and which has been registered with the local authorities, wherever applicable, and is under supervision of a registered and qualified Medical Practitioner AND must comply with all minimum criterion as under: i. has qualified nursing staff under its employment; ii. has qualified Medical Practitioner (s) in charge; iii. has a fully equipped operation theatre of its own where Surgical Procedures are carried out; iv. maintains daily records of patients and will make these accessible to the Insurance company’s authorized personnel. 1.18 Day Care treatment - means medical treatment, and/or Surgical Procedure which is: i. undertaken under General or Local Anaesthesia in a Hospital / Day Care Centre in less than 24 hrs because of technological advancement, and ii. which would have otherwise required Hospitalisation of more than 24 hours. Note - Treatment normally taken on an Out-patient basis is not included in the scope of this definition. 1.19 Deductible - means a cost sharing requirement under a health insurance Policy that provides that the Insurer will not be liable for a specified rupee amount in case of indemnity policies and 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. COCOCure | UIN : NAVHLIP21369V022021 Registered & Corporate Office: Navi General Insurance Limited (Formerly DHFL General Insurance Limited) 402, 403 & 404, A & B Wing, 4th Floor, Fulcrum, Sahar Road, Next to Hyatt Regency, Andheri (E), Mumbai -400099 Toll-free number: 1800 123 0004 8200 | Fax: 022-4001 8251 | Website: www.naviinsurance.com | Email: [email protected] CIN: U66000MH2016PLC283275 | IRDAI Registration Number: 155 Page 3 of 78 1.20 Dental Treatment - means a treatment related to teeth or structures supporting teeth including examinations, fillings (where appropriate), crowns, extractions and Surgery. 1.21 Dependent Child – means biologically or legally adopted son or daughter of the Policyholder whose completed age is
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