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Mera Mediclaim Plan an Individual, Non-Linked, Non Participating, Pure Risk Premium, Combi Insurance Plan

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Mera Mediclaim Plan an Individual, Non-Linked, Non Participating, Pure Risk Premium, Combi Insurance Plan Mera Mediclaim Plan An Individual, non-linked, non participating, Pure Risk premium, Combi insurance plan SECTION 1: KEY POLICY INFORMATION 1. PART A: WELCOME LETTER/ POLICY SCHEDULE 1.1. Welcome Letter Date: <<dd-mm-yyyy>> [Name of the policyholder] [Father/husband name] [Address] [Mobile number] <Sourcing Branch> Subject: <<Mera Mediclaim Plan>> <Policy No> Dear <<Title>>. <<Name of the policyholder>>, It is our pleasure to welcome you to family of our valued customers. Mera Mediclaim Plan is unique offering which combines strengths of PNB MetLife India Insurance Company Limited (PMLI) and Care Health Insurance Limited (formerly known as Religare Health Insurance Company Ltd) to provide you benefits of both Life and Health insurance, packaged in one product. We have made efforts to ensure that your policy document is simple and easy to understand. Items of sig nificance have been especially highlighted and cross referenced with the Policy Terms in the Key Features Document enclosed with this policy. We suggest that you familiarize yourself with this document since it would be helpful in your hour of need. Your Policy Document contains the following sections which describe the policy benefits in further detail: • SECTION 1: WELCOME LETTER AND POLICY DOCUMENTS o Welcome Letter o Life Insurance – Policy Preamble/ Policy Schedule o Health Insurance – Policy Schedule o Premium Receipt o Customer Information Sheet • SECTION 2: LIFE INSURANCE o Definitions o Key Features, Benefits & Premium Payment Conditions o Policy Servicing Conditions o General Terms and Conditions o Grievance Redressal Mechanism • SECTION 3: HEALTH INSURANCE o Definitions o Benefits o Optional Covers o Exclusions o Portability o Claims Procedure & Management o General Terms and Conditions Final Policy Document_1st April 2021 Mera Mediclaim Plan UIN: 117Y102V01 Page 1 of 157 Mera Mediclaim Plan An Individual, non-linked, non participating, Pure Risk premium, Combi insurance plan • SECTION 4: GENERAL POLICY CONDITIONS APPLICABLE TO LIFE INSURANCE AND HEALTH INSURANCE BENEFITS • SECTION 5: ANNEXURES • Copy of Proposal Form In case if there is any discrepancy in the proposal form please or the policy terms and conditions, please notify us. If there is any objection to the same you may return the policy for cancellation under the provision of Free Look Period. Both PMLI and CHI(formerly known as Religare Health Insurance Company Ltd ) are committed to offer you seamless customer service across various touchpoints. We are unerringly focussed on providing you access to highest quality of healthcare and peace of mind. Also enclosed for your convenience is your Care Health Card(s) which should be presented at the time of an emergency or planned hospitalization, to access cashless treatment at CHI’s extensive network of hospitals (please visit www.pnbmetlife.com OR www.carehinsurance.com to view the list of hospitals across the country). Free look provision: Please go through the terms, conditions and exclusions of enclosed Policy very carefully. If you have any objections to the terms, conditions and exclusions of your Policy, you may return the Policy for cancellation by giving a sig ned written notice to us within 15 days (30 days in case of distance marketing only for life cover) from the date of receiving your policy, stating the reasons for your objection and you will be entitled to a refund of premium paid, if no Claim has been made under the Policy, subject to deduction of proportionate risk premium for the period of cover, stamp duty and/or the expens es incurred on medical examination (if any). In case of any query at any point in time kindly feel free to call or write to us at any of the con tact details mentioned below. We value your patronage and are committed to offering you the best services always . Yours Sincerely, PNB MetLife India Insurance Company Limited as Lead Insurer Care Health Insurance [Signature] [Signature] [Name of signing authority] [Name of signing authority] [Designation of signing authority] [Designation of signing authority] Key Contacts PNB MetLife India Insurance Co. Ltd. Care Health Insurance Limited Toll free no: 18004256969 Toll free no: 1800-xxx-xxxx Website: www.pnbmetlife.com Website: ww.careinsurance.com e-mail: [email protected] e-mail: [email protected] Final Policy Document_1st April 2021 Mera Mediclaim Plan UIN: 117Y102V01 Page 2 of 157 Mera Mediclaim Plan An Individual, non-linked, non participating, Pure Risk premium, Combi insurance plan Table of Contents SECTION 1: KEY POLICY INFORMATION ............................................................................................................ 1 1. PART A: WELCOME LETTER/ POLICY SCHEDULE.......................................................................................... 1 1.1. Welcome Letter .................................................................................................................................... 1 1.2. Policy Preamble .................................................................................................................................... 6 1.3. Policy Schedule ..................................................................................................................................... 6 1.4. Customer Information Sheet ..................................................................................................................16 SECTION 2: LIFE INSURANCE TERMS and CONDITIONS ......................................................................................25 2. PART B: DEFINITIONS APPLICABLE TO YOUR POLICY ..................................................................................25 3. PART C: POLICY FEATURES, BENEFITS & PREMIUM PAYMENT CONDITIONS...................................................29 3.1. Policy Features......................................................................................................................................29 3.2. Policy Benefits .....................................................................................................................................29 3.2.1. Death / Terminal Illness Benefit..........................................................................................................29 3.2.2. Maturity Benefit...............................................................................................................................31 3.3. Premium Payment Conditions ................................................................................................................32 3.3.1. Payment of Premium ........................................................................................................................32 3.3.2. Alteration of the Premium payment mode ...........................................................................................32 3.3.3. Grace Period....................................................................................................................................32 3.3.4. Premium mode loading / Modal Factors ..............................................................................................32 4. PART D: POLICY SERVICING CONDITIONS .................................................................................................33 4.1. Free Look Period ..................................................................................................................................33 4.2. Premium Discontinuance.......................................................................................................................33 4.2.1. Lapse..............................................................................................................................................33 4.2.2. Paid-Up Value ..................................................................................................................................33 4.3. Loan ...................................................................................................................................................35 4.4. Surrender............................................................................................................................................35 4.5. Policy Revival .......................................................................................................................................36 4.6. Termination of the Policy ......................................................................................................................36 5. Part E .................................................................................................................................................38 6. PART F: GENERAL TERMS AND CONDITIONS .............................................................................................39 6.1. Nomination .........................................................................................................................................39 6.2. Assignment .........................................................................................................................................39 6.3. Claims Procedure .................................................................................................................................39 6.4. Maturity Benefit Payout Procedure.........................................................................................................40 6.5. Taxation..............................................................................................................................................40
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