Group Health Insurance (Revised) Policy Wording

GROUP HEALTH INSURANCE (Revised)
Policy Wording
Future Generali India Insurance Company Limited. IRDAI Regn. No. 132 | CIN: U66030MH2006PLC165287.
Regd. and Corp. Office: 801 and 802, 8th floor, Tower C, Embassy 247 Park, L.B.S. Marg, Vikhroli (W), Mumbai – 400083. Call us at: 1800-220-
233 / 1860-500-3333 / 022-67837800 | Fax No: 022 4097 6900 | Website: https://general.futuregenerali.in | Email: [email protected]. Trade
Logo displayed above belongs to M/S Assicurazioni Generali - Societa Per Azioni and used by Future Generali India Insurance Co Ltd. under
license.
UIN: FGIHLGP21165V022021
Group Health Insurance (Revised) – Policy Wordings
GROUP HEALTH INSURANCE (REVISED)
I. Preamble
Whereas the Insured Person designated in the Schedule hereto has by a proposal and declaration dated as stated in the schedule
which shall be the basis of this Contract and is deemed to be incorporated herein, has applied to Future Generali India Insurance
Company Ltd. (herein after called the Company) for the insurance herein after set forth in respect of Employees/Members
(including their eligible Family Members) named in the schedule hereto (herein after called the Insured Person) and has paid
premium as consideration for such insurance.
The Insured Person is eligible to be covered under this policy from birth/90 days (as a dependent child) upto the age of 80
years with lifelong renewability subject to continuous renewal of the group policy. This Policy records the agreement between
the Company and the Insured Person and sets out the terms of insurance and the obligations of each party.
II. DEFINITIONS:
The following words or terms shall have the meaning ascribed to them wherever they appear in this Policy, and references to the
singular or to the masculine shall include references to the plural and to the female wherever the context so permits:
A. Standard Definitions
1. Accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means.
2. Any one Illness means continuous period of illness and includes relapse within 45 days from the date of last consultation with
the Hospital/Nursing Home where treatment was taken.
3. AYUSH Day Care Centre:

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 the supervision of
registered
AYUSH Medical Practitioner (s) on day care basis without in-patient services and must comply with all the following criterion:
i. Having qualified 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 authorized
representative.
4. AYUSH Hospital:
An AYUSH Hospital is 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 recognized 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 at least 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 authorized
representative.
5. AYUSH Treatment refers to the medical and / or hospitalization treatments given under Ayurveda, Yoga and Naturopathy,
Unani, Siddha and Homeopathy systems.
6. Cashless facility 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.
7. Condition Precedent shall mean a Policy term or condition upon which the Insurer's liability under the Policy is conditional
upon.
8. Congenital Anomaly refers to a condition(s) 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.
9. 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 claims amount. A co-payment does not reduce the Sum Insured.
10. 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 -
a. has qualified nursing staff under its employment;
b. has qualified medical practitioner/s in charge;
c. has fully equipped operation theatre of its own where surgical procedures are carried out;
d. maintains daily records of patients and will make these accessible to the insurance company’s authorized personnel.
11. Day care treatment means medical treatment, and/or surgical procedure which is:
a. undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of technological
advancement, and
b. which would have otherwise required hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.
12. 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.
13. Dental Treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings (where
appropriate), crowns, extractions and surgery.
14. Disclosure to information norm: The policy shall be void and all premium paid thereon shall be forfeited to the Company in
the event of misrepresentation, mis description or non-disclosure of any material fact.
15. Domiciliary hospitalization means medical treatment for an illness/ disease/ injury which in the normal course would require
care and treatment at a hospital but is actually taken while confined at home under any of the following circumstances:
i) the condition of the patient is such that he/she is not in a condition to be removed to a hospital, or
ii) the patient takes treatment at home on account of non-availability of room in a hospital.
16. Emergency care means management for an 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
insured person’s health.
17. Hospital: A hospital means any institution established for in-patient care and day care treatment of illness and/or injuries and
which has been registered as a hospital with the local authorities under Clinical Establishments (Registration and Regulation)
Act 2010 or under enactments specified under the Schedule of Section 56(1) and the said act Or complies with all minimum
criteria as under:
i. has qualified nursing staff under its employment round the clock;
ii. has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient beds in all
other places;
iii. has qualified medical practitioner(s) in charge round the clock;
iv. has a fully equipped operation theatre of its own where surgical procedures are carried out;
v. maintains daily records of patients and makes these accessible to the insurance company’s authorized personnel;
18. Hospitalization means admission in a Hospital for a minimum period of 24 consecutive ‘In- patient Care’ hours except for
specified procedures/ treatments, where such admission could be for a period of less than 24 consecutive hours.
19. Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function and
requires medical treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims
to return the person to his or her state of health immediately before suffering the disease/ illness/ injury which leads to
full recovery.
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the following
characteristics:
(i) it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
(ii) it needs ongoing or long-term control or relief of symptoms
(iii) it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
(iv) it continues indefinitely
(v) it recurs or is likely to recur
20. Injury means accidental physical bodily harm excluding Illness or disease solely and directly caused by external, violent and
visible and evident means which is verified and certified by a Medical Practitioner.
21. Inpatient Care means treatment for which the insured person has to stay in a Hospital for more than 24 hours for a covered
event.
22. Intensive care unit means an identified section, ward or wing of a hospital which is under the constant supervision of a
dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who
are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more
sophisticated and intensive than in the ordinary and other wards.
23. ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses which shall include the
expenses for ICU bed, general medical support services provided to any ICU patient including monitoring devices, critical care
nursing and intensivist charges.
24. Maternity expense/treatment means:

a. medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred
during hospitalization);
b. expenses towards lawful medical termination of pregnancy during the policy period.
25. Medical Advice means any consultation or advice from a Medical Practitioner including the issuance of any prescription or
follow-up prescription.
26. Medical expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment
on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been
payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have
charged for the same medical treatment.
27. Medical Practitioner means a person who holds a valid registration from the Medical Council of any State or Medical Council
of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is
thereby entitled to practice medicine within its jurisdiction; and is acting within its scope and jurisdiction of license. The
registered practitioner should not be the insured or close Family members.
28. Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital
which:
i. is required for the medical management of the illness or injury suffered by the insured;
ii. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or
intensity;
iii. must have been prescribed by a medical practitioner;
iv. must conform to the professional standards widely accepted in international medical practice or by the medical community
in India.
29. Migration means, the right accorded to health insurance policyholders (including all members under family cover and members
of group Health insurance policy), to transfer the credit gained for pre-existing conditions and time bound exclusions, with the
same insurer
30. Network Provider means hospitals or health care providers enlisted by an insurer, TPA or jointly by an Insurer and TPA to
provide medical services to an insured by a cashless facility
31. New Born baby means baby born during the Policy Period and is aged upto 90 days.
32. Non-Network Provider means any hospital, day care centre or other provider that is not part of the network.
33. Notification of claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes of
communication.
34. OPD treatment means the one in which the Insured visits a clinic / hospital or associated facility like a consultation room for
diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day care or in-patient.
35. Portability means the right accorded to an individual health insurance policyholders (including all members under family cover),
to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer.
36. Pre-existing Disease means any condition, ailment, injury or disease:

a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its
reinstatement.
b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the
effective date of the policy issued by the insurer or its reinstatement.
37. Pre-hospitalization Medical Expenses means medical expenses incurred during predefined number of days preceding the
hospitalization of the Insured Person, provided that:
i. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required, and
ii. The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
38. Post-hospitalization Medical Expenses means medical expenses incurred during predefined number of days immediately
after the insured person is discharged from the hospital provided that:
i. Such Medical Expenses are for the same condition for which the insured person’s hospitalization was required, and
ii. The inpatient hospitalization claim for such hospitalization is admissible by the insurance company.
39. Qualified nurse means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any
state in India.
40. Reasonable and Customary charges means the charges for services or supplies, which are the standard charges for the
specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into
account the nature of the illness / injury involved.
41. Renewal means 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 gaining credit for pre-existing diseases, time-bound exclusions
and for all waiting periods.
42. Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the associated
medical expenses.
43. 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 from suffering and prolongation of life, performed
in a hospital or day care centre by a medical practitioner.
44. Unproven/ Experimental treatment means the treatment including drug experimental therapy which is not based on
established medical practice in India.
B. Specific Definitions
45. Associated Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for medical
treatment on account of Illness or Accident on the advice of a Medical Practitioner. In case of copayment associated with room
rent higher than the entitled room rent limit, Associated Medical Expenses will not include :
a. Cost of pharmacy and consumables;
b. Cost of implants and medical devices
c. Cost of diagnostics
46. Break in Policy: occurs at the end of the existing Policy term, when the premium due date for Renewal on a given policy is
not paid on or before the premium Renewal date or within grace period days thereof.
47. Claim: means a demand made in accordance with the terms and conditions of the Policy for payment of Medical Expenses or
Optional EXTENSION in respect of the Insured Member as covered under the Policy.
48. Dependent means a person who is a member of the Primary Insured Member's family who is legally wedded spouse, natural
or legally adopted child, parents and parents in law and whose name is mentioned in the Policy schedule as an Insured Member.
49. Dependent Child: A dependent child refers to a child (natural or legally adopted), who is financially dependent on the primary
insured or proposer and does not have his/ her independent sources of income.
50. Policy Period The period commencing with the start date mentioned in the Schedule till the end date mentioned in the
Schedule
51. Policy Year means every annual period within the Policy Period starting with the commencement date
52. Policyholder: means the entity or person named as such in the Schedule.
53. Room rent: Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the
associated medical expenses.
54. Spouse: means an insured person’s husband or wife who is recognized as such by the laws of the jurisdiction in which they
reside.
55. We/Our/Us: means Future Generali India Insurance Company limited.
56. You/Your: means the Policyholder.
Please note
a) Insect and mosquito bites is not included in the scope of definition of Accident.
b) Medical Expenses would include both medical treatment and/ or surgical treatment
III. SCOPE OF COVER

Now this policy witnesseth that subject to the terms, Conditions, exclusions and definitions contained herein or endorsed or otherwise
expressed here on the Company undertakes that if during the period stated in the schedule or during the continuance of this policy
by renewal any Insured Person shall contract any disease or suffer from any illness (herein after called DISEASE) or sustain any
bodily injury through accident (herein after called INJURY) and if such disease or injury shall require any such Insured Person, upon
the medical advice of a duly qualified Physician/ Medical Specialist/ Medical Practitioner (herein after called Medical Practitioner) or
of a duly qualified surgeon (herein after called SURGEON) to incur Inpatient care/ Emergency care/ Domiciliary Hospitalisation
expenses for medical/ surgical treatment at any Nursing Home/ Hospital in India as herein defined (herein after called Hospital) as
an inpatient, the Company will pay to the Insured Person the amount of such expenses as would fall under different heads mentioned
below, and as are medically necessary and reasonable & customary charges incurred therefore by or on behalf of such Insured
Person, but not exceeding the sum insured for the person in any one period of such insurance as mentioned in the schedule hereto.
1. In Patient Expenses
We will pay the Reasonable and Customary Charges for Medical Expenses that are incurred during the Hospitalisation of the
Insured Person for Medically Necessary treatment required due to an Illness or Injury sustained by the Insured Person during
the Policy Period.
2. Day Care Treatment expenses

We will pay the Reasonable and Customary Charges for Medically Necessary Day Care Treatment taken by the Insured Person
on advanced technological Surgical Procedures requiring less than 24 hours of Hospitalization as listed out in Section VI of the
Policy.
3. Pre-hospitalisation Medical Expenses

We will pay the Reasonable and Customary Charges for Medical Expenses incurred up to 30 days prior to hospitalization on
disease/ injury/ illness, provided that:
4. Post-hospitalisation Medical Expenses
We will pay the Reasonable and Customary Charges for Medical Expenses incurred up to 60 days after discharge from the
hospital, provided that:
5. Domiciliary Hospitalisation Expenses

In this policy Domiciliary Hospitalisation expenses are limited to 15% of the sum insured. However that domiciliary hospitalisation
benefits shall not cover:-
1 Expenses incurred for pre and post hospital treatment and
2 Expenses incurred for treatment for any of the following diseases
i. Asthma
ii. Bronchitis
iii. Chronic Nephritis and Nephritic Syndrome
iv. Diarrhea and all type of Dysenteries including Gastro-enteritis
v. Diabetes Mellitus and Insipidus
vi. Epilepsy
vii. Hypertension
viii. Influenza, Cough and Cold
ix. All Psychiatric or Psychosomatic Disorders
x. Pyrexia of unknown Origin for less than 10 days
xi. Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharyngitis
xii. Arthritis, Gout and Rheumatism
xiii. Dental Treatment or Surgery
Note: The Company’s Liability in respect of all claims admitted including Pre-hospitalization Medical Expenses and Post-
hospitalization Medical Expenses during the period of insurance shall not exceed the Sum Insured for the person as mentioned
in the schedule.
6. OPTIONAL COVERS:
Optional Covers are available on payment of additional premium, the details of optional covers are mentioned in Annexure II.
IV. EXCLUSIONS:
1. Waiting Periods
All Illnesses and treatments shall be covered subject to the waiting periods specified below.
a) Pre-Existing Disease- Excl 01

i. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the
expiry of 48 months of continuous coverage after the date of inception of the first policy with us.
ii. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
iii. If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI
(Health Insurance) Regulations then waiting period for the same would be reduced to the extent of prior coverage.
iv. Coverage under the policy after the expiry of 48 months for any pre-existing disease is subject to the same being declared
at the time of application and accepted by us.
b) Specified disease/procedure waiting period- Code- Excl02

i. Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 12/48
months of continuous coverage after the date of inception of the first policy with us. This exclusion shall not be applicable
for claims arising due to an accident.
ii. In case 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. If the 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.
vi. List of specific diseases/procedures:
i. Waiting period of 48 months:

a. Any Internal Congenital Anomaly
ii. Waiting period of 12 months:

a. Cataract
b. Benign Prostatic Hypertrophy
c. Hysterectomy/ myomectomy for menorrhagia or fibromyoma or prolapse of uterus
d. Hernia
e. Hydrocele
f. Fistula in anus, piles
g. Sinusitis and related disorders
h. Surgery for prolapsed inter vertebral disc unless arising from accident
i. Surgery of varicose veins and varicose ulcers
j. Joint Replacement due to Degenerative condition, Age related osteoarthritis and Osteoporosis.
iii. 30 days waiting period Excl -03

a. Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded
except claims arising due to an accident, provided the same are covered.
b. This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.
c. The within referred waiting period is made applicable to the enhanced sum insured in the event of granting higher sum
insured subsequently.
2. Standard Exclusions
We will not pay for any expenses incurred by You in respect of claims arising out of or howsoever related to any of the
following:
a) Investigation & Evaluation- Code- Excl04
i. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
ii. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
b) Rest Cure, rehabilitation and respite care- Code- Excl05

Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
(i) Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as
bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
(ii) Any services for people who are terminally ill to address medical, physical, social, emotional and spiritual needs.
c) Obesity/ Weight Control: Code- Excl06

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1) Surgery to be conducted is upon the advice of the Doctor
2) The surgery/Procedure conducted should be supported by clinical protocols
3) The member has to be 18 years of age or older and
4) Body Mass Index (BMI);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes
d) Change-of-Gender treatments: Code- Excl07

Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the
opposite sex.
e) Cosmetic or Plastic Surgery: Code- Excl08

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. For this to be considered a medically necessity, it must be certified by the attending Medical Practitioner.
f) Hazardous or Adventure sports: Code- Excl09

Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports,
including but not limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc. unless
specifically agreed by the Insurance Company.
g) Breach of law: Code- Excl10

Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a
breach of law with criminal intent.
h) Excluded Providers: Code- Excl11

Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically
excluded by the Insurer and disclosed in its website/ notified to the policyholders are not admissible. However, in case of
life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the
complete claim.
i) Code- Excl12
Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
j) Code- Excl13
Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a
nursing home attached to such establishments or a Hospital where the Hospital has effectively become the Insured Person’s
home or permanent abode or where admission is arranged wholly or partly for domestic reasons.
k) Code- Excl14
Dietary supplements and substances which are available naturally and that can be purchased without prescription, including
but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of
hospitalisation claim or day care procedures.
l) Refractive Error: Code- Excl15

Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
m) Unproven Treatments: Code- Excl16

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.
n) Birth control, Sterility and Infertility: Code- Excl17
Expenses related to Birth Control, sterility and infertility. This includes:
(i) Any type of contraception, sterilization
(ii) Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF,
ZIFT, GIFT, ICSI
(iii) Gestational Surrogacy
(iv) Reversal of sterilization
o) Maternity : Code Excl 18

i. Medical treatment expenses traceable to child birth (including complicated deliveries and caesarean section incurred
during hospitalization) except ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during policy
period.
3. Specific Exclusions
We will not pay for any expenses incurred by You in respect of claims arising out of or howsoever related to any of the following:
p) Injury or Disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy,
War like operations (whether war be declared or not).
q) Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an
accident.
r) Vaccination/ inoculation (except as post bite treatment).
s) Charges incurred in connection with cost of spectacles and contact lenses, hearing aids, durable medical equipment
(including but not limited to wheel chair ,crutches, artificial limbs, belts, braces, stocking, Glucometer and the like), namely
that equipment used externally from the human body which can withstand repeated use; is not designed to be disposable;
is used to serve a medical purpose ;is generally not useful in absence of an Illness or Injury and is usable outside of a
Hospital) unless required for the treatment of Illness or Accidental Bodily Injury.
t) Any dental treatment or surgery which is a corrective in nature, unless it requires Hospitalisation and is carried out under
general anesthesia and is necessitated by Illness or Accidental Bodily Injury.
u) Personal comfort and convenience items or services such as television, telephone, barber or beauty service guest service
and similar incidental services and supplies.
v) Any External Congenital illness/ disease/ defect/ anomaly.
w) Venereal/ Sexually Transmitted disease other than HIV/AIDS.
x) Intentional self-injury.
y) Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons/ materials.
z) Costs incurred on all methods of treatment including Alternative treatments except Allopathic.
aa) Stem cell storage.
bb) Outpatient Diagnostic, Medical and Surgical procedures or treatments (OPD treatment),
cc) non-prescribed drugs and medical supplies,
dd) Hormone replacement therapy.
ee) Any kind of Service charges, Surcharges, Admission fees/ Registration charges etc levied by the hospital.
ff) Medical Practitioner’s home visit charges, Attendant/ Nursing charges during pre and post hospitalization period.
gg) Expenses related to donor screening, treatment, including surgery to remove organs from the donor in case of a transplant
surgery.
hh) Standard list of excluded items as mentioned in Annexure I and on our website https://general.futuregenerali.in
V. GENERAL TERMS AND CLAUSES

A. Standard General Terms and Clauses
1. Disclosure to information norm:

The policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, mis
description or non-disclosure of any material fact by the policyholder.
(Explanation: "Material facts" for the purpose of this policy shall mean all relevant information sought by the company in the
proposal form and other connected documents to enable it to take informed decision in the context of underwriting the risk)
2. Condition Precedent to Admission of Liability

The terms and conditions of the policy must be fulfilled by the insured person for the Company to make any payment for
claim(s) arising under the policy.
3. Migration
The insured person will have the option to migrate the policy to other health insurance products/plans offered by the
company by applying for migration of the policy at least 30 days before the policy renewal date as per IRDAI guidelines on
Migration. lf such person is presently covered and has been continuously covered without any lapses under any health
insurance product/plan offered by the company, the insured person will get all the accrued continuity benefits in waiting
periods as per the IRDAI guidelines on migration.
For Detailed Guidelines on migration, kindly refer the link

https://general.futuregenerali.in/general-insurance/pdf/Guide_to_Portability_and_Migration_25-Mar-2020.pdf
4. Complete Discharge
Any payment to the policyholder, insured person or his/ her nominees or his/ her legal representative or assignee or to the
Hospital, as the case may be, for any benefit under the policy shall be a valid discharge towards payment of claim by the
Company to the extent of that amount for the particular claim.
5. Multiple Policies
a) ln case of multiple policies taken by an insured person during a period from one or more insurers to indemnify treatment
costs, the insured person shall have the right to require a settlement of his/her claim in terms of any of his/her policies. ln
all such cases the insurer chosen by the insured person shall be obliged to settle the claim as long as the claim is within the
limits of and according to the terms of the chosen policy.
b) lnsured person having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed
under any other policy / policies even if the sum insured is not exhausted. Then the insurer shall independently settle the
claim subject to the terms and conditions of this policy.
c) lf the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the right to choose
insurer from whom he/she wants to claim the balance amount.
d) Where an insured person has policies from more than one insurer to cover the same risk on indemnity basis, the insured
person shall only be indemnified the treatment costs in accordance with the terms and conditions of the chosen policy.
6. Fraud
lf any claim made by the insured person, is in any respect fraudulent, or if any false statement, or declaration is made or
used in support thereof, or if any fraudulent means or devices are used by the insured person or anyone acting on his/her
behalf to obtain any benefit under this policy, all benefits under this policy and the premium paid shall be forfeited.
Any amount already paid against claims made under this policy but which are found fraudulent later shall be repaid by all
recipient(s)/policyholder(s), who has made that particular claim, who shall be jointly and severally liable for such repayment
to the insurer.
For the purpose of this clause, the expression "fraud" means any of the following acts committed by the insured person or by
his agent or the hospital/doctor/any other party acting on behalf of the insured person, with intent to deceive the insurer or
to induce the insurer to issue an insurance policy:
a. the suggestion, as a fact of that which is not true and which the insured person does not believe to be true;
b. the active concealment of a fact by the insured person having knowledge or belief of the fact;
c. any other act fitted to deceive; and
d. any such act or omission as the law specially declares to be fraudulent
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of Fraud, if the insured person /
beneficiary can prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to
suppress the fact or that such misstatement of or suppression of material fact are within the knowledge of the insurer.
7. Nomination
The policyholder is required at the inception of the policy to make a nomination for the purpose of payment of claims under
the policy in the event of death of the policyholder. Any change of nomination shall be communicated to the company in
writing and such change shall be effective only when an endorsement on the policy is made. ln the event of death of the
policyholder, the Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)}
and in case there is no subsisting nominee, to the legal heirs or legal representatives of the policyholder whose discharge
shall be treated as full and final discharge of its liability under the policy.
8. Redressal of Grievance
In case of any grievance the insured person may contact the company through
Website: https://general.futuregenerali.in/
Toll Free: 1800-220-233 / 1860-500-3333 / 022-67837800
Email: [email protected]
Courier: Grievance Redressal Cell, Future Generali India Insurance Company Ltd.
Lodha I –Think Techno Campus, B Wing –2nd Floor, Pokhran Road –2, Off Eastern Express Highway Behind TCS,
Thane West – 400607
Insured person may also approach the grievance cell at any of the company's branches with the details of grievance.
lf lnsured person is not satisfied with the redressal of grievance through one of the above methods, insured person may
contact the grievance officer at [email protected] or call at: 7900197777
For updated details of grievance officer, kindly refer the link https://general.futuregenerali.in/general-
insurance/pdf/Grievance_Redressal_Procedures.pdf
lf lnsured person is not satisfied with the redressal of grievance through above methods, the insured person may also
approach the office of lnsurance Ombudsman of the respective area/region for redressal of grievance as per lnsurance
Ombudsman Rules 2017. Kindly refer the annexure on Grievance Redressal Procedures.
Grievance may also be lodged at IRDAI Integrated Grievance Management System - https:/igms.irda.gov.in/
B. Specific General Terms and Clauses
1. Every notice of communication to be given or made under this policy shall be delivered in writing at the address as shown in
the schedule.
2. The premium payable under this policy shall be paid in advance. No receipt for premium shall be valid except on the official
form of the Company signed by a duly authorized official of the Company. The due payment of premium and the observance
and fulfillment of the terms, provisions, conditions and endorsements of this policy by the Insured Person in so far as they
relate to anything to be done or complied with by the Insured Person shall be a condition precedent to any liability of the
Company to make any payment under this policy. No waiver of any terms provisions, conditions and endorsements of this
policy shall be valid unless made in writing and signed by an authorized official of the Company.
3. Administration of Policy
1. Claims Procedure: Claims procedure for policies serviced by in-house service administrator (Future Generali Health
(FGH))
a. The Company’s in-house service administrator will provide the user guide & identity card to Insured Person within 15 days
from the date of issue of policy. User guide will have following details:
i. Contact details of in-house service administrator
ii. Website address of in-house service administrator
iii. Updated Network list of hospitals with their contact details.
iv. Claim submission guidelines.
b. Notification of the Claim intimation should be given within 48 hrs of Admission or before Discharge from Hospital/ Nursing
Home.
c. The Insured Person shall without any delay consult a medical practitioner and follow the advice and treatment
recommended, take reasonable step to minimize the quantum of any claim that might be made under this Policy.
d. The Insured Person shall immediately file the claim and in any case within 30 days of discharge from the Hospital provide
the Company with written details of the quantum of any claim along with all the original bills, receipts and other documents
upon which a claim is based and shall also give the Company such additional information and assistance as the Company
may require in dealing with the claim.
e. The Insured Person shall submit himself for examination by the Company’s medical advisors as often as may be considered
necessary by the Company.
2. Claims Administration: If Insured Person meets with any accidental Bodily Injury or suffers an Illness that may result in
a claim, then as a condition precedent to the Company’s liability, Insured Person must comply with the following:
i. Cashless treatment is only available at a Network Provider. In order to avail of cashless treatment, the following procedure
must be followed by Insured Person:
a) Prior to taking treatment and/ or incurring Medical Expenses at a Network Hospital, Insured Person must call us at our
call centre and request pre-authorisation by way of the written form.
b) After considering Insured Persons request and obtaining any further information or documentation that the Company
has sought, Company may, if satisfied, send the Network Provider an authorisation letter. The authorisation letter, the
ID card issued to Insured Person along with this Policy and any other information or documentation that Company has
specified must be produced to the Network Provider identified in the pre-authorisation letter at the time of Insured
Persons admission to the same.
c) If the procedure above is followed, Insured Person will not be required to directly pay for the Medical Expenses in the
Network Hospital that the Company is liable to indemnify under this Policy and the original bills and evidence of
treatment in respect of the same shall be left with the Network Provider. Pre-authorisation does not guarantee that all
costs and expenses will be covered. The Company reserves the right to review each claim for Medical Expenses and
accordingly coverage will be determined according to the terms and conditions of this Policy. Insured Person shall, in
any event, be required to settle all other expenses directly.
ii. If pre-authorisation as above is denied by the Company or if treatment is taken in a Hospital which is Non-Network or if
Insured Person does not wish to avail cashless facility, then:
a) Insured Person must give Notification of Claim, in writing, immediately, and in any event within 48 hours of the
aforesaid Illness or Bodily Injury. Insured Person must immediately consult a Doctor and follow the advice and
treatment that he recommends.
b) Insured Person must promptly and in any event within 30 days of discharge from a Hospital give the Company the
documentation (written details of the quantum of any claim along with all original supporting documentation, including
but not limited to first consultation letter, original vouchers, bills and receipts, birth/death certificate (as applicable))
and other information the Company asks for to investigate the claim or the Company’s obligation to make payment
for it.
c) In the event of the death of the insured person, someone claiming on his behalf must inform the Company in writing
immediately and send the Company a copy of the post mortem report (if any) within 14 days.
d) The periods for intimation or submission of any documents as stipulated under (a), (b), and (c) will be waived in case
of any hardships being faced by the insured or his representative which is supported by some documentation.
3. Claims Processing
a) Claims submission
i. Insured Person will submit the claim papers to in-house service administrator
ii. Following is the ‘necessary’ document list for claim submission:
 Claim form
 Original discharge summary
 Original set of investigation reports
 Original bills and receipts
 Pharmacy bills in original with prescriptions
b) Claims Processing
i. The Company’s In-house service administrator doctors will scrutinize the claims and flag the claim as settled/
Rejected/ Pending within the period of 30 days of the receipt of the last ‘necessary’ documents.
ii. Pending claims will be asked for submission of incomplete documents.
iii. Rejected claims will be informed to the Insured Person in writing with reason for rejection.
iv. In cashless claims, hospital will submit the claims to the Company’s In-house service administrator for payment.
c) Claims Settlement
i. The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last
necessary document.
ii. ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from
the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.
iii. However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate
and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last
necessary document- ln such cases, the Company shall settle or reject the claim within 45 days from the date of
receipt of last necessary document.
iv. ln case of delay beyond stipulated 45 days, the Company shall be liable to pay interest to the policyholder at a rate
2% above the bank rate from the date of receipt of last necessary document to the date of payment of claim.
(Explanation: "Bank rate" shall mean the rate fixed by the Reserve Bank of lndia (RBl) at the beginning of the
financial year in which claim has fallen due)
v. The Company’s In-house service administrator will send the discharge voucher with details of allowed and disallowed
amount
vi. Insured Person will send the signed discharge voucher to the Company’s in-house service administrator, on which
the administrator will send the cheque in name of Insured Person.
vii. Upon acceptance of an offer of settlement as stated in regulation 9(6) of IRDAI (Protection of Policyholders’ Interest)
Regulations, 2002 by You, We will make payment of the amount due within 7 days from the date of acceptance of
the offer by the insured.
4. Policy Period
a) The Policy can be issued for minimum tenure of 1 year
b) In case of Credit Linked Policies, the Policy can be issued for a maximum tenure of 5 years or up to the loan period,
whichever is less.
5. Renewal & Cancellation
a) This Policy may be renewed by mutual consent and in such event; the renewal premium shall be paid to the Company on
or before the date of expiry of the Policy or of the subsequent renewal thereof.
b) Any medical expenses incurred as a result of disease condition/ Accident contracted during the break period will not be
admissible under the policy.
c) The Company may cancel this insurance by giving the Insured Person at least 15 days written notice, and if no claim has
been made then the Company shall refund a pro-rata premium for the unexpired Policy Period.
d) The Insured Person may cancel this insurance by giving the Company at least 15 days written notice, and if no claim has
been made then the Company shall refund premium on short term rates for the unexpired Policy Period as per the rates
detailed below.
Short term rates are detailed below.
Period on risk Rate of premium Retained
Up to one month 1/4th of the annual rate
Up to three months 1/2nd of the annual rate
Up to six months 3/4th of the annual rate
Exceeding six months Full annual rate
In case the Policy Period exceeds one year, this Policy may be cancelled by the Insured Person at any time by giving at
least 15 days written notice to Us. We will refund premium on a pro-rata basis by reference to the time period cover is
provided, subject to a minimum retention of premium of 25%.
e) The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure of material facts, fraud by
the insured person by giving 15 days' written notice. There would be no refund of premium on cancellation on grounds of
misrepresentation, non-disclosure of material facts or fraud.
f) The Policyholder, shall throughout the period of insurance keep and maintain a record containing the names of all the
insured persons. The Policyholder shall declare to the company any additions in the number of insured persons as and
when arising during the period of insurance and shall pay the additional premium as agreed
g) It is hereby agreed and understood that, this insurance being a group policy availed by the Insured covering members, the
benefit thereof would not be available to members who cease to be part of the group for any reason whatsoever.
Such members may obtain further individual insurance directly from the Company and any claims shall be governed by the
terms thereof.
h) The premium rates or loadings for the product would not be changed without approval from Authority. However the
performance of the product will be reviewed annually and further pricing will be done on experience basis.
6. Addition and Deletion of members
a. The new members of the Group Insurance Policy can be added at periodic intervals. However the insurance coverage for
every member of the group insurance policy shall not exceed the maximum policy term.
b. The Company may issue multiple group insurance policies in tranches to the Group Organizer, subject to minimum group
size and maximum policy term, for providing insurance coverage to the new members on an ongoing basis.
c. All members of the group will be issued a Certificate of Insurance giving the details of the benefits, important conditions
and exclusions.
7. Dispute Resolution
a. Any dispute regarding the claim amount, liability otherwise being admitted, are to be referred to arbitration under the
Arbitration & Conciliation Act 1996. The law of the arbitration shall be Indian law and the seat of the arbitration and venue
for all the hearings shall be within India.
b. If these arbitration provisions are held to be invalid, then all such disputes or differences shall be referred to the exclusive
jurisdiction of the Indian courts.
8. Denial of liability
If the Company shall disclaim liability to the Insured Person for any claim hereunder and if the Insured Person shall not within
12 calendar months from the date of receipt of the notice of such disclaimer notify the Company in writing that he does not
accept such disclaimer and intends to recover his claim from the Company then the claim shall for all purposes be deemed to
have been abandoned and shall not thereafter be recoverable hereunder.
9. Territorial limit
All medical/ surgical treatments/ expenses under this policy shall have to be taken in India and admissible claims thereof shall
be payable in Indian currency (Indian Rupees).
VI. DAY CARE LIST
In addition to Day Care list – We would also cover any other surgeries/ procedures agreed by Us which require less than 24 hours
hospitalization as an inpatient due to subsequent advancement in technology.
I. Cardiology Related: 58. Esophageal Stent Placement

1. Coronary Angiography 59. ERCP + Placement Of Biliary Stents
60. Sigmoidoscopy W / Stent
II. ENT Related: 61. EUS + Coeliac Node Biopsy
2. Myringotomy With Grommet Insertion
3. Tympanoplasty (closure Of An Eardrum Perforation IV. General Surgery Related:
reconstruction Of The Auditory Ossicles) 62. Incision Of A Pilonidal Sinus / Abscess
4. Removal Of A Tympanic Drain 63. Fissure In Ano Sphincterotomy
5. Operations On The Turbinates (nasal Concha) 64. Piles Banding
6. Stapedotomy To Treat Various Lesions In Middle Ear 65. Surgery for Hernia
7. Revision Of A Stapedectomy 66. Surgical Treatment Of Anal Fistulas
8. Other Operations On The Auditory Ossicles 67. Division Of The Anal Sphincter (sphincterotomy)
9. Myringoplasty (post-aura/endaural Approach As Well 68. Epididymectomy
As Simple Type-I Tympanoplasty) 69. Incision Of The Breast Abscess
10. Fenestration Of The Inner Ear 70. Operations On The Nipple
11. Revision Of A Fenestration Of The Inner Ear 71. Excision Of Single Breast Lump
12. Palatoplasty 72. Incision And Excision Of Tissue In The Perianal
13. Transoral Incision And Drainage Of A Pharyngeal Region
Abscess 73. Surgical Treatment Of Hemorrhoids
14. Tonsillectomy Without Adenoidectomy 74. Sclerotherapy
15. Tonsillectomy With Adenoidectomy 75. Wound Debridement And Cover
16. Excision And Destruction Of A Lingual Tonsil 76. Abscess-decompression
17. Revision Of A Tympanoplasty 77. Infected Sebaceous Cyst
18. Other Microsurgical Operations On The Middle Ear 78. Incision And Drainage Of Abscess
19. Incision Of The Mastoid Process And Middle Ear 79. Suturing Of Lacerations
20. Mastoidectomy 80. Scalp Suturing
21. Reconstruction Of The Middle Ear 81. Infected Lipoma Excision
22. Other Excisions Of The Middle And Inner Ear 82. Maximal Anal Dilatation
23. Other Operations On The Middle And Inner Ear 83. Piles Injection Sclerotherapy
24. Excision And Destruction Of Diseased Tissue Of The 84. Liver Abscess- Catheter Drainage
Nose 85. Fissure In Ano- Fissurectomy
25. Nasal Sinus Aspiration 86. Fibroadenoma Breast Excision
26. Foreign Body Removal From Nose 87. Oesophageal Varices Sclerotherapy
27. Adenoidectomy 88. ERCP - Pancreatic Duct Stone Removal
28. Stapedectomy Under GA 89. Perianal Abscess I & D
29. Stapedectomy Under LA 90. Perianal Hematoma Evacuation
30. Tympanoplasty (type IV) 91. UGI Scopy And Polypectomy Oesophagus
31. Turbinectomy 92. Breast Abscess I & D
32. Endoscopic Stapedectomy 93. Oesophagoscopy And Biopsy Of Growth Oesophagus
33. Incision And Drainage Of Perichondritis 94. ERCP - Bile Duct Stone Removal
34. Septoplasty 95. Splenic Abscesses Laparoscopic Drainage
35. Thyroplasty Type I 96. UGI Scopy And Polypectomy Stomach
36. Pseudocyst Of The Pinna - Excision 97. Feeding Jejunostomy
37. Incision And Drainage - Haematoma Auricle 98. Varicose Veins Legs - Injection Sclerotherapy
38. Reduction Of Fracture Of Nasal Bone 99. Pancreatic Pseudocysts Endoscopic Drainage
39. Excision Of Angioma Septum 100. Zadek's Nail Bed Excision
40. Turbinoplasty 101. Rigid Oesophagoscopy For Dilation Of Benign
41. Incision & Drainage Of Retro Pharyngeal Abscess Strictures
42. Uvulo Palato Pharyngo Plasty 102. Lord's Plication
43. Adenoidectomy With Grommet Insertion 103. Jaboulay's Procedure
44. Adenoidectomy Without Grommet Insertion 104. Scrotoplasty
45. Incision & Drainage Of Para Pharyngeal Abscess 105. Circumcision For Trauma
106. Meatoplasty
III. Gastroenterology Related: 107. Intersphincteric Abscess Incision And Drainage
46. Pancreatic Pseudocyst Eus & Drainage 108. PSOAS Abscess Incision And Drainage
47. RF Ablation For Barrett's Oesophagus 109. Thyroid Abscess Incision And Drainage
48. EUS + Aspiration Pancreatic Cyst 110. Tips Procedure For Portal Hypertension
49. Small Bowel Endoscopy (therapeutic) 111. Esophageal Growth Stent
50. Colonoscopy, Lesion Removal 112. Pair Procedure Of Hydatid Cyst Liver
51. ERCP 113. Tru Cut Liver Biopsy
52. Colonscopy Stenting Of Stricture 114. Laparoscopic Reduction Of Intussusception
53. Percutaneous Endoscopic Gastrostomy 115. Microdochectomy Breast
54. EUS And Pancreatic Pseudo Cyst Drainage 116. Sentinel Node Biopsy
55. ERCP And Choledochoscopy 117. Testicular Biopsy
56. Proctosigmoidoscopy Volvulus Detorsion 118. Sentinel Node Biopsy Malignant Melanoma
57. ERCP And Sphincterotomy 119. TURBT
120. URS + LL 186. Electron Therapy
187. TSET-total Electron Skin Therapy
V. Gynecology Related: 188. Extracorporeal Irradiation Of Blood Products
121. Conization Of The Uterine Cervix 189. Telecobalt Therapy
122. Local Excision And Destruction Of Diseased Tissue 190. Telecesium Therapy
Of The Vagina And The Pouch Of Douglas 191. External Mould Brachytherapy
123. Incision Of Vulva 192. Interstitial Brachytherapy
124. Salpingo-oophorectomy Via Laparotomy 193. Intracavity Brachytherapy
125. Endoscopic Polypectomy 194. 3D Brachytherapy
126. Hysteroscopic Removal Of Myoma 195. Implant Brachytherapy
127. D & C 196. Intravesical Brachytherapy
128. Hysteroscopic Resection Of Septum 197. Adjuvant Radiotherapy
129. Thermal Cauterisation Of Cervix 198. Afterloading Catheter Brachytherapy
130. Mirena Insertion 199. Conditioning Radiothearpy For BMT
131. Laparoscopic Hysterectomy 200. Nerve Biopsy
132. LEEP (Loop Electrosurgical Excision Procedure) 201. Muscle Biopsy
133. Cryocauterisation Of Cervix 202. Epidural Steroid Injection
134. Polypectomy Endometrium 203. Extracorporeal Irradiation To The Homologous
135. Hysteroscopic Resection Of Fibroid Bone Grafts
136. LLETZ (large loop excision of the transformation 204. Radical Chemotherapy
zone) 205. Neoadjuvant Radiotherapy
137. Conization 206. LDR Brachytherapy
138. Polypectomy Cervix 207. Palliative Radiotherapy
139. Hysteroscopic Resection Of Endometrial Polyp 208. Radical Radiotherapy
140. Vulval Wart Excision 209. Palliative Chemotherapy
141. Laparoscopic Paraovarian Cyst Excision 210. Template Brachytherapy
142. Uterine Artery Embolization 211. Neoadjuvant Chemotherapy
143. Laparoscopic Cystectomy 212. Adjuvant Chemotherapy
144. Hymenectomy (Imperforate Hymen) 213. Induction Chemotherapy
145. Vaginal Wall Cyst Excision 214. Consolidation Chemotherapy
146. Vulval Cyst Excision 215. Maintenance Chemotherapy
147. Laparoscopic Paratubal Cyst Excision 216. HDR Brachytherapy
148. Vaginal Mesh For POP
149. Laparoscopic Myomectomy VIII. Operations On The Salivary Glands & Salivary
150. Repair Recto- Vagina Fistula Ducts:
151. Pelvic Floor Repair (Excluding Fistula Repair) 217. Incision And Lancing Of A Salivary Gland And A
152. Laparoscopic Oophorectomy Salivary Duct
218. Excision Of Diseased Tissue Of A Salivary Gland
VI. Neurology Related: And A Salivary Duct
153. Facial Nerve Glycerol Rhizotomy 219. Resection Of A Salivary Gland
154. Stereotactic Radiosurgery 220. Reconstruction Of A Salivary Gland And A Salivary
155. Percutaneous Cordotomy Duct
156. Diagnostic Cerebral Angiography
157. VP Shunt IX. Operations On The Skin & Subcutaneous Tissues:
158. Ventriculoatrial Shunt 221. Surgical Wound Toilet (wound Debridement) And
Removal Of Diseased Tissue Of The Skin And
VII. Oncology Related: Subcutaneous Tissues
159. Radiotherapy For Cancer 222. Local Excision Of Diseased Tissue Of The Skin And
160. Cancer Chemotherapy Subcutaneous Tissues
161. IV Push Chemotherapy 223. Simple Restoration Of Surface Continuity Of The
162. HBI-hemibody Radiotherapy Skin And Subcutaneous Tissues
163. Infusional Targeted Therapy 224. Free Skin Transplantation, Donor Site
164. SRT-stereotactic ARC Therapy 225. Free Skin Transplantation, Recipient Site
165. SC Administration Of Growth Factors 226. Revision Of Skin Plasty
166. Continuous Infusional Chemotherapy 227. Chemosurgery To The Skin.
167. Infusional Chemotherapy 228. Destruction Of Diseased Tissue In The Skin And
168. CCRT-concurrent Chemo + RT Subcutaneous Tissues
169. 2D Radiotherapy 229. Reconstruction Of Deformity/defect In Nail Bed
170. 3D Conformal Radiotherapy 230. Excision Of Bursirtis
171. IGRT- Image Guided Radiotherapy 231. Tennis Elbow Release
172. IMRT- Step & Shoot
173. Infusional Bisphosphonates X. Operations On The Tongue:
174. IMRT- DMLC 232. Incision, Excision And Destruction Of Diseased
175. Rotational Arc Therapy Tissue Of The Tongue
176. Tele Gamma Therapy 233. Partial Glossectomy
177. FSRT-fractionated SRT 234. Glossectomy
178. VMAT-volumetric Modulated Arc Therapy 235. Reconstruction Of The Tongue
179. SBRT-stereotactic Body Radiotherapy
180. Helical Tomotherapy XI. Ophthalmology Related
181. SRS-stereotactic Radiosurgery 236. Surgery For Cataract
182. X-knife SRS 237. Incision Of Tear Glands
183. Gammaknife SRS 238. Incision Of Diseased Eyelids
184. TBI- Total Body Radiotherapy 239. Excision And Destruction Of Diseased Tissue Of
185. Intraluminal Brachytherapy The Eyelid
240. Operations On The Canthus And Epicanthus 302. Remove/graft Leg Bone Lesion
241. Corrective Surgery For Entropion And Ectropion 303. Repair/graft Achilles Tendon
242. Corrective Surgery For Blepharoptosis 304. Remove Of Tissue Expander
243. Removal Of A Foreign Body From The Conjunctiva 305. Biopsy Elbow Joint Lining
244. Removal Of A Foreign Body From The Cornea 306. Removal Of Wrist Prosthesis
245. Incision Of The Cornea 307. Biopsy Finger Joint Lining
246. Operations For Pterygium 308. Tendon Lengthening
247. Removal Of A Foreign Body From The Lens Of The 309. Treatment Of Shoulder Dislocation
Eye 310. Lengthening Of Hand Tendon
248. Removal Of A Foreign Body From The Posterior 311. Removal Of Elbow Bursa
Chamber Of The Eye 312. Fixation Of Knee Joint
249. Removal Of A Foreign Body From The Orbit And 313. Treatment Of Foot Dislocation
Eyeball 314. Surgery Of Bunion
250. Correction Of Eyelid Ptosis By Levator Palpebrae 315. Tendon Transfer Procedure
Superioris Resection (bilateral) 316. Removal Of Knee Cap Bursa
251. Correction Of Eyelid Ptosis By Fascia Lata Graft 317. Treatment Of Fracture Of Ulna
(bilateral) 318. Treatment Of Scapula Fracture
252. Diathermy/cryotherapy To Treat Retinal Tear 319. Removal Of Tumor Of Arm/ Elbow Under RA/GA
253. Anterior Chamber Paracentesis/ Cyclodiathermy/ 320. Repair Of Ruptured Tendon
Cyclocryotherapy/ Goniotomy Trabeculotomy And 321. Decompress Forearm Space
Filtering And Allied Operations To Treat Glaucoma 322. Revision Of Neck Muscle (torticollis Release)
254. Enucleation Of Eye Without Implant 323. Lengthening Of Thigh Tendons
255. Dacryocystorhinostomy For Various Lesions Of 324. Treatment Fracture Of Radius & Ulna
Lacrimal Gland
256. Laser Photocoagulation To Treat Ratinal Tear XIII. Other Operations On The Mouth & Face:
257. Biopsy Of Tear Gland 325. External Incision And Drainage In The Region Of
The Mouth, Jaw And Face
XII. Orthopedics Related: 326. Incision Of The Hard And Soft Palate
258. Incision On Bone, Septic And Aseptic 327. Excision And Destruction Of Diseased Hard And
259. Closed Reduction On Fracture, Luxation Or Soft Palate
Epiphyseolysis With Osteosynthesis
260. Suture And Other Operations On Tendons And XIV. Pediatric Surgery Related:
Tendon Sheath 328. Excision Of Fistula-in-ano
261. Reduction Of Dislocation Under GA 329. Excision Juvenile Polyps Rectum
262. Arthroscopic Knee Aspiration 330. Vaginoplasty
263. Surgery For Ligament Tear 331. Dilatation Of Accidental Caustic Stricture
264. Surgery For Hemoarthrosis/pyoarthrosis Oesophageal
265. Removal Of Fracture Pins/nails 332. Presacral Teratomas Excision
266. Removal Of Metal Wire 333. Removal Of Vesical Stone
267. Closed Reduction On Fracture, Luxation 334. Excision Sigmoid Polyp
268. Reduction Of Dislocation Under GA 335. Sternomastoid Tenotomy
269. Epiphyseolysis With Osteosynthesis 336. Infantile Hypertrophic Pyloric Stenosis
270. Excision Of Various Lesions In Coccyx Pyloromyotomy
271. Arthroscopic Repair Of Acl Tear Knee 337. Excision Of Soft Tissue Rhabdomyosarcoma
272. Closed Reduction Of Minor Fractures 338. Mediastinal Lymph Node Biopsy
273. Arthroscopic Repair Of PCL Tear Knee 339. High Orchidectomy For Testis Tumours
274. Tendon Shortening 340. Excision Of Cervical Teratoma
275. Arthroscopic Meniscectomy - Knee 341. Rectal-myomectomy
276. Treatment Of Clavicle Dislocation 342. Rectal Prolapse (delorme's Procedure)
277. Haemarthrosis Knee- Lavage 343. Detorsion Of Torsion Testis
278. Abscess Knee Joint Drainage
279. Carpal Tunnel Release XV. Thoracic Surgery Related:
280. Closed Reduction Of Minor Dislocation 344. Thoracoscopy And Lung Biopsy
281. Repair Of Knee Cap Tendon 345. Excision Of Cervical Sympathetic Chain
282. ORIF With K Wire Fixation- Small Bones Thoracoscopic
283. Release Of Midfoot Joint 346. Laser Ablation Of Barrett's Oesophagus
284. ORIF With Plating- Small Long Bones 347. Pleurodesis
285. Implant Removal Minor 348. Thoracoscopy And Pleural Biopsy
286. K Wire Removal 349. EBUS + Biopsy
287. Closed Reduction And External Fixation 350. Thoracoscopy Ligation Thoracic Duct
288. Arthrotomy Hip Joint 351. Thoracoscopy Assisted Empyema Drainage
289. Syme's Amputation
290. Arthroplasty XVI. Urology Related:
291. Partial Removal Of Rib 352. Haemodialysis
292. Treatment Of Sesamoid Bone Fracture 353. Lithotripsy/nephrolithotomy For Renal Calculus
293. Shoulder Arthroscopy / Surgery 354. Excision Of Renal Cyst
294. Elbow Arthroscopy 355. Drainage Of Pyonephrosis/perinephric Abscess
295. Amputation Of Metacarpal Bone 356. Incision Of The Prostate
296. Release Of Thumb Contracture 357. Transurethral Excision And Destruction Of Prostate
297. Incision Of Foot Fascia Tissue
298. Partial Removal Of Metatarsal 358. Transurethral And Percutaneous Destruction Of
299. Repair / Graft Of Foot Tendon Prostate Tissue
300. Amputation Follow-up Surgery 359. Open Surgical Excision And Destruction Of Prostate
301. Exploration Of Ankle Joint Tissue
360. Operations On The Seminal Vesicles 384. ESWL
361. Other Operations On The Prostate 385. Cystoscopy & Biopsy
362. Incision Of The Scrotum And Tunica Vaginalis Testis 386. Cystoscopy And Removal Of Polyp
363. Operation On A Testicular Hydrocele 387. Suprapubic Cystostomy
364. Other Operations On The Scrotum And Tunica 388. Percutaneous Nephrostomy
Vaginalis Testis 389. Cystoscopy And "SLING" Procedure
365. Incision Of The Testes 390. TUNA- Prostate
366. Excision And Destruction Of Diseased Tissue Of The 391. Excision Of Urethral Diverticulum
Testes 392. Excision Of Urethral Prolapse
367. Unilateral Orchidectomy 393. Mega-ureter Reconstruction
368. Bilateral Orchidectomy 394. Kidney Renoscopy And Biopsy
369. Surgical Repositioning Of An Abdominal Testis 395. Ureter Endoscopy And Treatment
370. Reconstruction Of The Testis 396. Surgery For Pelvi Ureteric Junction Obstruction
371. Other Operations On The Testis 397. Anderson Hynes Operation
372. Excision In The Area Of The Epididymis 398. Kidney Endoscopy And Biopsy
373. Operations On The Foreskin 399. Paraphimosis Surgery
374. Local Excision And Destruction Of Diseased Tissue Of 400. Surgery For Stress Urinary Incontinence
The Penis 401. Injury Prepuce- Circumcision
375. Other Operations On The Penis 402. Frenular Tear Repair
376. Cystoscopical Removal Of Stones 403. Meatotomy For Meatal Stenosis
377. Lithotripsy 404. Surgery For Fournier's Gangrene Scrotum
378. Biopsy Oftemporal Artery For Various Lesions 405. Surgery Filarial Scrotum
379. External Arterio-venous Shunt 406. Surgery For Watering Can Perineum
380. AV Fistula - Wrist 407. Repair Of Penile Torsion
381. URSL With Stenting 408. Drainage Of Prostate Abscess
382. URSL With Lithotripsy 409. Orchiectomy
383. Cystoscopic Litholapaxy
Note: The standard exclusions and waiting periods are applicable to all of the above procedures depending on the medical condition/
disease under treatment. Only 24 hours Hospitalisation is not mandatory.
In case of any claims contact
Claims Department
Future Generali Health (FGH)
Future Generali India Insurance Co. Ltd.
Office No. 3, 3rd Floor, “A” Building, G - O – Square
S. No. 249 & 250, Aundh Hinjewadi Link Road, Wakad, Pune - 411 057.
Toll Free Number: 1800 103 8889
Toll Free Fax: 1800 103 9998
Email: [email protected]
Annexure I
List I – Items for which coverage is not available in the Policy
Sl No. Item
1. BABY FOOD
2. BABY UTILITES CHARGES
3. BEAUTY SERVICES
4. BELTS/ BRACES
5. BUDS
6. COLD PACK/HOT PACK
7. CARRY BAGS
8. EMAIL / INTERNET CHARGES
9. FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL)
10. LEGGINGS
11. LAUNDRY CHARGES
12. MINERAL WATER
13. SANITARY PAD
14. TELEPHONE CHARGES
15. GUEST SERVICES
16. CREPE BANDAGE
17. DIAPER OF ANY TYPE
18. EYELET COLLAR
19. SLINGS
20. BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES
21. SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED
22. TELEVISION CHARGES
23. SURCHARGES
24. ATTENDANT CHARGES
25. EXTRA DIET OF PATIENT(OTHER THAN THAT WHICH FORMS PART OF BED CHARGE)
26. BIRTH CERTIFICATE
27. CERTIFICATE CHARGES
28. COURIER CHARGES
29. CONVENYANCE CHARGES
30. MEDICAL CERTIFICATE
31. MEDICAL RECORDS
32. PHOTOCOPIES CHARGES
33. MORTUARY CHARGES
34. WALKING AIDS CHARGES
35. OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)
36. SPACER
37. SPIROMETRE
38. NEBULIZER KIT
39. STEAM INHALER
40. ARMSLING
41. THERMOMETER
42. CERVICAL COLLAR
43. SPLINT
44. DIABETIC FOOT WEAR
45. KNEE BRACES ( LONG/ SHORT/ HINGED)
46. KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
47. LUMBO SACRAL BELT
48. NIMBUS BED OR WATER OR AIR BED CHARGES
49. AMBULANCE COLLAR
50. AMBULANCE EQUIPMENT
51. ABDOMINAL BINDER
52. PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES
53. SUGAR FREE TABLETS
54. CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical pharmaceuticals payable)
55. ECG ELECTRODES
56. GLOVES
57. NEBULISATION KIT
58. ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC]
59. KIDNEY TRAY
60. MASK
61. OUNCE GLASS
62. OXYGEN MASK
63. PELVIC TRACTION BELT
64. PAN CAN
65. TROLLY COVER
66. UROMETER, URINE JUG
67. AMBULANCE
68. VASOFIX SAFETY
List II – Items that are to be subsumed into room charges
Sl No. Item
1. BABY CHARGES (UNLESS SPECIFIED/INDICATED)
2. HAND WASH
3. SHOE COVER
4. CAPS
5. CRADLE CHARGES
6. COMB
7. EAU-DE-COLOGNE / ROOM FRESHNERS
8. FOOT COVER
9. GOWN
10. SLIPPERS
11. TISSUE PAPER
12. TOOTH PASTE
13. TOOTH BRUSH
14. BED PAN
15. FACE MASK
16. FLEXI MASK
17. HAND HOLDER
18. SPUTUM CUP
19. DISINFECTANT LOTIONS
20. LUXURY TAX
21. HVAC
22. HOUSE KEEPING CHARGES
23. AIR CONDITIONER CHARGES
24. IM IV INJECTION CHARGES
25. CLEAN SHEET
26. BLANKET/WARMER BLANKET
27. ADMISSION KIT
28. DIABETIC CHART CHARGES
29. DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
30. DISCHARGE PROCEDURE CHARGES
31. DAILY CHART CHARGES
32. ENTRANCE PASS / VISITORS PASS CHARGES
33. EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
34. FILE OPENING CHARGES
35. INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
36. PATIENT IDENTIFICATION BAND / NAME TAG
37. PULSEOXYMETER CHARGES
List III – Items that are to be subsumed into Procedure Charges
Sl No. Item
1. HAIR REMOVAL CREAM
2. DISPOSABLES RAZORS CHARGES ( for site preparations)
3. EYE PAD
4. EYE SHEILD
5. CAMERA COVER
6. DVD, CD CHARGES
7. GAUSE SOFT
8. GAUZE
9. WARD AND THEATRE BOOKING CHARGES
10. ARTHROSCOPY & ENDOSCOPY INSTRUMENTS
11. MICROSCOPE COVER
12. SURGICAL BLADES,HARMONIC SCALPEL,SHAVER
13. SURGICAL DRILL
14. EYE KIT
15. EYE DRAPE
16. X-RAY FILM
17. BOYLES APPARATUS CHARGES
18. COTTON
19. COTTON BANDAGE
20. SURGICAL TAPE
21. APRON
22. TORNIQUET
23. ORTHOBUNDLE, GYNAEC BUNDLE
List IV – Items that are to be subsumed into cost of treatment
Sl No. Item
1. ADMISSION/REGISTRATION CHARGES
2. HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE
3. URINE CONTAINER
4. BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES
5. BIPAP MACHINE
6. CPAP/ CAPD EQUIPMENTS
7. INFUSION PUMP - COST
8. HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC
9. NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES
10. HIV KIT
11. ANTISEPTIC MOUTHWASH
12. LOZENGES
13. MOUTH PAINT
14. VACCINATION CHARGES
15. ALCOHOL SWABES
16. SCRUB SOLUTION/STERILLIUM
17. GLUCOMETER & STRIPS
18. URINE BAG
ISO No. FGH/UW/GRP/54/04
Dear Customer,
At Future Generali we are committed to provide “Exceptional Customer-Experience” that you remember and
return to fondly. We encourage you to read your policy & schedule carefully. We want to make sure the plan is
working for you and welcome your feedback.
What Constitutes a Grievance?

“Complaint” or “Grievance” means expression (includes communication in the form of electronic mail or other
electronic scripts, Inbound Call, SMS, Letter), 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;
Explanation: An Inquiry/Query or Request would not fall within the definition of the “complaint” or “grievance”.
“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
If you have a complaint or grievance you may reach us through the following avenues:
Help - Lines 1800-220-233 / Email [email protected]

1860-500-3333 / Website https://general.futuregenerali.in/
022-67837800
GRO at each Walk-in to any of our branches and request to meet the Grievance Redressal Officer (GRO).
Branch
What can I expect after logging a Grievance?

• We will acknowledge receipt of your concern within 3 - business days.
• Within 2 - weeks of receiving your grievance, we shall revert to you the final resolution.
• We shall regard the complaint as closed if we do not receive a reply within 8 weeks from the date of receipt of
response.
How do I escalate?
• You can directly contact our Grievance Redressal Officer at our Head office.
 You can email to : [email protected] or call at: 7900197777
 You can write directly to our Grievance Redressal Cell at our Head office:
Grievance Grievance Redressal Cell, Future Generali India Insurance Company Ltd.
Redressal Corporate & Registered Office:- 801 and 802, 8th floor, Tower C, Embassy 247 Park, L.B.S.
Cell Marg, Vikhroli (W), Mumbai – 400083
Please send your complaint in writing. You can use the complaint form, annexed with your
policy. Kindly quote your policy number in all communication with us. This will help us to
deal with the matter faster
What should I do, if I face difficulty in registering a grievance?

While we constantly endeavour to promptly register, acknowledge & resolve your grievance, if you feel that you are
experiencing difficulty in registering your complaint, you may register your complaint through the IRDAI
(Insurance Regulatory and Development Authority of India).
• CALL CENTER: TOLL FREE NUMBER (155255)
• REGISTER YOUR COMPLAINT ONLINE AT: HTTP://WWW.IGMS.IRDA.GOV.IN/
Grievances of Senior Citizens:

Now we have introduced a separate channel to address the grievances of our Senior Citizen customers. The
concerns will be addressed to the Senior Citizen's channel for faster attention or speedy disposal of grievance, if
any. Senior Citizens can register their complaints at [email protected]
Insurance Ombudsman:
If you are still dissatisfied with the resolution provided or if it is already 30 days since you filed your complaint, you
can approach the office of Insurance Ombudsman, provided the same is under their purview. The guidelines for
taking up a complaint with the Insurance Ombudsman, along with their addresses are available on the consumer
education website of the IRDAI. http://www.policyholder.gov.in/Ombudsman.aspx
For ease of reference, the list of Insurance Ombudsmen offices is as mentioned below.
Office of the Contact Details Areas of Jurisdiction
Ombudsman
AHMEDABAD Office of the Insurance Ombudsman Gujarat, UT of Dadra & Nagar Haveli, Daman
6th Floor, Jeevan Prakash Building, Tilak Marg, Relief and Diu
Road, AHMEDABAD - 380 001
Tel: 079-25501201/02/05/06
E-mail: [email protected]
BENGALURU Office of the Insurance Ombudsman Karnataka
Jeevan Soudha Building,PID No. 57-27-N-19 Ground
Floor, 19/19, 24th Main Road,JP Nagar, Ist Phase,
Bengaluru – 560 078. Tel.: 26652048 / 26652049
BHOPAL Office of the Insurance Ombudsman Madhya Pradesh & Chhattisgarh
Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar,
Opp. Airtel Office, Near New
Market, BHOPAL - 462 003
Tel: 0755 - 2769201 / 2769202 Fax: 0755-2769203
BHUBANESHWAR Office of the Insurance Ombudsman Orissa
62, Forest Park, BHUBANESHWAR - 751 009 Tel:
0674-2596461/2596455 Fax: 0674-2596429
CHANDIGARH Office of the Insurance Ombudsman Punjab, Haryana, Himachal Pradesh, Jammu &
S.C.O. No.101 - 103, 2nd Floor, Batra Building, Kashmir, UT of Chandigarh
Sector 17-D, CHANDIGARH - 160 017
Tel: 0172-2706196/2706468 Fax: 0172-2708274
CHENNAI Office of the Insurance Ombudsman Tamilnadu, UT- Pondicherry Town and Karaikal
Fatima Akhtar Court, 4th Floor, 453 (old 312), Anna (which are part of UT of Pondicherry)
Salai, Teynampet, CHENNAI - 600 018
Tel:044-24333668 /5284 Fax: 044-24333664 E-
mail: [email protected]
DELHI Office of the Insurance Ombudsman Delhi
2/2 A, Universal Insurance Bldg. Asaf Ali Road, NEW
DELHI - 110 002 Tel: 011-2323481/23213504
Fax: 011-23230858
GUWAHATI Office of the Insurance Ombudsman Assam, Meghalaya, Manipur, Mizoram,
Jeevan Nivesh, 5th floor Nr. Panbazar Overbridge, Arunachal Pradesh, Nagaland and Tripura
S.S. Road, GUWAHATI - 781 001
Tel:0361-2132204/05 Fax: 0361- 2732937
HYDERABAD Office of the Insurance Ombudsman Andhra Pradesh, Telangana and UT of Yanam -
6-2-46 , 1st Floor, Moin Court Lane, Opp. Saleem a part of UT of Pondicherry
Function Palace, A.C.Guards, Lakdi-Ka-Pool,
HYDERABAD - 500 004
Tel: 040-65504123/23312122 Fax: 040-23376599
JAIPUR Office of the Insurance Ombudsman Rajasthan
Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh
Marg, Jaipur - 302 005. Tel : 0141-2740363
ERNAKULAM Office of the Insurance Ombudsman Kerala, UT of
2nd Floor, Pulinat Building, Opp. Cochin Shipyard, (a) Lakshadweep,
M.G. Road, ERNAKULAM - 682 015 (b) Mahe - a part of UT of Pondicherry
Tel: 0484-2358759/2359338 Fax: 0484-2359336
KOLKATA Office of the Insurance Ombudsman West Bengal, Sikkim and UT of Andaman &
Hindusthan Bldg. Annexe, 4th Floor,4, C.R.Avenue, Nicobar Islands
KOLKATA - 700 072 Tel: 033-22124339 /40 Fax:
033-22124341
E-mail : [email protected]
LUCKNOW Office of the Insurance Ombudsman Districts of U.P:-
6th Floor, Jeevan Bhawan, Phase 2, Nawal Kishore Laitpur, Jhansi, Mahoba, Hamirpur, Banda,
Road, Hazratganj, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra,
LUCKNOW - 226 001 Fatehpur, Pratapgarh, Jaunpur, Varanasi,
Tel: 0522 -2231331/30 Fax: 0522-2231310 Gazipur, Jalaun, Kanpur, Lucknow, Unnao,
E-mail: [email protected] Sitapur, Lakhimpur, Bahraich, Barabanki,
Raebareli, Sravasti, Gonda, Faizabad, Amethi,
Kaushambi, Balrampur, Basti, Ambedkarnagar,
Sultanpur, Maharajgang, Santkabirnagar,
Azamgarh, Kushinagar, Gorkhpur, Deoria,
Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar
MUMBAI Office of the Insurance Ombudsman Goa and Mumbai Metropolitan Region
3rd Floor, Jeevan Seva Annexe, S.V.Road, Santacruz excluding Areas of Navi Mumbai & Thane
(W), MUMBAI - 400 054 Tel: 022-
26106960/26106552 Fax: 022-26106052
E - mail: [email protected]
NOIDA Office of the Insurance Ombudsman State of Uttaranchal and the following Districts
Bhagwan Sahai Palace of Uttar Pradesh:
4th Floor, Main Road, Agra, Aligarh, Bagpat, Bareilly, Bijnor,
Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, Budaun, Bulandshehar, Etah, Kanooj,
U.P-201301. Mainpuri, Mathura, Meerut, Moradabad,
Tel.: 0120-2514250 / 2514252 / 2514253 Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Email: [email protected] Farrukhabad, Firozbad, Gautambodhanagar,
Ghaziabad, Hardoi, Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj, Sambhal, Amroha,
Hathras, Kanshiramnagar, Saharanpur.
PATNA Office of the Insurance Ombudsman Bihar and Jharkhand
1st Floor,Kalpana Arcade Building,
Bazar Samiti Road, Bahadurpur,
Patna. Bihar, 800006
Tel.: 0612-2680952, Email:
[email protected]
PUNE Office of the Insurance Ombudsman Maharashtra, Area of Navi Mumbai and Thane
Jeevan Darshan Bldg., 2nd Floor, C.T.S. No.s. 195 to but excluding Mumbai Metropolitan Region
198, N.C. Kelkar Road, Narayan Peth, Pune – 411
030. Tel: 020-41312555
The updated details of Insurance Ombudsman are available on IRDA website: www.irdai.gov.in, on the website of
Office of Executive Council of Insurers: http://www.ecoi.co.in/ , our website www.futuregenerali.in or from any of
our offices.
Form for Request / Complaint / Feedback /Appreciation
I want to submit a REQUEST COMPLAINT SUGGESTION/ FEEDBACK APPRECIATION
POLICY TYPE MOTOR HEALTH PERSONAL ACCIDENT OTHER ________
POLICY DETAILS POLICY NO CLAIM NO COVER NOTE HEALTH CARD
EXISTING SERVICE REQUEST
CUSTOMER NAME FIRST MIDDLE LAST

NAME NAME NAME
ADDRESS
CITY PIN CODE
TEL NO. MOBILE NO.
Detailed description
D D M M Y Y Y Y
Customer’s Date
Signature
You may submit the form to the Nearest Branch Office or mail it to our Customer Service Cell at:
Customer Service Cell | Future Generali India Insurance Company Ltd.

Registered and Corporate Office: 801 and 802, 8th floor, Tower C, Embassy 247 Park, L.B.S. Marg, Vikhroli
(W), Mumbai – 400083. Website: https://general.futuregenerali.in | Email: [email protected] | Call us
at: 1800-220-233 / 1860-500-3333 / 022-67837800
_______________________________________________________________________________________________________________________
Office Use Only: Service / Case #
Comments:
_________________________________________________________________________________
_________________________________________________________________________________
Annexure II: OPTIONAL COVERS
1. EXTENSION FOR ROOM RENT
This is an optional cover which can be obtained by the insured under the Policy. It is hereby declared and agreed
that notwithstanding anything to the contrary in the Policy, If the Insured Member is admitted in a Hospital room
where the Room Rent incurred is higher than the eligible limit, then the Insured Member shall bear the ratable
proportion of the Associated Medical Expenses including surcharge or taxes thereon (excluding pharmacy,
consumables, implants , medical devices and diagnostics) as specified in the Policy Schedule in the proportion of the
Room Rent actually incurred, subject to co-payment as applicable and mentioned in the policy schedule, provided
that We have admitted a Claim under In patient benefit.
Special conditions applicable to Extension for Room rent

i. Copayment on Associated Medical expenses (excluding pharmacy, consumables, implants, medical devices
and diagnostics) is not applicable for admission in ICU room with higher room rent limit.
ii. Copayment on Associated Medical expenses (excluding pharmacy, consumables, implants , medical devices
and diagnostics) for opting a Non –ICU room with higher room rent limit is not applicable for those hospitals
where differential billing based on the room category is not adopted .
2. EXTENSION FOR MATERNITY AND CHILD COVER
This is an optional cover which can be obtained on payment of additional premium for all the Insured Persons under
the Policy.
When Maternity Expenses Benefit is opted for in the policy, Exclusion IV.2.o of the policy stands deleted. Option for
Maternity Benefits has to be exercised at the inception of the policy period and no refund is allowable in case of
Insured’s cancellation of this option during currency of the policy.
Special conditions applicable to Maternity Expenses Benefit Extension
This benefit covers treatment taken in Hospital/ Nursing Home arising from or traceable to pregnancy, child birth
including Normal/ Caesarean section.
1. These Benefits are admissible only if the expenses are incurred in Hospital/ Nursing Home as in-patient in India.
2. A waiting period of 9 months is applicable for payment of any claim related to normal delivery, caesarean section
and complications of maternity (including and not limited to medical complications). The waiting period stands
waived if additional premium is paid for the same.
3. Claim in respect of delivery for only first two children and/ or operations associated therewith (or as mutually
agreed) will be considered in respect of any one Insured Person covered under the Policy or any renewal thereof.
Those Insured Persons who are already having two or more living children will not be eligible for this benefit. In
case the first delivery is a twin (more than 1 child) delivery, then the second delivery will not be covered.
4. Pre-natal and post natal expenses including expenses for the new born baby are not covered. Pre-natal and Post-
natal treatment is covered within the maternity limits as inpatient only. Here Prenatal would mean complete
antenatal period, and Post natal would mean up to six weeks after date of delivery.
5. No Individual (Employee or Dependent) can be covered more than once in a policy. If Self and Spouse are both
covered under the GMC policy, maternity benefit will be available only once.
6. Corporate buffer is not applicable for maternity claims.
3. EXTENSION FOR VACCINATION COVER
This is an optional cover which can be obtained on payment of additional premium under the Policy, it is hereby
declared and agreed that notwithstanding anything to the contrary in the Policy, We will cover the Reasonable and
Customary Charges for vaccination of the Insured. This benefit shall be limited to maximum amount as mentioned
in schedule. When vaccination cover is opted for in the policy, Exclusion IV. 3. r of the policy stands deleted
4. EXTENSION FOR WAIVER OF WAITING PERIODS
This is an optional cover which can be obtained on payment of additional premium under the Policy. It is hereby
declared and agreed that notwithstanding anything to the contrary in the Policy, the waiting periods under the Policy
will be waived.
a) Waiver of Pre-Existing Diseases waiting period (including 30 days and 1 year,4years waiting period)
In consideration of additional premium received by the Company from the Policyholder, notwithstanding anything
to the contrary contained in any term, condition or exclusion of the policy or endorsement(s) here to, the scope
of cover under the policy is widened so as to pay claims arising out of a Pre-Existing Condition.
When Waiver of Pre-Existing periods is opted for in the policy, Exclusion IV.1.a) of the policy stands deleted
All other terms and conditions of the policy remain unchanged.
b) Waiver of 4 years waiting period

In consideration of additional premium received by the Company from the Policyholder, Exclusion IV.1.b.i) of
the policy stands deleted
c) Waiver of 1 year waiting period

In consideration of additional premium received by the Company from the Policyholder, Exclusion IV.1.b.ii) of
d) Waiver of 30 days waiting period

In consideration of additional premium received by the Company from the Policyholder, Exclusion IV.1.b.iii) of
5. EXTENSION FOR EMERGENCY AMBULANCE
declared and agreed that notwithstanding anything to the contrary in the Policy, We will reimburse up to a maximum
amount as mentioned in the schedule per Hospitalization, for the reasonable expenses incurred by the Insured on
availing ambulance services offered by a Hospital or by an ambulance service provider for Your necessary
transportation to the nearest Hospital in case of a life threatening emergency condition, provided however that, a
Claim under this extension shall be payable by Us only when:
1. Such life threatening emergency condition is certified by the Medical Practitioner, and
2. We have accepted Your Claim under "In-patient Treatment" or "Day Care Procedures" section of the Policy,
if applicable.
6. EXTENSION FOR EMERGENCY AIR AMBULANCE
declared and agreed that notwithstanding anything to the contrary in the Policy, We will pay the expenses incurred
for ambulance transportation in an airplane or helicopter for rapid ambulance transportation as set out in the Schedule
if the Insured Person suffers an Injury which causes emergency life threatening conditions during the Policy Year and
it is necessary to immediately transfer such person from the site of Accident to the nearest Hospital/ Day Care Centre/
Nursing Home.
Specific Conditions
a. Expenses for air ambulance transportation are restricted within India.
b. Return transportation to the Insured Person’s home by ambulance is excluded.
c. Insured needs to take an intimation before availing the benefit under Air Ambulance Cover.
7. EXTENSION FOR DEDUCTIBLE OR CO-PAYMENT
This is an optional cover which can be obtained by the Insured under the Policy. It is hereby declared and agreed
that notwithstanding anything to the contrary in the Policy, that Our liability to pay each and every claim under any
Benefit will be in excess of any Deductible applicable to that Benefit (if any) as specified in the Schedule.
Deductible will be charged for each separate incident reported for claims payment, even though the claim may be
registered under the same benefit more than once subject to the terms and conditions of the Policy.
Or,
This is an optional cover which can be obtained by the Insured on payment of additional premium under the Policy.
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, that Our liability to pay
each and every claim under any Benefit will be in excess of any Co-payment applicable to that Benefit (if any) as
specified in the Schedule.
Co-payment will be charged for each separate incident reported for claims payment, even though the claim may be
registered under the same benefit more than once subject to the terms and conditions of the Policy.
8. EXTENSION FOR AYUSH COVER
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will reimburse
Reasonable and Customary Charges for Medical Expenses incurred with respect to the Insured Person for
Hospitalization under Ayurveda, Unani, Siddha or Homeopathy provided that the medical/surgical/para-surgical
Treatment has been undergone in AYUSH Hospital.
When AYUSH cover is opted for in the policy, Exclusion IV. 3.z) of the policy stands deleted
Specific Exclusions applicable to this Benefit:

a) All preventive and rejuvenation treatments (non-curative in nature) including without limitation, treatments that
are not Medically Necessary are excluded.
b) Pre-hospitalisation Medical Expenses, Post-hospitalisation Medical Expenses and outpatient Medical Expenses are
excluded.
c) Treatment taken in Ayush Day Care is excluded, unless specifically covered and specified in the Policy schedule.
d) Any Alternative Treatment other than Ayurveda, Unani, Siddha or Homeopathy.
9. EXTENSION FOR SUM INSURED GETS DOUBLED IN CASE OF NAMED ILLNESS
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will pay you the
sum insured in case you are diagnosed with one or more of the named Illnesses as mentioned in the Policy Schedule.
10. EXTENSION FOR COVERAGE FOR NON-MEDICAL EXPENSES/ DEVICES
Insured for the charges incurred by Insured during the Policy Period on account of procuring medically necessary
prosthetic or artificial devices, Prescribed Diabetes monitoring kits including Strips, Hearing Aids or any medical
equipment including spectacles, contact lenses etc.
When coverage for Non-Medical Expenses/Devices is opted for in the Policy, Exclusion IV. 3. cc) of the policy stands
deleted
11. EXTENSION FOR ORGAN DONOR EXPENSES COVER
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will indemnify the
Insured for the medical expenses incurred in respect of donor for any of the organ transplant surgery during the
Policy Period, provided the organ donated is for Insured's use and the claim is considered admissible by the Company.
This benefit shall be limited to maximum amount as mentioned in schedule.
We shall not cover:

a) Pre-hospitalisation or Post-hospitalisation Medical Expenses or screening expenses of the donor or any other
Medical Expenses as a result of the harvesting from the donor
(b) Costs directly or indirectly associated with the acquisition of the donor organ.
(c) Treatment for an Insured Person unless, these expenses for the Insured Person are covered under Hospitalisation.
(d) We do not cover organ donor treatment for the harvesting of the organ.
12. EXTENSION FOR HOSPITAL DAILY CASH ALLOWANCE
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will pay the Insured
a fixed amount for each day of his hospitalization to compensate against the loss of wage/salary incurred by Insured
on account of hospitalization.
We will pay daily cash amount, for each and every completed day of Hospitalization up to a maximum number of
days subject to any deductible, as applicable and stated in the schedule, and it falls within the Policy Period. The
Claim under this extension will be payable only if we have admitted Our liability under "In-patient Treatment" section
of the Policy.
If an Insured Person is Hospitalised then We will pay the daily allowance specified in the Schedule of Insurance
Certificate for each continuous and completed period of 24 hours of Hospitalisation provided that:
(a) The Insured Person is Hospitalised for a minimum period of atleast 2 days with continuous and completed period
of at least 24 hours following which it will be payable from the first day of Hospitalisation;
(b) In any Policy Period, We shall not be liable to make payment of the Daily Allowance under this benefit for more
than the number of days as specified in the Schedule of Insurance Certificate, including all days of admission to the
Intensive Care Unit.
13. EXTENSION FOR ATTENDENTS/ AYAH/ NURSING CHARGES FOR POST HOSPITALISATION PERIOD
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will pay for the
Reasonable and Customary Charges for a Qualified Nurse for the Insured Person for a period of up to maximum days
as mentioned in the schedule subject to immediately following the Insured Person’s discharge from Hospital provided
that:
a) The Insured Person’s Hospitalisation was due to Illness or Injury sustained during the Policy Period.
b) The treating Medical Practitioner has recommended that the nursing charges are Medically Necessary.
c) We will not be liable to make payment under this Benefit in excess of the per day limits specified in the Schedule
of Benefits.
d) We will not be liable to make payment under this Benefit for any Insured Person in excess of number of days as
specified in the policy schedule during a Policy Year.
14. EXTENSION FOR DENTAL COVER
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will reimburse the
medical expenses related to dental treatment incurred by the Insured during the Policy Period. This benefit shall be
limited to maximum amount as mentioned in schedule.
When coverage for Dental treatment is opted for In the Policy, Exclusion IV. 3.t) of the Policy Stands Deleted
15. EXTENSION FOR VISION COVER
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will reimburse the
medical expenses related to Vision incurred by the Insured during the Policy Period. This benefit shall be limited to
maximum amount as mentioned in schedule.
16. EXTENSION FOR HEALTH CHECK-UP
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will cover the cost
of health checkup incurred by the Insured for medical examination undergone being a requirement from employer.
Such medical examination is generally conducted to understand health status of the employee. This benefit shall be
limited to maximum amount as mentioned in schedule.
17. EXTENSION FOR OPD TREATMENT COVER
medical expenses incurred by the Insured as an Outpatient. Outpatient means the one in which the Insured visits a
clinic / hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of a
Medical Practitioner. The Insured is not admitted as a day care or in-patient. However, any Insured person undergoing
any named day care procedure/ treatment will not be considered as an Outpatient. This benefit shall be limited to
maximum amount as mentioned in schedule.
When coverage for OPD treatment is opted for in the Policy, Exclusion IV.3. bb) of the policy stands deleted
18. EXTENSION FOR SPECIAL COVERS
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will indemnify the
medical expenses incurred by the Insured Person for the special covers (as opted from the listed conditions/ diseases/
surgeries) as mentioned in the Policy Schedule. This benefit shall be limited to the maximum amount as mentioned
in schedule.
19. EXTENSION FOR WELLNESS CARE
The additional premium will be as per the negotiated rates with the network providers for the specific wellness care
program.
Under Wellness Care, any program intended to maintain, improve, promote health and fitness are included. Some
examples of wellness care program includes health talks or sessions and health check-ups by network providers at
negotiated rates.
The Insured can avail the wellness care benefits as specified in the Policy Schedule.
20. EXTENSION FOR HOME HEALTH CARE
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will cover the
reasonable and customary charges towards Medical Expenses incurred for Home Health Care Services during the
Policy Period and availed through empaneled Service Provider on Cashless Facility basis.
The benefit will cover the specific conditions as agreed with the insured.
For the purpose of this clause, ‘Home Health Care’ is a range of health care services and Medically Necessary
treatment that can be given at home for an Illness or Injury. These shall include services such as nursing care,
investigations, medication (intravenous), chemotherapy, dialysis, transfusions, physiotherapy, post-surgical care etc.
21. EXTENSION FOR CORPORATE BUFFER
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, that in case the Sum
Insured is exhausted, then additional sum insured would be available to the Insured Persons as specified in the Policy
Schedule as per the terms and conditions of the Policy. The individual or floater Sum Insured would be first exhausted
followed by the corporate buffer amount which would be availed as per the floater/ individual Sum Insured.
22. EXTENSION FOR CRITICAL ILLNESS COVER
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy, We will pay the Insured
Person the Sum Insured as a lump sum amount mentioned in the Policy Schedule, in case the Insured Person is
diagnosed as suffering from the listed Critical Illness, provided it occurs or manifests itself during the policy period
as a first incidence.
"Critical Illness", for the purpose of this Policy, if covered, includes the following:
1. Cancer of specified severity

I. A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and
destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term
cancer includes leukemia, lymphoma and sarcoma.
II. The following are excluded –

i. All tumors which are histologically described as carcinoma in situ, benign, pre-malignant, borderline malignant,
low malignant potential, neoplasm of unknown behavior, or non-invasive, including but not limited to:
Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN - 2 and CIN-3.
ii. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
iii. Malignant melanoma that has not caused invasion beyond the epidermis;
iv. All tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or having
progressed to at least clinical TNM classification T2N0M0
v. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
vi. Chronic lymphocytic leukaemia less than RAI stage 3
vii. Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,
viii. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with
mitotic count of less than or equal to 5/50 HPFs;
ix. All tumors in the presence of HIV infection.
2. Kidney failure requiring regular dialysis

I. End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result of which
either regular renal dialysis (haemodialysis or peritoneal dialysis) is instituted or renal transplantation is carried
out. Diagnosis has to be confirmed by a specialist medical practitioner.
3. Primary (Idiopathic) pulmonary hypertension

I. An unequivocal diagnosis of Primary (Idiopathic) Pulmonary Hypertension by a Cardiologist or specialist in
respiratory medicine with evidence of right ventricular enlargement and the pulmonary artery pressure above 30
mm of Hg on Cardiac Cauterization. There must be permanent irreversible physical impairment to the degree of
at least Class IV of the New York Heart Association Classification of cardiac impairment.
II. The NYHA Classification of Cardiac Impairment are as follows:

i. Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes
symptoms.
ii. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
III. Pulmonary hypertension associated with lung disease, chronic hypoventilation, pulmonary thromboembolic
disease, drugs and toxins, diseases of the left side of the heart, congenital heart disease and any secondary cause
are specifically excluded.
4. End Stage Liver failure

I. Permanent and irreversible failure of liver function that has resulted in all three of the following:
i. Permanent jaundice; and
ii. Ascites; and
iii. Hepatic encephalopathy.
II. Liver failure secondary to drug or alcohol abuse is excluded
5. Multiple sclerosis with persisting symptoms

I. The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the following:
i. investigations including typical MRI findings which unequivocally confirm the diagnosis to be multiple sclerosis
and
ii. There must be current clinical impairment of motor or sensory function, which must have persisted for a
continuous period of at least 6 months.
II. Other causes of neurological damage such as SLE and HIV are excluded
6. Major organ/bone marrow transplant
I. The actual undergoing of a transplant of:
i. One of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from irreversible end-stage
failure of the relevant organ, or
ii. Human bone marrow using haematopoietic stem cells. The undergoing of a transplant has to be confirmed by a
specialist medical practitioner.
II. The following are excluded:

i. Other stem-cell transplants
ii. Where only islets of langerhans are transplanted
7. Open chest CABG (coronary artery bypass graft)

I. The actual undergoing of heart surgery to correct blockage or narrowing in one or more coronary artery(s), by
coronary artery bypass grafting done via a sternotomy (cutting through the breast bone) or minimally invasive
keyhole coronary artery bypass procedures. The diagnosis must be supported by a coronary angiography and the
realization of surgery has to be confirmed by a cardiologist.

i. Angioplasty and/or any other intra-arterial procedures
8. Aorta graft Surgery

Aorta Graft Surgery is defined as the actual undergoing of Surgery for disease of the aorta needing excision and
surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and
abdominal aorta but not its branches.
Exclusions:
a) Surgery following traumatic Injury to the aorta.
b) Surgery to treat peripheral vascular disease of the aortic branches is excluded even if a portion of the aorta is
removed during the operative procedures.
c) Surgery performed using only minimally invasive or intra-arterial techniques such as percutaneous endovascular
aneurysm with insertion of a stent graft.
9. Stroke resulting in permanent symptoms

I. Any cerebrovascular incident producing permanent neurological sequelae. This includes infarction of brain tissue,
thrombosis in an intracranial vessel, haemorrhage and embolisation from an extracranial source. Diagnosis has to
be confirmed by a specialist medical practitioner and evidenced by typical clinical symptoms as well as typical findings
in CT Scan or MRI of the brain. Evidence of permanent neurological deficit lasting for at least 3 months has to be
produced.

i. Transient ischemic attacks (TIA)
ii. Traumatic injury of the brain
iii. Vascular disease affecting only the eye or optic nerve or vestibular functions
10. Myocardial Infarction (First heart attack of specified severity)

I. The first occurrence of heart attack or myocardial infarction, which means the death of a portion of the heart
muscle as a result of inadequate blood supply to the relevant area. The diagnosis for Myocardial Infarction should be
evidenced by all of the following criteria:
i. A history of typical clinical symptoms consistent with the diagnosis of acute myocardial infarction (For e.g.
typical chest pain)
ii. New characteristic electrocardiogram changes
iii. Elevation of infarction specific enzymes, Troponins or other specific biochemical markers.

i. Other acute Coronary Syndromes
ii. Any type of angina pectoris
iii. A rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart disease OR following an intra-
arterial cardiac procedure.
11. Coma of specified severity

I. A state of unconsciousness with no reaction or response to external stimuli or internal needs. This diagnosis must
be supported by evidence of all of the following:
i. no response to external stimuli continuously for at least 96 hours;
ii. life support measures are necessary to sustain life; and
iii. permanent neurological deficit which must be assessed at least 30 days after the onset of the coma.
II. The condition has to be confirmed by a specialist medical practitioner. Coma resulting directly from alcohol or
drug abuse is excluded
12. Blindness
I. Total, permanent and irreversible loss of all vision in both eyes as a result of illness or accident.
II. The Blindness is evidenced by:

i. corrected visual acuity being 3/60 or less in both eyes or ;
ii. the field of vision being less than 10 degrees in both eyes.
III. The diagnosis of blindness must be confirmed and must not be correctable by aids or surgical procedure.
For other terms and conditions, please refer to the standard filed and approved Future Criticare product
23. EXTENSION FOR TOP-UP COVER
It is hereby declared and agreed that notwithstanding anything to the contrary in the Policy that the additional Sum
Insured will be available for the insured person, which can be utilized once the basic Sum Insured is exhausted. Top
up policy will be offered only to those members who are covered under the base GMC policy. This benefit shall be
limited to the maximum amount as mentioned in schedule.
24. EXTENSION FOR WAIVER OF SPECIFIC EXCLUSIONS
Under this cover insured has an option to waive any listed exclusions under section IV.2. This waived exclusion(s)
would be specified in the policy schedule. It is hereby declared and agreed that notwithstanding anything to the
contrary in the Policy, We will reimburse Reasonable and Customary Charges towards the expenses incurred for
conditions for which the waiver of exclusion benefit was opted.
Note:- This extension for waiver of exclusions is not applicable to Section IV. 2. o, IV.3. r, t, z, bb, cc and hh

Group Health Insurance (Revised) Policy Wording

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GROUP HEALTH INSURANCE (Revised)

3. AYUSH Day Care Centre:

24. Maternity expense/treatment means:

36. Pre-existing Disease means any condition, ailment, injury or disease:

III. SCOPE OF COVER

2. Day Care Treatment expenses

3. Pre-hospitalisation Medical Expenses

4. Post-hospitalisation Medical Expenses

5. Domiciliary Hospitalisation Expenses

a) Pre-Existing Disease- Excl 01

b) Specified disease/procedure waiting period- Code- Excl02

i. Waiting period of 48 months:

ii. Waiting period of 12 months:

iii. 30 days waiting period Excl -03

b) Rest Cure, rehabilitation and respite care- Code- Excl05

c) Obesity/ Weight Control: Code- Excl06

d) Change-of-Gender treatments: Code- Excl07

e) Cosmetic or Plastic Surgery: Code- Excl08

f) Hazardous or Adventure sports: Code- Excl09

g) Breach of law: Code- Excl10

h) Excluded Providers: Code- Excl11

l) Refractive Error: Code- Excl15

m) Unproven Treatments: Code- Excl16

n) Birth control, Sterility and Infertility: Code- Excl17

o) Maternity : Code Excl 18

V. GENERAL TERMS AND CLAUSES

1. Disclosure to information norm:

2. Condition Precedent to Admission of Liability

For Detailed Guidelines on migration, kindly refer the link

I. Cardiology Related: 58. Esophageal Stent Placement

List IV – Items that are to be subsumed into cost of treatment

ISO No. FGH/UW/GRP/54/04

What Constitutes a Grievance?

Help - Lines 1800-220-233 / Email [email protected]

What can I expect after logging a Grievance?

What should I do, if I face difficulty in registering a grievance?

Grievances of Senior Citizens:

I want to submit a REQUEST COMPLAINT SUGGESTION/ FEEDBACK APPRECIATION

POLICY TYPE MOTOR HEALTH PERSONAL ACCIDENT OTHER ________

POLICY DETAILS POLICY NO CLAIM NO COVER NOTE HEALTH CARD

EXISTING SERVICE REQUEST

CUSTOMER NAME FIRST MIDDLE LAST

CITY PIN CODE

TEL NO. MOBILE NO.

Customer Service Cell | Future Generali India Insurance Company Ltd.

1. EXTENSION FOR ROOM RENT

Special conditions applicable to Extension for Room rent

All other terms and conditions of the policy remain unchanged.

b) Waiver of 4 years waiting period

All other terms and conditions of the policy remain unchanged.

c) Waiver of 1 year waiting period

All other terms and conditions of the policy remain unchanged.

d) Waiver of 30 days waiting period

All other terms and conditions of the policy remain unchanged.

Specific Exclusions applicable to this Benefit:

We shall not cover:

1. Cancer of specified severity

II. The following are excluded –

2. Kidney failure requiring regular dialysis